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Primary Health Care

Frequently Asked Questions

What is Primary Health Care?


Primary health relates to professional health care received in the community, usually from your GP or practice nurse. Primary health care provides an entry point to the health system, delivers core medical and preventative care and helps patients co-ordinate and integrate their care.

The Definition of Primary Health Care drawn up at the International Conference on Primary Health Care, Alma-Ata, September 1978 is:

"Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process."

What is the Primary Health Care Strategy?


A strong primary health care system is central to improving the health of all New Zealanders and reducing health inequalities between different groups.

The Primary Health Care Strategy sets a new vision and direction for the future of primary health care in New Zealand and builds on the goals and objectives of the New Zealand Health Strategy and the New Zealand Disability Strategy.

The vision of the Primary Health Care Strategy is that:
  • People will be part of local primary health care services that improve their health, keep then well, are easy to get to and co-ordinate their ongoing care
  • Primary health care services will focus on better health for a population, and actively work to reduce health inequalities between different groups.

The vision of the Primary Health Care Strategy will be achieved through:
  • A population health approach, with a greater focus on health promotion and the prevention and management of chronic conditions
  • Involving local communities
  • Greater emphasis on bringing health professionals together and encouraging multi-disciplinary approaches
  • Improving service accessibility, affordability and appropriateness
  • Improving co-ordination and continuity of care
  • Providing funding and services according to the population's health needs, instead of a fee-for-service approach when individuals are unwell.

Since the launch of the Primary Health Care Strategy in 2001, and the establishment of the first PHOs in 2002, the sector has achieved significant progress with implementation putting in place the foundations for a system that will deliver real health gains for New Zealanders.

The focus on the next phase of implementation has moved from establishment to concentrating on delivering on the central aims of the Primary Health Care Strategy which include reducing inequalities, engaging communities and improving the prevention and management of chronic conditions.

The Primary Health Care Strategy Implementation Work Programme sets the direction for the next phase of implementation and provides a picture of what the Primary Health Care Strategy should have achieved by 2010. It focuses on a new way of working with a greater emphasis on the roles and relationships of, and between providers, PHOs and DHBs, and full engagement with the wider sector and communities.

What is a Primary Health Organisation (PHO)?


PHOs are the local structures for delivering and co-ordinating primary health care services. PHOs bring together doctors, nurses and other health professionals (such as Maori health workers, health promotion workers, dieticians, pharmacists, physiotherapists, psychologists and midwives) in the community to serve the needs of their enrolled populations.

PHOs vary widely in size and structure and are not-for-profit. The first PHOs were established in July 2002 and there are now 81 PHOs around the country. DHBs worked with local communities and provider organisations to establish PHOs in their regions.

The Minister of Health released a set of minimum requirements that guided the establishment of PHOs, and set out standards that PHOs must meet. This includes a requirement that PHOs will give communities, iwi and enrolled people the opportunity to have their say about the services PHOs provide.

PHOs get a set amount of funding from the government to subsidise a range of health services. The funding is based on the numbers and characteristics (eg, age, sex, ethnicity) of people enrolled with them. That funding pays for:
  • Providing care and treatment when people are ill
  • Helping people stay healthy
  • Reaching out to those groups in their community who have poor health or who are missing out on primary health care.

All PHOs receive additional funding for Health Promotion programmes, and are able to access Services to Improve Access funding to provide new services or improved access to reduce health inequalities among high-need groups that are known to have the worst health status.

A new very low cost access payment for PHOs and practices that charge very low fees to patients was introduced on 1 October 2006. The very low cost access payment was introduced as a way to support, encourage, and reward PHOs and their practices that, in order to deliver on very low cost access to primary health care and reduce health inequalities, have forgone revenue from patient fees.

What are the benefits of belonging to a PHO?


Children under six years old are eligible for reduced cost doctor visits and free prescription medicines regardless of their doctor belonging to a PHO or not.

If you are enrolled in a PHO you are eligible for reduced cost doctors visits, and pay only $3 per prescription medicine (as long as the medicine is fully subsidised and as long as the prescription is from your usual PHO doctor).

PHOs are funded under two different models – Access and Interim. To ensure that funding was targeted to the areas of greatest need - most funding was directed at Access PHOs in the early phases of the implementation of the Primary Health Care Strategy. Access PHOs and practices have high proportions of low-income, Maori and Pacific peoples - groups that have traditionally had poorer health outcomes than the rest of the population. Since 1 July 2002, all people enrolled with general practices in Access-funded PHOs have been eligible for subsidies to lower the cost of doctors' visits.

The first step in extending low cost access to people in Interim-funded PHOs took place in October 2003 when enrollees aged between 6 and 17 years became eligible for subsidies to lower the cost of doctors’ visits. The final rollout for people enrolled in Interim PHOs (those aged 25-44 years) took place on 1 July 2007.

How do I join a PHO?


Nearly four million New Zealanders (95 percent of the population) are now enrolled in a PHO, and most general practices are now part of a PHO. If you are not enrolled in a PHO, ask your regular doctor if they are part of a PHO.

To enrol, usually you will have to sign a form which the doctor, nurse or medical centre receptionist will give you. The form will usually ask you for your personal details such as name, age, date of birth, address and ethnicity. The information collected at enrolment comes under the Privacy Act 1993 and the Health Information Privacy Code 1994, so the privacy of your information is protected.

Can I belong to more than one PHO?


No. You can only enrol in one PHO at a time, but you can change PHOs if you wish. You can visit other doctors or health care providers as a casual patient, and be charged casual rates, but you should enrol with the family doctor you use most often. By building a relationship with your PHO health professional like your family doctor or nurse, they'll get to know you better and you'll get continuity of care.

If you're away from home and get sick, you can still see a doctor in the area you're visiting as a casual patient.

What if I have to see my doctor regularly because of a chronic condition?


One of the things PHOs are focusing on is improving care for people with chronic conditions.

A service called Care Plus has been introduced through PHOs and it is aimed at people who need to visit their family GP or nurse often because of significant chronic illnesses such as diabetes or heart disease, have acute medical or mental health needs, or a terminal illness. Care Plus services are provided at a low or reduced cost.

Many PHOs around the country are offering Care Plus. Ask your doctor or nurse if your PHO is offering Care Plus. They will assess you to see if you are eligible for Care Plus. If you are not eligible it may be that they can help you in other ways or review your existing care.

Read more about Care Plus

What do I do if I have a problem with my PHO?


District Health Boards (DHBs) are responsible for the ongoing management of any PHO in its area, which includes monitoring fees charged to patients to ensure government subsidies are being used appropriately. If you are concerned about the level of fees you are being charged, or have any general enquiries about enrolment or your PHO you should contact the Primary Care Portfolio Manager at your local DHB. If you are unsure which DHB area you are in, check the maps of DHB districts.

What about Community Services Cards and other subsidy cards?


Can I still use my Community Services Card?
If you hold a Community Services Card you may find this useful:
  • If you are out of town and need to visit a doctor who is not part of your PHO
  • If you visit non-PHO practices
  • For after-hours visits, and
  • For accessing travel and accommodation assistance and home help services.

I didn't notice a difference when subsidies were introduced for my age group
If you hold a Community Services Card (or a High Use Health Card) you may have only noticed a small difference in fees following the introduction of subsidies for your age group. This is because these cardholders have already been receiving a subsidy towards the cost of GP visits and pharmaceuticals. The biggest impact will be for people enrolled in a PHO who do not hold either of these cards.

Read more about Community Services Cards

What if I hold a High Use Health Card or a Pharmaceutical Subsidy Card?
If you visit a provider frequently you may qualify for a High Use Health Card and/or a Pharmaceutical/Prescription Subsidy Card, which will entitle you to lower-cost health care visits and/or medicines.


Page last updated: July 2007


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