Doctor fees could double for some Northlanders with changes to a scheme which allows thousands cheap visits to the GP.
A report to the Minister of Health proposed revising the Very Low Cost Access Scheme (VLCA), under which 46 of Northland's 55 general practices cap their patient fees at $17.50 or less - about half what a visit would cost at a non-VLCA practice.
Instead, the report by the Primary Care Working Group titled "General Practice Sustainability", recommended moving to a funding system which targeted individual high needs patients.
Mary Carthew, interim chief executive at Manaia PHO, said she was comfortable with the shift towards more targeted funding.
"At the moment we've got large practices that are not VLCA and [high need] patients there that want to stay with their GP ... Those patients will be better off," Ms Carthew said.
Presently, a practice which qualified for VLCA funding could offer low fees to all its patients, regardless of their individual circumstances. VLCA practices get extra government funding - called capitation - for charging low fees in high-needs communities. Forty-six clinics in Northland were eligible for the scheme.
Details of exactly how the changes would work were yet to be announced but would be based on income, Ms Carthew said. The idea of using Community Services Cards to identify high-need patients was floated in the report.
"But that principle has been decided: we've got a limited resource and it needs to be distributed correctly," she said. "The big thing has been acknowledging that the current model is not optimum."
But Whangarei GP David Atkinson said the "dismantling" of VLCA would see the money go back into the "main pot, and redistributed", causing problems for patients who faced hardship, but did not quite meet the threshold.
"It is very likely that poor people will be worse off ... and that they will be put off attending the doctor when they are in need. It happens way too often already."
Funding targeted at individuals would also be complicated and expensive to administer, he said.
"It is going to disadvantage a great many who have migrated to VLCA practices for the very reason of cost. It would have been far better to bolster what was already a workable scheme to include the whole of Northland."
Following the announcement of the 2016 Budget last month, Health Minister Jonathan Coleman said he was yet to make a decision regarding changes to VLCA.
A Ministry of Health spokesperson said work to determine the best general practice funding model was ongoing.
"Further modelling work is being done to understand all of the potential consequences of any proposed changes to funding models," the spokesperson said.