Home' GP Pulse : GP Pulse June 2013 Contents College News
ISSUE 24 : June 2013 : P3
A new era for primar y care
Following our Special ePulse on 17 May about the new PHO Services Agreement, we now provide more detail about what the
agreement contains and how it will affect general practice.
This is the biggest change in the primary
health sector for a decade. The existing
PHO Agreement includes a set of minimum
requirements that were introduced when
PHOs were first established in 2002. The new
agreement, scheduled for implementation from
1 July 2013, better reflects the role of primary
care in an integrated health system.
The changes within the PHO Services
Agreement are designed to improve people’s
health and the individual patient experience,
while supporting the clinical and financial
sustainability of the health system. The new
agreement spells out the objective that health
services should be provided on a ‘best for
patient care’ and ‘best for system’ basis.
incentive framework that will have a whole-
of-health-system approach. This will be
developed with extensive sector input ahead
of phased implementation from 2014. This
has begun with the first meeting last month of
an expert group who are providing advice on
the structure and design of the framework. A
larger, multi-disciplinary reference group will
help shape the detail of the framework.
Negotiating team member and College
President Dr Tim Malloy says, ‘I really think
we have achieved something that matters.
There was a strong sense of collaboration and
shared goals throughout our negotiations. The
agreement provides a platform for stronger
local relationships and improved flexibility
and innovation for general practice. There is
support for a strong and sustainable primary/
General Practice New Zealand’s Chair,
Shelley Frost says,‘We were heartened by the
commonality of vision and approach evident
throughout the negotiation process. The new
agreement is not transformational in itself,
but it does enable a much more collaborative
approach to service development and delivery
within a health alliance. This heralds a new
era of clinically led service design and shared
accountability and strengthens the role of
community-based health care services.’
Main changes for general
The new agreement will include:
• clarification of aspects of after-hours and
holiday cover responsibilities, including
the ability to provide phone or electronic
triage or consultation and the requirement
to provide access to face-to-face
consultations where clinically indicated
• more transparency of service information,
respecting the requirements of the Health
Information Privacy Code, and use of public
• removal of the need for separate PHO-
level Maori health plans in favour of
PHO commitment to and involvement
in developing and implementing specific
deliverables in the DHB Maori health plans
• clarity on the timing of practices moving
between PHOs while leaving the ability for
practices to choose PHOs.
Alliancing is a new concept that fosters greater
collaboration and consistency of services
and will be critical in developing the local
relationships that will drive the strengthening of
primary care and its accountability. Each DHB
that is not currently part of an alliance will form
one with their local PHOs by 1 July 2013.
PHOs not currently part of an alliance will
continue to provide and receive funding for
management services, health promotion
services, services to improve access, and Care
Plus services after 1 July 2013 until flexible
funding pool arrangements are agreed.
The new agreement will incorporate many of
the provisions of the current PHO Agreement.
To ensure consistency in implementing
national requirements, a national template will
be developed for PHO contracts with local
service providers, including general practices.
New contracts are expected to be in place in
the second half of this year.
Contracts will be ‘evergreen’, where
high-performing PHOs are investing in
infrastructure or significant change models, as
this may better support local innovation and
significant financial investment.
A range of suppor t will be available to help with
implementing the new agreement, including
advice and guidance on introducing the alliancing
arrangements.Ministry of Health representatives
will also be presenting on the new agreement
at the Conference for General Practice in July.
The new agreement provides clarity on the
respective roles of DHBs, PHOs and providers.
It is structured to enable more flexibility
to incorporate local service models, while
maintaining consistency across nationally
funded services. It also provides a transition
process into the new flexible funding pool
arrangements associated with alliancing, which
were agreed by Cabinet earlier this year.
The agreement will also soon include a new
primary care integrated performance and
The changes within
the PHO Services
designed to improve
and the individual
while supporting the
clinical and financial
sustainability of the
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