The Role of the Health Workforce New Zealand



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Regional workforce development hubs


HWNZ set up regional workforce development hubs (formerly known as ‘training hubs’) in 2012. The hubs coordinate workforce development and training, optimising available resources from the four DHB regions (Northern, Midland, Central and South Island). The aim is to make the educational journeys of health professionals within and across these regions easier by reducing duplication and providing a consistent curriculum. Each hub is led by a regional director of workforce development.
The directors of workforce development work closely with various organisations involved in the hubs – including HWNZ, DHBs, education providers and professional associations. The directors work with the DHBs in regional service planning, and ensure that all HWNZ-funded trainees have a career plan and access to career guidance. More information can be found in the Career planning section of this report (page 26).
The initial focus of the hubs has been on standardising pre-vocational medical training. Other objectives include retention and recruitment to meet particular regional needs and the roll-out of training initiatives, such as the MCNZ’s PGY1 and PGY2 pre-vocational curriculum.
HWNZ acts as a resource for the hubs and guides the alignment of their activities with government, Ministry and HWNZ strategies for health. Examples of the hubs’ activities include:

coordinating clinical simulation training and sharing simulation resources across DHBs

developing a regional e-learning strategy to enable learning modules to be shared

introducing a Lippincott online evidence-based nursing procedure manual13

advanced care planning training for end-of-life care.


Career planning


HWNZ expects career plans to be in place for all the trainees it funds. Career plans provide guidance to help trainees plan and follow their career aspirations, and to identify the support they will need along the way.
Employers are expected to provide all HWNZ-funded trainees with career advice, pastoral care and a career plan that aligns individual aspirations with regional and national future workforce requirements.
A career plan identifies the skills and knowledge an individual needs to reach current and future goals, and sets out how these can be developed, including through:

formal and informal learning

coaching

mentoring

experience-based programmes.
Advice and career plan templates can be found at www.health.govt.nz. Labour market data aimed at helping medical undergraduates and resident medical officers choose a specialty are available at www.kiwihealthjobs.com, part of a joint project between HWNZ and DHB shared services organisations.


Removing barriers to innovation


The implementation of new and extended roles is sometimes hampered by regulatory or other constraints. The examples that follow describe ways in which barriers to innovation have been removed.

Clinical pharmacist prescriber


The new role of clinical pharmacist prescriber was developed by the Pharmacy Council with support from HWNZ. It provides experienced clinical pharmacists with an opportunity to register in a new advanced scope of practice, once they have completed specialised training and competency assessments.
Since July 2013, qualified clinical pharmacists have been able to work in a collaborative health care environment and prescribe medication to patients under the care of an integrated team. Based on the diagnosis of a medical practitioner, a pharmacist prescriber can, for example: assess the effectiveness of a patient’s current medicines; review and interpret test results; and make prescribing decisions to modify the dosage of an existing medicine.

Extending legal functions to a range of health practitioners


Historically, certain functions have been reserved in law for ‘medical practitioners’. For example, the Holidays Act 2003 specifies that only medical practitioners may provide a certificate as proof of illness. The Land Transport Act 1998 permits only medical practitioners and optometrists to provide reports on people who are unfit to drive.
These restrictions can create unnecessary delays and have cost implications. HWNZ has been working on legislative changes that widen the range of health practitioners who can undertake particular functions. These changes are expected to achieve:

more timely and effective treatment

better access to services

more flexible service delivery



better use of the skills of the wider workforce.


Funding


HWNZ provides funding for postgraduate training and education programmes to develop the health and disability workforce. This funding contributes towards the costs incurred by DHBs in providing training for medical and nursing graduates. HWNZ also funds DHBs to support Māori and Pacific trainees completing vocational training programmes.
Other organisations receive funding from HWNZ for the delivery of postgraduate education and training programmes. For example, the RNZCGP is funded to deliver the first year of the GPEP, as well as the employment of GPEP registrars.
HWNZ funding does not cover the total costs of training. The DHBs and other organisations that employ post-graduate health professionals must cover the additional costs.
New Zealand has traditionally made a higher investment in medical education than other health workforce development programmes. If we are to deliver affordable care according to new models of service delivery in future, a greater focus on other professions, may be required.
Notes follow on the various sectors of the health workforce (shown in Figure 2) for which HWNZ funds training.
Figure 2: Distribution of HWNZ funding, totalling more than $165 million1414


Non-vocational medical: this funding contributes towards DHBs’ delivery of PGY1 and PGY2 training programmes. This training is undertaken by graduates who have completed a six-year degree in medicine and are employed by a DHB.
HWNZ funding also covers the delivery of training programmes for doctors to obtain a Diploma in Paediatrics and a Diploma in Obstetrics and Gynaecology.
Vocational medical: the largest proportion of HWNZ funding is provided to the DHBs for vocational medical training programmes. The training is undertaken by registrars who have completed the PGY1 and PGY2 requirements and have enrolled in training programmes run by a medical college. Most vocational training programmes are funded by HWNZ and are typically delivered within the DHBs. HWNZ funding ranges from $42,518 to approximately $60,000 per FTE trainee a year.
GP training: HWNZ funds the GPEP programme, which is administered by the RNZCGP. Successful applicants to general practice vocational education programmes train under clinical supervision in accredited practices. These practices are located in urban and rural settings, to allow trainees to experience a variety of general practice environments before they qualify.
Postgraduate nursing: HWNZ funding for nursing programmes covers the postgraduate certificates and diplomas that qualify nurses for work in specialist areas, such as mental health. It is also available to applicants for a Master’s degree as a prerequisite for registration as a nurse practitioner.
Nurse Entry to Practice: the NCNZ approves and monitors NETP programmes under an agreement with HWNZ. NETP programmes are also delivered outside hospital settings in aged residential care facilities, primary health organisations and by Māori health providers.
Allied health: HWNZ funds training and education programmes for anaesthetic technicians, pharmacy internships, sonographers, radiation therapists, medical physicists, medical laboratory scientists, cervical cytologists and psychology internships.
Midwifery: HWNZ funding contributes towards the delivery of MFYP programmes, which provide a supportive, professional environment for midwifery graduates in their first year of practice. HWNZ also provides funding for postgraduate complex care training programmes, for midwives working in secondary and tertiary settings with women who have complex care needs.
HWNZ funding is provided to the Midwifery Rural Recruitment and Retention Service to support the recruitment of midwives to join or set up practices in rural areas experiencing a shortage of midwives (through grants for the establishment of lead maternity carer (LMC) practices).
Hauora Māori/Māori support: the Ministry of Health has put in place a number of initiatives to attract Māori into the workforce and to support ongoing Māori workforce development. The Māori Provider Development Scheme supports the development of the Māori health and disability provider sector to develop more effective health service provision.
HWNZ allocates funding for DHBs to provide mentoring, cultural supervision and cultural development activities to support Māori and Pacific trainees to complete vocational training programmes. The Hauora Māori training fund helps DHBs develop Māori staff in the non-regulated workforce. It provides access to training programmes to develop formal competencies for current roles and for career development opportunities.
Pacific support: HWNZ funds similar programmes to the Hauora Māori programmes to develop and extend the Pacific workforce. This includes, for example, the provision of scholarships for qualifications in psychology, psychotherapy, mental health nursing and counselling, which are covered by the Pacific Mental Health and Addictions Awards Scheme run by Le Va, a national provider for Pacific mental health and addiction workforce development.
Mental health: HWNZ allocates funding to support the development of the mental health and addictions workforce, including through post-entry clinical training for mental health nurses, as well as psychiatry and health psychology training. Workforce roles across the mental health continuum are represented in the programmes delivered, and postgraduate, undergraduate and support worker qualifications are included.
For example, HWNZ provides funding for Te Rau Matatini to deliver programmes for the Māori mental health and addictions workforce. This includes scholarships and bursaries, fostering Māori health leadership and professional development programmes, and supporting Māori nursing programmes.
Another example is Te Pou’s Skills Matter programmes for nurses and allied health professionals in the mental health and addiction sector, including social workers, occupational therapists, psychologists and addiction practitioners. Each year Te Pou funds more than 260 places across two broad themes identified in conjunction with HWNZ as having the highest need for workforce development.
Skills Matter supports new entrants into mental health and addiction to develop the specific skills required in this specialist field. The programmes are known as New Entry to Specialist Practice programmes. In addition, Te Pou supports existing practitioners to develop their advanced or specialist skills in cognitive behavioural therapy and clinical leadership in nursing practice programmes.

Allocation of the HWNZ funding pool


For transparency, accountability and contestability, HWNZ proposes to introduce a phased approach to the funding of educational and training providers, starting with the clinical vocational programmes provided by DHBs. Under this model, 70 percent of the total HWNZ funding pool for medical vocational training would be allocated to DHBs from the beginning of an academic year, for the delivery of programmes to specified types and numbers of medical vocational trainees.
A further 20 percent of the total funding pool would be allocated part way through the year, once it was clear that agreed targets had been satisfactorily met. The final 10 percent in the pool would be available for distribution to DHBs towards the end of the year for programmes and initiatives that were demonstrably aligned with HWNZ’s funding priorities.
The new funding model will be expanded to cover the other programmes for which HWNZ provides funding once it is embedded in clinical vocational training.


Appendices

Appendix 1: Summarised recommendations of Workforce Service Forecasts


To produce its Forecasts, HWNZ commissioned independent reports from small groups of clinicians. The Forecasts build pictures of the future health workforce in key areas such as aged care, diabetes and mental health.
This appendix summarises the 13 Forecasts published to date. The reports in full can be found at www.health.govt.nz. Reviews of the dermatology and plastic surgery workforces are due to be released later this year.

Aged care | February 2011


This report looked at factors that impact on the health of older people, the relationships between these factors and how to reduce an unsustainable increase in demand for aged residential care and hospital admissions among older people.
Recommendations included:

strengthening preventive and rehabilitative care

greater focus on clinicians working in community and primary care settings.

Anaesthesia | March 2011


This report looked at how to sustain the anaesthesia workforce in coming decades. It identified workforce shortages in some regions.
Recommendations included:

anesthetists working across multiple worksites within a region

improvements to theatre productivity

making more training positions available in smaller hospitals.



Diabetes | May 2011


This report looked at how to respond to the rise in diabetes across all age groups. Appropriate expertise will be increasingly required to meet the complex demands of those with all types of diabetes.
Recommendations included:

more mobile health care services

care being provided remotely via electronic communications

primary health services identifying and managing high-risk individuals

specialist interdisciplinary teams focusing on patients with more complex needs.

Eye health | December 2010


This report looked at how eye health services could be integrated at the primary, secondary and tertiary level, with the consumer at the centre of the pathway.
Recommendations included:

a community model of care

more efficient use of the various eye health workforces.
Since this Forecast was completed, changes to the Medicines Act 1981 allow optometrists to be authorised prescribers. Optometrists are now able to diagnose and manage glaucoma in the community, and prescribe medication.

Gastroenterology | March 2011


This report looked at how people affected by gastroenterology health issues can be cared for by a well- prepared and responsive gastroenterology workforce.
Recommendations included:

mobile clinics and teams for rural areas and smaller centres

health professionals working across primary, secondary and tertiary settings

expansion of the nurse specialist role, a role already in place in some DHBs.



Māori health | August 2013


This report, by Reanga Consultancy New Zealand Ltd, looked at how to deliver health equality for Māori and a workforce that demonstrates cultural competence, and ensure that clinical and cultural competencies are well integrated.
Recommendations included:

fostering recognition that clinical and cultural competence are inseparable

greater integration of Māori cultural competence, to enhance Māori engagement and access to health care

the establishment of a Māori workforce development centre of excellence.


The recommendations in the report represent the views of the steering group and the wider Māori workforce sector. The report should be considered as part of a number of sector views and publications that propose delivering better health care and preparing a workforce that demonstrates cultural competence.
HWNZ and the Ministry of Health are working to enhance coordination of Māori workforce activities with a view to increasing the proportion of Māori and Pacific peoples in the health workforce.

Maternity | December 2012


This report looked at how the maternity sector should look in the future. The working group found that developments were needed in four key areas of maternity care:

improving readiness for children

proactive planning and action from confirmation of pregnancy

safe, effective and seamless care through pregnancy, birth and infancy

developing capable parents and safe environments for infant and child development.
This report has been received by HWNZ to generate discussion and debate around key issues in the future of reproductive health, women’s health, family planning and early childhood.

Mental health and addiction | June 2011


This report proposed a shift in focus towards primary and integrated care and preventive interventions, building on the ‘Better, Sooner, More Convenient’ primary health care policy.15
Recommendations included:

improving mental health and addiction support services so that they provide better access for those with unmet mental health needs, including the elderly and at-risk young people

developing mental health care skills in primary care teams.
This report sits alongside a number of other initiatives across the Ministry and the mental health and addictions sector, as part of Rising to the Challenge.16
HWNZ and the Ministry have established an action plan to implement recommendations from the Workforce Service Forecast and Rising to the Challenge.

Musculoskeletal | March 2011


This report looked at how to improve efficiency and effectiveness in musculoskeletal care.
Recommendations included:

making managing musculoskeletal disorders a core competency for GPs and physiotherapists

developing a workforce skilled in caring for older people

placing more emphasis on rehabilitation and self-care.


See notes on the Rehabilitation Forecast for related recommendations.

Pacific health | January 2013


This report looked at ways to increase the number of Pacific peoples in the health workforce and improve outcomes for Pacific patients.
Recommendations included:

implementing an improved model of care

developing leadership and coordination to affect this new model

addressing issues in the training and development of the Pacific workforce

focusing on the Auckland region, home to seven in 10 of the Pacific population.
Some recommendations are being addressed through the Ministry of Health’s Pacific work programme. HWNZ and the Ministry have established a working group with key stakeholders to address several of the remaining recommendations.

Palliative care | February 2011


This report looked at the provision of palliative care in the community, hospitals, residential care and hospices.
Recommendations included:

developing regional clinical networks that link locally, regionally and nationally to meet future palliative care needs

aiming to give people requiring palliative care better health and disability services closer to home.

Rehabilitation | December 2011


This report looked at support systems for ill or injured patients on treatment pathways from acute care through to their return to their communities and homes after illness or injury.
Recommendations included:

increasing provision of rehabilitation training

improving care coordination once patients have been discharged from hospital. See notes on the Musculoskeletal Forecast for related recommendations.

Youth health | April 2011


This report looked at how to deliver health services that are youth-centred and mainly delivered in primary care settings.
Recommendations included:

more workforce training in youth health

better monitoring of young people’s needs

more youth-centred services to increase access for vulnerable and at-risk young people.




Appendix 2: Voluntary Bonding Scheme maps


Figure 3: Medical hard-to-staff communities 2015


Figure 4 Nursing hard-to-staff communities 2015


Figure 5: Midwifery hard-to-staff communities 2015

Included, but not marked on the map, are Ashburton, Darfield and the Hurunui region in the South Island and Taumarunui, Tokoroa, Huntly, Thames, Coromandel and the Taupō region in the North Island.





1 Statistics New Zealand. 2012. National Population Projections: 2011(base)–2061. Wellington: Statistics New Zealand.

2 OECD Health Data 2013.

3 Ministerial Review Group. 2009. Meeting the Challenge. Wellington: Ministerial Review Group.

4 Ibid, page 38.

5 More information on workforce demographics can be found in The Health of the Health Workforce 2013/14.

6 Ibid.

7 Ministry of Health. 2012. Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012–2017. Wellington: Ministry of Health.

8 Ministerial Task Group on Clinical Leadership. 2009. In Good Hands: Transforming clinical governance in New Zealand. Wellington: Ministry of Health.

9 BERL Economics. 2014. Health and Disability Kaiāwhina Worker Workforce 2013 Profile, for Careerforce. Wellington: Business and Economic Research Ltd.

10 Using the Australian and New Zealand Standard Classification of Occupations 2006.

11 BERL Economics. 2014. Health and Disability Kaiāwhina Worker Workforce 2013 Profile, for Careerforce. Wellington: Business and Economic Research Ltd.

12 Statistics New Zealand. 2007. Disability Survey 2006. Wellington: Statistics New Zealand.

13 ‘Lippincott’ is a detailed procedural manual for nurses.

14 This does not include funding for the Voluntary Bonding Scheme ($6.1 million in the 2013–2014 financial year).

15 A government initiative to deliver a more personalised health care system that provides services closer to home.

16 Ministry of Health. 2012. Rising to the Challenge: The mental health and addiction service development plan 2012–2017. Wellington: Ministry of Health.

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