General practice and the New Zealand health reforms--lessons for Australia?

New Zealand's health sector has undergone three significant restructures within 10 years. The most recent has involved a Primary Health Care Strategy, launched in 2001. Primary Health Organisations (PHOs), administered by 21 District Health Boards, are the local structures for implementing the Primary Health Care Strategy. Ninety-three percent of the New Zealand population is now enrolled within 79 PHOs, which pose a challenge to the well-established Independent Practitioner Associations (IPAs). Although there was initial widespread support for the philosophy underlying the Primary Health Care Strategy, there are concerns amongst general practitioners (GPs) and their professional organisations relating to its implementation. These centre around 6 main issues: 1. Loss of autonomy, 2. Inadequate management funding and support, 3. Inconsistency and variations in contracting processes, 4. Lack of publicity and advice around enrollment issues, 5. Workforce and workload issues, 6. Financial risks. On the other hand, many GPs are feeling positive regarding the opportunities for PHOs, particularly for being involved in the provision of a wider range of community health services. Australia has much to learn from New Zealand's latest health sector and primary health care reforms. The key lessons concern: The need for a national primary health care strategy, active engagement of general practitioners and their professional organisations, recognition of implementation costs, the need for infrastructural support, including information technology and quality systems, robust management and governance arrangements, issues related to critical mass and population/distance trade offs in service delivery models.