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Primary Health Organisation detail reached

Agreement reached on Primary Health Organisation detail

Health Minister Annette King and the spokesperson for a group of General Practice Leaders, Dr Paul McCormack, say one of the last sticking points delaying some general practice groups becoming Primary Health Organisations has been resolved.

Ms King and Dr McCormack said agreement has been reached on a fees framework which meets Government objectives to provide access to low or reduced cost visits to GPs, ensures a fair deal for GPs, and also allows local variations negotiated by District Health Boards and PHOs.

“We are pleased with the result, which has been the culmination of robust discussion between the Ministry of Health and General Practice groups and which will facilitate the new primary health care arrangements,” Ms King and Dr McCormack said. The agreement applies to PHOs receiving increased Government funding to provide low or reduced cost access to GPs.

“This is a crucial part of the Government's primary health care strategy as it carries enormous potential to improve the health of New Zealanders with the highest health needs and begins removing one of the biggest obstacles to accessing first line health services for New Zealanders,” they said.

The key components of the fees framework are:
· The framework will be part of the contract between PHOs and DHBs.
· PHOs will work closely with DHBs. PHOs will consult with DHBs, advise them of the range of fees to be charged for GP services, and fees will be identified in a schedule listed in the contract between DHBs and PHOs.
· A process is set out for dealing with fee changes and increases.
· An undertaking by the Government to regularly adjust PHO funding to maintain its value.

Ms King and Dr McCormack said PHOs and DHBs would be the two key parties the two key parties to work out “the finer local arrangements about how PHOs organise and deliver services, including the level of fees charged, and this will be managed through their usual contracting process.”

Ms King said the Ministry of Health will continue its key role in ensuring that Government policy is implemented through these arrangements.

The group of general practice leaders is the Independent Practitioners’ Association Council of New Zealand, New Zealand Medical Association, the Royal New Zealand College of General Practitioners, First Health, CareNET, ProCare and Southlink Health.

A copy of the fees framework is attached.

PRIMARY CARE FEES FRAMEWORK FOR ACCESS FUNDED PHOS 1. The purpose of this document is to set out the framework that will apply to the patient fees charged by health providers contracted to PHOs that are funded in accordance with the Access Funding Formula.

2. The DHB expects that enrolled patients will have access to low or reduced cost primary health services from the providers contracted to the PHO. The PHO recognise the DHBs’ requirement to have certainty that the increased payments to health providers that are made under any Services Agreement, which subsidise a patient’s fees, will be reflected in low or reduced costs to patients.

3. The PHO will ensure that those increased subsidy payments will result in low or reduced fees charged by their health providers to enrolled patients and that those fees are fair to the providers and reasonable for the patients.

4. Before entering into a Services Agreement, the PHO shall be obliged to consult with the DHB in relation to the level of patient fees to be charged for standard consultations by health providers.

5. The PHO will advise the DHB of the fees that are intended to be charged by each of their health providers for a standard consultation. The PHO will provide the DHB with supporting documentation demonstrating how the fees have been informed by the currently known level of fees in the region, and how increased subsidy payments translate into low or reduced costs to patients, being both fair and reasonable to patients and providers.

6. The level of fees to be charged for a standard consultation will be identified in a schedule to the Services Agreement. If it is necessary to increase the level of fees at any time during the term of a Services Agreement, the PHO will advise the DHB of those increases and the reasons for those increases.

7. It is acknowledged that it is the Government’s intention to regularly adjust PHO funding to maintain its value.

8. If after the commencement of the Services Agreement, the DHB considers that the level of fees being charged by health providers in the PHO for a standard consultation is unreasonable, the DHB may give notice to the PHO that it wishes to refer the matter to a fee review committee. Such fee review committee will be established and comprised of four people: two members nominated by the DHB, a member nominated by the PHO and a member nominated by the PHO to represent the relevant health providers.

9. The role of the fee review committee shall be to make a recommendation as to whether the fees for standard consultations are fair and reasonable to patients and providers. In formulating its recommendation, the fee review committee shall take into account the fees charged by contracted health providers and other PHOs that are funded under the Access formula, the need to ensure the viability and sustainability of the health providers that are the subject of the fee review, and any other evidence provided by the PHO and DHB to support the fee levels. 10. The recommendation of the fee review committee will be made by consensus. If such consensus is unable to be reached, the individual views of each member will be notified to the DHB and PHO.

11. If the recommendation of the fee review committee is not acceptable to either of the parties, then the matter is to be managed in accordance with clause D.14 (resolving disputes) of the Standard PHO Agreement for Access PHOs (a copy of which is available on the Ministry of Health’s website).

12. The principles outlined above will apply to fees charged for specific patient groups by health providers contracted to PHOs that are funded in accordance with the Interim Funding Formula at such time as Access level funding flows through the PHO for these specific groups of the enrolled population.

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