Budget 2022: Hope or hype? We’ll have to wait and see

While the dollars are certainly promised in this record pledge to New Zealand’s health system, Justin Butcher, Pinnacle acting chief executive, isn’t breathing a full sigh of relief just yet.

“It’s easy to get swept up in the headline hype of budget day, but we’ve been down that road a few too many times. We’ve seen announcements not equate to outcomes, and we know there are multiple challenges the sector is yet to overcome,” says Justin.

From his regular visits to general practices and hui with GPs across the network, Justin knows they are overwhelmed in many ways, and have been dealing with mounting cost pressures – particularly since the pandemic began.

“Our teams are nothing short of amazing. They’ve dug in and done the mahi which to be honest was already rising substantially before the pandemic began. Questions of sustainability are the consistent feedback theme I hear,” says Justin.

While COVID has dominated, many of the other services practices would usually offer have gone to the wayside. This loss of income generating services, combined with the costs incurred to work safely through COVID, are simple math that can’t be denied or underestimated.

“The costs incurred by practices are many and varied. To name a few we’ve had practices who have hired or purchased portacabins or made alterations to their premises to allow for alternative entrances and exits to provide a safe ‘red stream’ environment. There have been IT costs to support working from home, increased phone lines to cope with demand and costs incurred to improve ventilation. The funding associated with COVID hasn’t really been enough to cover these types of things, and frankly we’re not seeing anything concrete ahead that will address issues such as this for our practices.”

It will be interesting to see how the $86m over four years for GPs in high-needs areas plays out.

“On the face of it, it is a welcome move to increase an already very small portion of the Vote Health pie. We know offering more care through improved opening hours and more appointments is an instrumental part of delivering pae ora. But, given where we are right now in terms of workforce shortages, issues of nursing pay parity and no tangible national strategy to address workforce planning just having more funding in high needs areas isn’t a sign of optimism.

Sustainability issues are not limited to the balance sheet either – workforce wellbeing is a hugely concerning issue.

“Practices are committed to giving a good service to their communities. But we completely understand the demands of COVID are still very much on their plate – necessitating more evening and weekend work than ever before. We’ve got winter approaching and persistent workforce shortages in critical clinical roles. Doing more or launching something new and different could still feel a little on the hard side for many,” says Justin.

“Right now in our network we have multiple practices who are critically down on FTE. That puts enormous pressure on the remaining team to deliver for their community. They step up and try to cover gaps but at a great cost to their personal wellbeing. We’re very conscious of burnout right now.”

However, Pinnacle’s mission to ensure primary care is supported as much as possible with the resources it has, has never been stronger.

“We’re battling on, we’re driven by our purpose: Kia hauora te katoa, kia puaawai te katoa - Everyone healthy, everyone thriving,” he says.

“The Pinnacle network has a high Māori and high rural population. Issues of access and equity are not just words on paper for us. People in our communities have different levels of privilege and therefore different ability to access the health care they need.”

We’re delighted to see the lower screening age for Māori and Pacific in the National Bowel Screening Programme, after calling for that in 2020. We run a very successful smoking cessation programme, so more money to deliver on the Smokefree Aotearoa 2025 Action Plan is also welcomed, particularly for the roll-on health impacts being smokefree can deliver to our Māori and Pacific populations.

Regarding equity, we see intention in many of the Vote Health initiatives and beyond, with initiatives across the board that could help address the social determinants of health. But we’re aware many believe it hasn’t gone nearly far enough, and think now is the time we should listen more and be guided by our Māori providers.

Pinnacle’s extended care teams (ExCT) are one of our key success stories. They add a huge amount of value by allowing health practitioners to work at the top of their scope, which adds capacity to the primary care team. The team environment also allows individuals to extend their practice as they learn from one another, which grows capability.

“ExCTs are one of our key methods of improving equity and access to health services. We’re happy to see money earmarked in the budget for supporting development of comprehensive primary care teams.”

Pinnacle will closely follow other initiatives from this budget too, such as extending school-based health services. Our school-based team continues to deliver outstanding results for students year after year, and the impact that can have on a young person’s future cannot be underestimated.

At the end of the day a budget is a signal, an intention.

“We’ll keep on listening, collaborating, innovating and above all else - striving to deliver more and better outcomes. We welcome every penny of increased funding and will continue to advocate strongly to ensure the money makes it to the frontline people and places where it’s so sorely required. We’ll also keep pushing for clarity and consensus on the role of general practice in the reformed system, with an aligned budget allocation to deliver it. The gap between those two has been too large for too long.”

• New Waikato approach produces highest smoking quit rates in NZ - Waikato people are quitting smoking in higher numbers than just about anywhere else in Aotearoa New Zealand, and the statistics are particularly positive for Māori and pregnant women in the region.
• School-based health service collaboration supports rangatahi in the classroom and at home - On a mission to reduce barriers to healthcare for rangatahi in low-decile schools, clinicians in the Waikato School-based Health Service (SBHS) are using a collaborative care model that is improving health outcomes and engagement for both students and their whānau.
• Working smarter: the rise of Extended Care Teams - From Tairāwhiti to Taupō and across to Taranaki, Pinnacle Extended Care Teams (ExCTs) in the Midlands Health Network are experiencing increased referral demand and growing support from general practices.
• Reducing HbA1c with whanaungatanga: the measurable impact of patient-centric primary care - Sue van Mierlo is a nurse practitioner based in Taupō, working as part of the Lakes Extended Care Team (ExCT). In her role, she supports people to self-manage long-term conditions and diseases, mostly working with people who have high needs, including managing diabetes. A large number of her clients are Māori.
• 2020–2021 Pinnacle and Midlands Health Network Annual Performance Report - A range of patient stories celebrate our ExCTs in this report.

Here is a selection of links and a roundup of some of the budget related headlines.

• Wellbeing Budget 2022 - Official budget website
• Budget 2022: Summary of initiatives - Full details of Vote Health Initiatives (starting on page 118).
• Ministry of Health: Budget 2022: Vote Health - Official MOH budget summary.
• The Spinoff: Budget 2022: The great Spinoff hot-take roundtable - A roundup of multiple experts as they react to the announcements, including Samantha Burton’s piece “Little to address critical GP shortage”.
• Radio NZ: Budget 2022 at a glance: What you need to know - Covering the main expenses in an easy-to-read list.
• NZ Doctor: GPs virtually invisible in Budget – Sam Murton - RNZCGP president responds to the budget.
• Newsroom: Budget 2022: ‘Largest investment ever’ in health system - Billions of dollars will go into the reformed, centralised health system over the next four years, but Māori will see just a little of it, Marc Daalder reports.
• The Spinoff: ‘The opportunity is gone’: Māori health spending criticised as ‘woefully inadequate’ - Budget 2022: While the government hailed it as a significant step for hauora Māori, others said the amounts set aside for Māori were insultingly small. Don Rowe reports.