Doctors' worries over being undercut means free care for under-6s unavailable after hours.
Parents from some low-income Auckland suburbs face paying up to $25 for young children to see a doctor at an after-hours clinic, despite subsidies intended to reduce the charges.
Child advocates are upset that not all of Auckland's network of 11 after-hours accident and medical clinics are free for children under 6.
The top-up patient fees were not abolished at White Cross Ascot in Greenlane and three other after-hours clinics because in talks on fees in all age groups, GPs' representatives did not want patients being diverted to cheaper after-hours services nearby.
Waitemata and Auckland district health board meeting minutes record concern from the chairman of the Auckland Regional After Hours Network, Ian Scott, that families in low-income areas such as Glen Innes faced a $25 fee for under-6s at the Ascot clinic - or a longer drive over to the Otahuhu White Cross for a free consultation.
"Ian Scott advised that the problem had been that ProCare PHO [primary health organisation] had insisted that A&Ms should not undercut general practitioner charges."
The chief executive of White Cross, Alistair Sullivan, said, "From a patient-access point of view, we would have preferred to have under-6s free at all our clinics.
"The inability to [do that] was a direct result of the consultation exercise with PHOs and their views on the desirability of not, in their words, undercutting general practitioners' co-payment levels for under-6s."
A ProCare manager, Jude Keys, said the PHO had wanted to avoid distorting primary care with fees that might have encouraged people to delay seeking medical care "and turn up to after-hours A&Ms for every medical issue".
Child Poverty Action Group spokeswoman Dr Nikki Turner, a GP, said it was unfortunate that the Auckland after-hours network hadn't delivered universally free after-hours doctor visits for under-6s in the region.
The network, funded mainly by the three Auckland DHBs, subsidises care for under-6s, the elderly, and those in between who live in a low-income area or hold a community services or high-user health card.
Most GPs in Auckland charge no fees for under-6s during office hours. But some do charge, including in Epsom ($29), Remuera ($15 and $28) and St Heliers ($20 and $28). Some in other, mainly wealthier areas also levy fees for under-6s.
* Not all of the 11 after-hours accident and medical clinics are free for children under 6.
* Families in some low-income areas face a $25 fee.
* Most GPs in Auckland charge no fees for under-6s during office hours.
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