A frustrated Northland GP has spoken out about the difficult decision to leave the region's primary health care entity that will lose a third of its general practice members in the next few weeks.
Dr Paula Mathieson of Rata Family Health in Whangārei has given notice to leave Mahitahi Hauora and join Auckland-based Comprehensive Care from July 1.
Four other GP practices in Whangārei — Bush Rd Medical Centre, Central Family Health Care, Kensington Health and West End Medical Centre — left last year and six others are leaving next month.
They are James St Doctors, Te Aroha Noa Medical Centre on Bank St, Green Cross Health-owned The Doctors Tui, The Doctors Kamo, The Doctors Tikipunga and The Doctors Kerikeri.
Their decision followed frustration over the amount of overhead costs Mahitahi Hauora deducted from funding it received from the Northland District Health Board, the process around the appointment of the PHE's chief executive Jensen Webber and board chairman Geoff Milner, and the latter's perceived conflict of interest in that role, given he's also the chief executive of Ngati Hine Health Trust- a beneficiary of NDHB funds.
They are also unhappy with the end of some outreach services that used to take place under Manaia PHO that merged with Tai Tokerau PHO in 2019 to become Mahitahi Hauora.
Mathieson was on the Manaia PHO board for about seven years and said it was a high-performing organisation in a low socio-economic region.
"I am fourth generation in Whangārei so have had a long history and every reason to want an organisation in Whangārei to thrive and I've invested my time, sacrificed my children's time to be on the board, so for me it makes me cry."
Under the Services to Improve Funding (SIA), money was set aside for dietitians, diabetes and respiratory nurse specialists, supermarket tours and bus services under Manaia PHO, she said.
However, Mathieson said those initiatives stopped under Mahitahi and questioned what has replaced them.
"It wasn't quite so bad in Manaia's time because we had tangible things that we could see our patients receive from our SIA funding. Then Mahitahi was formed and a whole lot of things have stopped. Support for general practice has stopped."
At Comprehensive Care, she said the SIA funding went to a trust of the GPs in Whangārei that have left Mahitahi Hauora and would be used to fund "tangible" things, which she felt good about.
The other problem, she said, was a lack of GPs, patients and Maori health providers from Whangārei on the Mahitahi board despite them being the major stakeholders that have the most enrolled population in the PHO.
"Anybody can see that's a huge risk that your major stakeholder has no representation on your board. And it turned out to be a significant risk for them. One of the big things Mahitahi lost, which Mahaia had, was relationships and communication."
Mathieson described as "madness" a decision by Mahitahi to charge general practices for services they chose to buy after ending top-slicing to ensure GPs received all funding from the Northland DHB.
Under the new approach to service delivery, Mahitahi Hauora said it has worked on a transparent actual cost basis to enable practices to decide if they wanted to buy the services.
An all-inclusive monthly base fee of $1.04 per month will be charged to GP practices with up to 2500 enrolled patients, 96 cents for up to 5000 patients, and 55 cents for practices that have more than 10,001 patients.
"A lot of the services are IT, things you'd expect to access, and corporate things. I can't see much actual health out of the things I can buy," Mathieson said.
"We gather the data in general practice, we personally enter them into a computer system and Mahitahi is expecting us to pay to access that information. They're expecting me to pay to access my intellectual property. It's crazy."
Mahitahi Hauora chief executive Jensen Webber said it was important to understand costs were associated with the secure storage and processing of data, and that the PHO data analysts created tools to analyse and display data in a way practices could easily understand, identify patterns and use to support clinical care.
"We also combine practice data with data from other sources to improve the quality and accuracy of data and identify systemic problems. In these respects, Mahitahi Hauora adds value to the raw data practices provide to support better decision-making for practices."
He said Mahitahi Hauora did not believe data gathered in general practices was the latter's intellectual property.
On the SIA funding, Webber said all of that money was now being given directly to practices to fund services as they saw fit.
Commenting on the Mahitahi board, Webber said a majority of the board was made up of general practice owners and that it also has two GPs: Dr Suzanne Phillips and Dr Taco Kistemaker, based in Paihia and the Far North respectively.
"We recently had a vacancy on the board but we did not receive any applications from Whangārei-based GPs. Patients are directly represented through our Consumer Voice Advisory Rōpu, which is made up of members of the community who represent a range of communities, hapū and iwi across Tai Tokerau," Webber said.