Community Services Card a barrier, not a remedy for disparities – iwi leader


Community Services Card a barrier, not a remedy for disparities – iwi leader

The local iwi welcomes its role in housing for Porirua, but cautions on primary care funding
Wellington region iwi Ngāti Toa Rangatira has challenged the Government on primary care funding, suggesting changes based on the Community Services Ca, TERESA WALL, SIR MATIU REI, Tā Matiu Rei, chair of Te Rūnanga o Toa Rangatira, with Teresa Wall, chair of Ora Toa PHO


I struggle with this concerning article for many reasons...

Firstly there is absolutely no mention of reducing inequities, something we are all desperately trying to achieve in General Practice. VLCA funding increases inequities for GPs and patients! Nobody can argue that giving $18 GP visits to wealthy patients is a reasonable use of vote health. Capitation funding must be targeted, for Ta Matiu to call for the continuation of VLCA funding is wrong. What is needed is the better targeting of funding so high needs patients in my non-VLCA funded practice and others like it in New Zealand can access the care they need, not just in VLCA practices!

All this is in the Moodie report, to hear otherwise is like going back to the dark ages and reeks of VLCA patch protection. VLCA funding must go. Primary Care can only succeed with a single, fair, equable, targeted funding model. To hear calls for VLCA funding to continue is very, very concerning.



My non-PHO low income Māori miss out, Geoff's Access low income Māori miss out, but middle to high income Māori and non-Māori in VLCA clinics get more funding and apparently complaining about this is "bureaucratic racism" and "tyranny of the majority"!?!.

As far as I am concerned, funding should be targeted to need and the CSC is currently the only realistic way to identify high need, although it could be improved by changing the threshold limits and by stopping the rich rorting the system with trusts and assets.  Anyone attending a VLCA clinic who is accepting low fees despite high income has no right to use the "R" word about GPs outside the VLCA system struggling to care for low income Māori and non-Māori! 

You cannot expect accessible, equitable and affordable primary care when Government's contribution for primary care access represents 1.46% of Vote Health - a pitiful $276 million a year after the last Budget - barely more than Government pays Pharmacists to dispense medications.

If you expect General Practice to fund Primary Care and to make it affordable, equitable, accessible, sustainable and to remain a high-quality service you simply will not have General Practice to access in the future. If you expect another section of the population to cross-subsidize the visits to make Primary Care sustainable and affordable for the disadvantaged, the "better off" will attend less frequently and the service will collapse from lack of funds. If you think that General Practice is teeming with "rich doctors" who can afford to wear the cost then please explain what other sector of the population has experienced a 30% reduction in income over the past 7 years? It started well before 7 years ago but the pace is accelerating. At what point will you want to have a discussion or will you simply let General Practice die?

It’s nice to see someone like Tā Matiu challenge the prevailing VLCA narrative. For PHOs like Ora Toa with 90% high needs and mostly Māori/ Pacific, even VLCA funding has been underfunding the complexity of the work (as evidenced in the Waitangi Tribunal Hearings recently). GPs for whom the Moodie Report reads well for them financially speak of it like it’s got some sort of untouchable truth attached. Well not all GPs think the same sorry. The closest I’ve come to that is the Alma Ata Declaration, but when people read about community’s making decisions about general practice, we feel threatened.

Of course there is beaurocratic rascism, not just with the CSC but across our whole sector. If you don’t acknowledge that there’s a big problem.

Please stop bashing Māori providers and Union clinics. These practices don’t make a profit and usually make a loss, have hard working and very skilful GPs, who are working hard to close the gaps:. it just makes you look mean, greedy, and interested in your own bottom line.

Abraham Lincoln eloquently described democracy as "Government of the people, by the people and for the people". Is this not the ultimate expression of "community involvement"? If Government devalues a service and does not adequately fund it - irrespective of the funding model - is it the service's fault or is it Government's and thereby the communities'? If you as a service provider devalue your service then you devalue the service of all other similar providers. If you as a General Practice - whether owner-operator, Maori, Union or other - run at a financial loss how long will you remain sustainable? When you are no longer sustainable who will provide the service? Is wishing to remain sustainable and continuing to provide an affordable service unreasonable? Do you realise you can only be a martyr once? Is it in fact ethical to martyr yourself and thereby deny others in the future access to services? Insulting your fellow service providers is unacceptable. Please  actually read the Alma Ata Declaration and note the role of the State.

Donald, you have missed the point entirely! I find your accusation of Mäori bashing offensive and would appreciate if you would retract that statement.

I work as a GP in Northland, a region with a high population of low income and Mäori. Obviously being a non-VLCA practice I cannot provide my patients with the subsidised GP visits they require due to the grossly flawed funding formula we currently suffer. The solution is a singe, fair, targeted funding model so your and my high needs patients can access the care they need, not just yours. We can't afford to waste vote health, VLCA does just that. If we target this funding we will end up with better access for your high needs patients Donald, can't you appreciate that? In addition the thousands of high needs and low income Mäori who ARE being bashed by the poorly targeted funding will get improved access to the care they desperately need. Only then will we have a funding system that helps General Practice get closer to delivering our obligations to the Treaty with respect to Mäori health.

Continuing VLCA and squandering millions on subsidising GP visits on the wealthy in VLCA practices is plain stupidity. Continuing VLCA effectively entrenches a funding policy that states your Mäori patients are worth more than my Mäori patients; we don't need to state what that means. It's bizarre that in trying to achieve equity there are still some who fight so hard against it.

Oh Donald,

Your poor and high needs patients are no more worthy of high level funding than my poor and high needs patients. Your wealthy patients are no more worthy of high level funding than my wealthy patients.

I feel it would be very disrespectful to state your post just makes you look mean, greedy, and interested in your own bottom line too. So I wont.

What I will say is that primary care funding is a sick joke. One that is taking my health and years as I battle for my patients and business.

We are all in this together Donald.

PS I have hit Bryan's like button heaps of times to make it look popular too.


Thanks for that Tim but I do not need affirmation. What I need and want is an adequately funded, affordable, accessible, sustainable and high quality patient-centred Primary Care system for all New Zealanders and those who call New Zealand home. I do not need or want friction between providers. I certainly do not want a system where anybody is marginalized or disadvantaged on the base of race, colour,creed or gender. We should not be bickering amongst ourselves. We need responsible Government to address the issues as a priority and not to engage in talk-fests whilst obfuscating the issues. Problem is we do not have responsible Government we have Government denying responsibility or simply passing the buck. We need Government where it actually reads the brief when it is provided.