TE PUAWAI
that despite the failure thus far to have the primary health care strategy deliver on its expected outcomes, little has been learnt about how to engage with the full spectrum of primary health care providers in order to ensure a different outcome.
We are also aware of plans around changes to the flexible funding pool( FFP) and a shift to alliance based contracting between PHOs and DHBs set for 01.07.13. As you will be aware many nurses working in primary care utilise the FFP arrangement in order to activate and deliver many nursing services so essential to our populations. Without our participation in these discussions and a consequent lack of insight into the specifics of this proposal that will clearly impact extensively on nursing services( services often providing first point of care for high health need populations), the provision of multidisciplinary care approaches is potentially marginalised.
Failure to engage at a high level with nursing around funding issues has resulted in years of frustration and poor PHC strategy implementation. While in theory, nurse practitioners at least can enrol patients and receive capitation funding, widespread ignorance, consistent misinformation and technical obstructions remain. As recently as last year NPs have filed capitation claims and had them rejected by the MoH. In an article published in NZ Doctor in November last year 1, the Minister of Health Hon Tony Ryall clarified the availability of capitation resulting in expressed astonishment from GPs and GP leaders who( more than 10 years after release of the PHC strategy) were seemingly unaware nurse practitioners could indeed claim capitation. We would suggest that this is indicative of a failure on the part of the Ministry of Health to either understand or be completely transparent about the intended use of funding streams. The inability for nurse practitioners to directly access the general medical services( GMS) subsidy is yet a further barrier to nurse practitioners being financially viable in General Practice businesses. While the Ministry has previously indicated that work is occuring in order to support clinical integration and reduce barriers to multidisciplinary team working, it is unclear when this will result in nurse practitioner access to the GMS subsidy. Some of us worked on the original PHC strategy and first PHO agreement( version 17) and were told then that it was not necessary to free up access to GMS as it would be shortly abolished! There are related technical problems, well explained in this email message from a practice manager to a frustrated NP employed in General Practice
“ The government funding model for general practice is complicated and unless fundamentally understood at a practical level will confuse to the point where issues are not, and have not been resolved. Those in positions of power tend to understand the broader rules around funding streams but not the practical application, which is fundamentally flawed at the present and needs updating to accommodate NPs as equals to GPs.
Firstly, understand that capitation is made up from an allocated sum per patient PLUS a virtual“ GMS” which is a variable amount dependent on a patient’ s demographic. The GMS component is redundant whilst the patient sees their usual provider, but activates in the form of clawbacks( taken money) or reverse clawbacks
1 Marriner, Katie. 2012. Extending GMS to NPs crucial: Carryer. New Zealand Doctor. 21 November.
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