Health minister boosts hopes for rural GP training with ‘hub’ announcement


Health minister boosts hopes for rural GP training with ‘hub’ announcement

David Clark April 2019, rural conference
Health minister David Clark addresses the National Rural Health Conference in Blenheim
Health minister David Clark renewed flagging hopes of some kind of training centre for rural general practice with a surprise announcement at this mor


I see no point in congratulating the Minister for anything. Simply hollow words. There is literally no point in training anybody to participate in a service that is inadequately supported in the first place. These "sound-bites" are just meaningless rhetoric from the Minister and a cynical attempt to buy votes. Stop patting him on the back. Demand detail. "What are you going to do and how do you expect it to work?" The lack of this sort of demand is why we have the issues in the first place. 

Rural communities are increasingly vulnerable because of inadequate services and an over-dependence on volunteer services (particularly rural emergency services) that are over-stretched to begin with. Those who are left and working harder for less are hardly going to serve as inspiration for those coming through. "Be like me". Yeah right. Training more "lambs for the slaughter" is not going to solve the issues and is particularly unfair to the lambs. Stripping away status so you can strip away funding whilst still expecting services to continue was and is unsustainable for many providers. Pretending that all is good and the issues are being overstated is disingenuous. We are not facing a crisis, we are in a crisis. If you cannot see that then......I don't know. Chardonnay Socialists.

Totally agree Bryan, at best we will train GPs for the far better conditions in Australia.  Not sure if this export business makes economic sense, but it will not improve rural GP retention one bit. 

100% agree Bryan. The system has been shafted for so long it's not only the rural sector that's dying, many urban / provincial regions have turned into GP ghettos also. Dr Dolittle Clark had a chance of improving things by keeping his election promise of bringing in a single boosted targeted funding formula. Sadly he's realised he was totally lost and announced a total freeze until his review in 2021. Hopeless. 


I wish I could believe him. 

I have not even a login to the Uni of Auckland library to read the Christmas edition of the BMJ; and we have been training their 4th 5th and 6th years (fees do not trickle down) since last century. 

Maybe Santa will bring me a dog eared copy of Grays. 

pasted w permission as I think he is parroting "consultant speak" doubt his mind i engaged. 

Transforming the NZ Health and Disability sector in a page [and a half ]

            [Robin Milne Independent Chair of BOP Alliance; Ex CEO of the Western Bay Health CHE]

A personal perspective formed after27 Years of direct and indirect involvement in the Health sector, Public and Private , Primary and Secondary; Governance and Management , including much exposure to Whanau Ora /Maori Health planning and provision.


1. We need to see the future through a new lens not a remoulding of the current model. Redesign must be from the outside [community] in and not the current inside [hospital] out model. [A failed sickness treatment model]

2. To ‘power’ the transformation the sector desperately needs more resonant Leadership and fresh thinking throughout.   

3. The successful ‘embedding’ and adoption of Smart technologies will be a ‘mission critical’ enabler of the change to a more patient empowered environment. Such embedding to be Community/Primary led, with rural, remote and hard to access populations being the first cabs off the rank.[ I mean deeply embedding not just adding on to current care models as has often  been the case in the past. Certainly in the BOP]

4. The emphasis must squarely go on Wellness not Sickness [as is currently the case]. We need to be talking about thriving not surviving! [Whanau Ora has a lot to offer in this regard if given a chance].

5. Given that circa 80% of the patients seen in the health sector are generated  outside of the sector it seems foolish not to focus on changing the health trajectory of this 80% cohort.

6. The new ‘Wellness  Lens ‘ needs to have three dimensions  i/Societal Wellness;  II/Population wellness and;  III/ Individual/Whanau Wellness. 

7. To facilitate this there needs to be massive change at the Ministry Level, which would see a morphing of the Current Ministries; MSD and MOH to form a hybrid Ministry of Societal, Population and Personal Wellness.  [ Old Chinese Proverb; ‘A fish dies from the head’ and that is what is slowly  happening to our Health  system because of a lack of  strategic cohesion at a ministry level.

8. Wellness would mean ‘holistic’ wellness along the lines of Te Whare Tapa Wha model. With Mental Wellness being viewed as the ‘King’ of priorities.

9. There needs to be a clear funder provider split, along the lines of the RHA’s of the 1990s. The  will never be a meaningful flow of resources and decision making  from the DHBs to the Primary and community settings under the current model.

10. PHOs need to be redesigned, for a whole number of reasons. They are currently very expensive and largely ineffective conduits between community based providers and ‘Hospital’ based services and providers. They are not good agencies for significant change and in the ‘new world’ we will need these frontline organisations to be very community/patient focused and not provider focused.  We need to move away from the current  ‘Provider Ora’ model

11. DHBs [Governance function] could disappear without trace in their current garb without any value loss.  They are largely redundant relics of a system that viewed health provision as an exercise in local democracy.  In the new scenario Hospitals and the like could become specialised treatment centres [STCs] a blend of Public and Private Facilities and in some cases PPPs.  The STCs could be overseen regionally so as to minimise replication of facilities, administration and back office functions.  The Crown Health Enterprise [CHE] model was not all wrong in my view.

12. Many existing hospital based services would be decanted from the hospital campus to become part of the integrated community service networks. Although this is the current intent very little meaningful devolution has occurred. This failure being a function of a lack of will and a lack of change leadership  ability.

13. The’ new’  funding[Wellness investment ]organisations Could be regional to help prevent duplication and create economies of scale where that made ‘triple aim sense’ .However commissioning and provision will be very local in order to provide ‘close to the  action quick response decisions to be made. Currently this is more ‘glacial’ in character.

14. The current race to regionalism is a race to the bottom in my book.  Repeatedly we see local priories subsumed by regional initiatives that do nothing to improve local service provision, where 90% of the patient interactions take place. I example the Midland Regions E SPACE  project as a case  of  an expensive and momentum sapping  exercise that does little to enhance primary and community service provision and certainly fails any ‘triple aim’ test.

This is merely a personal ’ brain dump’ of the quantum of change that I envisage is required to make meaningful improvement  to our health and wellness in Aotearoa, NZ ;   as a society and as individuals within it . It’s time to ‘drain the swamp and stop just shooting crocodiles’. i.e root cause not symptoms.  And the root causes mainly lie in the inequities, the poverty and the deprivation currently eroding our way of life. Vested interest groups and ‘luddites’ make the change task even harder.  This is all too important for us all not to give it our best shot!! A workshop like this provides a good vehicle for meaningful and progressive korero; so let’s not waste it.   

Thank you

Robin Milne