The realities of a primary health nurse practitioner’s daily life
As a nurse practitioner, I am running most days. I start early to clear my inbox, then I start seeing people about 8am. Sometimes I meet people at the door at 7am, waiting for someone to see a child who is sick.
This is a rural area. We’ve advocated so many years to say: ‘Take your child to [a] hospital’. But it’s a long drive to hospital for many. From Te Hapua to Kaitāia it’s about an hour’s drive. Then you may have to go to Whangārei from Kaitāia, so that’s another two hours’ drive — and it’s bouncing. Sometimes you may need to go to Auckland, and that’s another four hours’ drive.
If you’ve got no petrol and you’ve got no means – the closest place you can get to is perhaps your general practice – then that is where families will come. These are some of the realities that compound our work.
I’ve worked in secondary care services for about five years and then moved into primary care. I felt that I filled my basket [there].
You’ve got to know your game to come to primary care and you’ve got to be highly skilled. You’ve got a broad range of services from antenatal, postnatal care – and we’re not funded for it, but we see it. And we also see Tamariki Ora/Well Child, we see vaccinations, we see childhood illnesses and we move into teenage illnesses and mental health. So you’ve got a marriage of skill bases within general practice – hence the word general, because they’re life-span issues.
It’s the passion that drives you. I’m very passionate about Māori health, which we see a majority of the time. I’m also passionate about rural health — we do things differently in rural health.
The funding is not as great, but the connectivity within rural health and how you work and weave and navigate and connect with others and have great relationships – is part of the enjoyment of your role. It’s not only within health, it’s also within policing, education and social services. You become one big whānau. It’s like the hāpu context we talk about as Māori . That makes me quite comfortable working in that context because it’s very much a part of what we do as Māori, but it’s also inherent as nurses.
For many of the nurses I am working alongside, there still seems to be that passion and commitment to general practice. They seem to be still there – there is some movement, some short staffing in areas. But the commitment, dedication and loyalty to general practice continues to glow at the moment.
— By Rhoena Davis
Jensen Webber, chief executive of Northland’s biggest primary health organisation (PHO) Mahitahi Hauora, has warned of some of its 28 practices may have to close due to lack of funding, burnout and staff shortages.
Mahitahi Hauora’s director of nursing, Rhoena Davis, said a different approach is needed to the current model which funds practices according to patients’ age and gender rather than need.
‘GPs are leaving practice due to burnout and retirement — so are nurses.’
“This exacerbates long-standing neglect and discrimination for our patients with chronic care needs from the health system,” she told Kaitiaki. “In other words, they’re not fairly funded to actually address complex needs.”
A better way would be to allow local primary health providers to work with iwi-Māori partnership boards to determine the design and funding needed to care for their community, Davis said.
Years of underfunding, with high workloads, had seen many of Northland’s primary health workforce quitting — often for better paid roles at Te Whatu Ora or elsewhere.
‘The younger nurses are looking at the carrot that’s hanging from secondary care services.’
“GPs are leaving practice due to burnout and retirement – so are nurses,” she said.
“The younger nurses are looking at the carrot that’s hanging from secondary care services. As a young nurse, I would be doing the same,” Davis said. “It’s about family and it’s about ‘how do I advance what I’m doing and what I’m doing for my family’.”
More equitable funding would allow for enough clinical roles to meet different communities’ needs, as well as close the pay gap between general practice and Te Whatu Ora, Davis said.
“My personal perception is the solution would be to have appropriate funding models for primary care which iwi-Māori partnership boards and primary care providers determine and co-design and fund in accord with their community and wellbeing.”
Northland general practice ‘in crisis’
A recent Mahitahi Hauora survey found Northland’s general practices were “in crisis” after years of workload pressures and underfunding, Webber said in a recent press release.
“Our Te Tai Tokerau GPs are telling us loud and clear that they are feeling strained after years of workload pressures and underfunding. There is no doubt about it, Northland is in crisis.”
Some of Mahitahi Hauora’s rural practices may be forced to closed due to financial instability, “leaving those communities with the highest and most complex needs patients without access to primary care”.
In the survey of Mahitahi Hauora staff across 28 practices, 88 per cent of respondents said they needed more funding for enough clinical staff and 76 per cent said that lower pay in primary health was the main barrier to staff recruitment and retention, the release stated.
Funding limitations ‘acknowledged’
Te Whatu Ora director living well Martin Hefford said the organisation acknowledged the limitations of capitation funding, which did not consider “important factors such as socioeconomic status or ethnicity”.
Work to make funding more flexible, such as including multi-morbidity factors, was underway and would start unrolling in August, he said.
A primary care development programme had also been established to support primary and community services, including urgent and after-hours care and rural health.
“We are continuing to work on future models that will incorporate community involvement in local health service planning and delivery. This will include working with iwi-Māori partnership boards, community leaders and other stakeholders.”
Other efforts to remedy the funding had included a five per cent increase for primary and community health services from July 1, 2023; an equity adjustment to some practices in 2023/24; and more than $30 million to general practices over 2023/24 to assist with nursing pay parity.
Te Whatu Ora also acknowledged the workforce pressures primary care teams were facing, he said.