11 Primary health care...11 Primary health care This workforce grouping, which icorponrates several community-based allied health workers, is included in this report to reflect the

The New Zealand Health Workforce A stocktake of capacity and issues 2001 89

11 Primary health care

This workforce grouping which incorporates several community-based allied health workers isincluded in this report to reflect the strategic directions in New Zealand health care The PrimaryHealth Care Strategy released in February 2001 describes primary health care as

essential health care based on practical scientifically sound culturally appropriate and sociallyacceptable methods that isbull universally accessible to people in the communitybull involves community participationbull integral to and a central function of New Zealandrsquos health systembull the first level of contact with our health system (Ministry of Health 2001h)

111 The primary health care workforce

The health worker groups described in this section provide personal care in the communitythough many of these groups also provide care in an acute carehospital setting The rationalefor including them here is that at least part of each workforce group is accessible to people at aprimary level via direct contact

The workforce covered by this definition crosses boundaries with other sector groups such asthe public health mental health and disability sectors A number of workforce groups work inthe primary health care setting but are not included here because they are described elsewhere inthe report For example counsellors are described in the lsquoMental Healthrsquo section and Maumlori andPacific community health workers have been described in the lsquoPublic Healthrsquo section

Nine health professional groups are included in this section comprising approximately 15312workers (Table 111) All of these workforce groups are at least partly based in a primary healthcare setting although three of the nine35 have a large proportion working in hospitals A very lowpercentage of these groups are Maumlori and Pacific people36 There is good information availableabout this group as they are mainly regulated and eight of the nine groups conduct annualsurveys

There are approximately 11881 health workers in the primary health care sector (plus anunknown number of community health workers) (Table 111) This is total number of health workers in a community setting which is described by Table 92 (this table

not equivalent to the

35 Dietitians midwives and physiotherapists36 However Maumlori and Pacific community workers are not included here

includes secondary workers)

90 The New Zealand Health Workforce A stocktake of capacity and issues 2001

Table 111 Characteristics of the primary health care workforce

Workforce group Estimatednumber of total

workforcegroup

Maumlori

Pacific

Per100000

population

Estimatednumber in a

primary healthcare setting

Per100000

population

Sourcedate

Chiropractors 218 07 00 6 218 6 APC 00

Dietitians 343 16 00 9 47 1 APC 00

General practitioners and other primaryhealth care medical practitioners

3396 20 10 89 3396 89 APC 00

Midwives 2081 34 17 55 978 26 APC 00

Osteopaths 318 8 318 8 Census 96

Pharmacists 2831 07 02 75 1699 45 Reg active 00 andSurvey 95

Physiotherapists 2500 07 01 66 1283 34 APC 00

Podiatrists 240 16 00 6 199 5 APC 00

Primary health care nurses 3385 89 3385 89 APC 00

Workforce groups not included in this section of thereport but which have a component working in theprimary health care sector

Registered psychologists 13 00 358 9 APC 00

Community health workers

Total 15312 17 01 403 11881 313

Table 92 lsquoWorkforce delivering services in a community settingrsquo gives a better indication of the numbers of workers in a community setting

112 Chiropractors

Chiropractors work as autonomous primary-contact health workers They diagnose and treatpatients whose health problems are associated with the bodyrsquos muscular nervous and skeletalsystems especially the spine Chiropractors believe interference with these systems impairsnormal functions and lowers resistance to disease They also hold that spinal or vertebraldysfunction alters many important body functions by affecting the nervous system and thatskeletal imbalance through joint or articular dysfunction especially in the spine can cause painChiropractors use drugless and non-surgical health treatments Some chiropractors specialise insports injuries neurology orthopaedics nutrition internal disorders or diagnostic imaging

1121 Capacity

Chiropractors purchased 218 APCs in 2000 which is almost twice as many as in 1990(Table 112) There are 15 Maumlori and no Pacific chiropractors All chiropractors work in thecommunity mostly in private practice

Table 112 Characteristics of the chiropractor workforce

Number withan APC

Number whoresponded to survey

Male

Female

Maumlori

Pacific

Working inthe community

1990 110 105 89 11 100

1991 07 0

2000 218 139 727 273 07 0 100

change(number)

982 62 392 60

Source APC surveys 1990 1991 and 2000 The response rate for the 2000 survey was 638 This limits the accuracy of thegender and ethnicity data


1122 Education and training

Chiropractors must complete two-thirds of a Bachelor of Science in a health sciences field beforestarting a Bachelor of Science (Chiropractor) These degrees may then be completed at the sametime Postgraduate studies are also available The clinical component is two years of full-timestudy The pre-clinical component is part time at the New Zealand School of Chiropractic Thismeans that most pre-clinical students are studying concurrently at a university and the NewZealand School of Chiropractic Each graduate will be fully recognised with double bachelordegrees

1123 Specific regulation and interest groups

Chiropractors must be registered with the Chiropractic Board The New Zealand ChiropractorsrsquoAssociation also represents chiropractorsrsquo interests

1124 Key issues

No submissions were received

113 Dietitians

Dietitians work with people to help them improve their health through nutrition Dietitians plancommunicate implement and evaluate effective nutritional management strategies based oncurrent scientific practice to keep the public and individuals informed about food and nutrition

Clinical dietitians (based in hospitals) community dietitians (based in the wider community) andprivate-practice dietitians may see patients independently or have them referred by other healthprofessionals (for example medical practitioners) They work with patients to gather informationabout their needs in a variety of settings educate patients about special diets and prescribeartificial nutrition for unconscious patients Clinical dietitians present research and case studies atseminars

A public health dietitian works in population-based health services gathering information aboutnutritional needs for public health initiatives (ranging from food security through to communitydevelopmenthealth promotion initiatives) This may lead to the development of informationand activities to resource awareness campaigns or work with community groups

A food service dietitian manages a food service plans menus plans and designs kitchens advisesand educates other health professionals acts as a consultant to the food industry and designs andimplements food safety policies

Dietitians also provide information for non-governmental agencies (such as the New ZealandHeart Foundation and the Cancer Society) nutritional information for food industryorganisations such as the New Zealand Dairy Board and nutritional information to sports andfitness centres and eacutelite athletes (professional and amateur) Some dietitians work with drugcompanies to market specialist nutritional37

37 Source Career Services 2001


1131 Capacity

Dietitians purchased 343 APCs in 2000 and the majority of them work for a DHB in a hospitalsetting Only 137 percent of those responding to the survey worked in a private practice setting(Table 113)

Table 113 Characteristics of dietitians in the workforce

Number withan APC


Male

Female

Maumlori

Pacific

Working inprivate practice

1990 290 249 04 996 5

1991

2000 343 248 24 976 16 137

change(number) 183 -05 610 16 224

Source APC surveys 199091 and 2000 The response rate for the 2000 survey was 723 This limits the accuracy of thegender and ethnicity data


Dietitians require a University of Otago Bachelor of Science (Human Nutrition) or a Bachelor ofConsumer and Applied Sciences (BCApSc) majoring in human nutrition and food servicemanagement followed by a Postgraduate Diploma in Dietetics This postgraduate diploma isoffered by distance teaching Dietitians can and do undertake further postgraduate studies suchas Master in Science Master in Public Health PhDs qualifications in sports nutrition and thePostgraduate Diploma in Community Nutrition

Currently places are held for all eligible Maumlori candidates for the Postgraduate Diploma inDietetics (the qualification leading to registration)

Table 114 Nutrition related training available in New Zealand

Undergraduate and postgraduate Short courses and single units

Massey University ndash Palmerston North CampusBachelor of Science (Human Nutrition) or (with honours)

Graduate Diploma in Science (Human Nutrition)

Master of Science (Nutritional Science)

University of OtagoBachelor of Arts (Human Nutrition)

Bachelor of Consumer and Applied Sciences (Human Nutrition) and (withhonours)

Bachelor of Science (Human Nutrition) and (with honours)

Master of Consumer and Applied Sciences (Human Nutrition)

Postgraduate Diploma in Consumer and Applied Sciences (HumanNutrition)

Postgraduate Diploma in Dietetics

Postgraduate Diploma in Science (Community Nutrition)

Postgraduate Diploma in Science (Human Nutrition)

The Open Polytechnic of NZFood and Nutrition

University of AucklandStudy in Nutrition

University of OtagoStudy in Community Nutrition

Study in Dietetics

Study in Human Nutrition



To practise in New Zealand dietitians must be registered with the New Zealand Dietitiansrsquo BoardThe New Zealand Dietetic Association Inc represents the interests of this workforce group

1134 Key issues38

Public health and primary health careWith the current emphasis on public health and prevention of disease there is increasingopportunity for dietitians to work in the primary health care and public health sectors The shift toprimary health care settings generally ndash including to community care for older people and mentalhealth services ndash will increase the demand for dietitians practising in the community There areissues around remuneration models which may affect the degree to which this shift occurs

It is currently reported that the workforce is insufficient to ensure optimal nutrition care in manyservice areas

The ethnic composition of the dietetic workforce is also of concern particularly as it does notreflect population groups with the highest level of need The number of Maumlori and Pacificdietitians in recent years has grown significantly but there is a need to train more

Appropriate usageThere are opportunities for more appropriate utilisation of dietitians for patients with acutenutrition needs There is some concern about the standard of nutrition in places of residentialcare for older people

The complexity of clinical work is increasing to provide for nutritional interventions and supportsuch as home-based enteral feeding and total parenteral nutrition therapy given in hospital and inthe community

Recruitment and retention in hospitalsSeveral DHBs report difficulties in recruiting and retaining skilled and experienced dietitiansLow salaries in public hospitals student loans and lack of professional developmentopportunities contribute to recruitment and retention problems particularly of experiencedpersonnel

Specialist services for people with diabetesThe Auckland Diabetes Centre reports an insufficient specialist workforce to ensure adequateaccess to specialist diabetes services across New Zealand including a reported lack of availabledietitians with diabetes expertise39

38 Sources include submissions from the New Zealand Dietetic Association Incorporated and the Dietitians Board39 Source Submission from the New Zealand Dietetic Association Incorporated


Generalist versus specialistTo ensure that people living outside larger centres are provided with adequate services thedietitian workforce needs to have specialists skills for some districts and generalists skills inothers

Training and educationA particular issue for the University of Otago training dietitians is the cost of clinical accessrequired by DHBs This has the effect of limiting studentsrsquo clinical experience in health serviceenvironments

114 General practitioners

A general practitioner is an appropriately qualified medical graduate who has particular knowledgeand skills to provide personal family whaumlnau and community orientated comprehensive primarycare that continues over time is anticipatory as well as responsive and is not limited by the age sexrace religion or social circumstances of patients nor by their physical or mental states40

General practitioners (GPs) are medical practitioners who provide ongoing medical services forindividuals and families in the community including examining diagnosing and treating patientsproviding screening and prevention services and health education and health promotion Theyalso provide management within the community for many long-term chronic conditions and areincreasingly involved in mental health sexual health services school-based clinics and hospicecare GPs also have a role in referring patients to funded health services including allied healthprofessionals specialist medical practitioners andor hospital services

The GPrsquos workplace is usually a building owned or leased by a group of self-employed GPs andbased in the community A new initiative for GPs has been the introduction of budget holdingfor managing pharmaceuticals and laboratory tests leading to savings in the cost of these items tothe New Zealand government

Not all GPs are full time and self-employed and an increasing number are locums part time andsalaried (RNZCGP submission)

1141 Capacity

The 2000 APC survey reports that 39 percent of the medical workforce work mainly as GPs or inother primary care capacities There were 2701 GPs in 2000 and 695 other primary care medicalpractitioners Sixty-three percent of GPs are male compared to a total medical workforceaverage of 66 percent The 63 Maumlori GPs comprise 2 percent of the GP workforce and the27 Pacific GPs comprise 08 percent of the workforce (MCNZ 2000b)

40 URL httpwwwrnzcgporgnz 2001


There has been a cumulative decrease of 5 percent of active doctors identifying general practiceas their main work site between 1995 and 2000 and a sharp increase in the number identifying asprimary care not GP This could be attributed to form changes making options more visible butcould also reflect an increase in the number of GPs moving into sub-specialties such asappearance medicine sports medicine and accident and emergency medicine (RNZCGPsubmission)

The RNZCGP membership survey 2000 found that 18 percent of its members work part time ingeneral practice (RNZCGP 2002)

While approximately 66 percent of medical practitioners in 2000 were trained in New Zealandonly 49 percent of the RNZCGP membership41 graduated in New Zealand

1142 Education training and regulation

GPs must complete two full years of appropriate registered medical officer experience and maythen choose to participate in the General Practice Education Programme to gain vocationalregistration

To practise independently GPs need vocational registration from the Medical Council They aresupervised by a registered GP until they have completed the Fellowship requirements of theRNZCGP which may require participation in Stage 1 of the General Practice Educationprogramme They may then apply to the Medical Council for registration

1143 Key issues42

Increasing demandGPs predict that future demographic and disease profiles43 will necessitate longer consultationsIncreasing public expectations and lower thresholds for health actions are also likely to affect thistrend This suggests that in future GPs will be looking after a smaller number of patients thanthey currently manage The RNZCGP also reports that increasing numbers of GPs are optingfor part-time general practice as they take on academic management and other non-clinical rolesGPs are also increasingly moving into sub-specialties such as appearance medicine sportsmedicine and accident and emergency medicine Their roles are expanding beyond primary careinto secondary care and there is increasing devolution of hospital-based care to GPs All thesefactors are likely to increase the demand for GPs

41 The RNZCGP membership includes more than 92 of practising GPs42 Source Submission to HWAC from the RNZCGP43 As discussed in Part I of this report demographic changes such as an ageing population coupled with a predicted increase in

the prevalence of diseases such as diabetes and mental illness will place a greater demand on general practice services in theforeseeable future


DistributionA shortage of GPs in rural areas and more deprived urban areas has led to overwork which inturn has contributed to further shortages The RNZCGP reports that there is a lsquocrisis in the ruralGP workforce evident In the morale professional and social support available to and incomeof rural practitionersrsquo44

The CTA has initiated funding of placements for postgraduate year two medical practitioners inrural practices so that these medical practitioners gain an appreciation and understanding of ruralpractice The aim is to have rural general practice recognised as a rewarding career opportunity

Recruitment and retentionGeneral practice faces significant challenges in recruiting and retaining medical graduatesSurveys of Auckland and Christchurch Medical School students (Gill et al 2001) found that themajority expressed a desire to work in the higher-paid clinical specialities rather than generalpractice Student debt was reported as contributing to this choice in addition to contributing tothe choice by some graduates to go overseas

The RNZCGP reports evidence of an increasing reluctance to enter general practice or to stay ingeneral practice due to heavy workloads concerns about litigation falling remuneration andincreasing compliance tasks and costs

Although the CTA has funded 10 additional places the RNZCGP believes that a lack of fundedplaces on the General Practice Education Programme continues to influence poor recruitmentrates

Maumlori and Pacific peoplesThere is a shortage of Maumlori and Pacific medical practitioners and the RNZCGP reports thatinitiatives are urgently needed to encourage Maumlori and Pacific people to undertake GP trainingand to support them once training is complete One such initiative is the Maumlori developmentposition within the College which has been funded by the CTA

Maternity carePartly due to funding mechanism changes and the structure of maternity care there has been arapid decline in the number of GPs practising or training in intrapartum obstetrics TheRNZCGP reports that this has had effects on practitioner workloads particularly in ruralpractices and on womenrsquos ability to access GP obstetricians

44 Submission to HWAC from the RNZCGP


115 Midwives

The midwife works in partnership with women on her or his own professional responsibility to givewomen the necessary support care and advice during pregnancy labour and the postpartum periodto facilitate births and to provide care for the newborn This care includes promoting and supportingthe normal childbirth process identifying complications in mother and baby accessing appropriatemedical assistance and implementing emergency measures as necessary Midwives have an importantrole in health and wellness promotion and education for the woman her family and the communityMidwifery practice involves informing and preparing the women and her family for pregnancy birthbreastfeeding and parenthood and extends to certain areas of womenrsquos health family planning andinfant wellbeing

The midwife may practice in any setting including the home the community hospitals clinics healthunits or in any other service45

The Nurses Amendment Act 1990 reintroduced the ability of midwives to provide maternity careto women giving birth without the need for medical oversight Midwives were also given thepower to prescribe as part of maternity care to order laboratory tests and to claim maternitybenefit payments at the same rate as GPs

1151 Capacity

Of the 3618 registered midwives (Table 115) in New Zealand 2081 were reported as active in2000 Of these 465 percent were working in a lead maternity care (LMC) capacity46

Table 115 Characteristics of midwives in the workforce 2000

Number with midwiferyqualifications

Numberactive

Male

Female

Maumlori

Pacific

Working inLMC capacity

3618 2081 02 988 34 17 465

Source APC surveys 2000


To work as a midwife it is necessary to hold a Bachelor of Midwifery degree Registered nursesmay complete a shortened course to obtain this Midwifery courses were offered at fiveeducational institutions in 2000

45 New Zealand College of Midwives submission46 The lead maternity care giver takes responsibility for the care provided to the woman throughout her pregnancy and

postpartum period including the management of labour and birth


Table 116 Midwifery training available in New Zealand

Undergraduate Graduate and postgraduate Single unit and short courses

Auckland University ofTechnologyBachelor of Health Science(Midwifery)

Christchurch PolytechnicInstitute of TechnologyBachelor of Midwifery

Massey UniversityBachelor of Arts including withHonours (Midwifery)

Otago PolytechnicBachelor of Midwifery

Bachelor of Midwifery for RegisteredMidwives

Bachelor of Midwifery for RegisteredNurses

Waikato Institution of TechnologyBachelor of Midwifery

Auckland University ofTechnologyPostgraduate Certificate in HealthScience (Midwifery)

Massey UniversityMaster of Arts (Midwifery)

Postgraduate Certificate inMidwifery

Postgraduate Diploma in Midwifery

Otago PolytechnicMaster of Midwifery

Postgraduate Certificate inMidwifery Practice


Victoria University of WellingtonMaster of Arts (Nursing orMidwifery)

Aoraki PolytechnicCertificate in ChildbirthEducation

Victoria University ofWellingtonStudy in Nursing and Midwifery


In order to practise as a midwife midwives must be registered with the New Zealand NursingCouncil and hold a current APC

1154 Key issues47

RecruitmentSeveral DHBs reported difficulties with recruitment and retention of skilled and experiencedmidwives Many midwives prefer not to work for hospitals where the skill mix and staff salariesare not satisfactory

StabilityMidwives now provide 70 percent of the LMC maternity services and the service is primarilybased in the community Hospitals also require midwives to be employed to provide coreservices in both primary units and secondary maternity services Arrangements related tocontracting and funding maternity services have gone through a number of changes over the lastdecade As the predominant providers midwives need some stability to their funding and servicerequirements to be able to continue with this level of service Hospital restructuring hasparticularly affected leadership capabilities and professional development for the midwives theyemploy

47 Source Submissions to HWAC from the College of Midwives


Midwives in rural communitiesIn rural communities midwives are often the only health professional providing maternity careSupport for rural midwives is a priority to ensure a stable rural service

Maumlori maternity servicesThere is a significant demand from Maumlori women and whaumlnau for Maumlori midwives Midwiferydoes attract Maumlori applicants and since the introduction of direct-entry midwifery some 18 to 20percent of the graduates have been Maumlori The New Zealand College of Midwives reports thatretaining Maumlori midwife graduates is problematic as they are under pressure to provide extensiveservices beyond their role as midwife and as a result burnout is common

Ageing workforceThe average age of midwives is 44 the average age of student midwives is 33

116 Osteopaths

Osteopaths treat disorders of the body by manipulating the spine muscles bones and jointsThey aim to relieve pain and improve the function of the body They diagnose problems treatmuscles bones and joints by using movements advise patients on exercises posture and lifestylemay refer patients to other specialists for treatment if necessary and sometimes carry outworkplace assessments for occupational overuse patients or for other workplace injuriesOsteopaths take a whole-person approach to care They look for underlying causes for diseasenot only treating symptoms48

1161 Capacity

There is no recent information about the numbers of osteopaths practising in New ZealandHowever 318 individuals identified themselves as osteopaths in the 1996 census (Table 117)Approximately two-thirds were men and 87 percent were self-employed

Table 117 Characteristics of osteopaths in the workforce 1996

Number identified inthe 1996 census

Male

Female

Self-employed

318 67 33 87

Source Statistics New Zealand Census 1996

48 Source wwwosteopathconz



Osteopaths complete a five-year double-degree training programme Members of the NewZealand Register of Osteopaths Inc (NZRO) usually train at a recognised institution in the UKor Australia The osteopathic curriculum is medically broad-based It includes comprehensivetraining in the musculoskeletal system and use of manipulation

Currently there is no training available in New Zealand


Osteopaths are not regulated The International Society of Osteopathic Practice (ISOP) andNZRO are two groups representing the interests of osteopaths

1164 Key issues49

Submissions recommended that the osteopathy profession be regulated under the proposedHealth Practitionerrsquos Competence Assurance Bill

117 Pharmacists

Pharmacy is a specialised health science concerned with the preparation of medicines and withpatient-orientated activities to improve patient health outcomes through encouraging medicinesto be prescribed and administered effectively safely and cost-efficiently There are four maincategories (clinical community hospital and industry) and there are three levels of workforcewithin these settings Pharmacists pharmacy technicians and pharmacy assistants all havespecialised roles This analysis focuses on pharmacists

Clinical pharmacyThese pharmacists work independently or are employed by primary care organisations Theyundertake a range of activities to encourage safe effective and cost-efficient prescribing andmedicine administration

Community pharmacyThere are over 900 pharmacies in the community in New Zealand which dispense prescriptionsor pharmacy-related products The community pharmacy also provides a range of clinicalpharmacy services including patient counselling on the optimal use of their medication andliaison with prescribers

49 Source Submission to HWAC from UNITEC


Hospital pharmacyAll the major hospitals and some of the smaller hospitals in New Zealand have a pharmacydepartment which looks after the pharmaceutical needs of patients in the care of the hospitalThe hospital pharmacy also provides clinical pharmacy services and information on drugs andmedicines to medical practitioners and nurses and makes specialised medicines for particularpatients

IndustryA small proportion of pharmacists are employed in the pharmaceutical industry They work in arange of roles including general management marketing sales regulatory affairs productformulation medical information and management of clinical trials

1171 Capacity

There were 3774 pharmacists registered in 2000 Approximately three-quarters were active and20 percent of these work for fewer than 10 hours per week Sixty percent were working incommunity pharmacies (Table 118) In 1995 approximately half of all pharmacists were maleand there were 26 Maumlori pharmacists comprising 07 percent of the workforce

Table 118 Characteristics of pharmacists

Number ofregistered

pharmacists

insurvey

data 1995

Estimated number ofactive pharmacists in

New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89

Source APC surveys 1990 and 2000 and Pharmaceutical Society of New Zealand surveys 1995

The University of Otago and the Pharmaceutical Society of New Zealand undertook a workforce survey of pharmacists in1995 It had a 928 response rate but only 698 of the survey forms were useable


Pharmacists require a university degree and practical training whereas pharmacy technicians andassistants can either train on the job and earn while gaining their qualifications or gain aqualification through full-time study in a variety of settings


Table 119 Pharmacy training available in New Zealand

Undergraduate and postgraduate Technician and assistant programmes

University of OtagoBachelor of Pharmacy

Master of Clinical Pharmacy and of Pharmacy

Postgraduate Certificate in Pharmacy

Postgraduate Diploma in Clinical Pharmacy

University of AucklandDiploma in Pharmacy Practice

Bachelor of Pharmacy

Master of Pharmacy Practice

Academy GroupNational Certificate in Pharmacy (Assistant)

Auckland University of TechnologyCertificate in Pharmacy (Technician)

Bay of Plenty PolytechnicNational Certificate in Pharmacy (Assistant)

Southern Institute of TechnologyNational Certificate Pharmacy (Assistant)

The Open Polytechnic of NZNational Certificate in Pharmacy (Assistant)

National Certificate in Pharmacy (Technician)

The College of Pharmacists is also a major provider of postgraduate continuing educationprogrammes The Membership Programme requires 400 hours of study and the FellowshipProgramme requires 2000 hours of study


The Pharmacy Act 1970 provides for the registration of all pharmacists and all pharmacists mustbe members of the Pharmaceutical Society of New Zealand

Pharmacy technicians must hold a national certificate recognised by the Pharmaceutical Societyof New Zealand This certificate is a registered qualification of the NZQA

1174 Interest and related groups

These include the

bull Pharmaceutical Society of New Zealand ndash the statutory registration body for allpharmacists responsible for ensuring that pharmacists and pharmacies are registered andfor promoting quality in the profession of pharmacy

bull New Zealand College of Pharmacists

bull New Zealand Pharmacy Education and Research Foundation (NZPERF) ndash established in1967 as a charitable trust for the benefit of the pharmacy profession

bull Pharmacy Defence Association ndash formed to protect the interests of pharmacists with itsmain aim to support individual pharmacists as well as the good name of pharmacy as aprofessional group

bull New Zealand Hospital Pharmacistsrsquo Association (NZHPA) ndash formed in 1952 but nowknown as the New Zealand HealthCare Pharmacistsrsquo Association membership is open toall pharmacists and pharmacy technicians involved in the provision of health care

bull Pharmacy Industry Training Organisation

bull Pharmacy Guild of New Zealand


1175 Key issues50

ShortagesSeveral DHBs have reported shortages of pharmacists There are anecdotal reports of shortagesin both hospitals and community pharmacies based on the number of vacancies ThePharmaceutical Society of New Zealand Workforce Survey in 1995 found that 24 percent ofpharmacies employed only one full-time pharmacist This leads to difficulties when locums arescarce Shortages are also reported internationally in the US UK and Australia

Changing demandClinical pharmacy roles in the primary sector are on the increase

MoraleHospital pharmacies report low morale due to loss of experienced and specialist pharmacistsbeing replaced by new graduates lack of time to fulfil clinical pharmacy functions and lowersalaries than are available in the primary health care sector

Lack of diversityConcerns were raised by both the Pharmaceutical Society and Pharmacy Guild about thedemographic profile of pharmacists which remains predominately EuropeanPaumlkehauml despiteefforts to recruit more Maumlori and Pacific people

Lack of strategy planning or statisticsThe Pharmaceutical Society of New Zealand is concerned that workforce development has beenhindered by a lack of long-term strategy development They are also concerned about a lack ofclarity and certainty about the roles (and funding) of pharmacists in meeting the objectives of theNew Zealand Health Strategy Apart from a survey last conducted in 1995 information is notcollected on gender ethnicity workplace setting or number of hours worked nor are there anydata on the number of pharmacy technicians and assistants

50 Sources Submissions from the Pharmaceutical Society of New Zealand and the Pharmacy Guild of New Zealand


118 Physiotherapists

Physiotherapists work in partnership with individuals and their communities to develop maintainand restore maximum movement and physical function They work to restore function andindependence to those who have disabilities or problems caused by physical psychological orother disorders Physiotherapists discuss movement problems with clients and identifytreatments to reduce pain and improve movement They plan exercises for patients to improvestrength and fitness educate people on the prevention of further injury help improve breathingpatterns (cardiorespiratory physiotherapy) and help people to relax Physiotherapists also helpimprove co-ordination balance muscle strength and sensation (neurological physiotherapy)They work in private practice hospitals and clinics rehabilitation centres community centressports venues factories and offices education and academic centres and clientsrsquo homes51

1181 Capacity

Physiotherapists purchased 2500 APCs in 2000 Approximately half were working in privatepractice demonstrating a trend towards private practice since 1990 (Table 1110) Thisworkforce group is predominately female and there is very low representation of Maumlori andPacific people Of those responding to the survey 1107 (or approximately 70 percent) identifieda disability sector work type as at least part of their work From this we estimate approximately150052 physiotherapists work at least part time in the disability sector and we have included thisnumber in the disability sector section summary table

Table 1110 Characteristics of physiotherapists

Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68



There are two physiotherapy training courses available in New Zealand Both are four years longand consist of a first year studying a common health science curriculum and three years studyingphysiotherapy Both courses include a large practical component and compulsory training inorthopaedics cardiorespiratory treatment neurology musculoskeletal studies paediatrics andwomenrsquos health Postgraduate training courses are also available

51 Source wwwkiwicareersgovtnz52 Rounded to the nearest 500


Table 1111 Physiotherapy training available in New Zealand

Undergraduate Postgraduate and graduate Single unit courses

Auckland University ofTechnologyBachelor of Health Science(Physiotherapy)

University of OtagoBachelor of Physiotherapy

UNITEC Institute of TechnologyPostgraduate Diploma of Health Science(Manipulative Physiotherapy)


Master of Physiotherapy

Postgraduate Certificate in Physiotherapy

Postgraduate Diploma in Physiotherapy

University of OtagoStudy in ManipulativePhysiotherapy

Study in Occupational HealthPhysiotherapy

Study in Sports Physiotherapy

1183 Specific regulations and interest groups

Physiotherapists must be registered with the New Zealand Physiotherapy Board The NewZealand Society of Physiotherapists Inc also represents the interests of this workforce group

1184 Key issues53

RegulationThe Physiotherapy Board of New Zealand is concerned about quality and its effectiveness inprotecting the public Currently the Board can only set entry-level competency and itsdisciplinary powers are narrow However this concern may be addressed by the proposedHealth Practitionersrsquo Competence Assurance Bill

Recruitment and retentionSeveral DHBs report difficulties in recruiting and retaining physiotherapists This is reported tobe exacerbated by competition with the private sector The following aspects of recruitment andretention were covered in the submission

bull New graduates in New Zealand high student loans are reportedly acting as an incentive forphysiotherapists to go overseas In addition there are fluctuations in job opportunities fornew graduates resulting in a high turnover of junior staff particularly in the hospital sector

bull Hospital physiotherapists international benchmarking studies indicate New Zealand staffinglevels are half those applicable overseas Workloads in some hospitals are considered bythe New Zealand Society of Physiotherapists to be at the margin of safe practice There isalso an increasing reliance on unqualified physiotherapy assistants There are difficulties inobtaining locums especially in rural areas

bull Community there are difficulties in attracting suitable staff to work in the community asetting which is not appropriate for unsupervised new graduates

bull Absolute shortage of Maumlori there are very few Maumlori physiotherapists

53 Sources Submissions from the New Zealand Society of Physiotherapists and the Physiotherapy Board of New Zealand


119 Podiatrists

Podiatrists prevent diagnose and treat ailments diseases defects or disabilities of the lowerlimbs Their work includes routine foot care the care of lower limbs for people with diseasessuch as diabetes the diagnosis and treatment of sports-related injuries nail and skin surgery andbiomechanical assessment They treat problems with medication by electrical mechanical orsurgical means prescribe corrective orthoses and footwear advise patients and refer to otherhealth professionals54

1191 Capacity

Podiatrists purchased 240 APCs in 2000 (Table 1112) It appears that substantially morepodiatrists are working in private practice than in 1990 an increase of 81 podiatrists or69 percent (Table 1112)

Table 1112 Characteristics of podiatrists

Number withan APC

Number who respondedto the survey

Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69



Podiatrists require a Bachelor of Health Science majoring in podiatry which is a three-year courseoffered by the Auckland University of Technology (AUT) Students work in AUTrsquos podiatryclinic while studying the theoretical aspects of podiatry


Podiatrists must be registered with the Podiatristsrsquo Board before they can practise The NewZealand Society of Podiatrists represents the interests of the workforce group

54 Source Career services 2000


1194 Key issues55

Recruitment and retentionFunding constraints for public hospitals lead to limited opportunities for podiatrists Mostpodiatry graduates go into private practice The supply of podiatrists is limited throughout NewZealand but is particularly problematic in rural areas

Under-utilisationPodiatry is particularly beneficial for those with diabetes including high numbers in the Maumloriand Pacific populations Promotion of this profession to other health professionals may ensurepodiatry is better utilised by health services Podiatry education is being integrated intomainstream health science education which is likely to enhance the profile and utilisation ofpodiatry as well as its contribution to health outcomes

The professional scope of practice for podiatrists excludes prescribing rights

1110 Primary health care nurses

The role of primary health care nurses is evolving in response to the Primary Health CareStrategy and primary health care nursing is expected

to work autonomously and collaboratively to promote improve maintain and restore healthPrimary health care nursing encompasses population health health promotion disease preventionwellness care first point of contact care and disease management across a lifespan Models of practiceare determined by the setting and the ethnic and cultural grouping of the people Partnership withpeople ndash individuals whaumlnau communities and populations to achieve the shared goal of health forall is central to primary health care nursing56

Primary health care nurses include practice nurses as well as nurses who specialise and work forprimary health care organisations such as Family Planning or the Plunket Society

Practice nurses work with GPs to provide treatment care and information for patients They canbe responsible for assessing peoplersquos health by undertaking tests planning and carrying out healthcare for patients initiating first aid and emergency treatment administering injections andimmunisations promoting and educating health care to patients preparing and assisting withspecial procedures and minor surgery and providing ongoing screening programmes and clinicsfor patients

Plunket nurses provide support for parents in health and parenting and regularly assess thehealth of children from birth up to the age of five57

55 Source Submission from the New Zealand Society of Podiatrists56 As defined by the Primary Health Care Nursing Expert Advisory Group to the Ministry of Health (August 2001)57 Source Career Services 2000


11101 Capacity

In the 2000 APC survey 3304 registered nurses and 81 enrolled nurses reported working asprimary health care nurses (which includes practice nurses) or in family planningsexual health58

This comprises 97 percent of the total active nursing population However overall 23 percentof active nurses are working in a community setting (Table 92) as this also includes districtpublic health occupational and intellectual disability nursing


Every primary health care nurse must be a registered comprehensive or general and obstetricnurse A range of graduate certificates are available for specialisation in primary health care roles(See section 102 lsquoNurses and Midwivesrsquo subsection lsquoEducation and trainingrsquo)

11103 Key issues59

Implementation of the primary health care strategyThis strategy calls for a more team-oriented approach among different primary providers andheralds a changing role for primary health care nursing While a national education frameworkalready exists within some primary health care disciplines (for example practice nurseaccreditation) other primary health care nursing areas have not established frameworks TheMinistry of Health is working to develop a more comprehensive national framework for primaryhealth care nursing in New Zealand

The College of Nurses Aotearoa has identified a number of issues for the implementation of thePrimary Health Care Strategy including (College of Nurses Aotearoa (NZ) 2001)

bull There is no national educational framework for primary health care nurses and nocompetency-based APCs

bull Rigid contractual arrangements for primary health care nurses have discouraged thecollaborative relationships needed for optimum care They suggest that it is important toensure that the formation of the primary health organisations will be not-for-profitorganisations influenced by all providers

bull Practice nurses may become increasingly isolated from their peers especially in rural areaswhere there is usually a small primary health care team with only one nurse

58 Source wwwNZHISgovtnz59 Sources include submissions from the College of Nurses Aotearoa (NZ) and New Zealand Nurses Organisation


1111 Sources of information used for the lsquoprimary health carersquosection

Career Services 2000 URL httpwwwkiwicareersgovtnz

Clinical Training Agency 2001 The Health Workforce A training programme analysis Wellington Ministry ofHealth

Department of Health 1991 The New Zealand Health Workforce 1990 Wellington Department of Health

Health Funding Authority 2000 Maternity Services A reference document Hamilton Health FundingAuthority

Medical Council of New Zealand 2000 The New Zealand Medical Workforce in 2000 WellingtonWellington Medical Council of New Zealand

New Zealand Health Information Service (NZHIS) 1996 New Zealand Health Workforce 1994Wellington Ministry of Health

New Zealand Health Information Service (NZHIS) 2001 Selected Health Professional Workforce in NewZealand 2000 Wellington Ministry of Health URL httpwwwnzhisgovtnz

Nursing Council of New Zealand 2000 New Zealand Registered Nurses Midwives and Enrolled WellingtonNursing Council of New Zealand

Pharmaceutical Society of New Zealand Annual Report 2000 and Workforce Survey 1995 URL httpwwwpsnzorgnz

Royal New Zealand College of General Practitioners URL httpwwwrnzcgporgnz

Statistics New Zealand 2001 Regulation of Health Services Professionals Wellington Statistics New ZealandURL httpwwwstatsgovtnz

URL httpwwwchiropracticacnz

URL http wwwpodiatryorgnz


Table 111 Characteristics of the primary health care workforce

Workforce group Estimatednumber of total

workforcegroup

Maumlori

Pacific

Per100000

population

Estimatednumber in a

primary healthcare setting

Per100000

population

Sourcedate

Chiropractors 218 07 00 6 218 6 APC 00

Dietitians 343 16 00 9 47 1 APC 00

General practitioners and other primaryhealth care medical practitioners

3396 20 10 89 3396 89 APC 00

Midwives 2081 34 17 55 978 26 APC 00

Osteopaths 318 8 318 8 Census 96

Pharmacists 2831 07 02 75 1699 45 Reg active 00 andSurvey 95

Physiotherapists 2500 07 01 66 1283 34 APC 00

Podiatrists 240 16 00 6 199 5 APC 00

Primary health care nurses 3385 89 3385 89 APC 00

Workforce groups not included in this section of thereport but which have a component working in theprimary health care sector

Registered psychologists 13 00 358 9 APC 00

Community health workers

Total 15312 17 01 403 11881 313

Table 92 lsquoWorkforce delivering services in a community settingrsquo gives a better indication of the numbers of workers in a community setting

112 Chiropractors

Chiropractors work as autonomous primary-contact health workers They diagnose and treatpatients whose health problems are associated with the bodyrsquos muscular nervous and skeletalsystems especially the spine Chiropractors believe interference with these systems impairsnormal functions and lowers resistance to disease They also hold that spinal or vertebraldysfunction alters many important body functions by affecting the nervous system and thatskeletal imbalance through joint or articular dysfunction especially in the spine can cause painChiropractors use drugless and non-surgical health treatments Some chiropractors specialise insports injuries neurology orthopaedics nutrition internal disorders or diagnostic imaging

1121 Capacity

Chiropractors purchased 218 APCs in 2000 which is almost twice as many as in 1990(Table 112) There are 15 Maumlori and no Pacific chiropractors All chiropractors work in thecommunity mostly in private practice

Table 112 Characteristics of the chiropractor workforce

Number withan APC


Male

Female

Maumlori

Pacific

Working inthe community

1990 110 105 89 11 100

1991 07 0

2000 218 139 727 273 07 0 100

change(number)

982 62 392 60

Source APC surveys 1990 1991 and 2000 The response rate for the 2000 survey was 638 This limits the accuracy of thegender and ethnicity data






1124 Key issues


113 Dietitians








1131 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 290 249 04 996 5

1991

2000 343 248 24 976 16 137

change(number) 183 -05 610 16 224





















Study in Dietetics





1134 Key issues38

















1141 Capacity










1143 Key issues42














115 Midwives




1151 Capacity




Numberactive

Male

Female

Maumlori

Pacific


3618 2081 02 988 34 17 465




























1154 Key issues47








116 Osteopaths


1161 Capacity




Male

Female

Self-employed

318 67 33 87









1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59



























1124 Key issues


113 Dietitians








1131 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 290 249 04 996 5

1991

2000 343 248 24 976 16 137

change(number) 183 -05 610 16 224





















Study in Dietetics





1134 Key issues38

















1141 Capacity










1143 Key issues42














115 Midwives




1151 Capacity




Numberactive

Male

Female

Maumlori

Pacific


3618 2081 02 988 34 17 465




























1154 Key issues47








116 Osteopaths


1161 Capacity




Male

Female

Self-employed

318 67 33 87









1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59























1131 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 290 249 04 996 5

1991

2000 343 248 24 976 16 137

change(number) 183 -05 610 16 224





















Study in Dietetics





1134 Key issues38

















1141 Capacity










1143 Key issues42














115 Midwives




1151 Capacity




Numberactive

Male

Female

Maumlori

Pacific


3618 2081 02 988 34 17 465




























1154 Key issues47








116 Osteopaths


1161 Capacity




Male

Female

Self-employed

318 67 33 87









1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59

























1134 Key issues38

















1141 Capacity










1143 Key issues42














115 Midwives




1151 Capacity




Numberactive

Male

Female

Maumlori

Pacific


3618 2081 02 988 34 17 465




























1154 Key issues47








116 Osteopaths


1161 Capacity




Male

Female

Self-employed

318 67 33 87









1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59






























1141 Capacity










1143 Key issues42














115 Midwives




1151 Capacity




Numberactive

Male

Female

Maumlori

Pacific


3618 2081 02 988 34 17 465




























1154 Key issues47








116 Osteopaths


1161 Capacity




Male

Female

Self-employed

318 67 33 87









1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59





























1143 Key issues42














115 Midwives




1151 Capacity




Numberactive

Male

Female

Maumlori

Pacific


3618 2081 02 988 34 17 465




























1154 Key issues47








116 Osteopaths


1161 Capacity




Male

Female

Self-employed

318 67 33 87









1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59
































115 Midwives




1151 Capacity




Numberactive

Male

Female

Maumlori

Pacific


3618 2081 02 988 34 17 465




























1154 Key issues47








116 Osteopaths


1161 Capacity




Male

Female

Self-employed

318 67 33 87









1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59























115 Midwives




1151 Capacity




Numberactive

Male

Female

Maumlori

Pacific


3618 2081 02 988 34 17 465




























1154 Key issues47








116 Osteopaths


1161 Capacity




Male

Female

Self-employed

318 67 33 87









1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59












































1154 Key issues47








116 Osteopaths


1161 Capacity




Male

Female

Self-employed

318 67 33 87









1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59


























116 Osteopaths


1161 Capacity




Male

Female

Self-employed

318 67 33 87









1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59




























1164 Key issues49


117 Pharmacists








1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59

























1171 Capacity



Number ofregistered

pharmacists

insurvey

data 1995


New Zealand

Male

Female

Maumlori

Pacific

Working in the

community

1990 3468

1995 3637 698 514 486 07 02

2000 3774 2831 60

change(number)

89


























These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59











































These include the









1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59























1175 Key issues50










1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59

























1181 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 1777 1531 158 842 43

1991 10 0

2000 2500 1509 17 83 07 01 513

change(number)

407 -15 51 39 -8 68




















1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59





































1184 Key issues53









119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59























119 Podiatrists


1191 Capacity



Number withan APC


Male

Female

Maumlori

Pacific


1990 170 133 31 69 69

1991 0 0

2000 240 127 339 661 16 0 827

change(number)

41 -5 54 35 69








1194 Key issues55












11101 Capacity





11103 Key issues59























1194 Key issues55












11101 Capacity





11103 Key issues59























11101 Capacity





11103 Key issues59





































Documents

11 Primary health care...11 Primary health care This workforce grouping, which icorponrates several community-based allied health workers, is included in this report to reflect the