The new coalition government: a step forward for primary care funding?

In our guest editorial this month, Peter Crampton looks at the health agreements announced by the new coalition government.¹ He commends their intention to implement the Sapere report on capitation funding, which recommends funding based upon age, sex, ethnicity, deprivation and morbidity, which correlate to health need, as well as considerable investment in the extended primary care team. Of course, the devil will be in the detail. The actual formula that will be used and the degree to which primary care will be adequately funded is yet to be determined.

This issue we re-introduce an old favourite in the Journal of Primary Health Care – the Back to Back series, whereby two professionals present opposing views to a moot. This explores areas of uncertainty, where there is no one right answer, and helps stimulate debate. The first moot is ‘prompting lifestyle interventions to promote weight loss is safe, effective or patient-centred’, With Lawrenson arguing Yes,² and Ballantyne, Steers and Gray No.³ Continuing the theme on eating and nutrition, Babbott and colleagues examine adolescent eating patterns and body image, recommending targeting positive constructs such as body appreciation and intuitive eating may be useful in facilitating wellbeing,⁴ and McKerchar and colleagues explore how patients determine what is normal and what is abnormal gut function, and how they might view the diagnosis of a ‘functional disorder’.⁵

In a secondary analysis of postpartum survey data, Tutty and colleagues have found low levels of pre-pregnancy folic acid use in Central and South Auckland, with 58% use in planned pregnancies and 21% in those unplanned.¹ Māori women were much less likely to take folic acid supplementation (12%), as were those cared by a community midwife rather than an obstetrician.

Solutions need to fit with specific contexts. A qualitative study by Cullen and colleagues looking at what influences quality improvement in rural, urban and Kaupapa Māori primary care settings found that while generally no formal methods were applied, teams drew on available knowledge, their networks, and resources to identify adaptable and suitable quality improvement interventions that addressed identified needs.⁶ Another qualitative study by Higgs and colleagues explored Pacific seniors’ learning about their health and wellbeing from a weekly gathering involving exercise, health information and cultural activities.⁷ The role of allied health professionals was identified in providing a holistic approach aligned with the pan-Pacific Fonofale model of health.

Menezes and Eggleton have conducted a literature review looking at key ethical issues experienced by rural general practitioners, and found that the majority arise from overlapping relationships.⁸ In small communities, their patients will inevitably be people with whom they also have personal relationships. Professional guidelines developed by Medical Councils do not account for this reality, and rural practitioners should look to progress a specific rural ethics agenda. In another rural-focused study, Blattner, Rogers-Koroheke and Clay describe how a component of a the postgraduate rural medical programme, remote community marae-based workshop, was converted to a virtual platform during COVID-19 pandemic restrictions.⁹

An important study by Pledger and colleagues examined the demographics of people enrolled in Primary Care Organisations and found enrolment rates of Māori, Pacific and those most socially deprived are low, and their rates had dropped further during the COVID-19 pandemic.¹⁰ This has serious implications, meaning that those with the greatest health disparities are least likely to have access to general practice care.

Prior to the removal of the $5 co-payment prescription charge in July this year, Nind and colleagues looked at the profiles of consumers at pharmacies with different service delivery models – independent, corporate, hybrid, and mail-order, with corporate and hybrid pharmacies already providing free prescriptions.¹¹ They saw this providing important comparator data to assess how removing co-payment may change consumer habits. This study is particularly pertinent given that our newly changed government may reintroduce co-payments. Pharmacist prescribing is growing slowly, but lagging behind countries such as Canada and the UK. Ghabour and colleagues found that barriers include a lack of time and funding to undertake the training, as well difficulty finding a medical supervisor.¹²

A Letter to the Editor from Jerjes expresses grave concern at the mass exodus of general practitioners (GPs) from practice due to burnout, which weakens the foundation of the healthcare system.¹³ While he describes the situation in the English NHS, Aotearoa New Zealand faces a similar crisis of losing our GP workforce, both from burnout but also from a large cohort reaching the age of retirement. The reality is now that many practices have closed their books, so New Zealanders cannot find a GP, and those who are enrolled might have to wait a week or more to be seen. The long-predicted GP workforce shortage has arrived.

The issue is rounded off by our regular Cochrane Corner column, with Jordan discussing the evidence regarding cranberry product use to prevent urinary tract infections.¹⁴

This is our last issue of the Journal of Primary Health Care for the year. We would like to take the opportunity to wish you all the very best season’s greetings. We hope our hard-working primary care professionals can get some relaxing holiday time and be refreshed for the year ahead.

Meri Kirihimete, kia haumaru te noho, e hoa mā

Conflicts of interest

Tim Stokes and Felicity Goodyear-Smith are Editor-in-Chief of the Journal of Primary Health Care.