Hauora Taiwhenua’s RuralFest drives call for rural health reform

Firstly, our congratulations to the Rural Communities Chapter in celebrating the 10th year of RuralFest! This “working day” at parliament continues to hit the mark providing a platform for rigorous conversations and action.

On the 20th of April our rural community leaders presented to members of parliament through a structured day of speeches, Q and A, workshops and networking. A well-timed event with the 2026 Election this year and the parties on the road and in the media sharing their vision for health.

Throughout the day members reinforced a consistent message to government: rural communities already deliver complex, high-acuity healthcare every day, yet funding, system design and policy settings continue to treat rural services as smaller versions of urban care.

The forum centred on five priority calls to actions identified by Hauora Taiwhenua members from the Aotearoa New Zealand Declaration on Rural Health, developed during and recently launched at our 21st WONCA World Rual Health Conference. All Ministers received the Declaration prior to the RuralFest and were encouraged to consider and respond to the document in their speeches.

The five priority calls are:

Item 2, the call for the acknowledgement of “rural generalism” was a top topic. From a rural community point of view, it already exists and works. Examples of this were shared by rural GPs and rural health Executives with this evidence presenting a unified national voice grounded in frontline experience and practical solutions.

In response to the call for acknowledgment of “rural generalism” Minister of Health Hon Simeon Brown acknowledged strong support for rural generalism and said there was “a huge opportunity” to grow the model across regional hospitals and primary care.

“We do need to be looking at that rural generalist model,” Brown said. “We are growing a workforce which is able to deliver that care in those communities.”

The tone of RuralFest remained strongly solutions-focused throughout the day, with discussions spanning maternity funding, PRIME emergency response systems, Māori health planning, community-led care models, rural research, and emergency preparedness.

Minister for Rural Communities Mark Patterson acknowledged both the pressure on services and the strength of rural leadership.

“Healthcare is the service under the most pressure,” Patterson said. “But what also comes through is the passion and determination of the people delivering it.” He noted that rural health leaders had been clear about both the challenges and the solutions required.

Gill Genet, Deputy Chair of the Rural Communities Chapter, in her opening speech, mirrored this and reminded attendees of the scale and importance of rural Aotearoa.

“Rural is the second largest city in New Zealand,” she said. “It is almost 20 percent of New Zealand’s population, the economic powerhouse, the tourism powerhouse – yet rural health and wellbeing still has a massive inequity and access issue.”

Asked about fair funding (Item 1), Brown confirmed that the Government expects rurality to be included in updated capitation negotiations.

“The government’s been clear that we expect rurality to be one of the factors which will be part of the reweighted capitation implemented this year,” he said. He also confirmed Cabinet had agreed that capitation funding models should be reviewed regularly, rather than remaining unchanged for extended periods.

Karl Metzler, Chief Executive of Gore Health, outlined longstanding disparities between community-owned rural hospitals and Health New Zealand-operated facilities delivering comparable services giving evidence of what happens on the ground.

“Gore Health receives roughly $12 million per annum in base funding,” he said. “A comparable hospital receives roughly $25 million. We provide mirror-image services… but we are trying to recruit and retain staff on a completely uneven playing field.”

Dr Robin Baird, Chair of the Rural General Practice Chapter, called for rural weighting to be formally incorporated into capitation funding models, recognising that rural practices manage both planned and unplanned care without the ability to redirect demand elsewhere.

He went on to describe rural services as “cold buildings and warm bodies” that communities depend on daily. “All over rural New Zealand today, people went in and opened up cold buildings and turned on the lights and the heating,” he said. “We need to keep the lights on in rural New Zealand – the buildings and the people inside them.”

Speakers emphasised that rural providers must sustain facilities, workforce capability, emergency response capacity, and after-hours care with significantly smaller funding bases than urban counterparts.

One of the clearest messages from RuralFest was that rural healthcare cannot be treated as a scaled-down version of urban care.

Dr Rebekah Doran, Clinical Director of Hauora Taiwhenua and a rural GP, said rural clinicians routinely work across urgent care, chronic disease management, after-hours care, and hospital-level medicine – often as the sole responder in high-risk situations.

“Rural GPs are not just urban GPs placed in rural towns,” she said. To illustrate the realities of rural medicine, Doran described responding alone to a critically unwell patient in a remote setting without immediate backup.

“You don’t know whether you’re dealing with a heart attack or anaphylaxis – and there’s no one else coming,” she said. “That level of clinical risk is routine in rural settings, and it’s why training and support need to be designed differently.”

Her call to action was clear: rural training, staffing and support systems must reflect the level of clinical risk and complexity routinely managed in rural settings.

Dr Jane George, Co-Chair Rural Scientific, Technical and Allied Health Chapter said New Zealand still lacks accurate national data on rural workforce distribution.

“You can’t do workforce planning if you don’t know where your workforce is,” she said.

Members called for national workforce data collection to be aligned with the Geographic Classification for Health across all regulated and community-based professions, including Kaiāwhina and Māori health workers.  Without this data, long-term workforce planning, training investment and future service design remain constrained.

Training hubs were also identified as critical to building sustainable rural workforce pipelines with Dr Rory Miller saying that “newly announced rural health training hubs represent a significant opportunity – but only if supported by long-term planning and investment.”

“We know that if people train in rural communities, they’re more likely to stay,” he said. “But without a coherent strategy, a framework and adequate funding, we are worried they won’t succeed in the way we need them to.”

Brown acknowledged the need for a coordinated national plan to ensure the hubs deliver measurable workforce outcomes.

Further, Tania Kemp, nurse practitioner and director of Aotea Health on Great Barrier Island, described how new rural urgent care technology has improved local care while exposing critical infrastructure gaps.

“We’ve got half of a really good package,” she said. “We’re still going around with a USB stick to download images and send them manually.” Kemp said unreliable connectivity limits the effectiveness of rural healthcare innovation and creates additional pressure on already stretched providers.

Hauora Taiwhenua Members stressed that telehealth, remote diagnostics, and integrated care systems cannot succeed without reliable digital infrastructure in rural communities.

National MP Barbara Kuriger agreed connectivity remained one of rural New Zealand’s biggest challenges.

“One size doesn’t fit all,” Kuriger said. “The delivery model for rural healthcare is different.”

RuralFest made one thing clear: rural health communities understand the challenges, have identified the solutions, and are ready to work alongside government to deliver change.

The next step is sustained action – delivering on the five priorities identified by our members through funding, workforce planning and system design that reflects rural reality.

The question now is whether the system will respond.

More information on the Aotearoa New Zealand Declaration on Rural Health and ongoing advocacy is available via Hauora Taiwhenua Rural Health Network.