Opinion: The Government’s pragmatic 2023 winter plan, published last week, is intended to reduce pressure on the health system, predominantly in regions where access to hospital care is a persistent problem.
Highlights of the plan include telehealth services to support primary care and ambulance services, pharmacy-based minor ailment services, community radiology services, and more ‘comprehensive’ primary care teams.
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These initiatives are welcome, but their implementation won’t be plain sailing. Commentary after the plan’s announcement has emphasised the potential pressures it could place on an already over-stretched health workforce. We echo those concerns.
However, there is perhaps a bigger concern to note. Though the plan speaks about primary care, not once does it refer to a plan to build a comprehensive approach to primary health care. It’s only a one word omission, but the implications of this difference are revealing.
Relying on telehealth to tackle barriers to health care without also considering the needs of different community groups will result in people being unable to access it or receiving inferior services
Primary care is a narrower concept that refers to the management of illness. Health Minister Ayesha Verrall’s statement that the plan intends to facilitate ‘hospital in the home’ services falls in line with this concept.
Primary health care, on the other hand, extends beyond the primary care concept to include disease prevention, health promotion, and a whole-of-society approach to achieving equitable outcomes and striving to reach the highest attainable level of health for all.
So will the winter plan’s initiatives address Aotearoa’s primary health care needs, particularly among our most disadvantaged communities?
Hospitalisations for severe acute respiratory infections (per 100,000 population)
To help answer that question, we need much more information. For example, how will telehealth services be implemented to meet the needs of Māori, Pacific and disabled communities? Current research highlights the need to consider equity issues in telehealth provision. These include people’s access to the internet and phones that allow them to use telehealth effectively.
Our research suggests there’s a need for ‘telehealth literacy’, among clinicians and people using these services. Relying on telehealth to tackle barriers to health care without also considering the needs of different community groups will result in people being unable to access it or receiving inferior services.
Whether telehealth services will continue to receive funding after this winter (Te Whatu Ora’s statement of “priority areas for winter 2023 and beyond” remains a rather abstract length of time) remains an unknown.
Additional details are also needed about the minor ailment scheme, in which pharmacists will treat more people. Similar schemes have been successful overseas, but we don’t yet know what it will mean for pharmacists’ workload here and how to best integrate this approach in all primary health care settings.
For example, setting up a minor ailment scheme requires changes to how a lot of pharmacies are run and additional pharmacists may be needed. We do not have enough pharmacists.
Alongside this, there are concerns about extended training for pharmacists, the amount of time it will take to organise the initiatives and how the plan will be funded.
Effective integrated care remains a cornerstone of good primary health care provision. Many of the initiatives described in the 2023 Winter Plan potentially provide a route to better health service access and integration. For example, having allied health rapid response services to support people at home could indeed lead to better use of available resources to meet health care needs.
We are cautiously optimistic about the potential of these initiatives. However, their successful implementation will be dependent on the capacity of the health workforce and the resources available to it. Given the current stressors on our frontline clinicians, their wellbeing must be a key consideration.
It’s clear the plan will need to be closely evaluated so we can continue to refine and create new ways to integrate health care that better meets the needs of everyone in our community.
This means investing in research, including robust data collection and effective reporting, particularly on the impacts for Māori, Pacific and disabled populations. This data will also give government officials and policymakers the information they need to better manage health service demand while optimising health workforce resources.
Recommendations in the recently released rapid review of the 2022 Covid-19 Winter Surge Package could usefully inform decision making about implementing this year’s initiatives. Specifically, the review considers the need for community partnerships and targeted communication for priority groups.
We fear the Government has failed to acknowledge these core aspects of good primary health care within the 2023 winter plan.