RACS Aotearoa New Zealand’s advocacy work has addressed the emerging policy program of the Coalition Government elected in October 2023. We opposed planned changes at Te Whatu Ora – Health New Zealand that would reduce clinical leadership roles in the face of budget constraints.

Ethnicity is an evidence-based marker of need - Aotearoa New Zealand
A recent Cabinet directive on Needs-based Service Provision requires delivery of targeted services, including those designed to be culturally responsive, to be based on “need not race”.

In response, RACS wrote to the Hon. Dr. Shane Reti, Minister of Health, urging acknowledgement of the substantial evidence base already supporting ethnicity as a determinant of health for Māori and other population groups. We emphasised inequity of access, inequity of service delivery, and inequitable health outcomes for Māori.

RACS joined its voice to leading academics in an editorial for Te Ara Tika o te hauora hapori – New Zealand Medical Journal and submission to Te Kahui Hauora Māori – National Hauora Commission outlining the evidence. Key points made were:
•    Ethnic health inequities in Aotearoa New Zealand are unjust and avoidable and it is our job as health professionals to use all tools at our disposal to intervene.
•    Ethnic health inequities cause more sickness, higher healthcare costs, and premature deaths—driving both direct and opportunity costs to taxpayers.
•    Ethnicity is a strong, evidence-based marker of health need in Aotearoa New Zealand and is superior to many other markers of need.
•    Using population patterns to assess risk is a core aspect of evidence-based medical practice.
•    The status quo is not a neutral starting point for resource allocation. It fails to address discrimination that already exists in our health system, which has a bias towards our dominant ethnicity.
•    Targeting by ethnicity—based on good-quality ethnicity data—is evidenced-based and leads to better allocation of healthcare resources.
•    Analyses should be used routinely to identify need, design health interventions, and monitor the effectiveness of the health system.

Read RACS submission.

Physician associates – Aotearoa New Zealand
RACS also wrote to the Hon. Dr. Shane Reti, Minister of Health, calling for a pause on plans to use physician associates to plug workforce gaps in Aotearoa New Zealand. This followed a joint letter from the Association of Salaried Medical Specialists (ASMS), the Resident Doctors Association and APEX (the union for allied scientific and technical health professionals), along with the Royal New Zealand College of General Practitioners, the College of Nurses Aotearoa (NZ) and the General Practice Owners Association, asking Dr Shane Reti to rethink plans to introduce the new category of healthcare worker.

Physician associates, also known as physician assistants or PAs, must be supervised by a doctor, but the supervision can be done at arm’s length and the supervising clinician does not have to be in the same room or even the same town. RACS says that raises questions about the quality of supervision and may compromise patient safety. RACS also questions the value of physician associates to an already stretched workforce, where doctors would be required to spend time providing training and oversight.

RACS urged the Minister of Health to carefully consider the role physician associates can play within the Aotearoa New Zealand healthcare system, saying there is a real need for regulatory clarity. It is crucial that we fully understand the implications of introducing new roles like physician associates before pushing ahead. There is growing disquiet overseas regarding the physician associate role, with several medical organisations in the United Kingdom raising concerns about patient safety, workforce shortages, and the lack of capacity for physician supervision and training.

The College asked Minister Reti to explore the option of expanding the use of nurse practitioners, with appropriate regulation, before considering the establishment of a regulatory body for physician associates. Mātanga Tapuhi nurse practitioners can work autonomously, have clinical education and training with a well-defined scope of practice, and are regulated by Te Kaunihera Tapuhi o Aotearoa - Nursing Council of New Zealand.

A RACS press release contributed to ongoing sector and media discussion of the regulation of physician associates.

Read RACS submission.

Nationwide governance for laboratories, pathology and histology in Aotearoa New Zealand

Te Whatu Ora – Health New Zealand sought our perspectives in a targeted consultation on a nationwide governance model to address issues around equity, consistency, and service sustainability for laboratory and pathology/histology services.

RACS suggested the creation of a Governance Group to design a service delivery model that:
•    delivers at a minimum equity for patients, regardless of who they are, where they live, and who orders their tests
•    ensures test results are available in a timely manner, noting delays for histology
•    recognises clinicians as the critical interface between patients and the health system
•    anticipates changing demographics and disease, patient and workforce needs, digital and technology, and integration of Artificial Intelligence
•    is sustainable in terms of future workforce, efficiency and environmental impact
•    reviews audits from laboratories to ensure that equity and sustainability, as well as quality and safety outcomes, are being delivered
•    reviews, consults and publicises ’choosing wisely’ with the aim of educating clinicians to reduce necessary and unuseful tests or test frequency
•    ensures key performance indicators (KPIs) are defined and consistently met.

RACS suggested the Governance Group take a clinical governance approach to design of a nationwide model for laboratory and pathology/histology services.
•    Clinicians should be involved at all stages of designing, implementing, and monitoring the system. Some critical decisions require clinical expertise and professional attention.
•    Contractual processes must include mandatory quality and safety standards and be designed to ensure sustained quality of care.
•    Design and implementation require particular attention to the patient experience and journey within the system—from clinician to laboratory to receipt of results from the clinician.
•    Clinicians should maintain an open professional culture and focus on professional values to deal with the inevitable challenges of changes within the system, particularly changes from public to private provision, or the reverse.
•    Education and training of the future pathology workforce should be considered.

Read the RACS submission.

Proposal to strengthen clinical leadership in Aotearoa New Zealand
Te Whatu Ora – Health New Zealand issued for consultation with its employees a proposal aimed at strengthening clinical leadership across the publicly funded health services.

Ros Pochin, Chair, Aotearoa New Zealand National Committee, wrote to the Chief Clinical Officer at Te Whatu Ora saying while RACS welcomes the commitment to enhancing clinical leadership, the current proposal risks undermining the quality of care and patient outcomes. Of particular concern is the reduction in Chief Medical Officer roles, and this being skewed to rural districts where significant health inequities already persist, including for Māori.

The timeline indicated a decision in early December 2024. RACS recommended suspending the process until a robust, evidence-based case for change is developed.

RACS advised that doctors need to be involved at all stages of designing a new clinical leadership structure. Some critical decisions require medical expertise and professional attention that may not be apparent from an operational perspective. Any new structure needs explicit mandatory quality and safety standards and guardrails to ensure sustained quality of care, with patient safety considered at every step of the change management process.

Read the RACS submission.

Aotearoa New Zealand submissions August to November 2024

1.    New Zealand Skin Cancer Primary Prevention and Early Detection Strategy
2.    Review of the Health & Disability Commissioner Act 1994 and Code
3.    Expedited Pathway for Vocational Registration in Aotearoa New Zealand
4.    Review of the End of Life Choice Act 2019 - Aotearoa New Zealand
5.    Anaesthetic Technician Proposed Scope of Practice and Competency Standards in  Aotearoa New Zealand
6.    A nationwide governance model for laboratory, pathology and histology services in Aotearoa New Zealand
7.    Needs-based Service Provision – Ethnicity is an evidence-based marker of need
8.    Regulation of Physician Associates in Aotearoa New Zealand
9.    Development of a new Hauora Māori Strategy for Aotearoa New Zealand
10.  Principles of the Treaty of Waitangi Bill - Aotearoa New Zealand
11.  Draft Suicide Prevention Plan 2025-2029 – Aotearoa New Zealand
12.  Proposal to strengthen clinical leadership in Aotearoa New Zealand