Primary and Community Health Aotearoa (PCHA) has reviewed
Dr Lester Levy’s recent editorial in the New Zealand
Medical Journal and is deeply concerned that once again,
primary and community health is reduced to an afterthought
in the national reform narrative.
The editorial lauds
financial recovery and hospital performance improvements but
fails to meaningfully address the real frontline of health
— the GP clinics, hauora providers, community nurses,
allied health professionals, and aged care workers who
deliver 90% of New Zealanders’ care.
“Hospitals
are critical but focusing on deficits and waiting lists
while recouping hundreds of millions from already stretched
community services is not reform — it is recycling an old,
broken model,” said PCHA Chair, Teresa Wall.
In
July, PCHA criticised Health New Zealand’s move to claw
back $270 million in so-called ‘savings’ from primary
and community health, a sector that has been chronically
underfunded for decades. That $270m is not a saving; it is a
cost shift that will resurface in emergency departments,
specialist services, and hospital wards.
The
Government has recently announced a suite of primary health
funding initiatives — including capitation uplifts, urgent
care expansion, digital access tools, and rural support.
PCHA acknowledges these as positive and necessary steps.
However, these initiatives are incremental and fragile
gains, and they are being delivered in the same breath as
the $270m clawback, which wipes out the benefit many times
over.
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“It is like giving with one hand and taking
away with the other,” said Teresa. “The new funding is
welcome, but it does not undo the chronic underfunding of
community care, and it is completely undermined when the
system simultaneously strips hundreds of millions from the
same sector.”
The irony of this
approach is stark: the stated goal of the health reforms is
to keep people well and out of hospital yet cutting
investment in the very services that prevent ill-health and
manage conditions early will do the opposite — it will
drive more people into hospitals, at greater cost to
taxpayers and with worse outcomes for
whānau.
New Zealand data illustrates
this clearly: an emergency department visit costs around
NZ$650, while a GP consultation costs about NZ$50. Starving
primary care of resources only ensures more New Zealanders
will end up in the most expensive part of the
system.
Focusing only on hospital costs is like
mopping the floor while ignoring the leak in the roof, it
treats the symptom but not the cause. Real reform requires
looking at the health system in its totality: fixing the
leak upstream in primary and community care so that
hospitals are not flooded downstream.
PCHA believes
this approach risks repeating the mistakes of the first
phase of the reforms:
• Communities are
sidelined while financial levers dominate
decision-making.
• Equity gaps are ignored,
particularly for Māori, Pacific, rural, and low-income
whānau.
• Workforce strain intensified, with
general practice and hauora services expected to do more
with less.
• Prevention was de-prioritised, leaving
hospitals to pick up the consequences of unmet community
needs.
“It is misleading to call this recovery.
Balancing books in hospitals while stripping capacity from
primary and community care is a false economy; it simply
pushes costs downstream,” said Teresa. “Without genuine
investment in community-based care and system-wide
innovation, we will never break the cycle of hospital
overload.”
PCHA calls for a fundamental re-balancing
of investment and system design, with primary and community
health at the centre of reform. Hospitals will always matter
— but without a strong, well-resourced community
foundation and a system that values prevention, equity, and
innovation, the health sector will remain in crisis,
inequities will worsen, and long-term costs will
escalate.
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