Nurses striking — how it has come to this

NURSES striking. It seems wrong, somehow.

We don’t expect those in the emergency and caring workforces to strike, and indeed those involved don’t find it easy to do — it cuts across their ethical framework. But on September 3 and November 9 many primary care nurses, working in general practices and emergency clinics, went on strike, because their pay was significantly (10.6%) less than that of nurses working in the public hospitals.

Another strike is planned for Monday.

Free marketeers claim such a problem should be solved by the market — if pay’s too low in one type of workplace, and that in another higher, employees will choose to work where it pays best, and the lower payers will have to raise their pay to match that offered elsewhere.

Many years ago, when hospital nurses got a significant pay rise, leaving primary care nurses at a relative disadvantage, the large general practice which cared (and still does) for Civis bit the bullet, and increased its nurses’ pay to match the hospital rate. It did the same this time. Why can’t other practices do the same?

A little history from the viewpoint of general practice (Civis isn’t part of the primary care workforce, but has a number of GP and primary care nurse friends to consult) may be instructive.

In 1970, the then government initiated a Practice Nurse Subsidy Scheme, which paid the salary of a registered nurse employed as a nurse (not undertaking reception duties) in a general practice, providing that the practice covered the cost of working space and other expenses (including travel if visiting patients at home), and that there was no charge to patients for their services. The subsidy was based on the public hospital pay rates, so there was no relativity issue.

Later, the PNSS was modified, providing only part payment of nurse salaries, and allowing part charges for nursing services. When the Primary Care Strategy was adopted by the then Labourled government in 2001, and capitationbased partfunding for general practice introduced, the PNSS was abolished, the subsidy money being rolled into the capitation payments that replaced the previous General Medical Services feeforservice GP subsidy.

But capitation’s annual increases, supposed to provide for inflation, have consistently failed to match the rate of primary medical care cost inflation, and some years after the full introduction of capitation the government changed the rules unilaterally by making primary care patient fee increases subject to official review and limitation. The then National Party health spokesman Tony Ryall promised that a Nationalled government would remove the limit on fees, but that never happened. So GP practices are doubly squeezed, by reduction, in real terms, of the capitation payments, and restriction of their right, in an only partly subsidised scheme, to charge patients fees, both forces compounding since their introduction. On top of that, services that are ‘‘fully’’ funded, such as child consultations, for which a fee can’t be charged, have never been funded at an adequate level.

Little wonder many practices struggle to make ends meet, and to pay their nurses at the same rate as public hospitals.

A series of governments, Labourled as well as Nationalled, has failed to fund primary care, the foundation of an effective health system, adequately.

And not just primary care. The mass resignation of managers (including the widely respected CEO) from Canterbury DHB is an obvious canaryinthemine regarding DHB funding (all DHBs are in deficit); hospices depend on fundraising; so do the ambulance services (they’re also involved in strike action).

In September, the Health Ministry, DHBs and employers agreed on the need for pay parity for nurses, but fine words butter no parsnips. Better funding of primary care is essential to enable this.

The new Labour Government needs to ensure that primary care (palliative care, and ambulance services too) is adequately funded. That includes the ability for GP practices to pay their nurses as much as hospitals do, without threatening their financial viability.