Submission

RURAL PRIMARY HEALTH CARE STRATEGY

Rural Women New Zealand represents the interests of more than 4000 members from over 300 branches located in rural areas throughout New Zealand. Our organisation works at local, regional and national level to strengthen the social, economic and environmental wellbeing of rural communities.

We commend the authors of this document for presenting a comprehensive, integrated package of proposals for creating an effective and vibrant primary health care sector in rural areas. Our major concern is whether funding will be made available for full implementation of the recommendations; or whether rural communities will continue to suffer from fragmented and inadequate attention to only some aspects.

The timeframe available for consultation has been short; particularly given the size of the document and exacerbated by the inadequacies of the telecommunications network in many parts of rural New Zealand.

Rural Women New Zealand wishes to make the following points:

Executive Summary: we see workforce issues as pivotal to the implementation of the strategy and recommend accordingly that this be prioritised as the first aim.

We fully support the development of a rural primary health care premium.

We have significant reservations about PHOs: on one count, we have reservations about securing qualified volunteers (when volunteer time is already at a premium); even more importantly, we are concerned that the PHOs will prove to be yet another layer of bureaucracy, diverting scarce funds away from direct health services to administration.

2.2 We support this recommendation and stress that the telecommunications infrastructure is vitally important to rural health services. In many areas of rural New Zealand reception is poor or unavailable and email and internet connections are frustratingly slow: skills development, collaborative teamwork and telemedicine outreach all critically depend on the quality and reliability of the telecommunications network.

2.3 & 2.4
We emphasise the importance of accident and emergency services; and the scarcity of volunteer ambulance personnel. Issues around time off from paid employment, costs of training and remuneration must be addressed.

2.7 We support the development of integrated care and improved utilisation of rural hospitals.

We note with concern that rural hospitals are not being funded for the structural changes and post-operative care requirements associated with the mobile surgery bus.

We note only passing mention of services for older people in rural communities and recommend this as a priority area for attention.

2.8 We emphasise the need for accessible local maternity services: retention and increase of the rural maternity workforce is very important.

3.2 We support establishment of the rural premium at a level that would support one in four rosters.

3.3 We support national initiatives for recruitment of primary health workers; including initiatives for the recruitment, placement and support of locums.

We recommend that rural training of health care workers includes recognition of difficulties for rural people accessing services and the need for consultation on scheduling or rescheduling appointments.

3.5 We strongly support initiatives for expanding the scope of practice for rural nurses; and look forward to the close integration of the Nurse Practitioners Strategy and Primary Nurses Strategy with this Rural Primary Health Care Strategy.

We commend the model implemented by Dr Smith and his community nurses in the Hokianga for further attention.

We stress the importance of developing and maintaining collaborative teamwork skills for effective, integrated rural practices.

3.9 We endorse the importance of support (including financial support) for pre-entry and continuing professional training. We recommend also the importance of effective training/induction packages which would include regional and cultural considerations.

In conclusion, Rural Women New Zealand welcomes this document; applauds its presentation of a comprehensive and integrated package of primary health care initiatives for rural New Zealand; and strongly recommends that funding be made available for full implementation of the recommendations of this Strategy.

Sherrill Dackers
Health Convenor

April 2002