Could lessons have been drawn from New Zealand for England’s NHS reforms?

How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand’s Primary Health Care Sector

“…They struggled to establish NP services. Their experiences affirmed evaluations of the Strategy which have highlighted the lack of a clear national implementation and accountability framework, local devolvement of funding and service development, and the ongoing business model of general practice (Finlayson et al., 2012; Gauld et al., 2019; Health and Disability System Review, 2020).…”

“…Structural changes and instability limited the organizational capacity to strategically plan PHC services to meet population health needs. Through a neoliberal “hands-off” approach (Tenbensel et al., 2011, p. 252) taken by both Labor and National governments, DHBs, PHOs, and general practices have been responsible for creating a highly fragmented and complex PHC sector that has made little impact on reducing health inequalities (Gauld et al., 2019; Goodyear-Smith & Ashton, 2019; Health and Disability System Review, 2020).…”

“…The DHBs are also responsible for the commissioning of PHC services through an annual service level agreement with primary health organizations (PHOs; Cumming, 2016). The PHOs’ member general practices and health providers deliver first contact primary care services, with the majority of services being delivered by general practices that are privately owned and led by primary care physicians (Gauld et al., 2019; Goodyear-Smith & Ashton, 2019). Services are funded through government subsidized capitation payments and user co-payments (Goodyear-Smith & Ashton, 2019).…”

“…The biomedical model of physician-led primary care is being challenged as failing to deliver comprehensive primary health care (PHC) required to meet the increasingly complex health needs of local communities (Baum et al., 2016; Commission on Social Determinants of Health, 2008; Goodyear-Smith & Ashton, 2019). Instead of delivering PHC, based on the World Health Organization principles (World Health Organization [WHO], 1978, 2018), health policy, public focus, and funding remain centered on primary care delivered through physician-led general practice (Gauld et al., 2019), despite growing concerns regarding the appropriateness and sustainability of such a model. Indeed, the interim report of New Zealand’s Health and Disability System Review (2019) stated:Continuing with the current model of care, based largely on a Western medical model, employing more and more medically qualified staff focused on treating illness, rather than promoting wellness, will not only be ineffective in achieving the equitable outcomes we desire, it will not be sustainable.…”

Going beyond health efficiency: What really matters?

“…Since no ideal healthcare funding model exists, each country should implement the system that suits its own socio‐economic and political goals. The literature often recommends that countries should compare themselves to others with the same health system model, and then apply and implement similar policies to improve overall health outcomes. This analysis shows that if countries want to improve their efficiency they should look at one of their reference countries, and a different health funding model should not be an obstacle.…”