My Weekend with PMAANZ
Behind every appointment, referral and reassuring conversation at reception are people working hard to keep a clinical practice running. Practice managers and administrators carry responsibilities that patients may never see, while supporting clinicians whose work is demanding in its own right. For these dedicated professionals, making time to learn, talk and reflect together matters.
I joined the Practice Managers and Administrators Association of New Zealand conference at Wellington’s Michael Fowler Centre from Thursday afternoon through to lunchtime on Saturday. The gathering brought together a programme spanning workforce wellbeing, equity, practice leadership and digital change.
As always I was met with literal open arms. Greetings and hugs all round, and time always taken to check in at a personal level first.
Getting down to the capital ahead of some nasty weather left room for a couple of catchup coffees and later Thursday afternoon’s masterclass led by Sally Duxfield, whose work focuses on wellbeing and performance. For people accustomed to looking after everyone else, giving their own recovery some attention can be difficult to prioritise. Sally's session explored neurobiology in the lives of busy professionals, with a focus on stress, concentration, recovery and decision-making under pressure. The programme promised practical approaches to managing overwhelm and sustaining performance, and Sally certainly delivered. Unfortunately, another coffee catchup meant I had to duck out early, but I grabbed Sally's book as her content is next level.
Welcome and opening sessions
There are few sounds as beautiful and evocative as a morning karanga. Emcee Lovey Ratima-Rapson is a skilled conference facilitator who also happens to have the mana and skill to deliver the karanga which followed the formal mihi whakatau, and then led the attendees in waiata after a greeting from PMAANZ chair Mary Morrissey.
Micheal Rongo, Director of Health at Ora Toa Health Services, delivered a very moving account of his personal experiences of inequity connecting equity as a concept with the reality of his lived experience and the place of whānau in shaping services. I felt a little despondent that we are still having to explain this, but Michael also offered hope through his account of work towards systemic change.
It is election year and with campaigning in full swing, Health Minister Simeon Brown set out the Government’s record on primary care funding, workforce development and access. He also acknowledged the work that sits behind a functioning practice: managing staff and finances, protecting information, supporting clinicians and helping patients through some of their most difficult days.
He's right of course. Practice managers carry responsibility for making the system work locally, often with limited influence over the decisions that shape it. The Q&A brought that tension into focus.
Asked about the target for patients to be seen within seven days, Minister Brown acknowledged that targets can create unintended consequences. He described it as a direction of travel requiring continued investment and workforce support. The question from the floor went to the everyday reality of practice management: how do we help teams make good decisions under pressure, rather than simply expect them to make faster ones?
There was a similarly practical challenge about where additional capacity would come from over the next two or three years. Brown accepted that training more doctors takes time. He pointed to overseas recruitment, recognition of qualifications and expanded nursing roles as measures that could help sooner. For managers trying to fill next month’s roster, the distinction between immediate relief and longer-term investment is significant.
One exchange captured the problem particularly clearly: practice managers are not always in the room when decisions are made, but they are there when those decisions must be implemented. Brown called for earlier engagement with Health New Zealand and candidly acknowledged that this had not always worked well.
The example that followed needed little explanation. Practices had learned through the media about expanded access to free childhood flu vaccinations, and their phones began ringing almost immediately. Brown accepted that advance communication had been missed and apologised. A few hours’ notice might seem a small administrative detail. For the person answering patients’ questions, briefing reception and organising delivery, it makes a considerable difference.
Brown’s comments on technology also connected with the pressures of his listeners. He saw AI-assisted notes, inbox management and other digital tools as ways to reduce administration and support teams. Alongside that opportunity, he acknowledged the additional cybersecurity responsibilities following the Manage My Health incident.
Friday Afternoon
Just after lunch Dr Luke Bradford current president of Royal NZ College of General Practitioners gave an update on the Foundation standards and other matters emanating from RNZCGP. It's crucial the practice managers and administrators are kept up to date as they have to ensure the practical implementation of these standards. Dr Bradford managed to make a fairly dry subject more interesting through creative use of AI-generated images, noting that the cartoon style always seems to have a woman with a ponytail, but never a bald-headed man.
Then it was time for me to take the stage for my own keynote, entitled Smart Practice. The intent was to give practice managers some useful ideas they could implement immediately. What was interesting was I got a good response to a quick survey using Ten Past Tomorrow's maturity scale for use of AI. A small but significant number rated themselves at level three which was unexpected but awesome. The graph below shows this survey compared to a smaller one we took at a recent webinar.
Level 1: Enthusiasts on self-selected tools. No defined use-cases, no training, no approved platforms, no controls - and nobody accountable.
Level 2: Approved paid tools. A policy, safeguards, trained staff, defined use cases. Leaders actively governing adoption.
Level 3: Work and roles reviewed though an AI lens. Processes redesigned, not automated. Governance tiered by risk.
Saturday morning
On Saturday morning we were treated to another excellent presentation on resilience, this time from neuroscience educator Kathryn Berkett. Her central message was that practice managers need opportunities to recover from stress throughout the day, particularly when they are continually responding to other people’s distress. Using a deliberately simplified “red brain, green brain” model, Kathryn explained how stress can make thoughtful decisions, empathy and perspective harder to access.
This was followed by Will Reedy the new CEO of Medtech Global. Will didn't waste any of his 20 minutes. Accompanied by long-serving Medtech executive Chrissie Patterson, they took both of the podiums and delivered a compact message outlining Medtech’s vision for the practice of 2030. The big drumroll here is integration with AI scribe Heidi, an acknowledged change from their previous direction on AI.
Several examples described prototypes or future plans, rather than capabilities already generally available, but this is a coherent vision that practices can understand.
Themes that appeared consistently throughout the conference were:
Start with the work and the people. Understand what the practice needs to achieve, who will do the work and where AI could help before choosing tools.
Think beyond clinical note-taking. Inbox prioritisation, task management, billing and claims, financial reporting and patient communication.
Different models for practice systems are coming.
Adoption requires investment in people. Training, confidence and workforce planning need attention alongside the technology.
Safety and governance matter. Practices need to evaluate whether tools deliver benefits safely and maintain oversight as AI systems change.
For practice managers, the practical message is that AI’s value depends on reducing everyday friction and giving teams the support to use it well.
The Manage My Health cyber-breach was mentioned frequently over the two days and I looked in on Vino Ramayeh's presentation on the same subject. Vino’s session ran alongside Tony Wai’s presentation on the newly formed Primary Health Organisation prosaically named thePHO. I spent a short time in Vino’s session before joining Tony Wai’s session on the role of practice management in shaping the next operating model for general practice.
Tony brings huge experience in this area from his many previous roles in primary care and aged care. He has a great greenfield opportunity at thePHO and is clearly not wasting it. I really liked his "practice first" approach.
Tony's argument was that practice managers need clear information, usable funding and the freedom to lead in ways that suit their communities. Without mentioning it he put his finger on the essence of lean thinking. Fix the systemic issue, don't keep dealing with the consequences of systemic problems. He described unnecessary administration and duplicated work as a “tax on care” and challenged PHOs to demonstrate their value by making practices’ work easier. Trust, he said, should sit alongside transparent funding and accountability for outcomes, with changes assessed for both patient benefit and financial and workforce sustainability. His closing question was practical: what one process, restriction or report could be removed to give practice managers more capacity to lead?
I left for the airport energised and encouraged by the experience, generosity and practical intelligence in this community. The warmth of those first greetings carried through into conversations about some genuinely difficult issues, with people willing to share what they had learned and help each other find a way forward.
Practice managers already know a great deal about what would make care work better. Giving them the time, support and influence to act on that knowledge is an opportunity we should take seriously. Thank you, PMAANZ, for the welcome and for bringing together people with so much to contribute to the future of primary care.
