Fees to see a GP are going up, despite the multibillion-dollar taxpayer boost for primary healthcare.
Costs are likely to rise by more than $1 for most patients after a controversial ruling by district health boards.
Doctors blame increasing costs, such as pay rises of up to 19 per cent for primary care nurses, a boost which the Government refuses to provide for, saying it is already paying enough.
Groups representing general practitioners predict many will push to impose higher fee rises, prompting a flood of reviews under a new system set up by health boards.
The Government is putting more than $2 billion more into primary healthcare over seven years to reduce patient fees and prescription charges.
During a bitter funding dispute last year - fuelled by Government concerns that some GPs had increased fees to cream off new subsidies - the 21 health boards implemented the new review process, which led boards to release their first "statement of reasonable GP fee increases".
It considers rises of between 4.5 and 6.3 per cent to be reasonable for the year to June 30, depending on the extent to which a clinic is state-funded.
Based on current average charges, adults' fees could rise by between 70c and $1.70 in most cases. Clinics which did not increase their fees in the last financial year can increase their charges by an extra 1.8 to 2.4 per cent under the statement.
Clinics wanting to increase their fees by more than the benchmarks must justify their bid to an independent review committee appointed by their region's health boards.
Appeals and arbitration are possible if the fee rise is rejected.
The benchmarks are based on Statistics NZ price indexes for labour, rent and other business "inputs".
Considered the simplest method, it excludes one-offs such as the pending pay increases for nurses.
Medical Association GP council chairman Dr Peter Foley thinks omitting the nurses' pay rises and the impact of the extra week's leave under the Holidays Act are fatal flaws.
He said 4.5 per cent "just doesn't get there. It fails to recognise the true costs of general practice, which this year has some significant one-off costs".
Independent Practitioners Association Council chairwoman Dr Bev O'Keefe agreed the nursing deal might push clinics into needing more than 4.5 per cent extra from patients.
"It's highly likely that we are going to end up with large numbers of practices falling outside ... [the above] parameters.
"It is our expectation that the large proportion of practices that find themselves subject to the fee review process will be found to be making reasonable increases, on the basis of sound business practice."
Health boards' spokesman Win Bennett confirmed that boards could withhold funding from a practice that implemented an increase above that rejected by the appeal process.
But Dr Foley said patients would be the losers if this happened.
* Advertised GP fees for subsidised adults: average around $27 during business hours, or $16 at low-cost "access" clinics.
* Unsubsidised adults: around $50 on average, but more than $80 in some places.
* Subsidies are available for most people enrolled with Primary Health Organisations. People aged 25 to 44 will be the last group covered, from July 1.
* Medical consultations can cover anything from asthma and influenza to gout and arthritis.
* A standard visit is commonly around 15 minutes, but times vary significantly.