Primary, Community, and Rural Early Actions Programme

The Primary, Community and Rural Early Actions programme has been the joint Te Aka Whai Ora and Te Whatu Ora approach to build the foundations of a sustainable, unified health system that better serves our communities, whilst also supporting and growing the healthcare workforce.  

Te Pae Tata interim New Zealand Health Plan 2022 set out the first two years of action as we began to transform health care in Aotearoa.   It identified a need to strengthen primary, community and rural care to achieve better and more equitable health and wellbeing for all New Zealanders.

This work continues to focus on achieving ‘Pae Ora’, better health and wellbeing in our communities. 

There have been four main priority areas within the Early Actions programme: 

1. Equity Adjustment 
2. Comprehensive Care Teams 
3. Extended Community Care 
4. Health Pathways 

From May 2023, we have implemented targeted investment for primary care, to address the burden of under-funding for Māori and Pacific providers and enable them to continue delivering high-quality services. 

This was part of the Budget 22 initiative ‘Primary Care Funding Formula – Equity Adjustments to Capitation’ and allocated $12.758m in FY 22/23 and $24.414m in FY 23/24 and beyond to Māori and Pacific providers and specific practices based on their enrolled Māori and Pacific (high needs) populations. 

The equity adjustment came about following the Waitangi Tribunal WAI2575 report and the subsequent Sapere Capitation Review which criticised the capitation funding system in New Zealand for not considering important factors such as ethnicity, socio-economic status when distributing funds to primary healthcare providers. 

Hauora Māori partners and Pacific providers tend to have a higher proportion of patients with complex health needs and higher rates of chronic illnesses, and as such the existing funding formula has been neither adequate nor fair. 

Whilst the equity adjustment doesn’t solve the problem, it is a first step towards addressing the current shortfall in the funding formula, which is part of a longer-term primary and community care funding review.

For more information about the equity adjustment, see the FAQs below. 

To enable better health and wellbeing in our communities, we have adopted a preventative and proactive approach to supporting whānau.  We are working to build the capacity of our workforce, so that we can be more responsive to health needs.  

This is about providing health care services that are accessible, affordable, and appropriate for all communities, whilst giving local communities a stronger say in health services through iwi partnerships and local networks.  

It will include the establishment of comprehensive primary and community care teams to contribute collectively to the aspirations and health needs of people in their community – with a focus on wellness, prioritising Māori (including early detection and intervention), hospital avoidance and supported discharge.   

To find out more about the introduction, funding, decision-making, and implementation of these new roles within primary and community care teams, click the link below.  

Comprehensive Primary and Community Care teams

Extended Care (POAC) is a funding mechanism to enable primary and community providers develop and deliver care for people who may have otherwise attended hospital and specialist services. Extended Care is being utilised for proactive, acute and planned services with the current provision being highly variable across Aotearoa. 

The Early Action Programme, through Systems Pressures funding, was able to support an uplift in extended care (POAC) activity. The uplift was applied to eight priority areas, Whangarei, Middlemore, Auckland, Tauranga, Palmerston North, Wellington, Christchurch and Invercargill for Winter 2023. These changes enabled increased access to primary and community services with the aim of, improving health outcomes and reducing pressure on hospitals.  

Planning to utilise a second phase of funding is underway. The second phase has the broad aim of continuing the expansion and development of services, focussed on equity, and supporting a standardised approach to delivering more healthcare in the community. There will also be a focus on implementing priority national pathways consistently across the motu.  

Expanding services will require support and training of the health workforce to extend the care they provide in their communities - particularly for rural, high Māori, Pacific and Tāngata Whaikaha (disabled) populations.   

Health Pathways allow clinicians access to evidence-based local guidance and support to make the right decisions together with their patients.    

Currently there are eleven different community Health Pathway programmes and two separate hospital programmes across the country. This priority area requires collaboration between the national Health Pathways team with clinicians and equity advisors to bring the different Health Pathways into one national programme. Ultimately, this work will deliver consistent, evidence based and equity focused care, regardless of where people live.  

Commissioners are working closely with the Health Pathways team as national pathways are developed to ensure each locality has access to a range of providers aligned to the evidence-based pathway. This local focus will ensure continuity of support for the wider health workforce in community and hospital settings, to access standardised guidance for how they deliver care.  

Te Aka Whai Ora is leading the prioritisation of the national pathways to ensure a strong equity, Te Tiriti and wellness approach is applied across the development of all pathways.   

The Early Actions Programme initiated the above areas of work as part of the health reforms in the first stage of Te Pae Tata. While the Early Actions Programme has ended, these areas of work are ongoing.  

We’ve compiled a list of the most asked questions and answers that are relevant for people interested in this mahi.