Larger GP practices in Northland will end up paying tens of thousands of dollars if they opt to access the services of Mahitahi Hauora after the embattled primary health entity outlined plans to charge for the work it undertakes.
From July 1, the PHE is ending top slicing on funding it receives from the Northland District Health Board to ensure general practices received all that money and can then buy services back from Mahitahi Hauora if they so choose.
Mahitahi Hauora either lost or are in the process of losing a third of their GP practices in Northland due to their frustration over funding arrangements and a working relationship that has deteriorated over the years.
The PHE has 33 member practices across Northland, including seven that will
leave in June.
The chief concerns of GPs that have left and those leaving in June are the amount of "top slicing" or overhead costs Mahitahi Hauora deducts from the funding it receives, 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.
Under the new model, Webber said under the new approach to service delivery, Mahitahi Hauora has worked on a transparent actual cost basis to enable its 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 large practice such as Bush Rd Medical Centre with about 11,000 enrolled patients will end up paying $72,000 annually and Dr Geoff Cunningham said Mahitahi Hauora wanted to charge GPs for services that were supposed to be free and for which the PHO was already getting paid to provide.
The practice is one of those that has left Mahitahi Hauora.
"It appears in an effort to financially survive they are looking at invoicing remaining practices for base services already funded by government streams such as register and data management," the Bush Rd Medical Centre doctor said.
"We are not getting top slicing of our funding with our new PHO Comprehensive Care, nor are we expected to pay for these core services which it appears Mahitahi PHO intends to charge remaining practices for under it's 'All Inclusive Package' deal," he said.
But Webber said the decision to charge for services was in recognition of the fact general practices were chronically underfunded, and Mahitahi Hauora saw the impacts of this in Northland every day in people's ability to access services and practices' ability to remain viable.
"We have turned the funding approach on its head, meaning that each general practice can now make its own decisions on how and what it buys from us as a PHO. The extra money that general practice receives can then be focused on providing valuable services for patients under our new 'Equity for Whanau' agreement with practices.
"Our new approach to funding is an important part of our commitment to better support our practices to improve equity and outcomes for priority groups because it enables them to focus resources on what will make the most difference for their unique, enrolled
"The new approach goes hand-in-hand with our new Equity for Whānau agreement with Mahitahi Hauora practices. This new agreement brings an end to the complex multiple contracts that often hampered efforts towards equity," he said.
Webber said Mahitahi Hauora and Northland DHB were currently negotiating contracts for 2022/23.
The details of these arrangements would include a transparent cost basis to fund services and Mahitahi Hauora also expected to obtain some revenue from the services packages practices may choose to buy, he said.
Northland DHB chief executive Dr Nick Chamberlain said Mahitahi Hauora provided a brief to NDHB before announcing it to its member practice.
"Practices would have the choice to commit to this new model and we'll leave it with individual practices to decide on their individual approach to this proposal," he said.