A $300m Māori health entity proposal has rocked Northland's healthcare community, forcing some general practice doctors to consider abandoning the region's primary health organisation.
The Oranga Māori Entity, formed by an alliance of Tai Tokerau Māori health providers and whānau wellbeing organisation Whānau Ora Collective, has also been condemned by the Northland District Health Board (NDHB), which says while the intention behind the proposal is sound, there are severe concerns over its execution.
The Oranga Māori Entity (OME) is described as a partnership between Māori health providers, iwi, Government and private health and social organisations which would be funded to operate the entirety of Northland's healthcare outside of hospital care.
It is supported by organisations such as Te Hiku Hauora, Te Hau Ora O Ngāpuhi, Ki A Ora Ngātiwai, Ngāti Hine Heath Trust, Whakawhiti Ora Pai, Te Hau Āwhiowhio ō Ōtangarei Trust, Hokianga Health and many other health and social services organisations and iwi groups.
The proposal is in response to the impending rollout of wide-ranging changes to New Zealand healthcare borne from recommendations of Heather Simpson's Health and Disability System Review.
Last year, Simpson advised radical changes including reducing the number of DHBs from 20 to as low as eight. A rollout of these recommendations was expected within months.
The proposal is also supported by Northland's primary health entity, Mahitahi Hauora, which manages primary healthcare services not already managed by the NDHB, such as general practice (GP).
Headed by Mahitahi board chairman Geoff Milner, the OME is bold reform aiming to address the widespread inequity in Northland healthcare - inequity heavily felt by Māori, low socioeconomic and rural populations.
However, some GPs are extremely frustrated after not being consulted before the proposal was sent to Health Minister Andrew Little on December 22.
"There's been a complete lack of consultation with a key stakeholder in this," Whangārei GP Dr Melissa Gilbert-Smith said.
Kensington Health's Gilbert-Smith, a GP of 15 years, said almost all primary care was done through GPs and she would have been more than happy to enter consultation on such a proposal.
However, as many GPs were only aware of the proposal about a week ago, Gilbert-Smith said some were considering leaving Mahitahi.
"I have had multiple responses [from GPs] saying this is appalling because nobody knew about it, not one GP that I have spoken to knew about it.
"There are a number of GPs exploring their options in regards to developing an independent GP voice."
Gilbert-Smith said this was one of many instances of poor consultation from Mahitahi to its workforce, a history which had eroded nearly all trust between the two parties.
A meeting between Northland GPs was held yesterday evening to discuss next steps.
Kamo GP Dr Geoff Cunningham warned Mahitahi's actions would endanger a desperately minimal GP workforce in Northland.
"I think the absolute contempt that's been shown to the GPs will greatly damage our current GP workforce and, potentially, our ability to attract new GPs to the region," he said.
"We need transparency and trust in a relationship and that's not there."
In September, the Northern Advocate detailed Northland's severe GP shortagewith population growth set to overrun the roughly 200 current Northland GPs - about half of whom are set to retire by 2028.
Moerewa Medical Services GP Dr Graeme Fenton empathised with some of his colleagues' concerns but was supportive of the proposal.
He believed if GPs were in more positions of influence, this consultation issue wouldn't occur.
"Until you get people in general practice getting off their bums ... instead of getting upset about it and say, 'Look this is not going to work, let's sit down at the table and say there is a different way to do this', that's what they need to do, don't try to destroy the system," he said.
Mahitahi chief executive Phillip Balmer didn't seem concerned about the GPs' feedback and warned against drastic action.
"It would be premature for GPs to be leaving without any dialogue or any understanding."
He said consultation was currently being sought from primary care stakeholders and invited GPs to discuss their concerns.
Milner, also the chief executive of Ngāti Hine Health Trust, said he was disappointed to hear GPs were considering leaving Mahitahi, but maintained the Government's short timeframe regarding health reform meant Mahitahi had a responsibility to submit the proposal.
"Mahitahi has done some work and made a submission recognising in around six weeks time, Government officials will be making decisions [on health reform]."
Milner would not comment further on Mahitahi board actions. While he said GP consultation was imminent, Milner emphasised the most important voice was that of the Northland community.
The proposal represents a long-held belief in the Māori health community that the NDHB's success in running equitable primary care services has been questionable.
In a letter from Milner to NDHB board chairman Harry Burkhardt in January, Milner labelled NDHB's plans for the future as "too conservative", and detailed Mahitahi's strong opposition to the NDHB leading the region's primary healthcare services.
"We do not support growing the centre (Northland DHB) and the continuation of leadership and influence residing in a single entity which has had this privilege (monopoly) for the past 20 years with variable results," the letter said.
NDHB chief executive Dr Nick Chamberlain alleged much of Northland's primary healthcare services, including iwi, had not been briefed on the OME proposal and he questioned Mahitahi's ability to execute such a venture.
"Mahitahi Hauora is not that well placed to lead all [primary care] services and still has more work to do with some of its core primary care stakeholders, such as General Practice.
"NDHB funds and provides over $300 million worth of [primary care] services and this involves thousands of healthcare workers. Taking over functions of this scale and breadth may have been underestimated."
Chamberlain, a former GP, said he had a number of GPs contact him about their lack of consultation, which was of great concern to the NDHB.
While he empathised with their position, he urged GPs to stay with Mahitahi - at least for now.
"We would prefer GPs to continue contracting with Mahitahi for support services, but their anger at the lack of engagement is understandable.
"There are a number of options open to them and I hope that they consider those carefully and listen to what Mahitahi has to say first."
Milner would not be drawn on Chamberlain's comments.
Minister of Health Andrew Little said all options were being explored to improve health outcomes, which was an essential task in Northland.