Achieving pae ora through primary and community healthcare
On this page:
- Keeping people well and providing care in communities
- The primary and community healthcare sector
- Challenges faced by the sector
- Challenges faced by New Zealanders
- Pae ora through primary and community healthcare
- Next steps
The Pae Ora (Healthy Futures) Act and the health reforms set the foundation for the transformation of our health system to support all New Zealanders to live longer and have the best possible quality of life. Fair access to health services, leading to fair health outcomes, is a key focus of the reforms.
Primary and community healthcare is a critical part of pae ora, as it plays a key role in preventing illness, treating disease early, and reducing the impact of long-term conditions. These services are critical to ensuring people stay well in our communities, reducing pressure on hospitals and other health services.
As an important next step in the health reforms, Manatū Hauora – Ministry of Health, with Te Whatu Ora – Health New Zealand and Te Aka Whai Ora – Māori Health Authority, will be leading a primary and community healthcare policy work programme over the next 18 months. Read the Achieving Pae Ora Through Primary Care cabinet paper.
This will focus on the key areas needed to achieve the vision of making sure all New Zealanders can access high quality healthcare in their local communities, leading to better health outcomes for everyone over the next 10 years, regardless of where they live.
This work builds on the six Pae Ora | Healthy Future strategies, published in July. These set the direction for a system that is equitable, accessible, cohesive and people-centred. This next stage begins work to turn these directions into real change on the ground.
It also follows the Health Workforce Plan 2023/24 developed by Te Whatu Ora and Te Aka Whai Ora, which includes many primary and community healthcare initiatives.
Aotearoa New Zealand needs a high-performing primary and community healthcare system to ensure that people stay well for longer and have access to health services when they need them.
Reforming the system means re-thinking these services from the ground-up so they can adapt to people’s needs and cultural expectations, rather than requiring people to fit into a one-size-fits-all delivery model.
Primary and community healthcare includes a very wide range of services based in the community, including Māori and Pacific providers, mātanga rongoā and rongoā service providers, general practitioners, pharmacists, midwives, allied health professionals, dentists and dental therapists, aged care and home care workers, disability support service providers, nurse practitioners, community and practice nurses, the non-clinical workforce, district nurses, community mental health and addiction services, public health nurses, non-governmental organisations, and in some cases rural hospitals.
Previous engagement with the primary and community care workforce has identified a range of challenges. These include:
- Workforce shortages are causing pressure across a broad range of health professions, with many health workers reporting they feel burnt out.
- Primary healthcare providers like GPs are doing more work, and it is more complex. Many practices have had to close their books to new patients.
- Current funding models do not work well for primary healthcare providers or their patients.
- Fragmented healthcare means there are not always good connections between different types of primary and community healthcare services.
- Primary and community healthcare providers do not always have the tools they need, including infrastructure and technology.
Most New Zealanders access the health system through local primary and community healthcare services. For many people, the current healthcare system is working effectively. However, some groups, including Māori, Pacific, women, disabled peoples, low socio-economic, rural populations, refugee and migrant, and rainbow communities, have faced more challenges in accessing primary and community healthcare.
Some of the challenges people have faced include:
- Cost, including patient co-payments and service charges.
- Lack of availability of services, including difficulties getting appointments or being able to enrol with a GP. Some GPs have closed their services to new patients.
- Difficulty accessing services, including after-hours particularly for rural communities.
- A focus on treatment of issues rather than prevention.
- Cultural safety – under-representation of Māori, Pacific, and disabled people in the workforce, and inconsistent cultural and disability of competency.
In July 2023, Cabinet agreed in principle to the following features for the future of primary and community healthcare.
- Comprehensive and accessible. This means that people should be able access a diverse range of high-quality health services close to home where possible. This includes increasing the use of data and digital technologies to deliver care.
- Continuous — people should be able to have an ongoing relationship with a primary and community healthcare team that provides seamless care, effectively manages long-term conditions and focus on preventing ill health and improving wellbeing.
- Coordinated – people will experience smooth referral pathways and transitions between services as their needs change.
- Individual and whānau-centred – Individuals and whānau should be supported to make decisions concerning their health and wellbeing and partner in delivery of their care. Services should be based on what matters to individuals and whānau and reflect the community they serve.
- Fit for purpose and continually improving – the primary and community healthcare system is sustainable, learns from whānau and community voices, research, evaluation and innovation, and adapts and improves over time, including through using digital advancements.
We will be talking to the primary and community healthcare sector, and other partners and stakeholders, about these proposed features. We want to check whether these are the right features and whether we have missed anything.
Over the course of the next year, we will be seeking people’s views on the changes needed to deliver on the vision for primary and community healthcare. We will be building on what we’ve heard through previous reports and engagement with the primary and community healthcare sector and the public.
Delivering on the vision for primary and community healthcare will see Manatū Hauora, Te Aka Whai Ora and Te Whatu Ora work with Māori as Te Tiriti partner.
The health reforms introduced by the Pae Ora Act strengthened the Crown’s commitment to Te Tiriti o Waitangi. The Act specifies that the health sector needs to engage with Māori to develop solutions that improve hauora Māori outcomes; to ensure equitable healthcare access and outcomes; to focus on prevention, health protection and promotion through a population health approach; and to engage with Māori to develop and deliver services that reflect their needs and aspirations.
Our initial focus will be talking with key Māori partners and health sector bodies about the proposed features for the future of primary and community healthcare.
We will also be seeking views from the healthcare sector and from users on different areas of the work programme and will update this webpage with opportunities as they arise.
There will be digital engagement opportunities for New Zealanders to have their voices heard.
Our initial engagement plan is:
- August to December 2023 - Engagement with key Māori partners and health sector bodies over the future of the primary and community healthcare system, with a focus on the proposed features for the future system.
In 2024 we will be seeking input from Māori partners, the healthcare sector and users on the following areas:
- Investment, financing and funding of primary and community healthcare, including how to ensure that funding arrangements are designed to drive the outcomes we are seeking. This will include work on the balance between investments in prevention and treatment, cost-sharing, and the settings for funding models.
- Workforce settings for primary and community healthcare including skills, capabilities and diversity, and ensuring the workforce has the right tools and resources to deliver improved outcomes.
- What is needed to strengthen the focus on prevention, including how to better manage long-term conditions, ensure that health services are responsive to wider determinants of whānau wellbeing, and how digital and data can be used to improve outcomes.
- The structure and function of the primary and community healthcare sector, including how organisation of the sector promotes integration and coordination of care and how planners and providers can innovate and tailor approaches to best meet the needs of the communities.
- How the system can better support Māori to design and deliver whānau-centred primary and community healthcare, including enabling Māori leadership in the health system, supporting whānau to direct their own health and wellbeing, supporting the growth and sustainability of Māori providers, and ensuring that all services are culturally safe.
We will be updating this webpage as we confirm dates for our engagement.
Want to know more? Contact [email protected].