Primary healthcare news, information & resources

Upcoming Government policy changes - what it could all mean for general practice

David Oldershaw, Pinnacle Midlands Health Network chief executive

While visiting practices I've found people are really interested in the policies of the new Government, but often aren't sure what to expect or when. While there are still many details to be determined the early policy priorities are quite clear. Here's what we know so far, how we are involved and what we will do to support the network to be as prepared as possible.

The Government's first priority - lower patient co-payments

Lowering patient co-payments for GP consults in order to improve access to general practice is the government's first priority. In its election manifesto Labour committed to lowering the cost of GP visits by $10 through:

  • lowering the fee cap for practices with Very Low Cost Access funding (VLCA) from$18 to $8 for adults and $2 for teens, with a funding increase to cover this
  • increasing government funding for all non-VLCA practices to lower their fees by $10
  • there is also an expectation Community Services Card (CSC) holders who are enrolled in a non-VLCA practice will pay the new VLCA fee (i.e. $8 for adults and $2 for teens), and practices will be compensated for this.

There are a huge number of questions that arise from these changes that are still to be answered.

  • How will practices be funded - by adjustment to capitation or by fee for service claiming? 
  • Is there enough money to compensate all practices fully? Who wears the risk?
  • With lower fees we can predict increased demand for GP consults. How will this impact on a system already under pressure?
  • At this stage it appears only GP consults will be covered. What about charges for nurse consults and others in the practice team? What about other charges like repeat prescription fees?
  • What will the impact be on other parts of the system such as Accident & Medical, after-hours providers and hospital emergency departments?
  • Won't reducing VLCA co-payments for non-CSC holders just exacerbate existing funding differences?
  • What about future price adjustments?

Despite these questions and potential unintended consequences the new Minister of Health has reiterated the Government's intention to deliver on this promise. 

The Government has indicated it expects these policy changes to be implemented by 1 July 2018. 

The timing seems questionable given consultation has barely begun, the lack of detail on implementation and the work that will need to occur to give effect to the policies.

Further primary care commitments

Since the establishment of the coalition Government, the following commitments have also been announced:

  • increased funding for GP training places, taking the intake to 300 per year
  • extending the free under 13 scheme to provide free doctors' visits for all under 14 year olds
  • health checks for all Year 9 students (13 and 14 year olds), connected to an extension of school-based health services
  • one free annual health check for over those over 65 years
  • increased support for more people with mild to moderate mental illness through GP teams and PHO referral pathways
  • consideration is also being given to free annual health checks for people with intellectual disabilities. 

The timing and implementation details for these commitments are not yet clear. 

The Government has also signalled a broader review of primary care funding, with the aim of further reducing barriers to accessing primary care and ensuring the financial sustainability of practices.

The terms of reference for this review have not been developed, and we expect to have the opportunity to contribute to them. We will want to make sure the review considers how to reverse years of under investment in primary care, and how to provide adequate funding to support implementation of new models of care that are required to ensure general practice remains sustainable into the future.

The Government has begun talks with representatives from primary care over implementation of its proposed policy changes. As you would expect the sector has been occupied with considering their potential impact. Pinnacle has been involved in discussions through the N4 group (which includes Pinnacle, ProCare, Pegasus and Compass) and in other national forums.

Preparing your practice

We are preparing for the negotiations on the proposed changes. We have to be pragmatic about the Government's intentions to follow through on their election promises, and we'll be working to make sure any deal is as fair as possible for practices. 

We have good data on GP service utilisation for all Pinnacle practices. As soon as there is a detailed proposal on the table we'll model what the impact might be for your practice and discuss this with you.   

We will be ready to advise on policy changes as details becomes clear, and our teams will support your practice to implement changes when they come into effect.

The Federation of Primary Health Care New Zealand

The combination of a new Government, new Minister of Health and, changes in the Ministry presents the first opportunity in years to influence health policy agenda. A new federation of primary healthcare providers is an attempt to unify as a sector and make the most of this. 

Annette King, former Minister of Health, has been appointed as inaugural chair of an establishment board for the Federation.

Pinnacle Incorporated chair Frank Cullen and I attended a national primary care summit where the federation was launched. For a number of years Pinnacle has stood apart from national advocacy organisations because we have been able to achieve more influence on our own. While we support the aims of the federation the jury is still out on the effectiveness of such a group. We will watch the activities of the establishment board with interest.

I will keep you posted on any developments. If you have any questions or comments on the approach of the new Government please get in touch,

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