The Empty Section: A Report Compiled for Pinnacle Independent Practitioners Association November 2002
Group or Institution
Waikato Institute of Technology (Wintec)
Author(s)
Holly Duggan,Trudy Eley, Raewyn Hallett, Katy Langley, Katherine Leppard, Sandra Pascoe, Cynthia Seama (Tutor: Hilary Graham-Smith)
Abstract
This report has been compiled by a group of second year Waikato Institute of Technology, Bachelor of Nursing students in collaboration with Dr. Steven Lillis, Clinical advisor to Pinnacle Independent Practitioners Association.
The government, in The Primary Health Care Strategy (2001), talks about the development of Primary Health Organisations (PHOs). Central to this strategy is the concept of community participation in the governance of PHOs.
The aim of this project, “The Empty Section” was to understand the difficulty of achieving true and meaningful community involvement in the governance of PHOs.
Semi-structured interviews were conducted with General Practitioners (GPs), Practice Nurses and administration staff from two semi-rural, one rural and two urban medical practices. The data collected was analysed thematically, and six themes were identified:
- Misinformation/lack of clarity
- Lack of guidelines/guidance
- Funding
- Compliance issues
- Change and loss of control
- Community involvement (advantages and disadvantages)
Fundamental to the themes was a lack of knowledge in relation to all aspects of PHO development and the Primary Health Care (PHC) Strategy.
The primary concerns of all the respondents were:
- The level of community involvement
- Unfinalised funding formulas
- Possible change of employment conditions
- The expectations of both government and the community
- Tokenism
- Increasing bureaucratic compliance requirements
These concerns were reflected in both express and attitude and are indicative of a developing culture of change weariness and change wariness amongst the provider community.
Providers hold legitimate concern that their involvement in a PHO will compromise their ability to practice independently and make them simply agents of the state. Until this issue is addressed, general practice is caught between a rock: the current system which does not allow for equity of access or encourage community development, and a hard place: the PHC Strategy.
A number of participants thought community involvement would be advantageous in directing primary health care to those most in need. One stated that community involvement would:
“,,, allow us to achieve a community perspective on how resources need to be allocated. The community perspective is both different and valid.”
Based on our discussions with providers the group offers the following recommendations:
- Utilisation of a community development model would improve implementation and evaluation of PHO development, within the PHC Strategy
- Ongoing information and education opportunities could be provided by DHBs and IPAs to enhance the knowledge base of the provider community about the strategy and PHO development
- A forum be established for the exchange of information between funders and providers, including feedback from existing PHO pilots
Endnote: The government stated in the Minimum Requirements for PHOs (2001), “PHOs must demonstrate that their communities, iwi and consumers are involved in their governing processes…” At the time of writing, the government has altered their position on the level of community involvement in governance, to that of a consultative role. In addition, the group also understands that the government has decided that PHOs may be formed across District Health Board (DHB) boundaries. This will allow for alliances to be formed between interested organisations and will also mean that existing Independent Practitioner Association (IPA) management infrastructures may be maintained.
These departures aside, the PHC Strategy stands as the guiding document for implementing change to the delivery of primary health care services in Aotearoa New Zealand. The project team hopes that this means that the government will review the timeframes for implementation and funding availability in order to facilitate the development of both the provider and consumer communities in regard to their knowledge about Primary Health Care Strategy and community involvement. Clarification of these issues is required to minimise confusion and scepticism. This will allow providers to move more positively towards involvement in the development of Primary Health Organisations.
Group/s Associated with the Research:
Pinnacle Independent Practitioners Association Clinical Advisor and Board Member: Steven Lillis
Te Korowai Hauora O Hauraki Chief Executive: Hugh Kininmonth
Waikato District Health Board Project Manager: Grant O’Brien
General Practitioners, Practice Nurses and Administrative Staff
A full copy of the report is available from:
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