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In this edition of Healthcare Review – OnlineTM, we consider structures for delivery of primary care health services, evaluating examples in both New Zealand and England.
The development of primary care organisations, in which general practitioners (GPs) are affiliated to a supra-practice body carrying out functions such as primary care development, peer review of practice and service commissioning, is a feature of several health care systems internationally.
In the Primary Health Care Strategy for New Zealand, released in February 2001, the Government indicated plans for primary health organisations, including general practitioners (GPs), nurses and other health professionals, which would be funded directly to provide primary care services to enrolled populations. This population-based approach is intended to allow better teamwork between health professionals and more flexible use of funds. It focuses on improving, maintaining and restoring people’s health.
The English National Health Service (NHS) has recently moved towards a more organised model of primary care. A national network of primary care groups was established in England in April 1999 and membership of a primary care organisation became compulsory for all GPs. Primary care groups bring together local providers of primary and community services under a board representing local GPs, nurses, social services, the health authority and the community. Three core functions for primary care groups defined by the Government were: to improve the health of their local population; to develop primary and community health services; and to commission secondary and tertiary services for their local population.
In the paper "Developing primary care organisations: Lessons from the English NHS", Emma Regen and Judith Smith, Health Services Management Centre, University of Birmingham, United Kingdom, examine the implementation of primary care groups and trusts in England with the aim of identifying lessons for the development of primary care organisations more generally [paper to be added to the edition by 19 March].
The paper draws upon findings from a Department of Health funded national evaluation study of primary care groups and trusts. It concludes that the successful development of primary care organisations requires adequate time and resourcing, some degree of stability in the policy context, robust methods for securing the commitment of stakeholders and clarity of organisational purpose.
The paper also provides a comparison between the English and New Zealand approaches to primary health care delivery.
Jackie Cumming, Director, Health Services Research Centre, Wellington, New Zealand, provides the paper "Population-based funding and primary health care in New Zealand: What changes can we expect?". Cumming describes the primary health organisations which will be key agencies involved in organising and/or delivering primary health care services to a defined population in New Zealand.
Cumming reviews issues surrounding the establishment of primary health organisations in New Zealand and the changes that New Zealand might expect from their establishment.
In the paper, "Repainting the General Practice Landscape", Drs Alex Chan, Kevin Gattey and Lannes Johnson, general practitioners in New Zealand, focus on models for primary care services that would nurture general practitioner subspecialisation with the aim of addressing waiting list problems for secondary services in health. They present a proposed model of general practice where capitation is applied at the independent practitioner association (IPA) level. IPAs would employ all workers in their practices and, with governance from the GPs, practice nurses and community, would organise primary care services for the locality. Included among advantages of such a model are the ability of IPAs to more cost-effectively run population-based health maintenance and disease prevention programmes and reductions in hospital waiting lists that would result if IPAs encouraged subspecialisation and skills were facilitated and maintained by expanded inter-GP referrals.
Editorial - Vol 6, No 1: Delivering Primary Health Care Services: English and New Zealand Perspectives
Friday, February 1st, 2002
