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Pinnacle MHN submission - Newborn enrolment with general practice bill


The Newborn enrolment with general practice bill seeks to improve health and social results for infants and children by requiring that newborns are enrolled with a general practice and primary health organisation before the newborn is due for his or her first immunisation at 6 weeks of age. Pinnacle MHN has written the following submission on this bill.

Pinnacle Midlands Health Network provides Primary Health Organisation services to 85 practices across the Midlands Region, serving over 400,000 patients.
 
We support the intent of this bill, as we have evidence that supports the contention that early enrolment with General Practice improves health outcomes for children, in uptake of immunisation, but also in wider system utilisation such as attendance at emergency departments and in ambulatory sensitive hospitalisations.
 
We have developed along with partners the National Child Health Information Programme (NCHIP) which demonstrates the value of having an electronic system that identifies when children do not receive expected well child services on time, and enables providers to find those children that slip between the cracks in the health system.
 
We are developing an extension to this system which will allow electronic enrolment at birth for children. The requirement in enrolment legislation for a physical signature on an enrolment form is a key barrier to implementation of this project which we are working around.
 
We would like to see this issue addressed in this legislation change such that the requirements for enrolment with a General Practice can include an approved electronic process or a physical signature.
 
Engagement with general practice, knowing and being known by the medical and nursing staff is essential to good service delivery. Currently the six week immunisation event is the first time a child needs to be brought into a GP service, and consequently this appointment is often delayed, causing delayed immunisation.
 
We believe that a third trimester General Practice visit for a pregnant woman will increase engagement with General Practice, it will allow a GP to provide a medical overview of antenatal care, provide another opportunity for maternal immunisations to be provided, and for completion of pre-enrolment documentation for the unborn child.
 
We would like to see the addition of a clause in this bill supporting early engagement in General Practice services through the addition of a third trimester antenatal visit for women being added to the antenatal care provided by lead maternity carers.
 
We would also suggest that where in Clause 6 the Bill states: 
(2) The general practice must-
(a) consult the newborn's caregiver and any other family members the provider considers appropriate as to another preferred general practice; and
(b) supply a list of general practices in the newborn's area of residence if so requested; and
(c) if the family chooses another general practice, refer the pre-enrolment request to that general practice.

(3) If the nominated general practice is unable to assist the family in finding another primary health care provider, it must refer the pre-enrolment request to the relevant DHB and primary health organisation.

(4) The DHB and primary health organisation that receive a referral under subsection (3) are responsible for assisting the family to pre-enrol the newborn with another provider prior to the newborn reaching 6 weeks of age.
 
The wording be changed to: 
(2) The general practice must refer the pre-enrolment request to the relevant primary health organisation.
(4) The primary health organisation that receives a referral under subsection (2) are responsible for assisting the family to pre-enrol the newborn with another provider prior to the newborn reaching 6 weeks of age.
 
The requirement for a practice which is working at full capacity or has another reason to avoid enrolment to "consult" with the family, and undertake additional work of finding an alternative provider is an additional burden on time for the staff and patient's family which should be avoided. The PHO is more likely to have the capacity to find an alternative provider within a reasonable timeframe, but this additional work will need to be resourced.
 
In Clause 7 the bill states:
Newborn not eligible for enrolment
A nominated general practice that receives a pre-enrolment request from a newborn who is not eligible for enrolment must change the newborn's status in the maternity system to either registered or casual, as the case may be, so that the newborn may receive fully-funded immunisations, if desired.
 
This needs to be changed as the general practice has no access to the maternity system to be able to change any data.
 
It should be the responsibility of the Lead Maternity Carer to know if the child is eligible for health services in New Zealand under the enrolment rules and for this to be demonstrated at the time of "pre-enrolment". This information should be readily available to the lead maternity carer, or birthing unit, who have already had to prove that the mother is eligible for services as part of their service delivery requirements.

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