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Lower after hours fees across the district

4 May 2005

Lower after hours fees across the district

The Board of Capital & Coast DHB has today agreed on an approach which will lower the cost of accessing after-hours GP type services across the district.

The decisions came in response to a report on the recent district wide consultation on after hours services, which drew more than 450 written responses from the public, and included meetings attended by over 300 residents.

All hospital-level services will continue to be free of charge (for all eligible NZ citizens and residents) at all of the DHB's facilities.

The Board is investing an estimated $2.1m a year to reduce the cost of accessing GP type services at times when regular family doctors are not open - in the hours between 5pm and 8am weekdays, and on weekends and public holidays.

The phasing in of lower cost access will start in July, with the opening of the new Kenepuru Accident & Medical Centre in Porirua. This is a joint initiative between C&C DHB and the GP-run Porirua After Hours service. Fees for residents of the C&C DHB district will be between 10 and 50 percent lower than the current GP after hours fees in Porirua.

Current after hours arrangements in Kapiti and Wellington will remain unchanged in the interim, and management will report back to the Board in November about the rollout of lower fees for after hours GP level services in these areas.

The Board also agreed to work towards the location of an after hours primary care service close to the Emergency Department at Wellington Hospital. This was strongly endorsed by those who made submissions in the recent public consultation, with more than two-thirds of submissions supporting this approach.

"I'm proud of the decisions taken today, which strongly reflect the results of the recent consultation," DHB chairman Bob Henare said today. "Many hundreds of people have spoken, and we have listened."

"I want to emphasise that while there must be fees for after hours GP-type services, no one will be turned away from our facilities if they cannot afford to pay.

"I want to thank all the people in the community, health professionals and staff who have taken part in this process. This result reflects their, and our, commitment and desire to improve services for people in this region," Bob Henare said.


The recommendations adopted by the Board are attached.

Recommendations adopted by the Board

- Note the Minister of Health has directed that C&C DHB provide a 24 / 7 Accident and Medical Service at Kenepuru and has also agreed there may be user part charges at that service for primary care GP type services

- Note the Board has previously taken decisions on having an Accident and Medical service at Kenepuru and that there will be user part charges for the primary care part of that service

- Note the robust consultation process based on the consultation plan agreed by the Board in February 2005 and the good response rate to the Managing After Hours in Our District consultation

Wellington Hospital Emergency Department and After Hours Primary Care Services

- Agree in principle that primary care should not be provided as an integral part of the Wellington Hospital Emergency Department, but that no one will be turned away and there will be no user part charges in the Wellington Hospital Emergency Department

- Agree an after hours primary care service should be co-located close to, but not be part of, the Wellington Hospital Emergency Department

- Agree that pending further work on a short to medium term solution, the Wellington Hospital Emergency Department will continue to provide an interim overnight (11pm to 8am) primary care after hours service, with the cost of this partially offset by PHO contribution, not by patients

- Agree that in principle the Wellington Hospital Emergency Department should have emergency care as its primary focus

User Part Charges for After Hours Primary Care

- Note that prior to July 2005, an exemption policy and process will be developed

- Confirm the previous Board decisions that no one will be turned away from after hours primary care provided by the C&C DHB because of an inability to pay, and that secondary and emergency care will always be free

- Confirm the previous Board decision to fund the lowering of user part charges from their current level for after hours primary care

- Agree the following considerations will apply in defining user part charges for after hours primary care:

o Community Services Card

o High User Health Card

o Access practice membership

o Maintaining fee levels equal to or higher than usual day time fees

- Agree that the Board accepts in principle that a priority should be given to moving to a free after hours service for under 6 throughout the C&C DHB area and management will report back in November on this priority

- Note that user part charges for all primary care may change over time as PHO funding increases

- Agree to reduce user part charges for primary care after hours at the Kenepuru A&M at an annual additional cost for that service of $1,092,000 once it is open, estimated July 2005. (NB: This $1.09 million is part of the total $2.09 in recommendation 11)

- Note the total cost of providing the 24/7 Kenepuru A&M service (includes staffing, materials, overheads, etc but excludes reduction of user part charges) is $3.1 million and will be funded from:

o Current Kenepuru Emergency Department funding to transfer to the A&M

o An estimate of volumes and funds transferring from Wellington Hospital Emergency Department (estimates based on 60% of triage 4 and 5 levels, from a domicile of Tawa north)


o PHO contribution that will partially meet the costs of overnight services

o GMS (transfer from Porirua After Hours to the Kenepuru A&M)

o User part charges

o An additional $1.0 million from C&C DHB to fund the shortfall (excluding any additional costs to lower user part charges for after hours primary care)

- Agree the Board is committed to

o the district wide consistency in after hours provision and

o the reduction of user part charges

o Clear public information about the staged nature of the changes to occur from November 2005 for the after hours services being put in place

o A clear review and evaluation process

- Agree in principle, for reasons of consistency across the District, and as part of further reorganisation of after hours services, to reduce user part charges for after hours primary at other C&CDHB after hours services subject to further discussions with affected PHOs and service providers, to report back on options and costs in November 2005

- Agree that while work continues with PHOs the current arrangement for the provision of access to overnight after hours primary care at Wellington Hospital Emergency Department will continue without part charge

- Note that lowering after hours fees and opening the Kenepuru Accident and Medical Centre will assist with reducing disparities and increase access for those in Kapiti, Porirua and Northern Wellington

- Request that management continues to work with PHOs and other stakeholders to develop a fair and transparent exemption process reporting quarterly via the Chief Executive Officer's report with a final report back in November 2005

- Request that management will work with the Kapiti PHO, the local after hours service and emergency services on a solution for after hours and emergency care access reporting quarterly via the Chief Executive Officer's report with a final report back in November 2005

- Agree to work to resolve the transport issues raised in the consultation with:

o The Regional Land Transport Committee, and

o Wellington Strategic forum, and

o All Quality Partnership Agreement Units in our District

o PHOs

Further Work

- Request that management work with PHOs to foster variable and flexible provision of primary care day time hours of opening, and report back in November 2005

- Note that management has begun a strategic medium term project, to report back to the Board in November 2005 and to be undertaken with PHOs and other stakeholders to review after hours services and develop a district wide comprehensive sustainable service. This process will also address:

o how to co-locate an after hours primary care service and the Wellington Hospital Emergency Department,

o improved after hours primary care services for Kapiti,

o access to after hours care including transport barriers

o Governance of After Hours Services

o Workforce, sustainability and remedying any gaps

o information and education opportunities

o coordination of after hours services

o Culturally appropriate services

o Evaluation criteria to be applied at all stages of ex- post review


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