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New funding for after-hours care ‘not going to go very far’ – GP and urgent care doctor

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General practice doctors are grateful for the government’s new funding for after-hours urgent health care, but there are major concerns about how it will be staffed.

The GPs say the funding acknowledges urgent care has been under pressure, but the funding is “reasonably light” for what the government is trying to achieve.

The government has committed to greater accessibility to urgent and after-hours healthcare in the regions, with several new 24-hour services planned around the country.

New funding of $164 million has been allocated over the next four years, with 24-hour urgent care clinics “identified” for Counties Manukau, Whangārei, Palmerston North, Tauranga and Dunedin.

The funding boost also covers “new and extended” daytime services for other centres, including Lower Hutt, Invercargill and Timaru.

In a pre-Budget announcement on Sunday, Health Minister Simeon Brown said the funding boost would mean 98 percent of New Zealanders would have access to in-person urgent care within an hour’s drive.

“Strengthening urgent and after-hours care is an important part of our government’s plan to ensure all New Zealanders have access to timely, quality healthcare,” Brown said.

There are currently 48 urgent care clinics across New Zealand, most of which are jointly funded by Health New Zealand and ACC. On top of that are many other after-hours services that provide similar levels of care, but are not considered to be urgent care clinics.

Dr Angus Chambers is the chair of GenPro – an organisation that represents the people who own general practices and urgent care centres. He said it was “definitely positive” to have some investment in the after hour urgent care space.

“It’s clearly a critical area for patient care and and it’s under quite a lot of stress, so it’s definitely good to see some thoughts into trying to support it.”

His two main concerns were around the amount of funding and the lack of a trained workforce available to staff the clinics.

“The funding seems reasonably light for what they’re trying to achieve.”

He said when the allocated funding is divided between the hundreds of services across the country, the “money’s not going to go very far”.

Chambers also compared it to funding for telehealth services, saying the “complexity of providing an in person after hours service is so much greater”.

After-hours involved doctors, nurses, a receptionist and facilities, he said.

“It’s just a little bit hard to see how they’ve come up with a figure.”

The other issue he said was going to be “staffing the services” because “the general practice workforce has never been weaker than it is at the moment”.

He said some of the money will need to be used to make these roles more attractive and keep people working in New Zealand.

Chambers said there were a lot of GPs working around the country at “far lower than market rates” to keep those services going, “because they’re part of a community”.

“They see the need for some meaningful work, but we shouldn’t have to expect GPs to work with altruism.”

Overall, Chambers said the “fix” for decreasing demand on hospitals, emergency departments and the after-hours problem was “high functioning general practice care” so that people can get appointments in a timely manner.

“If we could manage chronic disease so it doesn’t deteriorate, that is what will lead to far less demand.”

Chambers said involving people who provide these services in decision-making would result in better outcomes.

“I think would get greater efficiency and greater effectiveness by trusting the people who actually deliver this work, rather than bureaucrats who are very well meaning, but have really very little idea how to deliver these kind of health services which are very complex and require a lot of experience to get right.”

Dr Luke Bradford is the medical director at the Royal New Zealand College of General Practitioners. The college looks after the education and standards, advocacy and policy work for the country’s general practitioners, and has about 6500 members.

Bradford cautiously welcomed the announcement, saying it acknowledged urgent care had been under pressure and an unsustainable model.

“It’s a vital part in the delivery of the healthcare system, so to acknowledge that it needs increased support was really important.”

Bradford said the core issues for urgent care come from the financial viability of the model. He wants to make sure the funding supports the model.

Bradford said he understood the actual cost to see a patient was about $170 per person. Chambers added the cost to attend an after-hours clinic can range from $0-$260, which was highest he had heard. It varied based on age, ACC status and whether someone had a Community Services Card.

“Without funding going in, it’s user pays,” Bradford said, “there’s no way the fees being charged were covering that.”

Bradford said the other big issue was staff. Clinics are usually staffed – in large part – by GPs working “after hours and on top of their normal work,” he said.

Rural “on-call hours” and those in the smaller centres often were not paid so you were getting “tired GPs, GPs being underpaid to do it, and therefore you were struggling to staff them.”

He hoped that would level out due to this funding.

As to whether what the government has proposed was possible, Bradford said the “devil’s in the detail”.

He explained the 24/7 clinics were unlikely to be staffed by doctors overnight because there was not enough doctors.

“I suspect that it’ll be a combination of nurses and paramedics with telehealth support.”

But he did believe if conditions improved for clinicians working in urgent care, and if the clinics themselves were financially viable, “then a good service can be set up.”

The majority of the funding would have to go toward staffing, because “you have to pay a premium to the staff who are going to be working overnight”.

Staff safety was also a priority so people were not alone in buildings through the night, he said.

He was also unsure how extra nurses would be attracted to the roles, given the current pay disparity between primary care nurses and their hospital counterparts.

The New Zealand Nurses Organisation was also worried about staffing. Primary Health Care Nurses College chair Tracey Morgan said: “Our biggest concern is where will the staff come from.

“We welcome the focus on primary and community care but it ignores the main issue.

“The pressure on urgent care can’t be fixed without solving the chronic under-staffing issues the sector faces.”

She said until the government gave primary and community health care nurses pay parity with their Te Whatu Ora counterparts, “the sector will continue to lose nurses and health care workers to better paid jobs in hospitals and to better paid jobs overseas”.

 

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Police say person who fired gun at officers still at large

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Police say a person who fired a gun at officers in Napier is still at large.

Eastern District Commander Superintendent Joel Lamb said Police tried to stop a vehicle in the Pirimai Area at about 10pm on Tuesday.

He said someone in the back seat pointed what was presumed to be a firearm at officers pursuing the vehicle.

“Staff have then heard two distinct gunshots as the firearm was discharged.

“Fortunately, neither of our officers were injured, and the patrol vehicle did not sustain any damage.”

He said hours later, the vehicle was seen travelling north on the Waikato Expressway towards Auckland.

Police seized the vehicle at an address in Manurewa, but they had not found the alleged offender.

Lamb said people who lived at the Manurewa address were engaging with Police.

He said Eastern District and Counties Manukau Police were making enquiries.

“Presenting a firearm at a Police officer is a serious escalation that puts our staff and the wider community at risk. This behaviour is entirely unacceptable.

“We are taking this incident extremely seriously and will be pursuing all lines of enquiry to locate the offender and hold them accountable.”

Police asked anyone who witnessed the incident to contact Police on 105 or online using the reference number 261111/3764.

Information could also be provided anonymously via Crime Stoppers on 0800 555 111.

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New Zealand sides named for RLWC finals

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The players tasked with ending Australia’s Rugby League World Cup dominance have been named.

The Kiwis and Kiwi Ferns have announced their squads for this Sunday’s World Cup finals in Brisbane.

Both sides are chasing their first titles since 2008, and both are looking to end their opponents run of three crowns in a row.

“Our Kiwi Ferns have been so dominant in years gone by, and we want to bring dominance back to this jersey, so I think it will be a case of who wants it more,” said co-captain Georgia Hale of the impending clash.

The Kiwis get a major boost for the final as they welcome back Ronaldo Mulitalo after he served a one-match ban for a high tackle against Fiji Bati.

Mulitalo replaces Charnze Nicoll-Klokstad, who moves to the six-man bench, which again includes utility Te Maire Martin, middle forwards Naufahu Whyte, Erin Clark and Xavier Willison plus fullback Keano Kini.

Loose forward Joseph Tapine will make his 30th Test appearance in a familiar pack again, including second-rowers Isaiah Papali’i and Briton Nikora, and props James Fisher-Harris and Moses Leota.

Winger Jamayne Isaako is on the cusp of claiming the New Zealand record for most Test points.

His five goals against Tonga lifted his career points tally to 225 – level with Shaun Johnson – while centre Casey McLean goes into the final with 16 tries in just eight Tests.

Fisher-Harris will again captain the team.

Fullback Ponga said the goal of the group was clear.

“We have high expectations around what we want to achieve, and obviously winning a world Cup is one of them.”

Meanwhile, Ricky Henry has selected a settled side to take on the Jillaroos, led by their lethal centre combination of Stacey Waaka and Mele Hufanga.

Veteran Apii Nicholls takes the number one jersey, Leianne Tufuga and Mackenzie Wiki on the wings.

Henry has stuck with his halves pairing of Chantay Kiria-Ratu and Raecene McGregor with Alexis Tauaneai, Georgia Hale and Otesa Pule up front.

Rounding out the starting pack is Shaniece Monschau, Kaiyah Atai, and Angelina Teakaraanga-Katoa.

“We have been building well throughout the tournament; we understand the Jillaroos side, and will give it our all to make New Zealand proud this weekend,” said Henry.

RLWC Finals:

Kiwi Ferns vs Jillaroos- 6.10pm

Kiwis vs Kangaroos – 9.35pm

Sunday November 15

Suncorp Stadium, Brisbane

Live blog updates on RNZ

Kiwi Ferns:

1. Apii Nicholls 2. Leianne Tufuga 3. Mele Hufanga 4. Stacey Waaka 5. Mackenzie Wiki 6. Chantay Kiria-Ratu 7. Raecene McGregor 8. Alexis Tauaneai 9. Georgia Hale 10. Otesa Pule 11. Shaniece Monschau 12. Kaiyah Atai 13. Angelina Teakaraanga-Katoa.

Interchange: 14. Ashleigh Quinlan 15. Annessa Biddle 16. Shannon Mato 17. Ivana Lauitiiti.

Reserves: 18. Brooke Anderson 19. Zahara Temara 20. Brianna Clark 21. Abigail Roache 22. Tenika Willison.

Kiwis:

1. Kalyn Ponga, 2. Jamayne Isaako, 3. Dane Gagai, 4. Casey McLean, 5. Ronaldo Mulitalo, 6. Kodi Nikorima, 7. Jahrome Hughes, 8. James Fisher-Harris (c), 9. Jeremy Marshall-King, 10. Moses Leota, 11. Isaiah Papali’i, 12. Briton Nikora, 13. Joseph Tapine (v/c).

Interchange: 14. Te Maire Martin, 15. Naufahu Whyte, 16. Erin Clark, 17. Xavier Willison.

Reserves: 18. Keano Kini, 19. Phoenix Crossland, 20. Charnze Nicoll-Klokstad, 21. Scott Sorensen, 22. Leo Thompson.

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Opportunities to mitigate multi-million-dollar RNZ budget blowout likely missed – experts

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Multiple opportunities to identify and mitigate a multi-million-dollar budget blowout at RNZ appear have been missed, according to the former executive director at Audit New Zealand.

The public broadcaster on Monday revealed a near $12 million shock financial loss after a litany of financial blunders, which will now lead to sweeping job cuts.

The $11.8m loss is more than 25 times the $470,000 RNZ had expected to lose over the year to June.

CEO Paul Thompson took responsibility for the result, and said internal reports gave an inaccurate picture of the finances, meaning the scale of the loss only became clear in October.

RNZ’s former chief financial officer Hilary Parker resigned unexpectedly in early October.

The board said it would commission an independent review into what went wrong.

Independent contractor Stephen Walker, who left the Audit Office earlier this year, said the size of the loss was surprising, as was the length of time it took to identify it – months after the financial year ended.

Stephen Walker.
Independent contractor Stephen Walker is a former executive director at Audit New Zealand.

Supplied / OAG

“Probably more of a concern is that they had seemingly been unaware that they were running up a significant deficit until they were in the preparation stage of their annual report in October.”

Walker said public entities typically produced monthly financial reports.

An interim audit also took place before the end of the financial year, he said, but if the organisation hadn’t identified significant losses at that stage, the auditor could also be in the dark.

“It seems that there’s a real weakness in forecasting and budgeting that’s occurred here and that the monthly accounts, when they’re produced, either haven’t identified these significant variances against budget or the magnitude of them really hasn’t come to light until right towards the end of the financial year,” Walker said.

“And really at that point, there’s no opportunity for the chief executive, the leadership team to take, and the board to take, any corrective action because the year has effectively been completed.”

Walker said the “significant miss” was difficult to account for given it was more than 10 percent of RNZ’s total funding.

He said based on RNZ’s annual report, financial complexity didn’t appear to be a factor.

“This $11.8m loss isn’t made up of one particular item … it seems to have been contributed to by a number of separate expense lines running over budget. So I don’t think it’s necessarily to do with complexity.”

Among the errors, RNZ wrongly counted $2m from land sales as income in its budget. Staff costs also came in $3.2m over budget, including $1.4m in redundancy payments.

Professor at Auckland University’s business school Norman Wong said based on media reports the issues identified were “significant and troubling”.

Norman Wong.
Norman Wong.

Supplied / University of Auckland

“But recognising the sale of land as income in their budget is a basic error that one would have expected to have been caught and corrected well before it got to this point.”

With funding reductions at RNZ over the past two years, Walker expected greater scrutiny of financial results.

“Virtually every public entity has had their annual budget reduced. And so you would expect … the leadership team on a monthly basis and board – I’m not sure how frequently the board will consider the information – but you would expect them to be interrogating the results on a regular basis throughout the year,” he said.

Walker said initiating an independent review was the correct course of action and that he’d want to understand what information the leadership team and the board were regularly receiving.

He said he’d “love to say” surprising financial results were rare, but conceded they occured on a semi-frequent basis during his time leading the Audit Office.

“The benefit of independent scrutiny by the Audit Office – and the auditors providing that support to the Auditor General – [is] that the reporting is fairly presented at the end of the year, whether it’s good, bad or ugly.”

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