Review of the Voluntary Bonding Scheme 2017

Background

The Voluntary Bonding Scheme (VBS) was implemented in 2009 to provide a financial incentive to new graduates to encourage them to work in areas (locations and specialities) that were hard to staff. Since the Scheme began there have been nine VBS intakes.

Rationale for the introduction of VBS 

To address some of the geographic and specialty maldistribution of the health workforce which has impacted on New Zealanders’ access to health services closer to home.

VBS review 2017

Stage one completed: The Ministry of Health has undertaken some initial work as part of a 2017 review of VBS. This has included:

1. analysis of available evidence on the factors that make the professional groups and communities currently listed on VBS hard to staff
2. consideration of the evidence about effective ways to address those factors, including (but not limited to) the effectiveness of VBS.

Based on the initial work the Minister of Health has asked the Ministry to look at aligning VBS with a bundle of education sector and employer-led initiatives that combined are more likely to be effective in achieving the outcomes sought. The Minister also wants to see improvements to VBS including more rigorous criteria for verifying hard to staff professional groups, specialties and communities.

This information was outlined in a letter sent out by Health Workforce New Zealand on 2 May to all health stakeholders.

• Letter to stakeholders (Word, 431 KB)
• Letter to stakeholders (PDF, 214 KB)

Stage two: The Ministry is beginning discussions with key organisations and stakeholders on the aligned bundle of strategies that need to be operating together.

Rationale: International evidence shows four categories of strategies have been used in combination to address geographic and specialty maldistribution, ie, education, regulation financial incentives, and professional and personal support; refer the table below for illustrative examples.

Illustrative examples of effective strategies to address hard to staff health areas

Category of strategies	Examples
Education	Students from rural backgrounds or with strong interest in a speciality Health professional schools outside of major cities (eg, satellite locations in remote or rural areas) Clinical rotations or other targeted placements in hard to staff communities and specialities Curricula that reflects health needs (ie, in rural or speciality area) Familiarisation programmes in specific rural/remote/special areas Continuous professional development for rural health workers/those in speciality areas Initiatives in New Zealand already underway Rural immersion training programme Home science academies
Regulation	Enhanced scope of practice Different types of health workers Subsidised education for return to service Initiatives in New Zealand already underway Nurse prescribing Health Practitioners (Replacement of Statutory References to Medical Practitioners) Act Changes to the Standing Orders Regulations
Financial incentives	Appropriate financial incentives (direct or indirect), for example: Loan repayments Practice assistance for rural physicians Salary guarantees Service-requiring scholarships or bursaries Grants Provision of continuing professional education Initiatives in New Zealand already underway Voluntary Bonding Scheme – loan repayment or same incentive where no loan
Professional and personal support	Safe and supportive working environments – for example, through coaching, mentoring, and employee assistance Communities of practice or outreach support Career development programmes including distance learning, and telehealth Professional networks Public recognition measures Initiatives in New Zealand already underway Rural midwifery locum programme