Statement from General Practice Leaders

12 May 2005

Statement from General Practice Leaders
IPA Council, NZ Medical Association, Royal College of General Practitioners, Rural General Practitioner Network

General Practice non-compliance

1) General practice has decided not to provide information, until further notice, requested by the Ministry of Health under its fee subsidy programme

2) General practice strongly objects to the new unilaterally imposed requirements in the fee prescription for the implementation of the increased subsidies for 18¡X24yr old patients planned for July 1st. The requirements for fee approval and practice-identifiable fees break the rules of the already agreed fee subsidy contract.

3) General practice wants patients to receive their fee subsidies, but cannot participate in the next phases knowing that the result is micro-management of general practice that will erode our decision making and ability to deliver quality healthcare.

4) Information required for subsidies will therefore be withdrawn until the latest fee requirements are removed, and the Ministry engages with general practice under a working agreement that trusts and enables general practice to improve the health of New Zealanders.

Peter Foley
Spokesperson for the GP Leaders

THREE LETTERS ATTACHED

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12 May 2005

Dear PHO Chair and Chief Executive

We have today written to the Director General of Health (enclosed) expressing our concerns about the Ministry¡¦s directives to the DHBs regarding the implementation of the 18-24 year age group subsidy increases. The directives impose new contractual requirements on PHOs, and their contracted GPs, and instructs that the capitation payment will be withheld unless the new requirements have been met.

We do not accept this coercive approach, and have today advised all GPs in New Zealand (enclosed) to suspend any further notification of fees information.

We invite you to consider the attached correspondence and support your contracted GPs in taking this action.

Yours sincerely

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12 May 2005

Dear GP

We have today written to the Director General of Health (enclosed) expressing our serious concerns regarding the Ministry¡¦s breach of process, which undermines the spirit and intent of the Fees Policy negotiated in 2003 between the Minister of Health and GP leaders. The process has been breached in the implementation of the additional subsidies for 18-24 year olds. DHBs will withhold your access to new funding for 18-24 year olds unless you provide new information and the DHB is satisfied with the information provided by all members of your PHO. We object to the coercive manner that the Ministry is using, particularly when we have been offering to meet and discuss these issues over the last 10 months. This offer has not been taken up and instead the Ministry has chosen to impose these unilateral requirements. We believe this goes beyond DHBs' powers under existing PHO Agreements.

These new requirements are an attempt to fetter the right of individual GPs to set their fees. If we take no action in response to the Ministry introducing new requirements in this way then we can expect continued erosion of this right, with the risk that this will undermine the viability of general practice in the medium term. This would have negative impacts for the healthcare of all New Zealanders.

The specific new requirements are:
„h Notification to the PHO of the fees that you will charge for enrolled persons aged 65 and over for a standard consultation from 1 July 2005 (so that these fees may be compared with the fees charged for 18-24 year olds); and
„h Notification by the PHO to the DHB of each individual practice by name and the schedule of fees each of those practices will charge from 1 July 2005; and
„h Pre-approval by the DHB of the fees to be charged by every member of a PHO as a precondition to the DHB providing increased funding to the PHO as a whole.

We, as the leaders of the national general practice representative organisations, invite you to join with us in declining to co-operate with this coercion. We would like to be able to continue to meet our obligations under the contract established last year but we believe that the Ministry¡¦s actions make this currently impossible.

We want you to suspend any further notification of fees information, even though this could result in your DHB declining to provide increased funding for your 18-24 year old enrolled patients.

We will continue to keep you informed of matters that develop as a consequence of our letter to the Director General of Health, Dr Karen Poutasi.

Yours sincerely

Dr Doug Baird
Chair
IPAC Dr Peter Foley
Chair
GP Council Dr Jim Vause
President
RNZCGP Dr Tim Malloy
Chair
RGPN
NZMA

Encl:

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13 May 2005

Dr Karen O Poutasi
Director General of Health
Ministry of Health
P O Box 5013
Wellington

Dear Karen

We are writing to you to express our concerns about the Ministry¡¦s directives to the DHBs regarding the implementation of the 18-24 year age group subsidy increases.

General Practice entered into an agreement with the Minister of Health, in good faith, which resulted in the ¡§Fees Policy¡¨. We believed that the Fees Policy reflected the intentions and attitudes of the respective parties in relation to General Practitioners¡¦ right to set and charge a fee, and the Government¡¦s wish to ensure that most of the new funding available through increased subsidies be passed on to patients.

We are concerned that the goodwill expressed by both parties in the Fees Policy has been undermined by recent Ministry activities.

The notice given by DHBs to PHOs on the prescription for further increase in respect of 18-24 year old enrolled persons receiving first level services from non-access practices from 1 July 2005 imposes new contractual requirements and instructs that the capitation payment is to be withheld unless those new requirements have been met. We believe that this imposition is a breach of process contrary to the spirit and intent of the Fees Policy and goes beyond DHBs¡¦ power under existing PHO Agreements. We do not accept this coercive approach, and have today advised all GPs in New Zealand not to comply with the new requirements.

We want to reiterate our offer, made on several occasions over the last 10 months, to discuss these issues in an appropriate manner.

Yours sincerely

Dr Doug Baird
Chair
IPAC Dr Peter Foley
Chair, GP Council
NZMA Dr Jim Vause
President
RNZCGP Dr Tim Malloy
Chair
RGPN

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