Key Primary Health Players Feel Excluded in Development of Commissioning Framework

The country’s leading primary and community health membership organisation says time is running out for the group responsible for developing a Commissioning Operating Model for Te Whatu Ora, to engage with key players in the primary health sector.

Chair of the Federation of Primary Health, Steve Chadwick, says they understand a draft commissioning model is due to be presented to the Te Whatu Ora design council by the end of this month.

“Clearly the Federation wants to be central to the commissioning work that is underway, and at this stage, our members know nothing about what is proposed. We would welcome the opportunity to be actively involved and suggest it is critical that those working at the coal face have significant input into a number of key areas and the commissioning model is one,” she says.

The Federation hosted a commissioning workshop on Friday 2 September which was facilitated by Professor Don Matheson, a public health expert and a Federation board member. It was well attended, with 24 of the Board and Federation member primary health organisations represented.

Professor Matheson says one of the key aims of the workshop was to drill down into what the primary health sector sees as essential to effective commissioning. 

“The Federation supports the move to a partnership-based commissioning approach, recognising the leadership role that whānau and communities’ play,” he says. “One of the very strong positions that came out of the workshop was that primary and community care providers and patient’s families/whānau and caregivers, must be enabled to actively participate in the commissioning processes.”

Additionally the workshop galvanised the Federation’s position that there must be a move away from micromanaging contracts, towards an increased emphasis on achieving health and wellbeing outcomes.

“There is a real opportunity for the sector to do things differently with a commissioning approach. Currently we tend to run with a bright idea from a policy person, a political party, or because it has been done in England or USA. We then try and manage that through a contract, which inevitably focuses more on the money and the outputs.  A decade later, we will do a review and wonder why we haven’t made any impression on health equity? A commissioning approach will still value bright ideas, but equally the insights from providers, patients and whānau, as well as the policy setting of health equity and Te Tiriti compliance.  With these outcomes in mind, effective commissioning is a dynamic process, using monitoring and evaluation to mark progress, and makes adjustments in a timely way.

The Federation of Primary Health also makes very clear that the rural community must not be left behind in the commissioning process, and supports actively linking health commissioning with local government and other government agencies, and local Iwi Māori Partnership Boards.

-Ends-

Additional:

Professor Don Matheson

Professor Matheson is an Honorary Research Fellow at Massey University Centre for Public Health Research. A former deputy director-general (Public Health and Primary Care Transformation 2020-2021 and Public Health 2000-2008) and an international health system consultant.

The Federation:

1. Supports the move to a partnership-based commissioning approach, recognising the leadership role that whānau and communities’ play

2. Recommends that a transparent, balanced, and fair commissioning approach be applied to the hospital sector, primary and community care providers and self-management, to cover the “health and wellbeing” journey for all New Zealanders across the whole health system

3. Supports the active participation of the primary and community care providers and patient’s families/ whānau and caregivers in commissioning processes

4. Supports effective engagement of the primary and community care sector, including providers, in how health and wellbeing is improved and how this is planned, resourced, delivered, and evaluated

5. Shares innovation, and encourages creativity to flourish in the commissioning response, supporting the move away from micromanaging of contracts, towards increased emphasis on achieving health and wellbeing outcomes

6. Fosters active collaboration across the primary and community care sector in support of commissioning processes

7. Actively links health commissioning with local government and other government agencies and local Iwi Māori Partnership Boards

From Terms of Reference Te Whatu Ora, Commissioning Operating Model External Advisory Group (July 2022)

Horopaki/Context

Commissioning is the process by which health services are designed, planned, organised, funded and monitored to achieve the Government’s vision of a health system that is people orientated, equitable, accessible and cohesive.

An effective commissioning function will ensure available resources are used to achieve the most equitable outcomes in the most efficient, effective and sustainable way. Health NZ is responsible for leading commissioning across the health system in partnership with the Māori Health Authority (MHA). The MHA is lead commissioner of kaupapa Māori services and services targeted for Māori.

There is a critical relationship for co-commissioning the system of care with both entities.

Advisory in partnership to co-commission the health system. Kaupapa/Purpose

An operating model translates strategic intent (the ‘why’) into operational capabilities (‘the what’). It serves as the foundation for execution and provides a clear guide for executive leadership team, managers and operational teams.

The commissioning operating model will articulate how we will organise ourselves, provide certainty around processes, and guide the behaviours and culture that are needed to realise our ambitions and the vision of the reform. In particular, it needs to articulate how it will interface with other teams across HNZ who hold some critical inter-linked functions with HNZ, and also MHA, where the commissioning function will also have a shared function arrangement for some services with MHA. The requirement is for a Day 1 operating model (1 July) and a Day 90 operating model.

Hōkaitanga/In Scope

Commissioning is an approach to using available resources to achieve the most equitable outcomes in the most efficient, effective and sustainable way. Commissioning is the process by which health services are designed, planned, organised, purchased and monitored to achieve the Government’s vision of a health system that is people orientated, equitable, accessible and cohesive.

The scope of the Commissioning operating model includes planning for hospital and specialist services, primary, community and population health services, at national, regional and local levels. It includes co-commissioning where HNZ has joint decision-making powers over commissioning with MHA.

It does not include commissioning that is the responsibility of the MHA or other entities. It also excludes disability services, other than for a small number of existing contracted services that are transferring to HNZ on 1 July 2022. It also excludes the purchasing of supplies for hospital and specialist services.