Time to heal the ulcer

How we currently fund our primary care system is all wrong, and we are too scared to admit it. I would compare the last 15 years of health funding tweaks to that of an attempt to heal a chronic leg ulcer simply by placing a new bandage on top of the dirty old one.

You can’t keep doing it the same way; putting a Band-Aid on top of a band aid undoubtedly makes the problem worse.

To be clear, I am not talking about the hard work, dedication, commitment and professionalism of our health workers. Today leg ulcers are mainly dealt with by our district nurses and they are awesome.

What I am talking about is how primary care gets funded. How the contracts and therefore the dollars cascade down from the Ministry of Health, through the DHBs, down to the PHOs and eventually to the coal face workers in primary care.

This column isn’t big enough to explain why some general practices receive more government funding than others, or why co-payments ( the bit you pay) vary depending on where you live or how old you are. Needless to say, the original intentions, I am sure, were sound, an attempt to use the limited funds as efficiently as possible and also help target care where it was most needed. That I have no problem with.

Neither do I have a problem with the new government’s pre-election promise to make the cost of accessing your GP cheaper. We know cost is one, but not the only factor that can prevent someone from seeing their GP. Anything that can reduce this barrier and help address inequity is a good thing for our community.

But the talk coming out of Wellington is that there is a risk of panic politics taking over.

Think of the pre-election promise of a $10 reduction in the cost of going to see your GP as another Band-Aid, when we really need a full funding review.

Moreover, continuing with the leg ulcer analogy, making the band aid $10 cheaper is nice but is it really going to affect how quickly the leg ulcer will heal? It may make the leg look pretty, and the patient may think he is feeling better, but actually the gangrene is spreading.

So what would I do? Here are my criteria for analysing any new primary health funding model: Is it better for the patient? Is it better for the doctor, nurse or health care provider? Is it better for the GP surgery? Is it better for the Ministry of Health?

Using these four questions, you can now look at any new model of care or funding proposal and decide if it’s worth a try. Does is make it easier to access and receive more timely health care? Does it make the doctors’ and nurses’ day flow better? Are the general practices financially worse off? (It shouldn’t make them bankrupt!) Most importantly, does it achieve the improvement in health outcomes that have been set by the government?

If the answer is to all four is yes, we should embrace the change.

So my message to the government is this: Let’s not rush in, eager to please, with a fresh Band-Aid. Let’s instead be bold and go for a full funding review. Let’s heal that necrotic gangrenous leg ulcer once and for all. The patient and the doctor will thank you for it.

"My message to the government is this: Let’s not rush in, eager to please, with a fresh BandAid. Let’s instead be bold and go for a full funding review. "