Labour Party - Speeches

Speech at Rural GP Network

29.03.2008

Associate Health Minister speaks at the New Zealand Rural General Practice Network's Annual Conference

Thank you for the invitation to speak here again at the New Zealand Rural General Practice Network Annual Conference.

I would like to thank your organisers, Dr Andy Minett and Kirsty Murrell-McMillan, your chairman Dr Tim Malloy, and all the rural health delegates for attending.

It is a privilege to speak to an organisation so committed to improving the health services available to rural areas.

This organisation has demonstrated its commitment to rural New Zealand in many ways, including administering the rural recruitment scheme and rural locum support, and successfully lobbying for $32 million over three years for the rural workforce through Rural Recruitment and Retention and Reasonable Roster Funding.

You are working to create real benefits for rural health, not only with regard to workforce issues, but also the services that patients receive.

As you know rural practice does face a number of different challenges compared with its urban counterpart and this Labour-led government has been working together with you as rural health practitioners because we are committed to rural health services that are sustainable and equitable.

This Government has a very good track record on rural health services and on rural affairs in general. Over the last few years we have committed $150 million to safer drinking water. We have opened new rural police stations and established rural liaison police officers. We have rolled out broadband to all rural schools through the PROBE project. On Thursday my colleague Ruth Dyson and I announced Rural Assistance payments for families in drought-stricken areas, hopefully to improve the mental health of stressed farmers.

In health, we spend $100 million every year to support rural services. $80 million is allocated to District Health Boards to cover the costs of providing hospital and community health care services and $20 million supports rural primary health care services.

In recent years we created the Rural Innovation Fund. We have reviewed the PRIME scheme and updated emergency medical training and equipment for rural practitioners. We have increased vocational training places for rural practitioners and rural placements for medical students. We have contracted with the Network for better recruitment and retention of rural practitioners and are building a team in the Ministry of Health to better understand rural New Zealand.

Last year I spoke to you about requiring DHBs to develop District After-hours Plans. Good progress has been made and although one or two are not up to the mark yet, the majority are in place and there are some standout examples.

These developments have all been on top of our increased commitments to the general health sector up from $7 Billion in 1999 to $12 Billion this year.

Primary Health Care Strategy

The Government has made significant funding available for primary health care services, with the strategy which is a first in New Zealand history.

94 percent of New Zealanders are now enrolled with a Primary Health Organisation which means they are benefiting from lower cost access to primary health care services through their general practice.

Practice fees have halved for the 24-44 age group enrolled in interim funded practices. A process is now in place to ensure practice fee increases are kept at reasonable levels and practice fees information is readily accessible to the public.

Significantly lower fees have meant that patients are happy to return for reviews and follow ups, thus improving the standard of care provided to them.

Thankfully the strategy has allowed for the expansion of the role of nurses within the practice. Nurses are now an integral part of the primary health care team. They provide a wider range of services, from ACC related services to smoking cessation advice or diabetes clinics and have been encouraged to increase their skill base and are now seeing a wider range of patients independently of the GP.

All these wonderful initiatives while helping New Zealanders have placed extra responsibilities on front line practitioners and in the rural areas sometimes added to our challenges.

GP numbers have always been a challenge for rural areas. Last month twenty fifth year undergraduate medical students embarked on a year of study in the Northland region as part of the Northland Regional-Rural Medical Programme ‘Pukawakawa’.

The students will work and live in the area basing themselves at Whangarei Hospital and smaller hospitals in the Northland area. I’m sure, as intended, they will attain a better understanding of the needs of the area and of rural health communities in general.

A similar programme was established at the University of Otago and has just completed its first year with resounding success. And I was pleased last night to present a medal to Pat Farry in recognition of the work he has put in for rural health.

The Ministry provided $300,000 in funding to support the creation of the Rural Medical Immersion Program where students had the opportunity to work and study in rural or small town environments.

The programme is now set to become a regular feature of the University of Otago Medical School with twelve students participating in the programme in 2008, with the addition of two new locations, Balclutha and Dannevirke to add to Greymouth and Queenstown.

The more hands on experience students get in the rural environment, the more likely it is that they will take up employment in those areas.

Other opportunities for training include an increase in funding for rural GP training, allowing for ten rural scholarships to medical school and twenty rural rotations for trainee doctors.

The number of funded places in the GP Vocational Training Programme has been increased from 69 last year to 104 this year. Last year six rural nurses were awarded scholarships to complete their Masters programme and register as nurse practitioners with prescribing competencies.

A number of other postgraduate scholarships were awarded to primary health care nurses working with rural populations. In addition, it’s great to hear 227 nurses have enrolled in a new post-graduate educational programme, which commenced in the 2008 academic year, to prepare them for practice in long term conditions management in the primary health care setting.

On top of all this two funding schemes have been introduced to help support midwives who practice in rural or remote areas.

This is a lot of activity in rural health training and hopefully over time will lead to a more sustainable, skilled and satisfied rural workforce.

The Rural Innovation Fund continues with the third round of applications closing at the end of this month. This fund needs to be accessible and I was alerted to a potential barrier in the application process yesterday that I will be following up. The Fund was created to encourage new ideas that would solve old problems, not create new ones. One off funding allows good ideas and new ways of doing things to be put into practice. If an idea works then there is the potential for introducing the concept nationwide.

Successful applicants have included:
• the Northland Collaboration of General Practitioners who used the fund to create a support position for medical students and locums in an effort to ease their integration into the community
• Jean Ross used the fund to help publish her book on rural nurses, which I was pleased to launch last night
• The New Zealand Institute of Rural Health received funding for the development of an online library of innovative rural health projects to raise awareness of current initiatives.

These are just a sample of the range of ideas for which the innovation fund is being used.

The mobile surgical bus continues to bring its services to rural communities providing elective day surgeries for patients and further training sessions for staff.

Throughout the year the bus accounts for 1500 surgical cases, surgical and advanced skills programmes for rural nurses and GP’s, and various training programmes. I trust that you all utilise and support this service which is at the cutting edge of technology and rural service delivery

On call and after hours funding

I am very aware of the Network’s concern about after hours funding and I want to thank the Network for its submissions on this issue. I value the engagement we have had and will continue to have but we haven’t reached a solution.

I know this is a very pressing issue to many in this room. The reasonable roster scheme, a funding stream that is clearly targeted at onerous and challenging rosters was a clear acknowledgment of this when introduced.

Time has moved on and Government does realise that pressure has built up for various reasons, such as younger GPs choosing locum work over more traditional longer term employment, international demand for GPs and limited options in rural education. That is in part the reason we funded the Networks recruitment and retention contract.

So today I want to make it very clear to you that I am committed to continuing to work to a sensible solution.

There are some anomalies in the current funding streams and the level of funding, and I am committed to addressing them.

I share your frustration in how slowly the Ministry has moved on this, and I am expecting real progress soon, but the process has been frustrated by the lack of agreed and shared data on the current workforce and workload situation.

It is my objective to identify the anomalies and find workable, equitable solutions. That work has already started and I directed the Ministry of Health to do detailed modelling on various funding levels and scenarios.

We have looked at the Network’s proposed solutions, but we are not convinced that they produce the progress we need. The modelling showed that there would still be anomalies in the allocation of funding to those practices and practitioners who need additional support.

The solutions to this issue will have to satisfy several criteria. They will have to ensure transparency and accountability in the way funding is disbursed. And as I just alluded to, they will have to be able to sensitively discriminate along two scales: the level of rurality, and the level of after hours roster burden. This will ensure that targeted funding will get to where it is needed.

I am not prepared to just throw money at a problem and then hope it is a quick fix. Instead we need to continue our track record of finding smart, innovative, solutions to these issues.

We must work to improve the Rural Ranking Scale in a more collaborative way based on the same data set and on good information. It will also require consultation with other Government departments that use it such as ACC for their Rural General Practice contract. We have to ensure that changes to address one problem do not create another.

I commit to work with the network to resolve the issue in a way that is fair to all practitioners and does reduce the pressure for those working onerous after hours rosters.

And you will be part of this process. The Network must have input in order to ensure genuine improvements.

At the same time I am also working closely with my colleague David Cunliffe, the Minister of Health, to see if we can address these issues by providing some short term relief through the Budgetary process.

Finally I would like to take this opportunity to recognise the contributions of your Chairman, Tim Malloy, who is retiring from his duties after 10 years leading this organisation.

From the beginning of his career, Tim has been a passionate advocate for the rural workforce and increased the profile of a number of important issues facing rural practitioners.

As rural health representative for a number of organisations, including the Royal New Zealand College of GPs, Tim actively sought to solve problems such as GP retention. He has been an active participant in GP education continually hosting undergraduates, PGY2s and registrars at his own teaching practice, Coast to Coast Healthcare.

Tim makes a powerful opponent in negotiations and is well respected by his peers and colleagues for his forceful leadership and commitment to rural health.

Many of the improvements to rural primary health care discussed today have been a result of Tim’s persistence in bringing rural health issues before the attention of the Minister.

Tim has made significant contributions to Government initiatives such as the Ministry of Health’s Rural Expert Advisory Group and the After Hour Working party and we thank him for his time and efforts.

I am sure he will continue to promote and participate in the rural health environment and I wish him well in his future endeavours.

Thank you again for the invitation to speak at this conference. An opportunity to gather and discuss the issues facing rural health today is an important one.

I believe that we must remain optimistic and offer a good future to those that might be considering a future in rural health.

It has been a pleasure speaking here this morning and I hope you all enjoy the remainder of your conference.