Thank you Barbara, between the lines, you have spoken volumes which have been lost in translation.
VLCA is an genteelism for the acronym VLCA, which actually means POOR.
POOR is a classic four letter word in MoH, a little like Ms Rowling's Voldemort.
The ten year "festering boil" you refer to is the Capitation System from HELL, circa Helen Clark's grand design Sociopathy to the power of XX. A Private Business strangled by PHO / DHB combo deal.
This Festering Boil has only been allowed to remain contained, but exquisitely painful, by the dreaded STAKEHOLDERS coven and cartel of the GP Neverland (ref. Peter Pan) Barrie. Time to wake up girls and boys, and in Realityland the ACC / HDC Thought Police stake your next keystroke.
The Solution ? Corporate Manslaughter charges laid on the Minister of Health, whoever Clark happens to be past or present.
In my hometown VLCA is an acronym for bullshit state funded grossly unfair insurmountable funding advantage (but I may be wrong).
PS: All Humans less than 18 are now POOR.
The Solution for Childhood Poverty? Look to the West, where Bob Hawke eliminated Child Poverty in 1990, according to Bob Hawke, who cried with his own sincerity whilst uttering to pre-election promise. I'm sure Jacinda Ah D'Oh will not fall into this abyss, as she has a child on the way and a Public Health System below ....
Peter Hughes is right to say "I find, in our country, that people are just sick to death of people like me, ducking and diving and spinning and running for cover" but I believe he is wrong to say the answer is just "They just want somebody to own something".
We are sick of reports full of meaningless management speak by non-clinicians, particularly from Ernst Young or some other accounting crowd, sick of "top down" directives from managers (Ministry, DHB or PHO), sick of non-evidence based audits and just sick of the army of managers earning 3 or 4 times our income thinking they are in charge, when they should be assisting the clinicians' goals.
The "revolution" has to be to remove this cancer, ideally as in "The Hitchhiker's Guide to the Galaxy" solution, putting all middle-management on the first (and only) spaceship to leave the planet. Alternatively the Minister has to both limit management budget of DHBs (maybe just 1% so the CEO can only afford a few henchpeople) and the number of reports he/she expects. This allows more money for both clinical services (primary and secondary) and assets (capital and maintenance). With the latter, the expectation of buying the cheapest needs to be replaced by buying the best (and spread the cost over future budgets) so that buildings last longer and (don't leak and rot).
The biggest loss of available funding for clinical services is the duplication of management into way too many DHBs and PHOs. The efficient services in LITTLE old NZ are nationally based and largely exclude those unnecessary organisations, each trying to re-invent the wheel. Immunization is a good example, the experts make the decisions and the General Practices carry it out. ACC also works generally well outside those organizations, but the Minister needs to tell them to pay specialist GPs properly.
There Dr David Clark, I won't even charge you for that advice.
No 8 wire does not meet the requirements of Foundation Standards or Cornerstone Accreditation. Thanks for that College. Leadership has not been proactive about what it takes to make or keep General Practice viable - practically, economically or emotionally. PHOs certainly have not. I don't think they actually know or are bothered to find out. They do not, nor have they ever, represented General Practice. And when those of us who run practices and know a bit about it make some statements we just get called "whingers" - and not just by Ministry and leadership but by certain media people too.
New Zealand volunteers have quietly gone about the business of providing free, essential surgery for people in developing nations for 40 years with the international hospital ship charity Mercy Ships.
New Zealand Doctor