For a country of 4.3 million people there appears to be 4.3 million ways of doing the same thing or achieving the same end.

While that is perfectly reasonable with activities such as getting fed and entertained, where personal choice reflects the personal likes and dislikes in foods, drink, music, books, film, etc, it is not reasonable when it comes to the funding of access to health and social services in what is considered an egalitarian and caring society.

Can you wield a pick and shovel?

The Social Security Act review is long overdue. Fundamentally the view of incapacity for work was based on the ability to wield a pick and shovel for 8 hours a day, five days a week.

While that is still a good standard for people who do manual work it is no longer applicable when many occupations are extensions of peoples hobbies, interests and extracurricular activities ranging from sex to stamp collecting, from gardening to computing, web design, playing and designing games and widgets.

How does one assess the ability to work of someone who buys stuff at auctions and garage sales then sells it on Trademe or eBay?

Similarly for a white collar worker who is stressed because they run a finance company that is going bust, or a company director who runs multiple paper companies and never pays his bills?

How do you evaluate a sales rep’s ability to work 14 hours a week or 15 hours a week?

The single most beneficial treatment for depression is a job, any job, not just one that pays unsustainable salaries for fiddling with other people’s money.

No Hollywood clinics here

“Many in the VLCA scheme not poor” (New Zealand Doctor, 18 November, p3) –true.

It is very hard to compete fairly alongside a group that gets $1000 a head of public funding for integrated services when you get $100 a head as a baseline for running a practice.

Currently, the Very Low Cost Access (VLCA) funding provides an additional 24 per cent on the baseline interim capitation formula, up from the initial 15 per cent proposed in 2006 when the scheme was started.

For us, 34 per cent of the practice is in quintile 5, 19 per cent are Maori/Pacifica but half of those are not community service card holders so total percentage of high needs patients is calculated at 42 per cent.

We don’t meet the 50 per cent criteria, but we are hardly a post code medicine territory; Dr 90210 making the rich and beautiful less rich and beautiful. Thirty per cent of over 65s have had a skin cancer removed and 18 malignant melanomas have been excised in the practice in the last 4 years!

Where are those clip removers?

When patients are sent back to general practice for clip removal after an operation in hospital, how many hospitals expect the patients to pay for their own clip removers? Are there New Zealand hospitals that send disposable clip removers with the patient?

Is general practice expected to buy their own? Do they resterilise them to save money?

Disposable ear pieces and vaginal speculae have been reused before but hopefully these cost saving measures have been relegated to the annals of practice mythology!

Clip removers are considerably dearer and to add twenty odd dollars onto a nurse consultation seems quite unfair since the hospital is paid several thousand dollars for each operation including after care!

Is this another example of 21 DHBs having 21 different policies and 81 PHOs have 81 separate funding solutions for a single simple problem?