What funding models and policy changes will help sustain New Zealand’s urgent care services?
New Zealand is recognised for early adoption and recognition of urgent care as a distinct medical specialty. Urgent care in NZ has been formally recognized since the early 1990s, making us one of the first countries to do so. The Royal New Zealand College of Urgent Care (RNZCUC), established in 1992, played a key role in this development. The RNZCUC set standards for urgent care clinics and practitioners, providing training, accreditation, and ongoing education for urgent care professionals.
Financial fragility, temporary closures and long patient waiting times have become typical in the urgent care and after-hours sector. Over the past 2 years, pressure has been building at urgent care clinics with more patients coming through and not enough staff to keep up. General practices and hospital EDs are under strain and urgent care clinics are caught in the middle.
Contributing factors include loss of workforce and lack of funding. The pay rates of nurses at Te Whatu Ora are significantly higher than in most of primary care. To close this gap, the primary care sector says it needs more government funding. The funding mechanism has undergone a few changes recently: there are 45 national clinics under ACC Urgent Care Clinic contract, wherein funding was increased by between 3 and 6 per cent from 1 July 2023. The contract holders also receive after-hours funding through the PHO Services Agreement and some receive time-limited sustainability top-up funding from Te Whatu Ora.
ACC is working towards devising a new service, to be provided under a new contract from July 2025. In a webinar in November 2023, ACC officials summarised work done on a review of primary acute care. The government had also undertaken several initiatives to bolster the workforce, including support for internationally qualified nurses to gain registration in NZ, and covering international doctors' salaries during induction courses and internships.
Te Whatu Ora is currently conducting reviews of the general practice/primary care and urgent care models of funding and care as well as a review of unplanned/unscheduled care. The latter review covers urgent care, after-hours care and other forms of unplanned/unscheduled care, PRIME (Primary Response in Medical Emergencies), ambulance services and telehealth. This review will investigate care in isolated rural communities, working with other funders of unscheduled care such as ACC, and strengthening management of unscheduled care. Developing a fit-for-purpose and equitable funding model for primary and urgent care is expected by December 2024, with review work to be completed by June.