Auckland medical centres say high cost of running practices in city behind charges for children's visits.

Ten of the 11 medical practices which do not provide free GP visits to under 6-year-olds are in Auckland with one GP saying the subsidies were too low given the high costs of practice in Auckland and could lead to other patients paying higher fees to help cover the extra costs.

The Ministry of Health has released the names of the 11 clinics which had not opted into the "zero fees" scheme for under 6s to the Herald and instead were charging fees ranging from $10 to $32.

The programme offers extra subsidies to private practices which do not charge fees to enrolled children aged under 6. Introduced in 2008, it is due to be extended to under 13-year-olds in July under a $90 million election promise by National last year.

Of 1021 practices in New Zealand, only 11 had not signed up for the under 6s, mostly in affluent areas in Auckland including Grey Lynn, Remuera, Epsom and Ponsonby. The only clinic in South Auckland was Papakura Family Medical Practice which has no children aged under 6 enrolled.

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Dr James Beetham at the Richmond Rd Medical Centre in Grey Lynn said the subsidy did not account for the higher costs of an Auckland practice.

"I hate the word free, because it's not free. I think it's propaganda. As a vote-buying tactic I think it's as low as you can [get] because it doesn't cost the politicians diddly squat." Instead it would mean dropping other free services or increasing fees for other patients to subsidise it.

About one quarter of the practice's patients were under 5 and very few had left to change to a nearby zero-fee practice, instead opting to pay the $18 fee.

Dr Jessie Liu, a doctor at the Windsor Medical Centre in Albany, said if the practice offered zero fees it would struggle to fit in other patients, such as the elderly. There was already a high demand with the $10 fee it currently charges for under 6s.

"If we make it free I'm sure we will be very overwhelmed by lots of mums coming from all over the place." She said the subsidies were low but that was not the reason her practice was not in the programme - it only made $70 more a year than it would if it had joined.

Dr Gerald Young, a director of City Med Doctors, said because it was a central city practice it did not attract the same level of subsidies as practices in poorer areas. It had very few children enrolled and did offer reduced fees of $20. He would consider the under-13s scheme, but the funding for it was based on two visits a year by each child and if there were more it ended up costing the practice or being subsidised by other patients.

The other practices did not respond to requests for comment.

Dr Kate Baddock, chairwoman of the GP Council, said the programmes stacked up financially for some practices but most took a loss because the subsidies were not high enough to compensate for the co-payments doctors can otherwise charge.

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Patient demand was another factor. "They obviously also have not been pressured by their patients, or the patients they had who would be concerned about it have already gone somewhere else."

Andrew Inder, the Ministry of Health's group manager for community health service improvement, said there were other practices near to the 11 in question which were on the scheme and nationally 99 per cent of children aged under 6 were enrolled with a practice that did not charge.

Health Minister Jonathan Coleman said he expected about 70 per cent of general practices to offer the under 13s zero fees from day one and that would increase over time.

Clinics revealed
The clinics and what they charge for an enrolled child under 6.
• East Coast Bays Doctors: $10-15.
• Richmond Rd Medical Centre: $18
• CityMed Doctors: $20
• Epsom Medical Centre: $29
• Meadowbank Family Doctors: $22
• Windsor Medical Centre, Albany: $10
• Marsden Medical Practice, Mt Eden: unstated.
• Ponsonby Medical Centre: $32 for under 5s.
• Remuera Medical Centre: $28
• Papakura Family Medical Practice: unknown, has no under 6s enrolled.
• Merivale Medical Practice, Christchurch: $17.