Compromise reached on PHC document.

NZNO's Primary Health Care (PHC) Nurses' Council and the College of Nurses have revised two key recommendations and dropped a third in their draft document, Investing in Health 2007, following feedback from nurses working in the PHC sector.

In March this year a strategy group of representatives from the two organisations and from the Ministry of Health met to review the goals and recommendations of the Ministry's original Investing in Health (2003) document. The group looked at what was needed to realise the full potential of nursing services in PHC. It developed a draft document, which concluded that radical change was required to free up nursing services in line with PHC strategy goals. The draft stated that nurses were frustrated by current obstructions, which prevented them delivering services in a manner which met the needs of the community.

The draft then went on to make a number of recommendations to primary health organisations (PHOs), the Ministry and to district health boards (DHBs). It was circulated for consultation and 82 submissions were received. These were independently analysed and, late last month, 20 representatives from a range of PHC nursing groups met to consider the analysis of the submissions.

Recommendations cause division

The group agreed that, except for some minor adjustments, all but three of the recommendations in the draft document had been well supported. There were three recommendations which had caused division. The first was that, wherever possible, GP employment cease in favour of a salaried model of employment to the PHO or DHB directly. This recommendation raised the ire of the General Practice Nursing Alliance, a group of around 50 practice nurses, which made a submission on the draft.

A report from last month's meeting stated that while many practice nurses did not consider their employment status a barrier to the nature of their practice or the collegial relationships with GPs, others fundamentally disagreed. The group agreed to a revised recommendation which now states: "That alternative models of employment of PHC nurses must be actively developed in partnership with the sector"

The second contentious recommendation, which was made to the Ministry, called for the PHO/ DHB contract to specify that people were enrolled with a PHO rather than with a specific GP. This was the second part of the recommendation; the first called for the contract to be carefully reviewed to ensure nursing services were enabled and able to be directly and fairly funded.

'Very constructive debate'

After "very constructive debate", a new recommendation, split into two parts, emerged. The first part called for the contract between DHBs and PHC providers to be carefully reviewed to ensure nursing services were enabled and able to be directly and fairly funded. The second part called for the enrolment process to be urgently reviewed to ensure PHC services were accessible for all.

The third recommendation to cause angst referred to Care Plus. last month's meeting decided against making any recommendation about Care Plus because it was currently under review. The revised recommendations will be given to the Ministry's chief nursing adviser Mark Jones, along with a strong recommendation to reconvene the Ministry's expert advisory group on PHC, as the way to progress the recommendations.