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To improve access to health care in our communities and promote better health and wellbeing Te Whatu Ora is working to support primary and community teams through funding additional roles.  

Te Pae Tata, the interim New Zealand Health Plan, requires action with a strong focus on improving equity and access to primary health care. One of these actions is the creation of Comprehensive Primary and Community Teams (CPCT). Research shows that expanding the skill mix available to primary care teams increases community access and improves equity outcomes. These teams have a priority focus on Māori, Pacific and rural people.   

Five suggested roles have been identified for consideration in creating CPCT. These are:  kaiāwhina, physiotherapists, pharmacists, care coordinators and in some rural areas, paramedics and in some rural areas, paramedics. These roles underpin the allocations of resource for CPCT, but this does not pre-determine or direct the final make-up of the CPCT. The final make-up of the CPCT is determined through local tailoring to ensure the established roles are responsive to local needs.

Operating Framework

The Operating Framework is a draft document that provides guidance to implementation.  Feedback on this document is welcomed with suggestions on how this may be enhanced is welcomed.    

This document will be revised as feedback is received, so electronic versions will be the most current form of this document. 

Funding decisions 

Funding for CPCT roles is allocated to regions to commission through collective decision-making that will allow for local tailoring. This decision-making will involve key stakeholders, including locality teams (where they exist), hauora Māori partners, Pacific partners, Te Aka Whai Ora, PHOs, and primary care providers. Regional Wayfinders have a key role in overseeing this collective conversation in partnership with Regional Directors. Kaiāwhina roles are commissioned directly by Te Aka Whai Ora and the Pacific Commissioning Team for hauora Māori and Pacific partners.  

Local tailoring 

Local tailoring considers the needs and aspirations of the whānau and community voice and the workforce currently providing health services in the area. This tailoring conversation seeks to promote collaboration between health providers to respond to these needs and aspirations in the context of the communities they serve. If these conversations identify a need for alternative roles as part of an expanded team approach, Regional Wayfinders have the flexibility to consider and approve.  

To find out more about what each of the suggested roles can offer primary and community care teams, click the drop down menus below. Or you can email earlyactionsprogramme@health.govt.nz to make contact with a Comprehensive Primary and Community Team navigator who can help talk through the most appropriate option for your practice team.  

Roles

Kaiāwhina 

There are many kaiāwhina and community support roles across health and social services.  In this case, kaiāwhina will be a newly introduced workforce as part of the comprehensive care team. 

The skills and cultural competencies of kaiāwhina will reflect the needs of their communities.  This is about providing a trusted face to help whānau navigate the health system to get the supports they need. 

Training and development for this role will be a priority for comprehensive care teams and there is an opportunity to transition and utilise the workforce who have been developed for the COVID response.  

These roles will be contracted through hauora Māori partners and Pacific partners, who will be employing the kaiāwhina roles. 

Care Coordinators 

People working in this role are likely to be either a registered nurse, social worker or other allied health professional. They will coordinate care for people, prioristising those who are at risk of unnecessary hospitalisation, Māori, Pacific people or those at risk of poor health outcomes. 

Activities of a care coordinator may include: 

  • Coordinating care and developing a single plan of care. 
  • Providing a whānau-led and coordinated plan of care across health and social services. 
  • Identifying those at greatest risk, who may be difficult to reach to plan their care with. 

Physiotherapists 

Physiotherapists can assess, diagnose, and provide education, treatment, and rehabilitation for a range of health conditions. Within a comprehensive care team, they will often see people first, instead of the general practitioner (GP) or nurse practitioner (NP), especially for those people with conditions relating to their movement or joints.  For example, a knee injury may be first assessed by a physio.  

Activities of a physiotherapist, as part of the comprehensive care team may include: 

  • Assess, diagnose, and treat musculoskeletal disorders and injuries. 
  • Provide rehabilitation programmes for people with long-term conditions, for example breathing or neurological conditions 
  • Provide support and education to people to best manage their own health. 

Practice Pharmacist

A pharmacist within the comprehensive care team can support and educate whānau on how to get the best out of their medicines.  This is particularly valuable for those who are on multiple medications. Some pharmacists, with additional training can also prescribe medications. 

Activities of a pharmacist as part of the comprehensive care team may include: 

  • Reviewing medicines prescribed for a person and monitoring the impacts and side effects to support the prescriber. 
  • Provide education and advice about medicines, including support for people taking them, especially when the medicine could have a higher risk of side effects. 
  • Ensure that when people change care settings, all parties are clear on the current medicines list. 

Paramedics 

Paramedics may be part of comprehensive care teams, especially in rural areas. They can support practice teams, particularly those who are acutely unwell or need same-day care. They may also support the primary care partner in after-hours care.  

Activities of a paramedic may include: 

  • Taking phone calls from people needing an urgent or same-day appointment to support the team determine which people need to be seen first (and by whom). This may include being able to manage some clinical problems over the phone.  
  • Phone consultations for those who do not need a face-to-face consultation. 
  • Providing some treatments such as inserting catheters, wound care and suturing.

Guidance For Employing Extended Care Paramedics

As the role of an extended care paramedic is relatively new within primary care teams, a reference guide has been developed to provide additional information. 

FAQS

Where has this additional funding come from?  

Budget 22 allocated $5.854m in FY 22/23, $61.146m in FY 23/24 and $35m in FY 24/25 to fund additional frontline clinical team members in primary care, including pharmacists, care coordinators, physiotherapists, kaiāwhina and other roles aligned to local needs.  

What is a comprehensive primary and community team?  

  • A CPCT is a core primary care team, with additional roles such as kaiāwhina, practice pharmacists, physiotherapists, and care coordinators, and in some cases extended care paramedics.  
  • CPCT members may or may not be co-located on site and will include Māori and / or Pacific workforce and partners.  
  • CPCT will usually require the development of collaborative ways of working with other health and wellbeing providers such as Māori or Pacific partners to work in an interdisciplinary manner.  

Why are CPCTs important?  

CPCTs can provide a broader range of roles and services to enable people with complex conditions receive earlier intervention, faster treatment, and better support to change social and lifestyle factors, particularly for Māori, Pacific and Rural whānau.  

These teams will improve both access to, and the range of care delivered to whānau locally. The local tailoring of CPCTs provides opportunity for collaboration and integration across partners and providers to ensure care provided is targeted to whānau that need it most.  

How has the implementation been phased?  

Phase one involved resourcing for CPCTs in the twelve early localities and kaiāwhina roles in selected areas of system pressures, including Counties Manukau, Northland, Auckland, Waitemata and Bay of Plenty regions. The local tailoring of this phase commenced in May 2023 and sees up to 193 additional roles in primary health care.  

 

Phase Two sees the balance of resourcing across the country, with local tailoring commencing August 2023. This sees a coverage across 50% of the total population and more than 70% Māori and Pacific population and up to an additional 320 roles within primary health care settings.  

How has the funding allocations been determined?  

CPCT funding has been prioritised to areas where there are higher numbers of Māori, Pacific and rural populations.   

 

To determine rural, the source information was based on the GCH (Geographical Classification for Health) classification. Although not specifically designed to classify practices or drive resource allocation, this tool is supported by the sector and experts as a valuable measure to correlate with health outcomes.  

 

For the CPCT investment prioritisation, practices were identified as rural based on the GCH geography they are based in, with some adjustments made for proximity to other health services. This was based on November 2022 enrolment information. 

How will CPCT be monitored and evaluated?  

A national measurement framework has been developed. As part of the implementation processes, it is expected that each regional and local area would identify the priority areas, aligned to the national framework, that the local CPCT will focus on.

Local tailoring – what is meant by this?  

Te Pae Tata – the interim New Zealand Health Plan identified roles that can be used to provide expanded care, including pharmacists, care coordinators, physiotherapists, kaiāwhina, and in some cases paramedics. These roles have underpinned the national planning and modelling.  

 

Funding for CPCT roles is allocated to regions to commission through collective decision-making that will allow for local tailoring. This decision-making will involve key stakeholders, including locality teams (where they exist), hauora Māori partners, Pacific partners, Te Aka Whai Ora, PHOs, and primary care providers. Regional Wayfinders have a key role in overseeing this collective conversation in partnership with Regional Directors. Kaiāwhina roles are commissioned directly by Te Aka Whai Ora and the Pacific Commissioning Team for hauora Māori and Pacific partners.     

 

Local tailoring considers the needs and aspirations of the whānau and community voice, geographical distribution and the workforce currently providing health services in the area. This tailoring conversation seeks to promote collaboration between health providers to respond to these needs and aspirations in the context of the communities they serve. If these conversations identify a need for alternative roles as part of an expanded team approach, Regional Wayfinders have the flexibility to consider and approve.    

 

The regional and local resource allocations provide a guide on the roles to be considered, but this does not pre-determine or direct the final make-up of the CPCT. The final make-up of the CPCT is determined through the above process to ensure the established roles are responsive to local needs.   

 

With the flexibility in local tailoring, there is guiding intent for the CPCT that must be worked within including:  

  • provision of additional frontline roles tightly integrated with the prioritised primary care teams   
  • new FTE applied according to the national modelling, supported by new ways of working  
  • require collaborative ways of working with other health and wellbeing providers such as hauora Māori or Pacific partner employers of kaiāwhina  

Who will employ these new roles?  

Local tailoring will determine within the collaboration as to the preferred employer of the new FTE (except kaiāwhina).  

What is the role of a Kaiāwhina within CPCT?  

This role will provide a trusted face to help whānau navigate the health system to access the support required. The skills and cultural competencies of kaiāwhina will reflect the needs of their communities.  

 

There are many kaiāwhina and community support roles across health and social services. In this case, kaiāwhina will be a newly introduced workforce as part of the CPCT.  

 

There are draft role descriptions that are available to use, and modify as required, in the kaiāwhina section of this webpage.  

Who will employ the kaiāwhina and how will they be trained?  

Te Aka Whai Ora and the Pacific Commissioning Team are leading the commissioning of these roles.  They will be employed by hauora Māori or Pacific partners.  

 

Training and development for kaiāwhina working in CPCTs is a priority. Workforce development funding accompanies funding for the roles, which will support kaiāwhina with skills development.  

 

The workforce taskforce has been leading on kaiāwhina development, with an ‘earn as you learn’ approach.  

How many new Kaiāwhina roles are there?  

CPCT implementation will see upto an additional 129 Māori and 56 Pacific kaiāwhina being employed into our primary health sector between hauora Māori and Pacific partners. 

 

  1. General Practice will still be short of clinical staff. How will the Kaiāwhina role help solve this problem?  

The role of kaiāwhina is expected to play a significant part in supporting Māori and Pacific people in navigation of health services and the delivery of holistic care.  

With the other CPCT roles, kaiāwhina are expected to contribute to releasing capacity within primary and community care, and will not resolve all of the workforce challenges facing primary care.  

     2. What is a Care Coordinator and what will they do?  

People working in this role are likely to be either a registered nurse, social worker, or other allied health professional.  

They are expected to coordinate care for people, prioritising Māori, Pacific people, those who are at risk of hospitalisation, or those at risk of poor health outcomes, by:  

  • Supporting a whānau-led and coordinated plan of care across health and social services  
  • Identifying those at greatest risk, who may have difficulty accessing care  
  • Coordinating care for those who are hospitalised to return home, or at risk of hospitalisation  

Other information 

Funding of these roles includes an allowance for overheads which sit with the employer, unless mutually agreed otherwise. 

 

The primary and community sector has had interdisciplinary professional roles working within it for decades. Clinical accountability, health and safety and risk management is no different for CPCTs than for those previous circumstances.