Dr Jon Wilcox wrote:

> You really may not believe this but our local Regional Health Authority
> in Auckland (popln. 1.2m) has only this morning placed its first
> advertisement for its new Super "Hospital" style Clinic (GP's apparently
> "don't have the right expertise") in the underprivileged Western Suburbs
> of Auckland. It was initially mooted to be run by paediatricians, but
> you guessed it the advertisement is for staffin proposals for a
> "Specialist Nurse" Super Clinic (competing head on with local GP's in
> the area).
> Any architectural commentary from John Marwick??

Despite rumours to the contrary I am a strong supporter of the generalist and these sort of
developments worry me. I think the "super clinic" idea is misguided and reminds me very much
of the polyclinic which is thankfully fading out in much of Northern and Eastern Europe.  From
a little knowledge I think the clinic Jon refers to in Auckland is designed to take some of
the heat off Auckland's central paediatric hospital where emergency referrals and acute
admissions from all parts of the city have rocketed recently.

However, it's good to know that Auckland is also the part of NZ where there is the greatest
number of new GP arrangements - with budget-holding and new contracts for about 75% of local
gps.  Docs are grouped into Independent Practitioner Associations (IPAs) ranging from 40 to
200 doctors. The IPAs have entered contracts for general practice services (docs & nurses) as
well as pharmaceuticals and lab tests.  I gather the first year or two has demonstrated
success in making savings against budget despite no very generous establishment or management
funding (cf UK).  Savings are now being applied to improved services or access to services -
not to improving premises or the like (cf UK again).  Changes in prescribing etc have been
brought about by setting up small, regularly meeting GP 'cells' to discuss practice.

As for nurse practitioners I find it reassuring that IPAs are beginning to widen their base to
include nurses in their structures. I have always been a believer in the primary care team.  I
have never felt threatened by the growth of nurses' skills and their ability to carry out many
primary care tasks - even when I was in full-time practice.  Perhaps it's easy for me to say
now that I am salaried but I found that working with a nurse expanded the range of services
the practice offered rather than reducing what I was doing.

--
Dr John Marwick, NZ Ministry of Health, PO Box 5013, Wellington, NZ
Home: 12 Konini St, Eastbourne, Lower Hutt, NZ
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