General practice models get scrutiny from Te Whatu Ora

“One of our concerns has been that we don’t simply look at capitation levels or even capitation systems without having a clear view on appropriate models of care”

Te Whatu Ora has begun exploring the structure of general practice, a topic that erupted into a war of words when broached last year by then-health minister Andrew Little.

Mr Little was accused of insulting health workers when he complained about what he called “old-fashioned business models”.

The Health and Disability System Review Panel in 2020 recommended a deliberate move away from the capitation funding contract (the National PHO Services Agreement) within five years.

Te Whatu Ora has been considering primary care funding and last year inherited the Sapere review of capitation. Those findings included, in effect, that general practice is significantly underfunded.

In a closed-door meeting on Friday, Te Whatu Ora, chair Rob Campbell was to lead a discussion on general practice ownership models and capitation, according to the board agenda, which is publicly available.

Afterwards, at an online media question-and-answer session, Mr Campbell said, “We have been considering for some time capitation and the Sapere review that related to that.

“One of our concerns has been that we don’t simply look at capitation levels or even capitation systems without having a clear view on appropriate models of care and what mix of models of care we see in the primary sector going forward.

“As you can imagine, there’s quite a wide range of views about the utility and desirability of some corporate structures, about the future of…sole practitioner GPs and their role in the system, so we are spending some time thinking and working our way through that.”

Asked what analysis had been done for the board to consider, Mr Campbell said the agency hadn’t let any contracts for that.

“[But] we obviously have a fair bit of expertise both around the table and in terms of the consultations we are doing internally and externally so we are getting plenty of advice about it.”

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The board didn’t reach any conclusions on the topic on Friday, in part because of the absence, for family reasons, of board member and specialist GP Jeff Lowe. “He will be very influential in that process,” Mr Campbell says.

Asked about the sole-practitioner general practice considered by Mr Little to be outdated and outclassed by a more corporate style of integrated primary care, Mr Campbell said, “[We] don’t have a view on that.”

Last May, Mr Little infuriated some in general practice when he answered a reporter’s question about rural healthcare by saying, “Part of the problem with rural health services is that there are old-fashioned business models that don’t work any more.”

Cromwell Family Practice co-owner and specialist GP Greg White responded that Mr Little had had insulted the thousands of rural health workers who had set up trusts, raised funds or run their own healthcare businesses.

RNZCGP medical director and specialist GP Bryan Betty said Mr Little’s comment was unhelpful when the Government needed the whole health sector to support the reforms.

At the time, when asked how the State could influence private and trust-owned practices to change, Mr Little it was through locality planning processes, and funding and incentives to drive health services to better meet community needs.

“I don’t expect the State to be a big owner of primary care practices. But I think the State, through its funding role, can incentivise and encourage more effective business models to provide better care.”