The divide between general practice doctors and their funding holder Mahitahi Hauora is widening after several Whangārei GPs wrote to Health Minister Andrew Little, claiming their relationship is untenable.
Dr Melissa Gilbert-Smith from Kensington Health, along with Dr Geoff Cunningham and Dr Andrew Miller from Bush Road Medical Centre, signed the letter sent to Little on Friday which described them as "shackled to an organisation that has not been fulfilling the minimum contractual and performance requirements of a [primary health organisation]."
About 15,000 people are registered to the two Whangārei practices. A further 10 practices are rumoured to support this letter but aren't willing to be publicly named. In total, their patients would represent about half of Northland's registered population.
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Mahitahi chief executive Phillip Balmer believes the GPs' claim is unfounded and said he was committed to hearing feedback from all primary care stakeholders.
The brewing dysfunction between Northland GPs and their primary healthcare entity came to a head when Mahitahi threw its support behind a health reform proposal, made by the Te Tai Tokerau Māori Health Providers Alliance, without consulting GPs.
The proposal, which was sent to the Government to be considered for impending sector reform, detailed the creation of a $300 million Oranga Māori Entity which would deliver all Northland primary care outside of hospitals.
Gilbert-Smith, Cunningham and Miller maintain they are committed to working collaboratively with iwi and Māori health providers to find ways to address Northland's crippling health inequity - which largely impacted Māori, rural and low socioeconomic communities.
However, they say Mahitahi - which is responsible for advocating on behalf of GPs - has violated its founding principle of collaboration, badly affecting trust between the two parties, and has forced GPs to consider forming their own independent body.
"[Mahitahi] have chosen to disregard the vision, principles and collaborative, transparent leadership on which it was established," the letter said.
"By sending out final position statements without consulting general practice or the Northland DHB, Mahitahi has damaged credibility and trust."
The letter was sent to Little following the minister's comments to the Northern Advocate last week, urging GPs not to be hasty and to stay with Mahitahi.
However, the letter is clear about GPs' reluctance to continue working with Mahitahi.
"We in General Practice in Te Tai Tokerau are poised to work with iwi and our DHB partners to co-design a system that actually works for our people, for tangata whenua ... We do not however support any ongoing role for Mahitahi Hauora."
The letter also referenced Northland's ageing, burnt-out GP workforce, with more than half intending to retire in the next decade - something that would significantly worsen Northland's primary care provision if they were not adequately replaced.
Balmer said he was concerned some GPs felt they hadn't been consulted on.
He said it was difficult to have the voice of GPs represented by an individual or small group of individuals, given the different challenges they faced as either rural or urban-based, or national or local providers.
"We welcome further consultation and discussion at the three upcoming forums we have arranged for General Practice and Maori Health Providers.
"Most importantly, we hope we can work together to agree a unified vision and position statement from all stakeholders in Te Tai Tokerau."
A representative for Andrew Little said the minister would respond to the letter's authors before any public statement was made.
Northland District Health Board chief executive Dr Nick Chamberlain acknowledged the letter but did not comment further. In a previous Northern Advocate article, Chamberlain agreed with Little, advising GPs to stay with Mahitahi.