Change the health model. Opt for wellness centres and equity to make a difference

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I HAVE A DREAM...

Change the health model. Opt for wellness centres and equity to make a difference

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Guest contributor

Professor Jenny Carryer
Jenny Carryer is professor of nursing at Massey University and executive director of the College of Nurses, Aotearoa

Jenny Carryer envisages a new direction for primary healthcare, focusing on health promotion, education and maintenance

Separating the tyranny of the acute from health maintenance would allow the development of genuine continuity of care For more than 20 years now,

Comments

Why would you exclude medically trained people from your wellness centres?

It sounds as though your model considers medical training as appropriate only for what you call the “tyranny of the acute” which I am sure your academic colleagues will tell you who are involved is not all that medical training provides the skills for. 

It sounds as though in your model there is nothing to be gained from having a doctor involved in dealing with the undifferentiated patient or dealing with complex care in the community. It sounds as though your model sees no role for doctors in what Starfield and others call primary care or family medicine - the provision of first point of contact, comprehensive, continuous care in the community. 

Given the weight of evidence that supports the involvement of doctors in primary care, and the value that medical care assistants, kaiawhina, nurses, nurse practitioners, pharmacists, allied health workers and doctors bring through working together on behalf of the whanau it is disheartening hat your vision lacks this vital aspect to the provision of wellness. 

The removal of doctors from midwifery care directly resulted in death and damage to babies and mothers; over 3 decades. The increase in perinatal mortality and morbidity was never measured nor was provision made do to so at the time. Now it is not spoken of because I suspect it would bankrupt ACC. I understand your distress at the Mess primary care is in but drs didnt create racism sexism, colonialism, post colonialism or neoliberalism. Also - all women groups can be really catty, angry places to work. Seen that too (dont deny it). Finally, people would die. Would u count them?

Rosemary, The ACC  is  apparently   now required  to  compensate  birth   "injuries"  where  as it  never used to . The total  anticipated  cost of  a  birth  hypoxia   injury  has  been estimated by  ACC  at  a  phenomenal   $50 million  pe event    covering the  whole of  life  till  death  ensues .

 To  be able to   work  out  this   costing and the  numbers  of anticipated  claimants   some one  must have the   perinatal mortality    data  for  the  last   30 years ? Yes ????? No?? .

 

A Primary Health Care Strategy completely devoid of input from GP's. Only a fool would think that this is a full and complete review with an outcome that is definative, only a fool...

 

I am quiet sure that an academic opinion based upon anecdote and introduced contrary to the available evidence won't result in a disaster. A cataclysm maybe, but not a disaster.

There is no doubt that there are significant issues we face and that the current model does not address all the issues. The answer is not "come to us, this is what you must do", it is more of "go to them, find out what you can do". Ask don't tell. Changing who does the telling won't fix the problems. Working out where you need to be or, alternatively, who needs to be there is the issue that needs solving. And then making sure there are communication pathways for those issues. But hey, I'm not the "Academic".

 

I have run a private/public business for decades. It's amazing what you learn from doing it.

 

Our problem is that without GP representation on Helen Simpson's review this rhetoric goes unchallenged.

Our representatives need to front foot some of the nonsense that is being dribbled here and now.

Removing GPs from primary care is about as intelligent as removing dentists from dental care or psychologists from mental health care and would have similar results as we have seen in NZ with third world statistics in those two areas.  Antenatal and postnatal care would be much improved if routine GP input was allowed (co-operation and teamwork not competition with midwives).

There is clear international evidence that the more GPs there are in primary care compared to other specialties, the better the health of a nation and the lower the cost. This example of undervaluing the GP role, rather than promoting teamwork is unfortunate but likely to be taken up by politicians who think GPs are just some generic "healthcare professional" of similar status to a "Health Improvement Practitioner", HCA or Kaiawhina.  

If the Government wants equitable outcomes, it needs to have a conversation with the Primary Care specialists (GPs), rather than further fragment care by setting up more pseudo-VLCA clinics without GPs.