Leading primary health care.

NURSING HAS articulated for many years the need to improve primary health care (PHC) services and views the development of nursing itself as central to successful service delivery. The last three years has seen considerable energy directed at PHC nursing by various nurse leaders, resulting in a number of Government and Ministry of Health initiatives. These initiatives have included scholarships and money for the development of innovative local nursing models. The document developed by nurse leaders, Investing in Health: A framework for activating primary health care nursing, provides advice and recommendations to the Ministry, district health boards (DHBs) and primary health organisations (PHOs) on a framework for PHC nursing in New Zealand. (1)

In 2002 I was involved in one of the 11 successful Ministry of Health innovations proposals. The proposal gained funding to establish a Primary Health Care Nursing Development Team to enable PHC nurses to deliver on the objectives of the Government's Primary Health Care Strategy. That team is led by two directors of nursing--primary health, one of whom is Maori. As one of those directors, I am involved in ensuring nursing is woven into the fabric of PHC by assisting nurses, employers, PHOs and the DHB in service innovation to improve people's health and independence. Identifiable primary health nursing leaders within all DHBs are required to bring the different groups of nurses together to work through the significant and complex contractual issues surrounding service provision. Without this leadership, the status quo is likely to continue under PHOs. A key example of the status quo is in the governance of some PHOs. The nursing profession welcomed the notion of shared governance between nurses and doctors in strong community partnerships. However, this has not been realised in the establishment of all PHOs.

The vision for the PHC nursing framework is "to create the environment that enables nurses to provide integrated comprehensive nursing care to individuals and population groups in New Zealand primary health care settings, that strengthens the primary health care team towards improving health for all". (1) This vision will be difficult to achieve without DHB nursing leadership. PHOs are receiving additional funding (Services to Improve Access and Care Plus) to provide enhanced services to their enrolled populations. The additional funding provides opportunities for nursing; however some PHOs are not aware of the different practice areas of practice of nurses who contribute to the care of their enrolled populations and are creating yet another area of practice to meet community need. This may lead to further fragmentation and duplication of nursing services. All nurses who contribute to the care of PHO enrolled populations need to meet nursing leaders in their DHB and PHO governing boards to explain their area of practice and what your nursing practice entails or could potentially entail to meet the needs of PHO populations. The additional funding could then be used to align nursing practice with the needs of the community and provide integrated comprehensive nursing services.

NZNO has also been at the forefront of developing a framework for cohesive PHC nursing leadership as the primary health care strategy is implemented. Last year, NZNO established a PHC Nursing Advisory Panel. The purpose of the panel was to develop a shared purpose and common structure within NZNO for PHC nurse members and to enable NZNO to respond to changes in the sector. In May 2003 NZNO's board of directors approved the establishment of a PHC Nurses' Council for a two-year pilot beginning this month, which meant the PHC nursing advisory panel was disbanded. The work completed by the advisory panel has ensured a solid foundation for the development of the council. The council has representatives from the College of Practice [Nurses.sup.NZNO], Nurses for Children and Young People of Aotearoa, the Public Health Nurses' Section and the District Nurses' Section. Three others represent Maori and rural perspectives in PHC. At the end of the pilot, a formal review will be conducted and decisions on any future development are to be approved by NZNO's board of directors. The key purpose of the council is to establish itself as the credible voice for PHC nursing within New Zealand and provide nursing leadership and strategic direction within a changing PHC context to NZNO's board, colleges, sections and members, I am honoured to chair the council, and believe my experience as director of nursing--primary health at MidCentral DHB will be valuable. Among the experience I bring is of working through significant and complex contractual issues for service provision with different groups of nurses, PHOs and the DHB funding division to enable nursing innovation.

Many nurses are working to achieve a real vision for PHC. We are moving way beyond our former roles in assisting the delivery of primary medical care and looking to a future where health, not illness, is the focus of our energy. I wish to congratulate NZNO on its strategic support of nurses to meet the objectives of the primary health care strategy.

REFERENCE

(1) Primary Health CareNursing Expert Advisory Group (2003) Investing in Health: Whakatohutia te Oranga Tangata. A framework for activating primary health care nursing in New Zealand. Wellington: Ministry of Health

--Chiquita Hansen, RCpN, BN, PGDipNursing, is the director of nursing--primary health at MidCentral District Health Board. She is also chair of NZNO's Primary Health Care Nurses' Council.