Departing Northland DHB boss reflects on 11 years at the top
"It’s one of my disappointments that general practices are struggling so much from a workforce perspective up here."
It was probably one of the few occasions when Dr Nick Chamberlain has had to dust off his CV when applying for a job.
The effort was worth it because his credentials landed him the role of Health NZ’s national director of the new National Public Health Service.
At the end of his tenure as Northland District Health Board chief executive, the former GP and sports medicine specialist had no plans to go back to clinical medicine — and as it turns out, he won’t.
The 59-year-old passionate Northlander starts his new job from July 1 but not before sharing the many highlights and a few regrets while leading the Northland DHB over the past 11 years.
“Health is a bottomless pit, and the more you supply in the way of health services, the more demand there is. It’s almost like you’re creating demand.”
As well as the health needs of Northlanders, the Northland DHB workforce grew significantly from about 2500 when he started in October 2011 to just under 4000.
With a background in general practice, Dr Chamberlain’s heart goes out to GPs and the stress they are under. He admits some things haven’t worked out.
“It’s one of my disappointments that general practices are struggling so much from a workforce perspective up here. It’s hard work, and remuneration is probably not as good as some other places.”
High deprivation, a high Māori population and rurality, seeing 20 to 25 patients a day all with complex needs including mental health issues, having the fourth oldest population in New Zealand and GPs retiring all contributed to the stress in general practice, he said.
New Zealand is only training 200 doctors to specialise in general practice when at least 300 are needed a year across the country.
“Most of those things we are trying to help with the new initiative we’ve got under way, putting $5 million a year into the general practice workforce, supporting them to get better education, supporting them to recruit overseas, recruitment costs, looking at setting up a centralised recruitment, paying GP registrars more.
“That’s something for Health NZ to look at — how do we incentivise and support general practice going forward? General practice will also need to change. It’s changing all the time. We’ll have to look at other workforces, nurse practitioners, physician assistants to support GPs because even if we train another 100 a year, we still won’t have enough
GPs going forward.”
Dr Chamberlain also gives his take on the fragmentation of the primary care sector and the establishment of Mahitahi Hauora.
It didn’t matter too much if general practices wanted to align themselves with primary health organisations outside Northland like Comprehensive and ProCare, as long as they were happy with the support provided by the entities.
“What’s really important is GPs have a choice over who they contract with for their support. It would be much worse if we tried to restrict that, which we were for a while.”
One of the things Mahitahi has done over the past few months, he said, was to set up a clinical hub which supported all general practices, irrespective of who their PHO was.
“If a GP can’t see a Covid patient, the clinical hub takes them on. If a GP thinks a patient is too complex for them, clinical hub takes them on, so that’s a great initiative. They are finding their place now in a new world, and so are the new PHOs.” Another disappointment for him is planned and elective care services and the wait times without adequate theatres at the Northland DHB.
Now that the theatres are there, he said a lack of nursing staff didn’t help.
Health NZ and the Māori Health Authority will benefit Northland, he reckons, as there’ll be a lot more resources shifted to where they need to go under a national strategy and approach. “Principles like wherever you live and whoever you are, you should have similar access to a set of services like anybody else. So if you live in Te Hapua, you should still be able to access a core set of services.
“There will very much be support closer to home. In the past, it’s almost if you live rurally, you accept the compromise of your healthcare services,” Dr Chamberlain said.
He’s particularly proud of the significant building programme to redevelop parts of the Whangārei Hospital, starting with the mental health unit, the Jim Carney Cancer Centre and its expansion including building a linear accelerator radiotherapy unit worth $53 million.
Then there was work at Te Kotuku consisting of the maternity unit, paediatric, special care baby unit and laboratory, building two extra theatres and a cardiac cath lab and the redevelopment of the Bay of Islands Hospital.
“The thing I am most proud of is our staff over the past two and a bit years during Covid and how they worked. The primary health sector had to really step up and help out a lot.
“The whole health sector did really well, with a complete system-wide approach. Our Achilles heel was our vaccination rates — they’re the worst in the country but I don’t think that’s through a lack of effort, it’s our population who are somewhat mistrustful of vaccination.”
Like all other DHBs across New Zealand, Northland DHB has had its debts wiped off before coming under Health NZ.
All Northland DHB staff, except Dr Chamberlain, have a guaranteed job under Health NZ and none of the services will be affected.
In summing up his 11 years in the top job, Dr Chamberlain said: “I’d like to be remembered as a good leader, somebody who got stuff done. Someone who was supportive of his staff and the whole of the health sector, and tried to work on the broader picture rather than just on one individual area.”