Northland Māori health providers are losing nurses due to what they say is an unsustainable model of primary healthcare.
They are among many health service entities experiencing a decline in nursing staff, largely due to the lower wages primary healthcare nurses receive compared to their district health board (DHB) counterparts.
Nurses in primary healthcare were paid roughly 11 per cent less than DHB nurses, about $7600 annually, which saw many primary healthcare nurses leave to work at DHBs or in other professions. The same pay gap existed for administrative staff.
Whangārei nurses and admin staff gathered on Monday to take part in a 24-hour strike, protesting the lack of pay parity. Another 24-hour strike had been planned for later in the month if the issue was not resolved.
Speaking in the Northern Advocate yesterday, prominent Northland GP Dr Tim Malloy warned primary healthcare would fail if pay parity wasn't established, causing longer GP wait times, lower-quality healthcare and the potential closure of clinics.
National pay parity negotiations were ongoing but the Ministry of Health's current position stated that general practice owners were responsible for establishing pay parity for their nurses.
However, Malloy said the current funding model for general practice was too restrictive, preventing practice owners from increasing their profit to offset the increased wages bill.
Read more: Malloy predicts primary care breakdown
The majority of general practices in Northland receive funding from the Government in order to provide healthcare at a reasonable price. In such practices, paid through the Very Low Cost Access (VLCA) scheme, children under 14 years old incur no charge, while those older than 14 can only be charged $19.50.
Malloy argued the Government's control of what general practices charged their patients gave them no ability to fill the 11 per cent wage gap and instead, they needed an injection of public funding.
Northland DHB chief executive Dr Nick Chamberlain, who was the national DHB representative in the current negotiations around pay parity, was a strong supporter of equal pay and was confident a resolution could be found.
"From a Northland perspective, I fully support the principle of pay parity across the health and wider public sector and I am working very hard with our Ministry of Health colleagues to progress this."
Kaitaia-based health provider Te Hiku Hauora was one of many that had lost nursing staff.
Te Hiku Hauora chief executive Bill Halkyard confirmed some of his most experienced nursing staff had left to work at the Northland DHB for financial reasons.
"This gives the DHB an advantage as far as nurse clinicians go, so it's definitely an unfair playing field and it does cause us problems recruiting and retaining nurses over the years," he said.
"If the gap's too wide, we aren't going to have a workforce."
Halkyard, who strongly supported pay parity, said the funding model for general practices restricted owners' ability to establish pay parity and he echoed Malloy's call for more public funding.
In addition to general practice nurses, Te Hiku Hauora employed nurses to execute health contracts supplied by the NDHB and Northland's primary healthcare entity, Mahitahi Hauora.
Halkyard described how these contracts, such as cardiac rehabilitation or adolescent health, for example, were bulk-funded - which meant providers were given one sum of money to deliver the contract's services, including paying staff.
However, Halkyard admitted some of these contracts were costing Te Hiku Hauora money to fulfill, simply because they were trying to pay their staff adequately.
He believed funding for such contracts needed to be increased, with targeted funds set aside to establish pay parity for nurses.
The value of primary healthcare nurses was reflected in the high proportion of overseas locum doctors working in Northland.
"We have the need for patients to keep retelling their medical history to these locums who are only going to be around for six months, whereas the nursing workforce will stay long-term in a community, so they are the constant and the backbone," he said.
With half of Northland GPs set to retire by 2028, Halkyard said being unable to employ nurses to service the region's most rural and high-need communities was unsustainable.
"If we know we're going to have a shortage of GPs and we're reliant on passing a lot of that workload over to nurses and we can't recruit nurses, then we've got a problem."
Whakawhiti Ora Pai, based in Te Kao, Pukenui and Te Hapua, is the northernmost healthcare provider in the country, servicing some of New Zealand's most isolated communities.
Whakawhiti Ora Pai general manager Errol Murray echoed his Kaitaia colleague - it was getting harder to recruit and retain nurses because of the comparatively low pay and travel requirements.
"If [nurses are] going to get paid lower than what they get paid at Kaitaia Hospital, they're not going to come or they don't stay long," he said.
While he'd been fortunate to keep his current nursing workforce, Murray said some had left due to the wage gap and travel requirements.
Murray believed new nursing graduates would choose to work for DHBs given the financial benefit - which posed an enormous risk when older primary healthcare nurses retired with too few nurses to replace them.
"You could end up with a very second-rate system ... there'd have to be new models developed."