31 July 2025
Opinion as featured in Newsroom
As a director of Tend Health with a long career in healthcare and governance, I feel compelled to respond to Ian Powell’s recent comment piece.
At Tend Primary Healthcare Organisation Ltd, our clinical directors (myself, Co-Founder Dr Mataroria Lyndon and Chief Medical Officer Dr Graham Denyer) work in genuine partnership with our non-clinical directors, each bringing deep expertise and a shared commitment to delivering better healthcare experiences for all New Zealanders.
The notion that our non-clinical directors somehow compromise healthcare quality is not only incorrect, it diminishes the vital contributions of the many dedicated professionals working across the wider health sector.
Expertise in finance, technology, operations, infrastructure and consumer behaviour all play critical roles in strengthening health outcomes. And while someone may not hold a clinical title, they are a patient and their lived experience, insight and professional capability deserve equal weight in shaping a system designed to serve all.
In no other industry would someone claim that good governance is the domain of one profession or background. In fact, strong governance relies on diversity of experience and perspective.
Health is no different. Patients, technology experts, financial leaders and clinicians each bring critical insights, and all have a role to play in shaping the future of healthcare.
The reality of digi-physical care
Ian Powell’s concern that telehealth models are likely to displace in-person care is misplaced.
The Tend group includes 24 physical clinics across Aotearoa, 13 of which are fully integrated into our operating model. Across these practices, over two thirds of appointments take place in person.
Telehealth accounts for the remaining appointments and is used only when clinically appropriate and patient-preferred.
This is entirely consistent with the Royal New Zealand College of GPs’ position: telehealth should supplement, not replace, in-person care. In fact, this blended approach has been used in New Zealand since the Healthcare Home model launched in 2011.
It reduces unnecessary travel and wait times, and enables better access for patients with work or caregiving responsibilities.
Why we formed a PHO
Tend’s decision to exit five primary health organisations in December 2024 was driven by a genuine clinical concern: system fragmentation.
In Auckland, we saw patients receiving different levels of service, not based on clinical need, but on PHO catchment.
For example, at our Kingsland clinic, patients could access fully funded postnatal care and sexual health checks. Yet just a few kilometres away in Pakuranga, patients with identical clinical needs were not eligible for the same services. This postcode lottery is inequitable and undermines clinical best practice.
Tend pursued conversations with several large PHOs to consolidate and find a pathway forward.
Their feedback was clear, they didn’t have the tools or scale to support the level of integration Tend was trying to achieve. More than one advised us to become our own PHO, acknowledging that we could deliver more than they could enable.
The 2020 Heather Simpson-led Health and Disability System Review clearly recommended that it should no longer be mandatory for DHBs to contract PHOs for primary healthcare services. Five years later, nothing has changed, a striking example of how slow our system is to adapt, even when the need for reform is clear.
Interestingly, once Tend took this step, Green Cross Health, which had advocated for reform for years, quickly followed suit. It showed what was possible when leadership meets action. Of course, corporate-run PHOs are not new. Tāmaki Health, owned by Mercury Capital and originally founded by the Patel family, has successfully operated Total Healthcare PHO for over 17 years and is recognised as one of the most effective in the country.
Comparing our PHO, established less than a month ago, to organisations that have been operating for decades is not only grossly unfair but fundamentally flawed. We are still working to establish some processes that mature PHOs have refined over years, yet we’ve already demonstrated measurable improvements in patient access, equity and care coordination.
Helping repair a broken primary care system
The issue of good governance becomes an even greater priority when managing a sector that’s in distress. Over the past five years, Tend has acquired many general practices.
Subsequent organisational audits have revealed concerning realities in some clinics from poor quality patient data and record keeping, to obsolete technology systems, questionable employment arrangements, and in some cases, unsafe clinical practice.
This is not a criticism of frontline workers. In the majority of these examples, clinicians were doing their utmost to provide the best care possible in extremely challenging conditions.
These situations reflect practices under significant pressure, where time, support or capability to address systemic problems is lacking and where some PHOs have failed to identify or meaningfully respond to these issues. Of course, there are many well-run, high-functioning practices across the country but in our experience, this is far from universal.
In one rural example, a single clinician was left to care for 4,500 patients. Following integration into Tend, wait times dropped from 28 days to six, and patient experience scores rose from less than 70 percent to 94 percent.
In another region, we saw a 26 percent drop in urgent care usage, year-on-year, showing the impact of structured, coordinated care.
Why scale matters in healthcare
Clinical improvement requires investment and scale is how we achieve it. Tend’s unified patient record system gives our clinicians instant access to medical histories, regardless of where the patient is in the country.
We’ve deployed AI-powered tools to reduce administrative burden and improve documentation. We’ve developed a patient app that combines bookings, 24/7 online care, secure messaging, results access, and repeat prescriptions. These tools cost tens of millions to build, something that individual practices or even traditional PHOs can’t absorb.
And it’s working: we’ve received feedback from over 65,000 patient appointments this year alone, with a 95 percent patient experience score and a 97 percent ‘Needs Met’ score. These are national-scale results achieved in a highly constrained funding environment.
Measuring what matters
The structure of a healthcare organisation, whether GP-owned, community trust or corporate, is irrelevant if the outcomes are strong. What matters is safety, quality, access, equity, and clinician wellbeing.
Tend’s ownership structure enables us to make substantial clinical investments, formalise governance, and modernise broken infrastructure. That is what patients need and what clinicians deserve.
Let’s judge every provider by the evidence. Not by who sits on the board, or whether the first consult is in a clinic room or on a screen, but by how well they meet patient needs. In Tend’s case, that includes our willingness to take on distressed infrastructure and bring it into the 21st century.
Looking forward, general practice is at a crossroads. Traditional models alone cannot deliver what the future demands. We need to evolve.
At Tend, our goal is simple: to help New Zealanders be the healthiest people in the world. To do this, we must measure success by outcomes, not ideology.