The workload and income is the elephant in the room... oh look over there I just saw a unicorn in a tutu...
And yet again, just who is the Federation of PHOs Primary Care? Certainly NOT representative of General Practice!
Wages are hard to pay. It is hard to generate enough income in a business to pay wages let alone generate profit. If you removed capitation, How many primary care businesses would flounder. I completely disagree with this entire paper. It flys against the prevailing current in business which is less real people - less wages. The current stagflation in wages accross the western world is due to supply shock bought about by techology. eg radiologists outsourcing their reporting offshore afterhours. You read this document and its " wages bill" stamped accross every page in red ink theyve not addressed. If you read the suicidal and dire comments coming from GPs covering 7-10k pts in UK; supersizing the practice does not solve the tidal wave of expectation and need. No/ this will not fly. It reads like a corporate bid to empty the public purse. I suspect if we look directly at other professions - banking, law; real estate, architects and watch the hollowing out of their concrete edifices THAT is where we are heading and lickety split. I suspect the answer will arrive like the iphone did - prepackaged and offshore; making a number of jobs redundant and one of them might be GPs.
More a nightmare than a dream - if all the "easy stuff" is managed by well paid nurses and kaiāwhina, then the "swings and roundabouts" principle is lost as GPs only deal with complex problems (including all those where serious problems were missed by the team). Unless our expertise for doing this is recognised and valued, we will disappear.
Jeff should become more flexible in timing and fees so more complex cases can be given more time and charged appropriately, so a more complex case is something that adds variety and challenge instead of the "heartsink" he describes. It is the receptionist (checking with the Practice Nurse, if necessary) who becomes the keystone of the practice team, breaking the "15-minute treadmill", not physios and psychologists who would prefer to have their own practices and premises.
I agree with Bryan Moore, we already have experienced providers (GPs) with the owner-operator model that had stood the test of time until it became undervalued and over-controlled. I prefer my GP practice to be small, provide continuity, kanohi ki te kanohi relationships and two way loyalty and to refer to other off-site providers (be they physios, dietitians, psychologists or non-GP specialists), but remain the overseer of a patient's overall health.
Let us see some evidence for improved and equitable health outcomes and better functioning primary health for all these "dream" new models of care - so far the only NZ research has revealed no improvement, other than a small reduction in ED admissions for Health Care Homes, something that could have been achieved better by valuing specialist GPs.
I guess since I am quoted I better place things into context: we, at our Practice, adopted a "team" approach long before "Health Care Home" was even a phrase let alone a policy. I strongly suspect that we are in no way unique. We looked at access and availability. We looked at individual skills and how we complemented each other. We allowed patients a choice as to whom they saw - although for certain things they still need to see certain providers. We do not differentiate between Doctor consultations and Nurse consultations - they are simply consultations - and if there are issues then we discuss these. We can do all this because we are a small team and we do not value one team-member over another. We talk to each other - a lot. We do not, however, think that we can be all things to all people.
I went along to a "Health Care Home" presentation and simply astounded this concept was "new". It was only new if you did not already take it as a given. Almost every Rural Practice I know functions this way - as do very may urban Practices. The issue I have with the Health Care Home concept as expounded is that you cannot possibly be all things to all people without complicating things to the point where core values are lost - even because at the simplest level the priorities will vary. Being able to communicate with others about concerns is as difficult as picking up the phone. What is required is a system that works, that is supported (including adequately funded), that communicates and that is patient and community centred - and this includes secondary services and NGOs. We don't have anything approximating this. We have silo'ed thinking and conflicting interests because the model is wrong. Whilst the biomedical model has provided significant benefits it also has significant issues. Time for a paradigm change and adopting the biopsychosocial model of care - and not rearranging the deck chairs on the Titanic.
Treating 23,500 elective day surgery patients in rural New Zealand is just part of the story. Education, training and workshops to support rural doctors and nurses is leaving a much bigger footprint
New Zealand Doctor