The Challenges Ahead: A Message from Outgoing Chairman, Paul McCormack

Paul McCormack steps down as founding Chairman of IPAC. His outgoing message was published in NZ Doctor in September 2003.

As I write this message, I have just stepped down after four and a half years as the first chairman of the IPA Council of New Zealand.  I am very confident that the Council will continue to make an energetic and constructive contribution to the health sector under its future leadership.

Over the past decade, general practice has repeatedly demonstrated its ability to be the most adaptive group of providers in the New Zealand health system. I wish to record my huge admiration for my general practice colleagues – both nurses and doctors and their teams – as I watch them yet again strive to achieve the best results for their patients in this challenging environment.

I applaud this govt for their clarity about the opportunity a well-resourced primary care sector can bring to the wider health system. I acknowledge too the modest increase in funding available to patients in primary care to address some of their access burden. The health system remains unbalanced, however, with the majority of DHB focus, energy and funding going into the part of sector that cares for a small percentage of the population – albeit with important and dramatic needs.

Sometimes, I wonder if the architects of the Primary Care Strategy just did not give enough thought to the role to be played by Organised General Practice in PHOs and how to bring the hearts and minds of general practice teams along.  At other times, I can see the opportunity for PHOs to add value to population health through community engagement and by supporting community development approaches – provided that we do not lose the capacity of organised general practice. The challenge is to do both well – with energetic and committed general practice teams working with similarly energetic and informed communities.

The new primary care environment offers many substantial challenges to general practice and to general practice leaders.  One of these tasks is ensuring clinical leadership continues through the continued contribution of organised general practice within PHOs.

Over the past 10 years, a "silent revolution" has occurred in general practice with the development of clinically-led integrated practice associations [IPAs].  Initially developed as contracting units, IPAs have evolved into organisations that have sought new challenges in budget-holding, disease management and even some secondary care.

The change has been dramatic – representing the move from isolated general practices to organised networks of practices supported by sophisticated infrastructures.  This in turn has supported a change in focus for general practice -- from one focused on episodic care to a wider focus on primary “health care” delivery, improving the health of New Zealanders.

The development of organised general practice in New Zealand through IPAs has been viewed internationally as one of the outstanding successes of the New Zealand Health reform process. There has been a parade of international observers seeking to understand the IPA achievements of the last decade.  These same contributions appear to have been substantially overlooked within New Zealand. It is important that these gains are not lost.

At the time of writing, over 1 million New Zealanders have their first line health need met by general practice teams who are part of a new Primary Health Organisation.  It is pleasing to observe the early successes of PHOs that have evolved from an IPA base that have achieved organised general practice and the community working together adding value to their communities.

Organised General Practice

Let’s be clear what the term “organised general practice” means.  Organised general practice extends and enhances general practice into a new future and accepts accountability for both health outcomes and efficient use of resources. Organised general practice describes the networks of providers supported by infrastructures that enable general practice teams to take on new responsibilities for enrolled populations – adding a focus on population health care to the long established focus on individual care.

I know that the Council is meeting these challenges head on.  A current IPAC priority is a research project documenting the contribution made by organised general practice to primary health care in New Zealand over the past decade.  This research will be launched at the first IPAC conference to be held in Rotorua in May 2004.  At the AGM last week, IPAC has affirmed the high value of the nurse-doctor partnership by implementing full nursing membership at the executive table as of right. And of course, the continued negotiation and final outcome of an effective national PHO contract will be critical to the future role of general practice in the delivery of primary health care in New Zealand.

I look forward to a New Zealand health system where nurses and doctors in general practice choose to bring their “hearts and minds” willingly into a new positive PHO future.

Paul McCormack
Past Chairman
IPA Council of New Zealand
www.ipac.org.nz

Publish Date : 29/09/2003
Author :  Paul McCormack