Justin during a helicopter rescue. Image credit: Newshub (full reference below).
Newly appointed Pinnacle chief executive, Justin Butcher, can see both challenges and opportunites ahead in Aotearoa New Zealand’s changing health landscape. With a background in frontline health services, project management and innovative leadership, he shares his vision for a strong, adaptable, and responsive health system that meets the needs of future generations.
Earlier this year Helen Parker gave early notice that she was heading back across the globe to be closer to her whānau. The Board wasted no time in deciding Justin would be the next Pinnacle chief executive.
“Helen has done an exceptional job of leading the organisation for the past three years,” says Board chairman Craig McFarlane. "The Board is very happy to see Justin step into the role. He provides obvious and real continuity for Pinnacle and the network, having been in the deputy and acting roles for the last eight months. We view Justin moving into the role as natural internal progression/promotion and we’re very happy that Justin is the person that is taking over from Helen."
Justin Butcher started working as a volunteer for St John in Cambridge at 20 years old while studying for a Bachelor of Management Studies at Waikato University. Mainly, he says, to bolster his CV for recruitment once he graduated. What he didn’t anticipate at the time was how much he would enjoy the work in the ambulance service.
After graduating and one month before he was due to start in the sought-after Deloitte graduate programme in Auckland, he gave up the placement in favour of working full time in the St John education programme and training to become a paramedic.
It was the start of a varied health sector career that has spanned frontline work, many primary care services and leadership roles.
“That’s how health is, it’s a bit infectious, it gets into your blood,” says Justin – pun fully intended. “More than 20 years later, here I am.”
‘Here’ is stepping into the role of Pinnacle MHN chief executive, taking over from outgoing chief executive, Helen Parker, who gave notice in April this year that she is moving overseas in September to be closer to family. As deputy chief executive, and acting CE for seven months while Helen was seconded to the Health New Zealand transition unit, Justin was the natural choice to step into the role.
On the journey from ambulance paramedic to chief executive Justin has gained valuable insights and experience that inform his approach and vision for primary care.
During the 10 years he worked with St John he completed further health sciences training to become an intensive care paramedic. Working in road ambulance and rescue helicopter services in the Waikato has shaped much of his career, and he says continues to motivate him today.
“One of the things that any frontline clinician gets the benefit of is the honour of going into people’s homes, often at some of their worst times,” says Justin.
“You really get to see the hardship that is present and a lot of the inequities that are faced within our health system. For me, that’s always served as a bit of motivation to try and change the system for the better.”
As a father of two young children, he also sees the importance of taking a multi-generational approach. “The health system isn’t just for my generation. I want to make sure it will be responsive for future generations, fit-for-purpose and in a strong place for them.”
Justin points to international examples of countries where there is a strong and well-resourced primary care sector, and corresponding decreases hospitalisations and ED attendances.
“I see a future where primary care in Aotearoa New Zealand is well resourced and well-funded to deliver on great health outcomes.”
He says current health system reforms are an opportunity to progress positive change in primary care, particularly around addressing the ongoing workforce crisis, a better funding model and equity for Māori.
Over the past 10 years working at Pinnacle, Justin has “lived and breathed” general practice, including taking a lead role with the Pinnacle practice engagement team in the Waikato and spending two years as general manager for Primary Health Care Limited (PHCL).
Returning to Pinnacle MHN to take up the role of general manager for regional services, he has managed relationships with practices, DHBs and clinical services across Te Manawa Taki, Midlands region. Then in 2020, just as the COVID-19 pandemic hit, he was appointed deputy chief executive at Pinnacle MHN, working closely with Helen Parker in what has been one of the most challenging times in recent memory for the health sector.
“It’s tough,” says Justin. “Our primary care workforce is under huge strain and pressure. Over the time I’ve been in health I think it’s the hardest it’s been for the people on the frontline.”
He says the COVID pandemic environment shone a spotlight on many already-existing challenges in primary care. “There’s a workforce crisis and we are under a tsunami of demand. We’ve got COVID, we’ve got influenza, we’ve got a system under strain. The teams within our practices are bearing the brunt of all that.”
He says the primary solution comes down to better primary care funding, with a formula that allows employers to remunerate their staff at the same level as their DHB colleagues.
“I don’t think there’s any disagreement that the current funding formula for general practice is broken,” says Justin. “Since its establishment we’ve seen complexity of care and utilisation increase, along with the tightening of eligibility criteria for secondary care services, which means that primary care is case-holding more complex patients.
“On top of that capitation doesn’t take into account equity, an increasing lifespan, and multi-morbidity that is becoming more and more prevalent within our communities.
“The result is a situation where working conditions and pay for the general practitioner and primary care nursing workforces is significantly below that of their colleagues in the hospital system.”
He says it was “disappointing” to see some of the costs and workforce pressures not recognised during the recent PSAAP negotiations, where primary care was offered a 3 per cent increase against a backdrop of a workforce crisis, record cost of living increase, and a still unresolved MECA negotiation for pay equity for nursing colleagues.
“We have to be courageous, we can’t continue to accept the status quo. Pinnacle will continue to advocate for meaningful change, and I’m hopeful the health reforms will help bring what we need.”
While the health reforms to date have focused on the amalgamation of district health boards into Te Whatu Ora, Justin recognises that primary and community care willl be next, and like all organisations Pinnacle will need to change and adapt to the new system.
“We would be remiss not to realise the impact of the coming changes on PHOs, and the need to change our approach to meet them and support a new model of primary care.
“Thankfully a lot of what we do at Pinnacle is already in line with where the reforms are heading. We are much more than just a PHO. Pinnacle holds about 100 other contracts for the delivery of services, such as our extended care teams, that have documented outcomes in line with where the reforms are heading.
“The value that we bring to the system through our expertise in data, change management, and quality and innovation will have a significant role to play as things move forward.”
In particular Justin says data sharing with other services will be important to plan primary health care services in the future. “We’re working to share as much aggregated data as possible within the locality framework, to better inform decisions about health planning and provision.
“During COVID we provided a heatmap that allowed organisations and practices to look at what suburbs had lower immunisation rates for targeted interventions. More recently we’ve done that with influenza, sharing that data with some of our Māori partners so they can go to areas of higher need.”
At a general practice level, Justin there is widespread acceptance that the current model of general practice will also need to evolve and adapt.
“The reliance on our traditional workforce needs to change, and will increasingly involve nurse practitioners, allied health professionals and our non-clinical health workforce. There is also a growing move to deliver more services in partnership with other organisations in the community.”
However, he says it’s vital any advocacy for a broader model of primary care does not lose sight of the essential role of the general practitioner.
“It’s incredibly important we recognise the value and the irreplaceability of the general practitioner role. There is immense value in having specialist, experienced GPs providing care in our communities.”
Partnership with Māori and continuing Pinnacle’s journey toward biculturalism is another focus area Justin is passionate about.
“Seeing the system start to re-orientate itself over the past five years to focus on Te Tiriti o Waitangi and Māori health outcomes has been a hugely positive thing,” he says. “The evolution of the Māori Health Authority and Iwi Māori partnership ports as part of the health reforms, along with the commitment to co-commissioning services to truly meet the needs of Māori, is a great step forward.”
Of the 460,000 service users enrolled with Pinnacle, 92,000 are Māori, making up a large portion of the network and its activity. “The evidence is that if we get it right for Māori, we get it right for everyone.”
“As a starting point, we need to acknowledge the explicit commitment made to Māori under Te Tiriti, and reflecting that commitment in all the organisation does.
“Pinnacle is continuing to evolve on its journey, but we’re not there yet – it’s still early days. We’re putting our energy into the right spaces, through the relationships we build and services we provide.”
That includes programmes like Te Manawanui in Taranaki, which was co-designed, co-implemented and now co-governed between Pinnacle, local Māori health providers, Te Whatu Ora and other services in the area to meet the needs of the community.
Pinnacle has also moved to increase diversity at a governance level with the establishment of Māori advisory group Te Taumata Hauora, providing advice and support to the board. There is also a greater emphasis on building authentic relationships with iwi across the rohe, including existing strategic partnerships with Turanga Health and Tui Ora.
In all the change and challenges ahead, Justin primarily sees his role as being a strong advocate for primary care, both regionally and nationally, championing Pinnacle’s vision of supporting all people to thrive.
“Pinnacle is doing everything it can to support and alleviate some of the current burdens in primary care, and we will continue to advocate strongly at every opportunity to ensure we maintain the sustainability of services, not just today, not just tomorrow, but for the long term.”
There is, he says, a lot to be done and limited resources with which to do it. Some things will take time.
“The simple answer is that there isn’t a silver bullet. We will need many different solutions that all contribute to meaningful change.”
Image credit: NewsHub.