Rosemary Minto is a nurse practitioner who works in a very low cost access clinic in Tauranga. She is passionate about the potential for primary health care to create a healthy Aotearoa.
I work in a primary health setting and the machinations of Government that affect my clinical practice, and the people I see are always of interest to me. So I was very interested in the Budget announcements about the $90 million for free healthcare and prescriptions for children under 13.
Working in a very low cost access clinic means I deal with deprivation and preventable illness every single day. The social determinants of health are not theoretical concepts for me; I can tell you exactly how a cold, damp house and not enough money and unemployment affects the health of children and adults alike. So, extending free healthcare is excellent news, and I congratulate the Government for this sensible and sustainable measure.
It is essential that the scheme be viable for general practice. Free health care for under 6s took several years to implement with the level of funding insufficient for many general practices to be interested in the programme. I hope this won’t happen again.
In the practice I work there is constant pressure between budgets and service provisions, and if the funding formula for under 13 visits isn’t sustainable we could end up in the position of cutting staff and services, an untenable option with current pressures on services and quality performance target pressures.
But if they get it right, fantastic. It will be an opportunity for nursing staff to work to the breadth and depth of their scope of practice.
There is more good news for low cost access funded practices in the budget. $1.5 million has been set aside next year for nurses in very low cost access (high need) practices. We’re not sure whether this is to fund more new graduate programmes or to employ experienced nurses, but it’s great that the Government has recognised the value nurses bring to low cost access practices. It demonstrates that nursing is being considered in the equation as planning, negotiation and implementation occurs.
Nursing voices are represented on Ministerial-level advisory panels on primary health and we fully expect to see the nursing workforce utilised well. Unfortunately, $1.5 million doesn’t go very far these days and it would be great to see the government commit more funding to ensuring nurses and nurse practitioners can be utilised to the fullest extent of their scopes of practice. Direct funding for nurse practitioners would have been a great step for this budget.
And whilst free healthcare for under 13s may mean that children are not showing up in ED departments with high acuity, it still means that the causes of their illnesses in the first place are not being addressed. Poverty and housing, unemployment are things that also need to be sorted before primary health can really do what it should. And that is create a healthy Aotearoa, where services are provided to people when and where they need them, with no barriers to access.
Unless the Government deals with the many social determinants of health, this funding will be yet just another drop in the bucket.