October 2017 April 2015 | Page 4

Te Puawai

Editorial
which largely enable the service delivery
models to continue unchanged. To a large
extent nurses are caught in the crossfire of
this tension. They are clearly able to see what
they need to do differently and they are
continually fobbed off with variations of “you
cannot do that as it will not generate any
money for the business”.
Many of them, prior to postgraduate study, are
unaware of the large volumes of tax-payer
money which come through the DHB via the
PHO to purchase a range of services for
patients. This is roughly 70% of the income
provided to General Practice. It has always
been clear to me from listening to PHC nurses
that there is considerable variation in how the
money is used in different settings. Different
practices utilising the same funding sources
demonstrate significant variation in services to
patients. Largely this is at the discretion of
practice owners and it appears that there is no
mechanism for requiring that Government
funding be spent in particular ways.

Professor Jenny Carryer
RN, PhD, FCNA(NZ) MNZM
Executive Director

I have just finished another 4 days of class
with a group of primary health care nurses
doing postgraduate education. As always I
am left somewhat overwhelmed by the
palpable frustration expressed about their
inability to deliver care in the way they can
see is needed to meet patient need.
I have long been aware of the tension
between the rhetoric espousing the need to
respond to the rising demand for PHC
services and the seeming reluctance to
change the policy and operational drivers,
© Te Puawai

It may be considered that targets are one
accountability mechanism. I have, however,
heard far too much about the way in which
target reporting is handled to feel that there is
any
genuine,
useful
or
consistent
accountability associated with reporting on
targets.
The Ministry has made clear that the private
business model of General Practice is here to
stay from a policy perspective. I have come to
wonder if nursing needs to be disconnected
from direct employment in that model and that
a large proportion of the funding for patient
services should in some way be able to
support nurses to provide a continuum of care
regardless of where patients are receiving
services. This would enable nurses to have
full autonomy over their practice, allow

College of Nurses Aotearoa (NZ) Inc
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