Review

General practice and the New Zealand health reforms – lessons for Australia?

Brian R McAvoy¹ and Gregor D Coster²

¹  Department of General Practice, School of Primary Health Care, Monash University 867 Centre Road, East Bentleigh, Victoria 3165, Australia

²  Department of General Practice and Primary Health Care, University of Auckland Private Bag 92019, Auckland, New Zealand

Australia and New Zealand Health Policy 2005, 2:26doi:10.1186/1743-8462-2-26

Published:	2 November 2005

Abstract

New Zealand's health sector has undergone three significant restructures within 10 years. The most recent has involved a Primary Health Care Strategy, launched in 2001. Primary Health Organisations (PHOs), administered by 21 District Health Boards, are the local structures for implementing the Primary Health Care Strategy. Ninety-three percent of the New Zealand population is now enrolled within 79 PHOs, which pose a challenge to the well-established Independent Practitioner Associations (IPAs).

Although there was initial widespread support for the philosophy underlying the Primary Health Care Strategy, there are concerns amongst general practitioners (GPs) and their professional organisations relating to its implementation. These centre around 6 main issues:

1. Loss of autonomy

2. Inadequate management funding and support

3. Inconsistency and variations in contracting processes

4. Lack of publicity and advice around enrolment issues

5. Workforce and workload issues

6. Financial risks

On the other hand, many GPs are feeling positive regarding the opportunities for PHOs, particularly for being involved in the provision of a wider range of community health services. Australia has much to learn from New Zealand's latest health sector and primary health care reforms.

The key lessons concern:

• the need for a national primary health care strategy

• active engagement of general practitioners and their professional organisations

• recognition of implementation costs

• the need for infrastructural support, including information technology and quality systems

• robust management and governance arrangements

• issues related to critical mass and population/distance trade offs in service delivery models