Media release from the RNZCGP

Investing in primary health achieves better and more equitable health outcomes than investing further in hospital-based secondary care, says College of GPs President Dr Jonathan Fox.

The Royal New Zealand College of General Practitioners hosted a two-day quality symposium last Friday and Saturday with both international and national input.

Dr Fox said a better primary care "fence" at the top of the cliff will reduce the "ambulance fleet" of expensive secondary care at the bottom.


"We also need a better quality fence, to move away from the No 8 wire ethic.


"This virtual fence requires collaboration from all players, health professionals from many disciplines and community members."

Other key points to emerge were:

•           Driving quality and patient safety systems requires good information systems

•           Primary care has already made a substantive commitment to the quality agenda, and that will accelerate as a result of the symposium.


Auckland DHB chair Pat Snedden, who chairs the national Quality Improvement Committee, expressed optimism for achievement of the primary care quality agenda, given the information he had seen shared at  the symposium, the quality and diversity of the people involved, the values expressed, the ethics of the profession,  and the commitment to get the work done.


QIC has already reported about the hospital-based system, and Mr Snedden had indicated before the symposium that QIC would refocus on primary care.


"My challenge to you is to have everybody in the tent. I suspect this is the most difficult challenge, to include in its primary care narrative, community non-GP participants."

Mr Snedden noted the "one heart many lives campaign" from Kaitaia is very clearly primary care at its most expansive, both clinically and culturally.

"What stands it apart is that it is embracing of general practice but is not doctor-centric. Doctors still find it hard to make it part of their core practising paradigm. But I am optimistic. The inequalities analysis is now intuitive.  This wider primary care understanding may become likewise intuitive in time."

Dr Fox immediately accepted the challenge.

"As a College, RNZCGP feels that primary care is more than up to it. The College will play its part without impinging on the sovereignty of any other groups."

Led by keynote presentations from Professor Barbara Starfield, from Johns Hopkins University in Baltimore  and Dr Maureen Baker (UK), and with a team from the Royal Australian College of GPs, the more than 230 participants spanning general practices (managers, nurses and GPs), IPAs, PHOs and DHBs combined with Ministry of Health and others to hear there is robust evidence that investment in primary care is cost effective with quick response.

"As a result, DHBs are to be encouraged to rebalance from the current focus on specialists and hospitals," Dr Fox said. "Primary care orientation focuses on getting citizens the healthcare they need."

Equally important was the Government's role in education, workforce, practice support and remuneration.

Good information systems are vital. To improve quality we need good evidence about what is actually happening, Dr Fox said.

"We need agreed targets, good measurements, good - and safer - information systems.  The electronic health record will reduce some current risks, but also creates new ones, so safety needs to be built into information systems from design through implementation.

"This also requires collaboration between government and health care providers."

Dr Fox said primary care has made a substantive commitment to the quality agenda and has accepted the need to take another step forward.

"We need to focus on our agreed quality directions rather than our differences, and build on the excellent quality activities currently in place in primary care and elsewhere and find better ways to share and spread good practice."