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A revolution in health was long overdue after decades of waiting for evolutionary change to fix a ‘broken system’, Professor Jenny Carryer told the Nurse Practitioners New Zealand conference.

The executive director of the College of Nurses was a key note speaker at the Blenheim conference last week and said it was a “dream come true to be in a room full of NPs”.

But she also shared her frustration that nearly 20  years after the registration of the first NP and the release of the Primary Health Care Strategy in 2001 – that set out a vision for reducing health disparity, improving equity and increasing the multidisciplinary team – that there had been so little change. Instead it was still ‘business as usual’ with none of the proposed structural or operational changes put in place to allow the vision to be realised, said Carryer.

She told the conference of her disappointment that the ‘refreshed’ New Zealand Health Strategy 2016 did not ask the “really important question” of why the 2001 Primary Health Care (PHC) Strategy had not made the gains or impact hoped for. Carryer said the catchphrase at the time the PHC strategy was released was that system changes would be evolutionary as change could not happen over night.

“I’m over evolution at this point ­­– it is too slow,” said Carryer who believed it was instead time for revolution.

“People out there who are suffering cannot wait another 20 years for us to get it right,” said Carryer.

“In terms of the revolution – I would argue that the current model of service delivery model is broken – particularly the general practice model. I don’t think it is a useful model – I don’t think it works and I don’t think it facilitates the kind of primary health care that the sector needs.”

She said in particular services were failing to deliver for Maori in a way that “should make us all ashamed”.

Carryer argued that for too long the health system had been viewed through a biomedical or doctor lens which had “priviliged” doctor leadership and doctor funding over the wider socioeconomic and personal determinants of health.

She said she was delighted at the Health and Disability System Review currently underway under the leadership of Heather Simpson which she saw as an “excellent opportunity” to make some “fairly radical changes”. She encouraged the gathering of 150 NPs, nurse leaders and NP interns to be actively involved in the review so that their vital knowledge of aged care, primary care and secondary care services was fed into the review process.

“I think this is a pivotal moment in time when we need to be very clear, very unified and very brave.”

She told the gathering of 150 NPs, nurse leaders and NP interns that they were pioneers in the true sense of forging new territory and relationships through sheer hard work in an environment that might not be ready for them.

“I’ve always seen NPs as a catalyst for a revolution or transformation of how we deliver health services. Because what NPs have which is so valuable and so different is – yes the skill to do assessment, diagnosis, prescribing, management etc – but these are done with the framework of enablement, acknowledgement of culture, acknowledgement of context, a focus on prevention and – most critically – a strong focus on social justice.”  She said that was a ‘package’ that the health system had been looking for since the launch of the PHC strategy.

She said after 20 years she was still “constantly stunned” by the level of ignorance amongst health funders and planners and health managers about the role of nurse practitioners.

She also said that current NPs working in primary health care were “forging a space in a largely business as usual” environment. “And I think that has risks around the need to ‘fit in’,” said Carryer. She said new graduate nurses for years had reported how disillusioning it was starting clinical practice to have much of what they learnt in their undergraduate degree “challenged and destroyed”. She feared that likewise nurse practitioners risked having to change and sabotage the way they would like to practice to fit into their practice environment – particularly as funders and planners “still tend to see NPs as a cheap substitute for medicine and the models of practice are designed on the medical model of care”.

“So there is a risk to fit in that NPs have to limit the way they practise.”

Carryer said she saw NPs as the agents for change and transformation in a health system.

She said collegiality and collaboration with medical colleagues was “clinically vitally important” for the patients they all cared for but political collaboration “would get NP nowhere because actually politically they are a fierce lobby group who serve their own interests, not ours”.

“It is important for patients’ wellbeing and safety that we have strongly collaborative relationships but in terms of arguing for transformation of current service models we must do it on our own, and fiercely and independently focused on the people we serve – or in many cases underserve”.

She finished by repeating that the current Health and Disability System Review “absolutely offered the opportunity for a long overdue overhaul” of the current model of care.

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