Primary care needs more than a new story

By Justin Butcher

Fresh thinking has a place in primary care. New ideas matter. Challenge can be healthy.

But primary care is too important to be reduced to branding, slogans, or simplistic claims about what should replace what.

Meaningful reform rather than rhetoric

If we are serious about improving access and sustainability, we need to stay focused on what actually helps general practice and the wider system work better. That includes the current advice to the health minister on the future of PHOs, the discussion about national targets, and the wider question of what kind of primary care system Aotearoa New Zealand needs next. The future role of PHOs is now part of active sector discussion, and Te Whatu Ora | Health New Zealand has been directed to work with the ministry and the primary care advisory group on a strategy for the future of PHOs and clinical alliances.

Those are not small issues. They go to the heart of how primary care is organised, what it is expected to deliver, and how much confidence practices can have that reform will be grounded in reality rather than rhetoric.

Supporting better care, not just better optics

The same applies to targets. The government has signalled a strong focus on timely access to primary care and announced consultation on a new target requiring more than 80 per cent of people to be able to see a primary care provider within one week, with implementation tied to 1 July 2026.

Targets can be useful, but only if they are meaningful and don’t encourage gaming.

If they are too blunt, or if they drive the wrong behaviour, they can create more problems than they solve. That is why the design of any access target matters. It needs to support better care, not just better optics.

The wider question is what kind of primary care system we are trying to build.

There is a lot of discussion at the moment about workforce, team-based care, and who can do what in different settings. That’s an important conversation. General practice needs strong multidisciplinary teams, and practices need options that reflect the reality of demand, workforce pressure and changing patient need.

That includes work under way around CPCTs, paramedics in primary care, and wider conversations about how team-based care can support access and continuity. It also includes a practical question that does not get enough attention: what makes sense to deliver closer to people through primary care, rather than leaving more and more pressure with hospital services?

Primary care built on trusted relationships and proven impact

In my view, that is where the conversation needs to sit.

Not on novelty for its own sake. Not on commentary from the sidelines. On what will genuinely help practices care for their communities well, and what will give the system more resilience over time.

Because anyone can promise a better model. The real test is whether they understand the pressures, the relationships, and the day-to-day realities well enough to make it work.

Primary care does not need more noise. It needs credibility, judgment, and practical improvement.

That also means being honest about what already exists. New structures can sound impressive. New entrants can make bold claims. But in primary care, credibility is not built through assertion alone. It is built through experience, trusted relationships, and the ability to work with practices and communities in ways that stand up in the real world.

That is why this moment requires careful judgement. Reform should be thoughtful. It should be tested against what general practice is already carrying. And it should be judged not by how confident it sounds, but by whether it will actually help deliver better care.

In the end, primary care will not be improved by whoever sounds most certain. It will be improved by what actually works for practices, patients and communities.