Develop the Primary Health Care Workforce
The Strategy will have significant implications for the number, mix, distribution and education of the primary health care workforce. The current mix and distribution of the primary health care workforce has been largely an unplanned response to demand and to various initiatives and incentives in the system. As a result the ratio of practitioners to patients is not closely matched to population need (some of the lowest number of doctors are in places of highest need). Because of Government subsidies New Zealand has a higher ratio of practice nurses to population than many other countries but the roles, competencies, and training of these nurses vary considerably. In recent years there has been some growth in managerial and support staff in first-contact services, as new organisations have appeared.
The workforce in other primary health care services is generally less plentiful. Community health workers and Maori and Pacific general practitioners and primary health care nurses are limited, public health and well-child nurse numbers have been mostly static, and midwife numbers show signs of falling recently after growth earlier in the last decade. Deficiency of appropriately trained workforce in these and similar areas may be a significant limiting factor in the speed of future achievements. They need to be addressed at the national level by the Health Workforce Advisory Committee as well as by professional bodies and providers.
Availability of Practitioners
Most people in New Zealand can easily access first-contact services (mostly nurses and doctors working in general practices) when they seek care. The numbers of general practitioners and practice nurses per head of population in New Zealand are on a par with, or higher than, comparable countries.
However, there are shortages of first-contact practitioners in some places around the country. Some parts of our cities have many fewer doctors and primary health care nurses than other parts, and some rural towns have difficulties in retaining sufficient practitioners to have a viable service. There are similar problems of variable availability in other primary health care services, such as maternity service providers.
In future, explicit minimum standards for availability of first-contact services will be stated as service coverage levels that District Health Boards will be expected to achieve. Availability of first-contact general practice-type services will be stipulated according to the size and isolation of the community. Minimum levels of primary level maternity services will also be stipulated taking account of local birth patterns and the availability of facilities.
These minimum levels will be made public and District Health Boards will be required to demonstrate availability and identify where there are service coverage gaps or risks.
Primary Health Care Nursing
The move towards greater population focus and emphasis on a wider range of services will increase the need for well-trained primary health care nurses. Such nurses will share a common set of generalist knowledge and skills as well as developing advanced skills in particular areas of professional practice. The concept of the primary health care nurse needs further development with clarification of the appropriate capabilities, responsibilities, areas of practice, educational and career frameworks and suitable employment arrangements. Primary health care nursing will be crucial to the implementation of the Strategy, and will therefore be best addressed at the national level.
Rural Workforce
Maldistribution of workforce is a particular issue for rural areas. Although New Zealand is now 80 percent urbanised, our rural communities are still extremely important to the economy. As well as sharing the health risks of urban people, those in the country also have risks unique to the rural environment and its agricultural industry. People living there need good access to essential primary health care services.
However the difficulties of attracting and retaining basic health services in rural communities have not lessened over recent years. Even some recent initiatives to further encourage rural general practice have so far made little impact on problems.
Rural problems need special consideration. They must encompass the issues of hospital facilities as well as the provision of services. In the country the differentiation between primary and secondary is less clear-cut.
The Ministry of Health will develop a coherent policy and package of assistance for rural communities. This work will involve local communities and iwi, all relevant providers, District Health Boards and the Ministry of Health.
Actions
District Health Boards will be expected to achieve minimum standards for first-contact service coverage levels, according to the size and geographical nature of the district and its communities, and to identify where there are service coverage gaps or risks.
- Primary Health Organisations will deliver services in a range of settings to reach all their enrolled population
- The Health Workforce Advisory Committee will be asked to consider the national workforce implications of this Strategy.
- The Ministry of Health will facilitate the development of a national approach to primary health care nursing that will address capabilities, responsibilities and areas of professional practice, as well as setting educational and career frameworks and exploring suitable employment arrangements.
- The Ministry of Health will facilitate the development of a coherent approach to rural health service provision including the difficult issues of attracting and retaining appropriate workforce. This work will involve local communities and Maori, and District Health Boards.
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The Strategy will have significant implications for the number, mix, distribution and education of the primary healthcare workforce.
New Zealand does not have an overall shortage of doctors or nurses in general practice - but there is uneven distribution and significant shortages in some places.
The difficulties or attracting and retaining basic health services in rural communities have not lessened over recent years.
Rural problems need special consideration - further work is needed.
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