Response to Recommendations of After Hours Primary Health Care Working Party

Response to Recommendations of After Hours Primary Health Care Working Party

Date of publication: 9 March 2006

The report Towards Accessible Effective and Resilient After Hours Primary Health Care Services was released to the sector for comment in October 2005. The following actions have been taken in response to the recommendations and the submissions received on the report. A summary of the submissions received is also available on our website.

Response to recommendations directed at District Health Boards (DHBs)

DHBs (at the DHBNZ Services Improvement Group meeting of 9 February 2006) have agreed to the report’s recommendations 1 - 4 aimed at them. DHBs, in collaboration with PHOs, after hours service providers (both PHO member practices and, where applicable, Accident and Medical Clinics) and Emergency Departments (EDs) will develop a District After Hours Planning and Funding Strategic Plan.

In addition to the aspects listed in recommendation 2, DHBs have agreed to consider the following in the development of the District After Hours Planning and Funding Strategic Plan:

the pressure on after hours services arising for some localities that experience an influx of casual visitors at certain periods
transport problems impacting on access to after hours services for some people
access to pharmaceuticals and dental care after hours
rural/urban differences and workforce retention and recruitment issues in rural areas.

Response to recommendations directed at PHOs

DHBs will also ensure that PHOs implement recommendations 5 -7 that are directed at PHOs.

Response to recommendations directed at the Ministry of Health

The Ministry of Health has agreed to implement recommendations 8 – 13 and the following actions have been taken.

I have written to Chief Executives of DHBs advising them of the time-frame for the completion of the District After Hours Planning and Funding Strategic Plans. As it is important that DHBs have sufficient time to take a collaborative approach with PHOs and after hours service providers in the development of these plans, completed plans will not be required by the Ministry until February 2007 (Quarter 2 of the 2006/07 Quarterly Report process). However, DHBs have been urged to commence planning without delay (if they have not already done so) and the Ministry will be pleased to accept plans at an earlier date. DHBs have been advised that the 2006/07 Operational Policy Framework (OPF) will confirm the following:

in Quarter One 2006/07, DHBs will report on progress towards developing their District After Hours Planning and Funding Strategic Plan
in Quarter Two 2006/07, DHBs will submit their Plan
in Quarters Three and Four 2006/07, DHBs will report against progress in implementing the plan using the template which will be developed in conjunction with DHBNZ.

The reporting template will be designed to support effective monitoring on progress towards accessible, effective and resilient after hours services and shared learning among DHBs.

The Ministry will proceed with arrangements for work to be undertaken on the development of a face to face sector disposition tool designed to assist a health professional determine which service – the primary health care service or the Emergency Department – patients should most appropriately attend for treatment. (The Working Party’s suggested intermediate option on page 12 of its report will not be pursued in the light of comments received).

Response to Recommendation to the Ministry of Health and ACC

The Ministry of Health and ACC has progressed the review of PRIME. The PRIME Advisory Group (involving representatives from the Rural General Practice Network, Royal New Zealand College of General Practitioners, ambulance sector and DHBs) has met twice. So far the PRIME Advisory Group has agreed to terms of reference covering governance and practitioner engagement, definition and objectives of the service, funding and remuneration, education and training, quality review and local planning though PRIME committees. Draft service specifications were distributed in December 2005 to PRIME Advisory Group members for feedback.

Response to Recommendation to ACC

I have written to the Chief Executive of ACC asking what plans or progress ACC has made in response to recommendation 15. Recommendation 15 stated that ACC should investigate options for payment for primary care services provided in Emergency Departments.

Funding issues

Six submissions on the report commented on the need for additional funding to support after hours services. As you are aware, the terms of reference agreed by the Working Party stated that the recommendations needed to be developed with the assumption that no further primary health care strategy funding will be available to support after hours services, but that there may be opportunities to better utilise available primary health care and DHB baseline funding to support after hours primary health care. The funding situation is unchanged.

Appreciation of contribution of Working Party members

In closing, while I expect after hours primary health care issues will continue to be a challenge, I am pleased with the progress made in 2005 in meeting the project aims of clarifying key stakeholders’ respective responsibilities for the provision of after hours primary health care and creating an environment that promotes locally developed solutions. I thank the members of the After Hours Primary Health Care Working Party for their contribution to that progress.

Dr Colin Feek
Deputy Director-General
Clinical Services Directorate