Has the time come for a possible primary health care MECA? As the industrial landscape for primary health care nurses changes, there is a growing call for NZNO to reconsider its bargaining strategies in the sector and work towards a possible MECA.

Earlier this year, when NZNO developed the first bargaining plan for the primary health care (PHC) sector, industrial staff identified the need to build large national colLective agreements (CAs) in the sector. This would enable PHC members to have collective coverage, to pursue better pay and conditions and win "fair pay". Multi-employer CAs would also assist us in getting over the issue of small worksites and the problem of 1200 potential workplaces all wanting NZNO to negotiate a single employer CA. We would never have the resources to do this!

Our initial plan set out five large national CAs. Three were already in existence--the practice nurse (PN) MECA, Plunket CA and Family Planning CA. We identified two further new national CAs--one for iwi/Maori health providers and another for community PHC providers. The plan also highlighted the need to establish a Maori nurses' network as a reference group to assist us in shaping the decisions and structure of future CAs for Maori providers. The network has been in the pipeline since the beginning of this year and is now established.

Growing questioning by members

However, during 2004 a number of factors have affected the sector. These have generated a growing activism and questioning by members about the future industrial landscape for PHC nurses. Some of the key questions have concerned issues such as:

* What is the appropriate nature of future employment relationships for PHC nurses in the sector? Should these be with district health boards (DHBs) or primary health organisations (PHOs)?

* What is the appropriate level of influence nurses should have over their practice and practice content if they are to assist in delivering the Government's Primary Health Care Strategy?

* What sorts of bargaining structures will secure fair pay and other conditions such as access to professional development for PHC nurses?

* The Fair Pay Campaign for DHB nurses and midwives has highlighted the growing gap between pay rates for nurses across different employers. PHC members are now actively calling on NZNO to address these issues.

* With the introduction of the Primary Health Care Strategy, the delivery of PHC services has been in a state of flux as PHOs have been introduced and extended.

The first PHOs were set up in July 2002 and by October this year, their numbers had grown to 77. Over 3.7 million New Zealanders are now enrolled and accessing PHC services through PHOs. All 21 DHBs now fund PHOs and coverage continues to increase, with new PHOs still being established.

The PHO board decides how the funding will be distributed within the PHO. The opportunities for nursing within PHOs were heralded by the Government and Health Minister Annette King. As the Ministry of Health says on its website (www.moh.govt.nz, primary health care strategy implementation, questions and answers): "The Strategy creates opportunities for nurses working in primary health care settings to develop integrated and collaborative models of primary health care practice to deliver more effective care to individuaLs and population groups".

This was to be achieved through greater alignment of PHC nursing services within DHBs. A new PHC practitioner was promoted whose role would be to help nurses get recognition as practitioners within the PHC team. To this end, Government funding has been made available to nurses in 2004/2005 for scholarships to assist in gaining PHC post-graduate qualifications. However, the reality is that, two years into the implementation of the strategy, there has been no revolution in the delivery of PHC, either through the greater professional autonomy of nurses or the alignment of nursing services. Overall, the pattern of nurses' participation in decision-making in the sector and influence on the focus and direction of PHC funding and provision of services has not changed. Since June this year, unexpected problems have aLso emerged in negotiating the practice nurse MECA. The employers' advocate, the New Zealand Medical Association, withdrew its advocacy services earlier in the year and only agreed to resume this role in late October. This has created a very unstable environment for the MECA's future. On a brighter note it has given NZNO a fresh opportunity to reconsider our future bargaining strategy.

Has the time come for a possible PHC MECA? A meeting in October with the NZNO PHC Council, which represents the key PHC sector constituents, explored again the question of possible options for bargaining in the PHC sector. Different ideas were discussed but the direction for future bargaining that received the greatest support was the idea of a PHC MECA. This would cover NZNO members whose employers are GPs, PHOs, iwi and Maori health providers and community organisations. Further discussions with the office holders of the College of Practice Nurses (NZNO) also drew a favourable response to a possible primary health care MECA.

Support for MECA campaign needed

One of the advantages of a single MECA would be the potential to bring more members together under one agreement, which in turn would enhance the collective strength of PHC members. To achieve this goal PHC members will need to support a significant campaign throughout 2005 and give a commitment early on to vote "yes" in a PHC MECA ballot. The purpose of the campaign would be to make the Government's Primary Health Care Strategy work properly, leading to better health for all people by:

* Creating an environment that Government has to respond to, to address members' issues such as fair pay in the PHC sector;

* Reinforcing nurses' autonomous practice through the unshackling of traditional employment relationships;

* Supporting the recognition of PHC nursing through appropriate industrial arrangements;

* Providing for a stable bargaining arrangement in the PHC sector;

* Achieving professional aspirations of PHC health workers; and

* Increasing collective activism, identification with NZNO and industrial awareness. We are now seeking feedback on the campaign and would love to hear from as many NZNO members in the sector as possible. Comments can be sent to me on e-mail [e-mail] or to NZNO policy analyst Maori Sharon Clair on [e-mail]. Alternatively, contact your local NZNO organiser.