The Northland District Health Board believes a whānau-centred approach is the best option to fix the region's inequitable healthcare system.
Details of the DHB's plans were released as part of a document sent to the Government's transition team, which is charged with executing wide-ranging health reform recommended by last year's Health and Disability System Review.
The DHB's proposal followed another proposal from the Te Tai Tokerau Māori Health Providers Alliance, which advised of the creation of a $300m Oranga Māori Entity (OME) to manage all primary care outside hospital care.
The alliance's proposal came as a shock to many in the healthcare community, with general practice doctors angered about a lack of consultation before it was submitted to Health Minister Andrew Little.
NDHB chief executive Dr Nick Chamberlain explained the DHB did not support the alliance's proposal, given the level of coordination it required from Northland's primary healthcare entity Mahitahi Hauora - which was formed just 18 months ago.
However, Chamberlain said the DHB's proposal acknowledged the OME's potential place in Northland's healthcare system, specifically concerning Māori health.
"Our proposal talks about the need to join up health and social services more and we do believe the [OME] could be the vehicle for that, providing some of the initiatives that the Ministry of Social Development, housing, education, want to support and fund, so that it's broader than just health," he said.
The DHB's proposal outlined a strong partnership with the articles of Te Tiriti o Waitangi (Treaty of Waitangi), with a specific focus on embedding rangatiratanga (authority/ownership) and mana motuhake (self-determination/autonomy).
It detailed how whānau would have better access to a healthcare system which empowered the individual and community's needs, integrated health and social services, and ensured it offered culturally respectful services.
Given the Health and Disability System Review recommended a drastic reduction in DHBs, Chamberlain said this proposal was a viable template even if the Northland DHB was absorbed by another.
"I believe what is put forward is a proposal that can be agnostic of whatever the Government decides is the final structure, because they make the decision."
The OME proposal, headed by Mahitahi board chairman Geoff Milner, was described as bold reform to address Northland's sobering inequitable health statistics by having Māori health providers and iwi at the centre of primary care with a separate hospital care system.
Tensions rose through the proposal process as a prior NDHB proposal described a significantly smaller role for Mahitahi, with many responsibilities being absorbed by the DHB.
Following this, Chamberlain - who is a non-voting member on the Mahitahi board - was excluded from subsequent board discussions and not informed of the OME proposal before it was sent to the health minister on December 22.
However, Chamberlain was confident this "breakdown in communication" wouldn't impact the two entities working together in the future - should they still exist with reform confirmation expected in the coming months.
"I think there's still a lot of support and [Mahitahi] may well support our proposal which doesn't impact on the functioning of Mahitahi."
Milner would not comment on the DHB's proposal.
Following the OME proposal release, GPs met late on Tuesday after it was suggested they should walk away from Mahitahi to ensure their voice was heard.
Whangārei GP Dr Melissa Gilbert-Smith said the meeting showed there was a real desire to work with iwi, Māori health providers and other primary care stakeholders to establish a functioning system.
She said there was unanimous agreement among the gathered GPs that there was conflict between GPs and Mahitahi. Further kōrero was required to decide what future steps were taken.