Petty accusations and lack of clarity: Fiery communication heralds opening of DHB-run practice


Petty accusations and lack of clarity: Fiery communication heralds opening of DHB-run practice

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Hāwera Hospital
A DHB-run general practice based at Hāwera Hospital has been a source of controversy since its creation last November

“Taranaki GPs are less sophisticated than other GPs due to their overprescribing of ‘downers’ and we ‘do not provide immunisation data in a timely manner’

Emails and letters give an insight into the inception of Taranaki DHB’s controversial general practice, including criticisms over the DHB’s lack of collaboration with local primary care providers.

A letter to the DHB’s chief executive Rosemary Clements and chair Cassandra Crowley from Pinnacle Midlands Health Network writes of an absence of collaboration, clarity, as well as “petty accusations”.

Taranaki DHB set up the South Taranaki Rural General Practice at Hāwera Hospital in November 2020, before officially announcing its opening in February this year.

Concerns were raised back in January, after a storm of complaints erupted from GPs and primary care leaders over the impact this practice would have on existing practices in the area.

On 4 June, New Zealand Doctor Rata Aotearoa filed two Official Information Act requests with the Ministry of Health, and health minister Andrew Little, asking for all correspondence regarding the South Taranaki Rural General Practice.

Over 300 pages of material were received in response, including emails, letters and phone calls between Taranaki DHB, ministry staff members and Pinnacle Midlands.

This includes the aforementioned letter, dated 18 November, written by Pinnacle’s deputy chair Brendon Eade and independent chair Craig McFarlane.

Key messages 

It begins by summing up the key “take-outs” from a meeting held between Pinnacle and Ms Clements and Ms Crowley the week before, with Dr Eade and Mr McFarlane writing of a discussion not held in partnership or “good faith” where it became apparent early on, the agenda was being “manipulated”.

“It became apparent to us all early into the meeting that your agenda to begin with a ‘discussion about the board’s priorities’ was intended to manipulate the conversation to ‘no alternative solutions’ to what you were going to tell us.

“This was confirmed when, as you left, we were advised that the new hospital-based practice was opening this week anyway. We have yet to have any information on what this new service looks like or how it fits with existing care pathways and service.”

Lack of collaboration 

Both parties agreed on the challenges facing south Taranaki primary healthcare to respond to the needs of its population, and of attracting permanent GPs.

But Dr Eade and Mr McFarlane go on to write that as per their previous communications they have not seen a collaborative approach, with the PHO, non-governmental organisations, or the community to co-design any solutions to these challenges.

“We don’t agree therefore that a practice on the hospital site using predominantly existing workforce capacity is the right solution, or that the DHB is the appropriate provider of primary care services.”

There was also a lack of clarity as to how the new practice addressed issues in the locality, who were its target patients, and “a clear lack of understanding” of enrolment underpinning a primary care service, write Dr Eade and Mr McFarlane.

“Indeed, Rosemary asserted that any new model of care needed to have the consumer voice as part of the design, but we fail to see this having been delivered.”

Petty accusations 

The authors also question the DHB’s logic in deciding to run its own primary care service, and not approaching Pinnacle, given the DHB has “no expertise or experience in this sector”.

“We do not know if it is the solution so would not explore that option without also exploring others.”

They add the PHO wishes to move forward more in a spirit of collaboration and partnership rather than of petty accusations, after being left bemused by statements presented by the DHB “as fact”.

For example, “‘Taranaki GPs are less sophisticated than other GPs due to their overprescribing of ‘downers’ and we ‘do not provide immunisation data in a timely manner’.

“Both statements are unsubstantiated by data the DHB has available. We are very aware of how primary care services can be improved, the complexity of the privately owned business model (and the enormous good value delivered by it).”

Fait accompli 

The letter finishes by stating Pinnacle’s clear position: “If we cannot be pragmatic and do this within a truly collaborative approach, we simply cannot publicly and privately support the option you have presented to us.

“Thus far it has been presented as a fait accompli with no evidence of collaboration with any other provider or consumer in south Taranaki.”

Timeline of an Official Information Act Request 

4 June 

New Zealand Doctor Rata Aotearoa files two Official Information Act requests relating to the DHB-run South Taranaki Rural General Practice based at Hāwera Hospital.  

  • First request: A request to health minister Andrew Little for all correspondence he has sent or received relating to the practice from 1 September 2019 to June 2021, including letters, emails and phone calls, as well as any advice or reports received or sent by the health minister. 

  • Second request: A separate request to the Ministry of Health for any correspondence between the ministry and Taranaki DHB, local PHO, and Taranaki primary healthcare providers. 

The request was sent and accepted both by Mr Little’s office, and the ministry. 

10 June 

The first request is fully transferred from Mr Little’s office to the ministry. New Zealand Doctor is told the information requested appears to be more closely associated with the functions and responsibilities of the ministry and to expect a response in “due course”.   

17 June 

New Zealand Doctor is asked by the ministry, now in possession of both requests, to refine the requests for information to exclude “all emails and phone calls”. 

8 July 

New Zealand Doctor is told the first request will be transferred back to Mr Little’s office, as the information requested is more closely aligned with the functions of the minister of health. 

“You can expect a response in due course. We apologise for the late notice.” 

9 July 

An email from Mr Little’s office states New Zealand Doctor can expect a response no later than 5 August 

2 August

Response received from the ministry

5 August

Response received from health minister Andrew Little