From the Minister's Desk

The Primary Health Care Strategy

Implementing the Strategy

Copies of the Strategy

Today I released the Primary Health Care Strategy - an important step towards a health system that people can trust, that is there when they need it regardless of their ability to pay, and that really helps reduce the inequalities that exist in health status. Indeed most of the principles, goals and objectives in the New Zealand Health Strategy will only be achieved through a strong primary health care system.

District Health Boards will be guided by this Strategy in how to organise and fund the provision of services to meet local needs.

The Ministry of Health will now be working with Boards to ensure that implementation of the Strategy goes smoothly.

A strong primary health care system means community involvement so that local people can have their voice heard in the planning and delivery of services.

Doctors, nurses, community health workers and others in primary health care will work together to reduce health inequalities and address the causes of poor health status. Services will be readily available at a cost people can afford. High quality care will ensure co-ordination over time and across the different providers needed to deal with a wide range of problems. Considerable work is needed to ensure that the Strategy can be put in to practice. The process will be one of evolutionary change over the next few years.

This issue of Health Moves outlines the vision and key directions of the Strategy, and plans for its implementation. Details about how to get copies of the Strategy are also included.

My vision is for the primary care sector and local communities to work together to improve the health of all New Zealanders. It is a vision worth achieving.

Hon Annette King
Minister of Health

A strong primary health care system is central to improving the health of New Zealanders and, in particular, tackling inequalities in health.

This Strategy provides a clear direction for the future development of primary health care so that it can play this central role within the new health system. There is evidence available about the specific contribution primary health care can make to improved health outcomes which has informed the new direction.

The Strategy follows on from the New Zealand Health Strategy and the draft New Zealand Disability Strategy. The Health Strategy sets out principles, goals and objectives for the health system - and these have guided the development of the Primary Health Care Strategy. The Disability Strategy, which is still being developed, has also helped shape this Strategy.

The Vision

Over five to ten years a new vision will be achieved:

People will be part of local primary health care services that improve people's health, keep them well, are easy to get to and co-ordinate their ongoing care. Primary health care services will focus on better health for a population, and actively work to reduce health inequalities between different groups.

This vision involves a new direction for primary health care with a greater emphasis on:

• population health and the role of the community
• health promotion and preventive care
• the need to involve a range of professionals
• the advantages of funding based on population needs rather than fees for service.

Key Directions

Six key directions for primary health care will achieve this vision:

1. Work with local communities and enrolled populations
2. Identify and remove health inequalities
3. Offer access to comprehensive services to improve, maintain and restore people's health
4. Co-ordinate care across service areas
5. Develop the primary health care workforce
6. Continuously improve quality using good information.

The New Zealand Public Health and Disability Act 2000 gives District Health Boards overall responsibility for assessing the health and disability needs of communities in their regions, and managing resources and service delivery to best meet those needs. Twenty-one District Health Boards will be supported by the Ministry of Health, which will be the national policy adviser, also responsible for regulating, funding and monitoring. This Primary Health Care Strategy will guide District Health Boards and the sector to achieve health and independence gains through primary health care.

Primary Health Organisations

The vision will involve moving to a system where services are organised around the needs of a defined group of people. Primary Health Organisations will be the local structures to achieve this. People will be encouraged to join a Primary Health Organisation by enrolling with a provider of primary care services such as a general practice or local health clinic. District Health Boards will work with Primary Health Organisations to achieve health goals.

Primary Health Organisations will be funded by District Health Boards for the provision of a set of essential primary health care services to those people who are enrolled. At a minimum, these services will include approaches for improving and maintaining the health of the population, as well as first line services to restore people's health when they are unwell.

Primary Health Organisations will involve their communities in their governing processes. All providers and practitioners must be involved in the organisation's decision-making, a distinct from one group being dominant.

Primary Health Organisations will be not-for-profit bodies and will be required to be fully and openly accountable for all public funds that they receive.

While primary health care practitioners will be encouraged to join Primary Health Organisations, membership will remain voluntary.

The Strategy will evolve over the next few years and may not be fully realised for five to ten years. During this transition there will be flexibility about how new initiatives develop, and tolerance of short-term teething problems. Key priorities for early action are:

• reducing the barriers, particularly financial barriers, for the groups with the greatest health need, both in terms of additional services to improve health, and to improve access to first contact services
• supporting the development of Primary Health Organisations that work with enrolled populations
• encouraging developments that emphasise multi-disciplinary approaches to services and decision making
• supporting the development of services by Mäori and Pacific providers
• facilitating a smooth transition to widespread enrolment through a public information and educational campaign to explain enrolment and promote its benefits for communities.

The Strategy outlines a new vision for primary health care. It does not contain details of implementation, which will involve evolutionary change to protect the gains already made. Involvement and collaboration with the primary health care sector will be a key feature of the implementation process in the coming months and years. This is crucial to ensure that all issues are considered in developing the new arrangements.

To achieve this involvement, working parties of providers, communities, District Health Boards, and the Ministry of Health will be formed around key areas of work. A primary health care advisory group may also be set up to help guide developments in the sector.

The Primary Health Care Strategy document is available from the Ministry of Health, c/o Wickliffe Limited, PO Box 932, Dunedin, tel (04) 496 2277, fax (03) 479 0979, e-mail moh@wickliffe.co.nz

The document is also on the Minister of Health's web site: www.executive.govt.nz/minister/king and the Ministry of Health's web site: http://www.moh.govt.nz

To respond to this newsletter, receive it, or have your name taken off the mailing list, please e-mail: healthmoves@moh.govt.nz or write to: Annette King, Minister of Health, Health Moves, Parliament Buildings, Wellington.