The Aotearoa New Zealand (NZ) health reforms came into effect on 1 July 2022 through the Te Pae Ora (Healthy Futures) Act. 1 A new national health system has been established with two new entities: Te Whatu Ora -Health New Zealand and Te Aka Whai Ora -Māori Health Authority. The reforms will, according to the government, lead to 'a more equitable, accessible, cohesive and people-centred system that will improve the health and wellbeing of all New Zealanders.' 2 But will these good intentions come to fruition? 'Big bang' health reforms come and go, and only sometimes do they result in an improvement in the existing system; at other times they lead to little more than structural redisorganisation. 3,4 A related question is 'what's in the reforms for general practice and primary health care?' -given that there is no new primary health care strategy, with the existing strategy now over 20 years old. 5 In this issue of the Journal of Primary Health Care our two guest editorials explore what the health reforms may mean for primary health care. Don Matheson and colleagues ask whether primary health and community care (PHCC) will in fact be brought in from the cold, as the last decade has seen little government attention to, or acknowledgement of the importance of, PHCC to NZ's publicly funded health system. 6 Their analysis raises two concerns. First, PHCC historically has been underfunded relative to hospital services, and the 2022-2023 health budget does nothing to readdress this longstanding problem. Second, there is an absence of a specific PHCC directorate within either Te Whatu Ora or the Ministry of Health. They conclude that the reform's legislation, budgets and structures have largely played down the considerable potential of the PHCC sector to drive health improvement and equity. In contrast, Tim Tenbensel focuses on the most important aspect of the reforms for PHCC, the development of 'localities', defined as a place-based approach to planning and delivering health and wellbeing services. 7 This approach fits with current international trends to promote integrated health and social care and to use health services to address the social determinants of health. Nonetheless, the devil is in the detail. Tenbensel highlights the challenges that need to addressed if localities are to be more than a set of good intentions: funding flows and structures that work; building successful partnership and collaboration in localities; health sector managers and primary care providers will need to think and act differently.The health reforms are also highly relevant to the findings of two original scientific papers in this issue on rural health. Blattner and colleagues surveyed rural hospital leaders on their perspectives of the place and contribution of rural hospitals in the NZ health system. 8 In short, rural hospitals do not fit neatly into the new Tier 1 (home and community services) nor Tier 2 (hospital, specialist and diagnostic services) categories of NZ health service provision. 9 Walker and colleagues, in their scopi...
