Primary Health Care

Services to Improve Access

Purpose
Standard Conditions for SIA Funding
Content for SIA Proposals
Approving SIA Proposals
SIA Funding
Monitoring and Reporting
Operational Policy Project

Purpose

A key priority for implementation of the Primary Health Care Strategy is to reduce barriers for the groups with the greatest need through additional services to improve health and improving access to existing first-contact services. The Strategy also identifies the need for encouraging developments that emphasise multi-disciplinary approaches to services and decision-making, including the co-ordination of services with secondary care, public health and other community-based services.

Services to Improve Access (SIA) funding is available for all PHOs to reduce inequalities among those populations that are known to have the worst health status: Maori, Pacific people and those living in NZDep index 9-10 decile areas. The funding is for new services or improved access and is additional to the main PHO capitation funding for general practice-type care. Funds are allocated according to the number of people from these population groups enrolled in the PHO. The need for high quality primary health services, that are culturally competent, is identified by Tangata Whenua and Pacific peoples as very important.

Section H.5.2 of Version 17 of the PHO Service Agreement specifies SIA as: Access for High Need Groups.

It states that:
You (the PHO) will agree with us (the DHB) the services and activities you will undertake to improve access to primary health care services for High Need Groups in your Enrolled Population as follows:

(a) You will design services and activities to improve access to primary health care services for High Need Groups in your Enrolled Population that may include outreach services in appropriate places and delivery approaches tailored for particular groups.

(b) You will submit to us for our approval, your proposed services and activities demonstrating how access funding will be used to improve access to primary health care services.

Successful examples

Examples of the successful use of SIA funding are: the provision of clinics at work sites, marae, church groups and schools; transport services to help people get to clinics; and interpreter services. Such services improve access to health advice and care.

While services should be designed and directed towards the target groups, people who have a similar need should be treated equally and charged the same; individuals must not be excluded or charged more because of their ethnicity or where they live.

This specification is deliberately broad to allow DHBs and PHOs flexibility to design services that meet the unique needs of each PHO community.

Standard Conditions for SIA Funding

To be approved for funding, SIA Proposals to DHBs must:

Be targeted to an enrolled population identified as Maori/Tangata Whenua, Pacific peoples and/or people living in NZDep index 9-10 decile areas
Show that the service is directed at improving the health of these target groups and improving their access to primary health care services
Provide a clear description of the service to be delivered and steps for implementation including:
- Name of the provider/s who will provide the services
- A timeframe for commencement of service delivery
- A budget appropriate to service delivery and management
SIA funding can be used to extend or continue existing services, however the PHO must demonstrate the actual use of SIA funding to ensure that the service is not funded twice.
SIA funding cannot be used to reduce co-payments across the whole enrolled population* however, under special circumstances a portion of SIA funding may be used to reduce co-payments if an Access PHO is experiencing significant financial difficulty. In this situation the PHO must meet the following criteria:
- access funded
- proven financial difficulty in providing first contact services at low co-payments
- have agreement and approval of the DHB with support from the Ministry.

* Reduced co-payments for the whole population is part of First Level Services capitation funding for Access PHOs and, increasingly, will be introduced for age groups under Interim funding. Thus SIA funding is not intended for this use.

Content of SIA Proposals

When developing proposals, DHBs and PHOs may want to consider the literature review on the topic of Improving Access to Primary Care for Maori and Pacific Peoples.

Initiatives aiming to improve access for Maori and Pacific people should reflect:

The need for partnerships in the planning and delivery of services
The value of services delivered for example, on Marae, in churches and in other locations where Maori / Pacific are comfortable and accessible
The benefits of access to Maori / Pacific health professionals and community health workers.

Some examples of strategies to improve access for these groups of people are:

Strategies relating to location of service delivery:

Marae based programmes for Maori
Community health centres for unemployed
Church based health programmes for Pacific Island communities
Mobile nurse-led outreach services in high need areas, for example, a free nurse/nurse practitioner-led clinics could be provided for assessment, triage and follow up and referrals for a GP consultation when necessary.

Strategies to enhance existing services:

School based clinics (targeting schools with high needs students)
Increased screening/management for high need patients with diabetes
Oral health for high need under 5's
Out-of-hours clinics in high need areas

Workforce development strategies:

Ethnic bi-lingual health workers
Cultural competency development for health practitioners, including Nurses, Doctors

Other strategies:

Transport especially in remote rural areas and areas of high need

Approving SIA Proposals

DHBs are responsible for approving SIA proposals from PHOs. They need to ensure that all proposals meet the standard conditions set out below. In order to ensure consistent application of these standard conditions DHBs are required to complete and submit a DHB assurance and recommendation for SIA funding form (Word, 58kB) to the Ministry before funding is approved. The Ministry no longer needs to see the full SIA proposal.

Submitting SIA Funding Form

Please email the SIA Funding Form to us as a Word attachment to primary_healthcare@moh.govt.nz

To complete this form and send it to the Ministry you will first need to save it to your own computer.

You can do this in one of two ways:

Right-click with your mouse on the link below and choose 'Save Target As', or
Click on the link below to open the form and follow the instructions below.
Click File
Select Save As
Type in a file name
Click Save

Note: When you want to complete your responses to the questions it is important that you always open this document from your own computer

Once completed send your completed Word document it as an attachment in an email to primary_healthcare@moh.govt.nz

SIA Funding

The level of funding available to PHOs for SIA activities varies according to the age, gender, ethnicity and deprivation, and are weighted toward high need groups (Maori and Pacific Island), and people living in areas of high deprivation (NZ deprivation 9 and 10).

Read more about Services to Improve Access funding

Monitoring and Reporting

The PHO is required to report its progress on SIA projects in its annual report. In respect of new SIA services, DHBs are encouraged to ask for a progress report prior to the annual report.

If a proposal has been approved and funding has begun, but subsequently the DHB has concerns about performance, the DHB can elect to suspend funding. If a DHB wishes to do this it must contact the Primary Health Team prior to the submission of patient registers for payment.

Operational Policy Project

Services to Improve Access is being considered as part of the Operational Policy Project (Workstream 1 - Funding and Accountability) of the Primary Health Care Strategy Implementation Work Programme. Public information about this project will be added to the Primary Health Care Strategy Implementation Work Programme section of this website.

Page last updated: January 2007