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Funding and sustainability of primary healthcare are urgent priorities to address if the recent health reforms are to achieve equitable health outcomes for all New Zealanders. Services operating as Very Low-Cost Access general practices provide care to populations with disproportionately high health and social needs; however, the complexity, volume and nature of work done by these practices is poorly understood. This case note review analysed the care provided to adults with diabetes attending a Very Low-Cost Access practice over a year and found these individuals had multiple health conditions, used many medications and multiple different types of staff were involved and provided very frequent care for most of the group. Findings highlighted the hidden, as well as the visible, complexity of work for such patients and extremely low fee-for-service invoiced to individuals when contrasted with the intensity of services provided and current funding models.
The funding and sustainability of primary healthcare are urgent priorities that must be addressed if the recent health reforms are to achieve the goal of equitable access and outcomes for ah New Zealanders. This is particularly critical for services where large proportions of the enrolled population have high health needs and/or multiple social disadvantages. Providing adequate services to such groups is recognised as challenging,1-2 and long-term under-funding of these services is recognised.3 These populations have higher rates of multi-morbidity, more frequently utilise health and other social services and have higher unmet needs than other groups.4-7 This results in high concentrations of complexity6 and the need for evidence-based interprofessional collaborative models of care,7 including a diverse range of regulated and unregulated workers.8 However, current data detailing the extent of work and the range of skills and workers needed within practices serving these populations are limited.9
Within a practice serving a high-needs population, this exploratory study aimed to ascertain the complexity of individuals with type 2 diabetes (T2D) and the volume of work undertaken by members of the practice team providing healthcare to these individuals over 1 year.
Context
Porirua Union Community and Health Service (PUCHS) operates as a Very Low Cost Access (VLCA) practice and serves a population of 7,189, comprising 48% Pacific Peoples, 21% Maori and 9.2% Refugee (many with English as a second language). Overall, 89% of this population...