That’s the proposition Health Hawke’s Bay (HHB), our region’s PHO (Primary HealthCare Organisation) is putting before the Bay’s 23 primary care practices … our GPs.

As BayBuzz reported here, in Hawke’s Bay and throughout NZ, there are rumblings of many GPs ‘defecting’ from their current PHOs. 

The motivation for this is mainly money – how much primary care funding flows through to the practices (as opposed to getting consumed by PHO overhead) and how is it allocated? The PHOs are the vehicle through which Health NZ allocates public funding for primary health care, and clearly central government would prefer to do that through thirty or so regional or national entities as opposed to a thousand or so individual local practices.

A number of Hawke’s Bay general practices (themselves businesses after all) have indicated they are considering leaving Health HB, presumably in search of a better deal. Health HB hasn’t indicated how many Bay practices are in this state of mind.

Health HB Chair Kevin Snee (four months in the job) and Chief Executive Irihāpeti Mahuika (three years) have been meeting with the practices to hear and address their concerns.

The bottom line seems to be that the GPs want a much stronger voice in Health HB decision-making.

And that’s what Snee and Mahuika have put on the table – direct representation.

Currently there are two layers of governance for Health HB (in a relationship much like the HB Power Consumers’ Trust and Unison).

The Te Matau ā Māui Health Trust holds the shares of Health HB (which is a registered charity). Its chief function is to appoint or remove HHB directors. Currently the Trust Board consists of ten Trustees:

• Two by the Hawkes Bay Faculty, Royal New Zealand College of General Practitioners.
• One by the Hawkes Bay Primary and Community Care Nurse Leads Group – Manu Tāpuhi
• Three by Ngāti Kahungunu Iwi Inc.
• Four (one each) by the Territorial Local Authorities within Hawkes Bay.

This Board is a conglomeration of former politicians, a few clinicians and iwi representatives). Under the new proposal, this Board will be dissolved. HHB’s Snee says those parties have agreed to this plan.

That leaves the Health HB Board, which Snee chairs. That group “sets the strategic direction of Health Hawke’s Bay, establishes the overall policy framework within which the business of Health Hawke’s Bay is conducted, provides effective oversight of the activities carried out by management, and protects shareholders’ interests”.

This Board presently includes Snee (a medical doctor, but more known for his senior roles in hospital management, including as former CEO of HBDHB) and eight others (two actual general practitioners, the rest are civic leaders, three of these with professional involvement in health care).

One can imagine why frontline GPs might be uncomfortable with this group of 19 governors (all public-spirited, to be sure).

Given agreement to dissolve the Trust Board, Snee proposes to reconstitute the Health HB Board, with the new representatives (‘owners’, such as that term applies to a charity) to be driven by the GP community. So, not all GPs on the Board (some other talents required), but with GPs clearly in the driver’s seat.

Snee comments:  “To remain viable and so general practice continues to see value in staying with Health Hawke’s Bay, we need to give practices greater involvement and influence and say on where investment in in primary care should be made. The new structure will provide general practice with stronger representation and oversight of priorities, ultimately benefiting patients in our region through the work delivered in general practice.” 

As I write, this proposition is being put to Health HB’s current general practices for their refinement and – hoped for – approval. The goal is to have a new governance model in place by July (for the coming financial year).

Snee argues that this model, with GPs dominating the table:

• Streamlines governance, 
• Gives greater overall transparency to Health HB funding commitments (much of which are formula-driven), 
• Enables administrative savings (in the $1-2 million range) to be passed through to practices, and, 
• Directly involves frontline providers in the key decisions about how primary care can best be delivered in Hawke’s Bay. 

All seemingly responsive to the GP concerns that have been expressed, but needing to overcome a certain level of GP skepticism.

My understanding is that this model is what Health HB will implement, whether or not some HB practices elect to align themselves elsewhere.

From the outside looking in, it is hard to fathom why a Hawke’s Bay general practice, perhaps as one of 50-plus practices in a new nationwide PHO, would prefer to have its funding and priorities determined by a distant executive group (and its Board) sitting in Auckland or Christchurch.

That said, here’s the reaction of one GP whose practice is considering change: “The effect on patients and local services is hard to predict. We will almost certainly have 3 PHOs in Hawke’s Bay — HealthHB, GreenCross, and thePHO. Each will likely be offering different funding streams and different services so what people can access in theory might be different depending on which practice they’re registered with and which PHO it falls under.”

With Health HB’s target date of July, we shall soon see where the dust settles.

Arguably, this is all ‘inside baseball’ … apart from bring confused, why should the patient/consumer care? Will their healthcare improve?

Ultimately this ‘governance reform’ will be judged on whether it actually releases more funding to the frontline practices and whether they – having sat at the decision-making table – indeed use the additional resources in ways that better address HB practitioner-defined community healthcare needs.

Experience does indicate that the more satisfied all players are in their working relationship, the better the outcomes. In this case, hopefully more patients better served.