HWNZ still struggles with the old cart before the horse scenario.
There is such a vast discrepancy across the country with pay and conditions as well as many GPs having to battle against opposition who hold VLCA and/or ACC contracts despite being in an open commercial environment.
Add to that a very real sense that they are powerless for change with a complete lack of any effective representation.
HWNZ can have all the dreams in the world of a happy and well staffed primary care work force, but with the vast majority GPs I know saying that they would never choose to be a GP again, the cart is well and truly before the horse.
What do you call that that huge, grey, big eared, four legged African animal with a trunk in the room? Let's not talk about it shall we. If we do have to talk about it let's devise a panel of 7 people to talk about it, but for God's sake, don't put a GP on it (despite the fact they have done 93% of todays health care contacts).
HWNZ has never valued General Practice or Fellowship training. General Practice was seen as just a place those who failed specialists training could work in, so re-enforcing the "just a GP" misconception that remains pervasive today. This is clearly reflected in New Zealand's very low GP to (other) specialist ratio and in the few GP Voluntary Bonding places HWNZ has allowed, compared to nurses, Midwives, and non-GPs.
HWNZ also falsely assumed GPs were well paid and unlike others, could fund their own training.
If it is to become an effective tool, not only does it need to become more independent as Des says, but it needs to be headed by and have a majority of real and vocationally registered (specialist) GPs advising and deciding on it's policy. The problem is, we all have our head down and tail up (possibly why we can't keep our head above water!) trying to provide the essential primary care NZers need without going under financially or burning out. As such, there are few GPs willing to be available for organisations like HWNZ, even if we were asked. Usually politicians decide PHO managers represent General Practice, which is not only false, but has allowed General Practice to abused, over-controlled, ignored and undervalued to the detriment of the health of all New Zealanders!
Des had made some very important comments about MOH dysfunctionality which co-incide with what many others have observed. I suspect that neither the politicians nor the MOH will ever want to see HWNZ as an independent Crown organisation unless of course, it needs an industrial dispute scrapegoat.
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New Zealand Doctor