The Royal New Zealand College of General Practitioners

As I write this the Rugby World Cup is at last underway; the country is basking in the warm afterglow of a stunning opening ceremony, the spine-tingling spectacles of haka and waka, and of pride in who we are, tempered only perhaps by a nervous excitement about one little piece of unfinished work on the rugby field!

Last week we had the Conference for General Practice, jointly hosted by the College and GPNZ. The theme, ‘Playing the Advantage’, was chosen with the World Cup in mind, to demonstrate the importance of working together, of making teamwork effective. Feedback has been overwhelmingly positive. As one young delegate said, "other conferences tell you what to do, this one made me think".

With that in mind, I have been thinking that the theme rather begs the question: if we are playing the advantage, what exactly is the game we are playing?

For me, one answer is change. Nothing new here perhaps. After all Ian McWhinney opens his Textbook of Family Medicine with this "The profound changes now occurring in medicine can only be fully understood if they are viewed from the perspective of history. There is nothing new about change: medicine has been changing constantly since its beginnings. Only the pace is different."

If the pace of change was considered fast then, in 1980, how on earth would we describe it today? What is even more disturbing is this possibility: however fast and far our world is changing now, it might not be enough.

Demand for health services, fuelled by new medicines and technologies, high societal expectations, the growing burden of long-term conditions and an ageing population, is rising faster than our ability to meet that demand. Add to the mix our workforce issues, a global recession, and the Canterbury earthquakes, and we have no alternative but to find new, and perhaps, radical solutions.

We are not alone in this. Many countries face similar challenges. But here’s the good news - New Zealand is better placed than most to meet those challenges. Here are some of our advantages:

Network Supported General Practice

We have been at the forefront of this international trend for some 15 years and have much experience to draw on. Networks offer management and clinical support for general practice, and provide a locus for education and clinical governance. Networks comprise nurses, doctors and managers working together, and looking to work more closely across both primary and secondary care – making the nirvana of integrated care a real possibility.

Academic General Practice

We have a wonderful resource in our universities, with many of our academics highly regarded both locally and on the international stage. We need to draw on their skills more, to work with them to understand the evidence to support new ways of working, and to describe and evaluate progress. There has been much unreported innovation in New Zealand primary care and with better evaluation successful developments can be shared more widely.

A permissive policy environment

When policy makers and clinicians share a vision, and unnecessary bureaucracy is reduced, we make progress. We have done so in the past, and we have a similar environment now. It’s not perfect, we all know that, but is certainly better now than in recent years, and we have a Minister and senior ministry officials supportive of general practice and the changes we are trying to make.

The College

The College, with its dual roles in quality and education, can bring several advantages to the table. Any period of rapid change brings both opportunity and the risk of unintended harm. The College can act as a guardian of professionalism, to ensure that important values are not sacrificed as we embrace new opportunities. The latest edition of Aiming for Excellence defines standards for general practice, and its new structure will permit greater flexibility for future developments. The fact that 70% of practices are engaged in Cornerstone is itself a tremendous achievement and testament to professionalism. The College will also help by preparing the workforce of the future through a renewed training programme, and will support lifelong learning through more meaningful CPD.

The Future

The challenge, as on the rugby field, is to mould these individual advantages, the strengths and talents that we have in abundance, into an effective team. New Zealand has a culture of hard work, innovation and a history of turning adversity to opportunity. We are small enough to make change rapidly, and we share a growing realisation that we have no alternative but to create solutions together.

The final day of the conference showed that it is all possible. Katrina Kirikino and Sam Johnson, two young New Zealanders with passion, conviction and humour, presented alongside the experience and wisdom of Peter Townsend. They showed us exactly how to play the advantage, and who could not be optimistic that success is tantalisingly close after being inspired by them?