But Community Health Hubs will not form routinely on their own
New Zealand has a history of investing in innovative community health and integrated service delivery models, with some facilities that mimic the community hubs model already in place, but these have frequently been more rural settings to provide less acute care and reduce demand on hospitals. Hubs have sometimes emerged out of necessity, as happened in Christchurch when earthquakes decimated a significant amount of existing clinical space. It also occurred – briefly – in the late 2000s when some DHBs took the opportunity to drive investment in Integrated Family Health Centres.
This opportunity is different and requires a different approach: this model envisions community hubs that deliver primary and specialist care and incorporate virtual care models, providing a platform for an integrated health care experience where primary, specialist, and diagnostic care is more available to more people from one place.
Organised at scale with clear investment mechanisms, Community Health Hubs could also become recipients of private capital. But this will not happen without Government support – financial and non-financial. Systemic barriers, different and disconnected funding models, and the degree of risk mean community hubs are unlikely to naturally self-form at scale. In short, widespread progress is unlikely unless there is greater support for health and medical professionals to access the specialist funding, business development support, and property expertise needed.
Government can catalyse both Community Hub investment and formation
A workforce strategy that invests deliberately in community hubs, and capital planning and investment that makes them a priority will be key to their success, but Government support need not involve a large financial commitment. De-risking investment, channelling care funding into community hubs and providing comparatively small amounts of seed funding can have an outsized impact on hub formation. Reducing barriers to investment can draw in private investment and private capital – multiplying the impacts of investment. In practice, this can involve:
- Coordinating funding streams and providing incentives to collaborate: By providing the right structural, financial and professional incentives, government can encourage the spontaneous formation of Community Health Hubs. Models that coordinate funding streams and provide easier referral pathways can encourage clinicians to cooperate and form hubs. In the early-2000s, Quebec redesigned its health system with privately owned Network Clinics. Government coordinated funding streams and provided incentives to join group practices. For example, practitioners gained easier access to diagnostics via integrated technical platforms and referral pathways.
- Partnering with the private sector: Private sector input has been key to the success of almost all Community Health Hubs. For example, in Public Private Partnerships (PPPs), experienced finance and development partners work with clinical participants to build a facility that supports care integration and then manages the facility. Government can de-risk investment by coordinating existing expertise: PHOs, Māori and iwi investors, and private health providers already making efforts to form community hubs. Where this has been tried, both in New Zealand and overseas, the market response has been positive:
- In the UK’s Midlands Region, limited funding in new GP and hub facilities has helped to spark investment in primary care hubs.
- In the UK, PPPs fund 300 health facility properties in local communities, through which the NHS leases space to 1,300 providers.3
- Government supported, privately funded healthcare in Ireland has led to more than 14 primary and specialist care centres being constructed since 2016.
- Providing seed capital: Relatively small amounts of seed capital from government can catalyse investment. For example, in Australia, the Primary Care Infrastructure Grant provided about AU$200,000 to expand facilities and incentivise community hub style services.4 This relatively modest financial support broke down initial barriers, helping to establish over 60 Superclinics.
- Offering flexible buy-in options: Many clinicians are happy to use a simple leasing model to participate in a hub. But for those seeking facility ownership as a way of building wealth, a Private (developer)-Private (clinician owned / equity)-Public (supported) partnerships could be used to provide this option, which would also reduce the initial outlay required by other parties.
