Otago Daily Times

Nurses strik­ing — how it has come to this

- Health · Society · Tony Ryall

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.

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