DHB’s ‘free care’ new entrant feared as threat to Hāwera practice viability

Taranaki DHB’s new general practice in Hāwera has GPs and primary care leaders worried about unfair competition.

Practices say the service is offering free appointments and picking off patients from existing medical centres.

However, the HealthPoint website states the practice is not enrolling patients, and the DHB has not provided answers to New Zealand Doctor|Rata Aotearoa’s questions.

The South Taranaki Rural Health General Practice was set up last November at Hāwera Hospital, and will be staffed by two nurse practitioners, one NP intern and two part-time GPs.

Independent GP Keith Blayney says he was asked to transfer the notes of one of his registered patients.

Dr Blayney says this is contrary to assurances the practice would be targeting people who don’t have a GP. He had also been advised it would be charging $49. “I wonder if they now realise that a DHB clinic run from within a public hospital is not legally able to charge patients, or receive ACC funding above the DHB allocation?”

Dr Blayney fears the new practice may worsen primary care viability and GP retention in Hāwera, where GPs already struggle. Practices in small rural towns can’t afford to lose patients and capitation funding, he says.

Pinnacle Midlands Health Network chief executive Helen Parker says she was aware the DHB was proposing to open a practice, as it applied to the PHO for a contract. Pinnacle declined.

“But we didn’t know they’d started enrolling patients until we had calls from practices saying they’d had requests to have patient notes transferred and that [the practice was] offering free general practice,” Ms Parker says.

General Practice New Zealand chief executive Liz Stockley has also received calls from concerned practices.

Ms Stockley questions the contractual basis for the practice, as offering free general practice “goes against” the PHO Services Agreement.

“It shows no respect for the work of the existing practices and PHOs. How are they able to offer free primary care? Where is this policy decision?”

Ms Parker put these concerns to Taranaki DHB on 8 January, but says she has had “no information” in response.

“It’s very disappointing, to have a new practice enrolling patients, with no communication to other practices.

“As far as I know, the practice doesn’t have a PHO contract, so what does the policy framework look like? Why would they approve a new model two to three months before the health-system reform designs are due to be published?”

New Zealand Doctor on 19 January approached the DHB with its own queries, and was told to wait a few weeks to a month.

LAST OCTOBER, we visited Hāwera Hospital and spoke with rural hospital doctor and GP Rory Kennelly, who was involved in setting up the new practice.

The aim was to provide an integrated care service “to try and meet the needs of the community that aren’t currently being met”, he says. He hoped it would reduce pressure on other practices in the area. At the time, the cost of consultations was yet to be decided, but Dr Kennelly said the service would be open to casual patients.

Dr Blayney doubts the service will help the patients most likely to benefit. Many Māori and low-income patients value having a face-to-face relationship with a trusted GP they’ve known for years, which they have to pay for, he says.

Well-off patients are likely to be using the South Taranaki Rural Health General Practice for convenience, says Dr Blayney.