An Open Letter to All New Zealand GPs

An Open Letter to All New Zealand GPs

In recent months, there have been moves by many IPAs to take over the PHOs they set up and have been running or at least controlling. Reasons given have included seeking greater business efficiency and programme effectiveness while increasing the general practice focus and reducing the bureaucratic control in primary care. Some commentators have even been quoted as saying that it is very frustrating at not being able to control how the billion plus dollars of public funding utilised in primary care is allocated.

For these reasons and many more un-stated ones, some GP leaders in South link Health, Rotorua General Practice Group, Pinnacle and other IPAs have made moves to dump PHO Boards and take control of the primary care funding attracted by the people enrolled with the PHOs’ GP practices. The major driving force appears to be to regain control over pharmaceutical and laboratory budgets that allowed tens of millions of tax payer dollars to be accumulated in some (and I stress some) IPA bank accounts in the 1990s. While a lot of good work was undertaken with this funding, much was used to simply expand the IPAs’ bureaucracies.

This good work has continued under PHOs, but the bureaucracy has exploded in IPAs (or as some are now described MSOs – Management Service Organisations). I would suggest that the bureaucracy that the GP leaders seek to curtail is actually in the IPAs/MSOs not in the PHOs by and large.

What do we all want out of the primary care spend that we as taxpayers put into our nation’s coffers to improve the wellness of our society?

Don’t we all want to:

* reduce duplication and the cost of running the administrative side of primary care by having widely experienced expert Boards, management staff and health care professionals under the one umbrella,

* increase the ability to integrate a wide range of health services, including GP, nursing, pharmacy, physiotherapy, podiatry and maternity services in primary care teams to achieve even better outcomes for all,

* integrate services provided by doctors better with specialist and hospital care, and perhaps most all

* ensure the continued sustainability of general practice as the clinical leaders of primary care.

I have worked in primary care for well over a decade as CEO of both an IPA and a PHO. The major differences between the 1990s and the 2000s can be seen in the shift to national consistency and primary care collaboration and away from dog-eat-dog competition among IPAs. The other major change has been the shift from subsistence GP incomes to very reasonable remuneration.

Does any right minded GP want to turn the clock back and go through all that again? I think not. The gains for all have been too great.

Hugh Kininmonth
Managing Director
Integrated Health Management

ENDS

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