Diffusion of the Primary Health Care Strategy in a Small District Health Board in New Zealand

Abstract

Introduction and BackgroundThe Primary Health Care Strategy (PHCS) declared that a strong primary health care (PHC) system was considered fundamental to improving the health of New Zealanders and for tackling inequalities (Ministry of Health (MoH), 2001). The launch heralded a radical policy change to strengthen service delivery in PHC (Workforce Taskforce, 2008) and provided an opportunity for PHC nurses to engage fully with government and their employers in developing new nursing roles and responsibilities (MoH, 2005). It coincided with an international call for nursing innovation to produce a new form of health service delivery given an increase in health care demand from people with chronic conditions (Halcomb, Patterson, & Davidson, 2006; Temmnink, Francke, Hutten, van der Zee, & Abu Saad, 2000). Changes to service delivery, shorter hospital stays and an increased focus on population health and health promotion, meant that the responsibilities for nurses working in primary health care (PHC) had increased (MoH, 2005).It was imagined that the extensive contribution nursing could make to reducing health inequalities, achieving population health gains and preventing disease, would be fully realised as a result of the PHCS (Expert Advisory Group on Primary Health Care Nursing, 2003). The expert advisory group reported that there was no nursing voice in decision-making, a noticeable lack of nursing leadership infrastructure in PHC settings and an absence of clinical career pathways. They also noted that PHC nurses lacked adequate resources to support their education, autonomy and skill development. This study thus explored and examined the situational and structural factors contributing to the implementation of the PHCS in a district health board (DHB) with a particular focus on the utilisation of nurses.BackgroundThere is an abundance of international literature that concentrates on the positive characteristics of PHC (Arford, 2005; International Council of Nurses, 2008; McMurray, 2007; Sloand & Groves, 2005; Starfield & Shi, 2007; Walker & Collins, 2009; World Health Organisation (WHO), 2008). A PHC paradigm privileges a broader remit than the provision of episodic care for ill health. It works toward the development of health by putting the emphasis on prevention, community involvement and working with sectors outside of health (Keleher, 2000; Sweet, 2010). The International Council of Nurses (2008) has said that it is through the principles of PHC that nursing can make an important contribution toward progress in the goal of "health for all" noting that nursing is considered the "very essence of primary health care" (p.7).Much of the relevant published New Zealand literature focuses on the introduction of primary health organisations (PHOs) and funding models associated with the implementation of the PHCS but makes little mention about the impact on PHC nursing. The PHCS promised the effective deployment of nurses to make the best use of nursing knowledge and skills. It was about aligning nursing practice with community need and developing funding streams for service delivery that supported nurses adoption of an integrated approach to practice incorporating both population and personal health (Kent, Horsburgh, Lay-Yee, Davis, & Pearson, 2005; MoH, 2005).There is emerging evidence that primary health care nurses do improve health outcomes and should be utilised accordingly (Cumming et al., 2005; Laughlin & Beisel, 2010; Finlayson, Sheridan, & Cumming, 2009; International Council of Nurses, 2008; McMurray, 2007; Nelson, Connor, & Alcorn, 2009; Sheridan, 2005). There is also evidence of the nursing potential to reduce inequalities in health between the social groups (Hoare, Mills, & Francis, 2012; International Council of Nurses, 2008; Marshall, Floyd, & Forrest, 2011). The conceptualisation of primary health care is also in harmony with the philosophy of nursing. …