There’s a perception that New Zealand has one of the better healthcare systems and services in the world. I’ve recently been on a General Practice New Zealand (GPNZ) master class integrated study tour to the UK, Brussels and the Netherlands. This was an opportunity to attend a conference on integrated health care, and to have conversations with healthcare professionals within their work environment at medical practices in the UK and the Netherlands. These doctors working in their communities appeared very interested in NZ and spoke about how they’ve heard from colleagues that we have a well-functioning health system.

Health literacy

So our first major challenge begs the question: if we have such a wellfunctioning health system, then why are our health statistics not improving? Many issues in the media focus on health issues and outcomes that are perceived to be in the individual’s control. We know issues such as obesity, smoking, and diabetes can have better outcomes with behaviour changes such as moderate alcohol consumption, and ensuring the right amount of exercise, and we can all aspire to this. We in the Bay face the same issues the health sector faces globally.

Our challenge is to focus on how we continue to provide high quality healthcare which is easily accessible to the community. This goes hand in hand with health workforce development; clinicians, doctors and nurses working to the top of their scope. To me clinical leadership is vital: who better to lead or provide governance in a sector that provides medical care within the community?

Solutions can also be found within our communities. When pondering the health of our communities and individuals, I think the last decade in NZ has shown us as a society we’re open and we’ve got our heads around important issues such as gay marriage, so why can’t we as communities and individuals get our heads around individual responsibilities for health and what inhibits people from caring about their health outcomes?

We know the demographics. In Hawke’s Bay we serve a population of 155,000 people. The next 25 years will see a growth in Maori and Pacific populations and a substantial growth in the numbers of older people. Maori and Pacific people have worse health outcomes across many areas when compared to New Zealand European. People living in deprived areas also tend to have worse health outcomes than those living in less deprived areas. In Hawke’s Bay, 26% of our population live in areas with the highest deprivation. So we face some serious challenges.

However, what is heartening from my perspective is the focus on health literacy coming from the Hawke’s Bay DHB and Health Hawke’s Bay. Accurate and understandable information delivered in an environment that is safe and friendly, has the potential to make a difference to choices people make about their lifestyle. Preventative, proactive measures such as this are hard to measure, but there must be a start somewhere. We have such a fine example of positive strategies in Iron Maori; what positive role modelling happens there. This can change people’s lives.

‘Joined up’ services

Our second major challenge and opportunity is working towards more ‘joined up’ service provision: finding ways for health professionals and allied sectors such as social welfare to work together is paramount to better service delivery. In Hawke’s Bay we are privileged to have a health system that works together to address the challenges of socio-economic conditions that continue to drive high health need and inequalities, particularly in our most vulnerable and deprived communities.

A lot of coalface activity is happening in our region. The Hawke’s Bay health sector is moving forward; it is becoming more effective in improving health and ensuring that its services are clinically and financially viable. Both DHB and the PHO are working together to address needs and enhance the opportunities and strengths we have in our community. They also ensure coalface involvement and have formal relationships with local iwi and Pasifika. Involving the people and communities with the most health challenges will create health leaders who will become the champions of change.

Sharing a common vision and working together and in collaboration with organisations that serve the same communities will protect scarce health resources from becoming even more diluted. This collaboration breaks down barriers and will reduce duplication. Within Radius we have a model that supports the business side of general practice and offers many resources including policies and procedures, clinical leadership, access to HR support plus a raft of other specialised support that’s needed in general practice today. Initiatives are also underway in collaboration with pharmacy and home healthcare.

Changing primary care

The third challenge and opportunity is to the actual model of healthcare service delivery. This does need to change in very incremental ways. In designing the way forward, we must not only understand the issues, but also ask the person at the centre of the system, the patient, what they expect.

Some of the work we (Radius Medical Group) have been doing lately responds to people’s expectation of a primary care system that encompasses technology, such as shared patient management systems, online scripts and appointments and same-day appointments, to name just a few. People expect that all their health professionals have access to their health information and are often surprised at the amount of time they need to repeat themselves. Patients are frustrated by fragmentation. When integration appears seamless, patients are more satisfied.

However, in other ways, the feedback we receive from patients points to the need for a change in some expectations. For example, we may be able to provide people with same day appointments, but this may not be with your usual doctor; however it will take care of your immediate health need. With a looming demographic gap in GP and nurse numbers, building a new culture, new ways of thinking, new core competencies, and coalitions of the willing are fundamental to the success of our health system in an environment with higher health needs. Clinical leadership and appealing to professionalism of clinicians will assist and is vital to achieving better outcomes for patients.

From my perspective working in primary care we have to think differently and apply our skills and collaborate as providers to meet demographic demands.

We know that the Emergency Department at our hospital is often at capacity. I believe the primary care community has the opportunity to support our hospitals. People need to be confident that their urgent healthcare needs can in many cases be met by their local general practice. There is a piece of work currently happening between the DHB and Health Hawke’s Bay that supports this shift which requires our communities to think differently.

Given limited health dollars and the demographics, as a health sector and as communities, we have to work smarter and together.

Adri Isbister serves on the board of Health Hawke’s Bay and is chief executive of Radius Medical Group. These are her personal views.

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