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Concerns expressed about maternity report

PRESS RELEASE TO: All Health Reporters/Chief Executives/Press Officers

FROM: Dr Philip Rushmer

DATE: 15 January, 2001

Concerns expressed about maternity report

Proposals outlined in a Health Funding Authority document about maternity services will do little or nothing to prevent GPs from giving up obstetrics, and may have serious consequences for specialist services, the New Zealand Medical Association says.

The NZMA remains of the view that fundamental changes are needed to the maternity system, to recognise the different roles of doctors and midwives.

The HFA report recommends that government funding for visits to Lead Maternity Carers (LMCs) is increased from approximately $24.60 to $29.50.

"This increase is better than nothing, but it will not bring back GPs who have given up obstetrics, or do anything to retain the few who remain," said Dr Philip Rushmer, NZMA Board member and GP Council Chairman. "An average GP visit costs about $37-45. Maternity services are free to the patient, so doctors are not allowed to charge any co-payment, meaning they often lose income by offering this service. The fee has not been raised for eight years.

"The proposed fee would still be lower than that for under-sixes ($32.50), which has not been reviewed for three years and which has never fully covered most doctors' costs."

Another concern, Dr Rushmer said, is the proposal to align all existing LMC contracts to the standard HFA contract (formerly called Section 51).

"Various contracts exist which have more favourable conditions than the S51 contract. These are generally working well and have enabled the provision of shared care between doctors and midwives. If these contracts are changed to comply with the terms and conditions of S51, this will be a further disincentive for doctors to remain working in obstetrics," Dr Rushmer said. "This will also further reduce choice for many women."

A third concern is the proposal to restrict specialist obstetricians from claiming under S51 where they are employed on-call by Health and Hospital Services (now District Health Boards).

"Often the on-call payments are very low, and it is important that specialist obstetricians can access adequate payments for their services. Already many obstetricians are giving up maternity work and turning solely to gynaecology. This would worsen this trend, and could undermine the provision of specialist services. The consequences of implementing this proposal need very careful assessment."

Dr Rushmer said many of the report's other proposals, concerning quality and access, were sensible and the NZMA looked forward to discussing all the recommendations with the Ministry of Health.


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