Pharmac has opted not to renew the contract for He Ako Hiringa – an online equity-focused education service for clinicians delivering primary care.
Instead, citing a “changed” health and disability system it will now move from having a multi-year contract with a single provider, to having relationships with a range of providers and commissioning work as needed.
It comes as Te Whatu Ora is yet to make a decision on whether it will continue to fund the online health resource Healthify.
“We are continuing to work with Healthify as we evaluate options for the delivery of consumer facing health information to improve access to the services we offer. Decisions are expected to be made in the coming months,” a Te Whatu Ora spokesperson said.
Pharmac Equity and Engagement director Dr Nicola Ngawati would not confirm if this was a cost-saving measure, but said the agency would “consider how we can provide an appropriate budget for the delivery of this work in the future”.
He Ako Hiringa – delivered by the medical data company Matui in partnership with The Health Media (which produces NZ Doctor and Pharmacy Today) – had the contract since 2020, but this will now finish at the end of June.
Royal New Zealand College of General Practitioners medical director Luke Bradford said when He Ako Hiringa took over the work from Best Practice Advocacy Centre (BPAC) in 2020 it was not well-known.
“When they changed contracts from BPAC and went to He Ako Hiringa I don’t think people, either the medical professionals, or the public naturally knew how to seek out what was on it and so it’s been a slow burn in terms of its pickup.”
He said it had now finally picked up, but it was coming to end.
“They were starting to put out some really good stuff around antimicrobial resistance and winter bugs and not needing antibiotics. The dashboard stuff around prescriptions was really interesting. I’d like to know where that’s going to be for prescribers because it is useful to be able to compare prescribing rates for medicines.
“But the problem with these mix and match contracts is as people get familiar with things they change, then something else will come along and we won’t necessarily know. People will miss what it is and it will take longer for it to build up again.
“What you do is you just create churn and inefficiencies in the system because no one knows what they’re looking for because of the change in contracts.”
He said cancelling the Healthify contract would be a “huge waste of time and money”.
“Healthify is brilliant and well-used.”
He Ako Hiringa was launched with a mandate to help clinicians address inequitable access to medicine.
It followed a number of calls for greater equity within the healthcare system including from the Waitangi Tribunal report on primary healthcare claims and the investigation of the New Zealand Health and Disability System Review Panel.
A review into Pharmac published in 2022 carried similar conclusions. One of the recommendations was “to agree Pharmac’s role in optimising the use of medicines should focus on ensuring medicines are assessed with an equity approach”.
At the time of this review it was unclear if He Ako Hiringa was helping to achieve this.
“Given that the programme has been operating for only about two years, and Pharmac is still awaiting more information about its results, it is difficult to assess whether Matui is having more impact than its predecessors in turning around medicines access inequities. Matui has also outsourced expertise, including individuals with considerable equity, Māori health and Pasifika health backgrounds.”
The report estimated Pharmac had spent about $30 million on education activities since 1999, but weren’t convinced it should be Pharmac commissioning this work.
“The use of data and analytics at a clinician level is an encouraging step, but we are not convinced Pharmac should be responsible for this work, a task it seems to have earned by default.
“We also think that having Pharmac as the only part of the health system with explicit obligations around ‘responsible use’ has meant that it has taken on activities that, while necessary, do not allow Pharmac to play to its strengths and that add to health system fragmentation,” the report said.
“A more cohesive approach is clearly required, but the question is what form exactly this new approach should take. In light of pending reforms to the health and disability system, our view is that overall responsibility for optimising the use of medicines should be a shared function of Health NZ and the Māori Health Authority and should be included in the New Zealand Health Plan, which is already a joint responsibility of these agencies.”
That plan is still in its interim phase and the Māori Health Authority has since been disestablished.
Dr Ngawati said Pharmac was grateful for the work Matui had done to support primary health care professionals over the past four years.
“A great example of this was their work on changing the perception of gout in primary care. It included equity-focused webinars to health professionals, articles, video, data insights and dashboards.
“This work was aimed to debunk myths about why people are living with gout and encourage primary care to prescribe preventative gout medicines.”
She said the He Ako Hiringa resources would be available on other websites, including Pharmac’s, but not the prescription dashboard.
Bradford said equitable access to medicine was far from being achieved.
“It’s not the medicines, it’s getting seen and diagnosed in the first place and medicines is a little bit at the end of it, which is actually what we’re going to undo when we take away free prescriptions.”
