The challenges of primary health care: more than 300 nurses gathered at Te Papa in Wellington last month to share experiences of primary health care nursing.
A committee of 12 organised the two-day event at Te Papa, conducting their meetings via email and conference calls. They had their first face-to-face meeting at the conference itself. Members included four NZNO staff and representatives from Te Runanga O Aotearoa NZNO, the College of Practice Nurses, Public Health Nurses' Section, District Nurses' Section, Nurses for Children and Young People Aotearoa and the NZNO primary health care nurses' expert advisory panel.
The conference aimed to pick up the themes of partnerships between communities and health care teams, as expressed in the Government's PHC strategy, said NZNO chief executive Geoff Annals in his opening words. "Some of us [look to the strategy] with a bright anticipation that sees only the opportunities to provide more effective care, and heedless to the real obstructions that may block us. Others of us look ahead with an angry frustration that sees only the obstacles, and blind to the very real opportunities before us.
"This hui brings us all here, the bright, and the angry, together. We are all here with a shared commitment to embrace the future. This means recognising both the obstacles and the opportunities. It means placing communities and people before professions and providers, and it requires cultural competence. Embracing the Future means being in partnership with people where they are, connecting the parts to make a healthy whole. This is what nurses do and what we do best. And this is what we will do together as nurses with our colleagues in other health professions and with our communities."
Filling in for Ministry of Health chief nursing adviser Frances Hughes, former manager of the Ministry's primary health care strategy, now principal adviser, sector policy, Kathy Spencer, gave the first address. This was entitled Primary Health Care Nursing: Bringing Strategy to Reality. Spencer congratulated NZNO for holding such a timely conference and reminded those present of the strategy's aims and why it was needed. These included better health for all, reduced health inequalities, more emphasis on population health, better access to PHC services, teamwork and a multi-disciplinary approach to service delivery, continuity of services and community participation.
Life expectancy gap widens
Recent Ministry of Health statistical information showed the gap in life expectancy between Maori and Pacific, and non-Maori, non Pacific peoples had widened to ten years, she said. (l) On average, 12 percent of people who felt they needed to see a GP in the last year didn't. The proportion for adults in the most deprived groups was 15 percent and for Maori nearly 20 percent. For all groups, cost was a major barrier, with around 75 percent of Pacific people naming cost as their main reason for not seeing a GP. The direct result was a high proportion of avoidable hospital admissions. In the most deprived groups, nearly one third of admissions could have been prevented with early primary care intervention, Spencer said. Pacific people had twice as many avoidable admissions as Europeans.
The minimum requirements of primary health organisations (PHOs) included working with groups with poor health to address needs; co-ordinating care with other providers; working with an enrolled population; having communities, iwi and consumers involved in the governing processes; enabling all providers and practitioners to influence decision-making; being not-for-profit; and being funded on a capitation formula.
The 11 nursing initiatives, which were chosen from 139 proposals and funded with $8.1 million over the next four years, had been chosen to assist with the transition to PHOs and delivery of the PHC strategy aims. The models were chosen to reduce service fragmentation and duplication, and provide shared learning opportunities for nurses around the country. Evaluation of the models begins next month when a researcher is appointed. An interim report and guide will be produced in June/July next year, a best practice guide in July 2005 and a final report in June 2006.
This year, $425,000 has been awarded to 183 nurses (20 percent from rural areas) to support them undertake postgraduate PHC nursing programmes. A further round of scholarship money will be available for 2004, with applications invited in November. Information about these will be on the webpage moh.govt.nz/nursing.
However, Spencer warned that nursing initiatives would not change the direction of PHC nursing on their own. She pointed to the new opportunities that would become available once the Health Practitioners Competence Assurance Bill was passed. "This will provide a lot more flexibility around scopes of practice and different ways of working. The PHO Care Plus initiative, which will affect five percent of enrollees (ie those with high needs), will also offer opportunities for nurses to work collaboratively with providers."
Although initially more funding was going to high-need PHOs under the "access" formula, other PHOs presently on the "interim" formula would receive increased funding over time. The aim was to have low-cost access for everyone in the country. "However, this is a long-term process and could take eight to ten years," said Spencer. Annual funding is projected to reach $195 million dollars in three years, an increase of $145 million on this year's $50 million new primary health care funding. Presently, around 1.7 million people are enrolled in 46 PHOs. By October this year, interim PHOs will be able to provide low patient fees for children under 18.
Creating real change
The challenges of the PHC strategy were to ensure real change took place, teamwork among health practitioners was encouraged and trust built among providers, said Spencer. She encouraged nurses to work with new and developing PHOs to become part of the organisation at service delivery and governance levels; to get involved in Care Plus and to spread the lessons learnt from the 11 nursing innovations.
1) Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980-1999. (2003) Wellington: Ministry of Health.
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|Title Annotation:||conference report|
|Publication:||Kai Tiaki: Nursing New Zealand|
|Date:||Sep 1, 2003|
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