Ministry contracting process flawed - NZ Doctor Viewpoint

IPAC Deputy Chair, Doug Baird, despairs of the Ministry contracting process - published in New Zealand Doctor 27 Feb 2003

The PHO contract between DHBs and embryonic PHOs is exercising the minds of many general practice leaders and others in the Health sector.  It is a document that could be expected to cement into place a good working relationship between providers of primary health care and the agents of the government who partially fund the care.

IPAC holds the view that the contract document developed by representatives of the Ministry and the DHBs in a secretive process, with very limited primary sector input, is fundamentally flawed.  Furthermore, despite the contract really being no more than a contract for general practice services, it is a document designed to control both the price and the nature of delivery.  In effect, it is an attempt to take over the control of general practice without either purchasing the business, or taking any financial risk.

Until this document, which had reached version 13 before IPAC discovered its existence, is truly negotiated between the representatives of organised general practice and the government it will be a noose that will rapidly tighten around the necks of all of us in general practice.  IPAC strongly advises all GPs, and the IPAs that they belong to, to eschew signing any document that will commit them to the levels of interference and control that the proffered Ministry of Health contract portends.

Fundamental to a good contract is the process of negotiating in good faith, the requirement that all parties reach a fair and equitable agreement that is sustainable and verifiable and that builds a strong and positive relationship between the signatories.

Basic to this for GPs is the inalienable right to charge a fee that is commensurate with the service provided and allows for sustainable high quality general practice, the preservation of clinical and business autonomy including the ability to reject interference that is not based on proven clinical practice, the right to retain information that would compromise confidentiality and advantage other organisations whilst not improving the health of their patients..

We understand that developing PHOs in Tairawhiti and Counties-Manukau are struggling to survive on the government funding provided with accompanying fee restraints in general practice.  Significant gaming of the Access formula has begun in South Auckland as we predicted. The Ministry’s assurances mean little to those facing business failure.

Given this, it is surprising to us that a considerable minority of PCOs appear to have rushed to sign up as PHOs without considering the iniquitous nature of the contract that the Ministry of Health would have them commit themselves to.

National media recently quoted a Cromwell campsite owner who had spent some years attempting to exercise his rights after the dam ruined his livelihood. He was quoted as saying that all government departments were both manipulative and deceitful.  This is a strong warning for organised general practice.  The PHO contract dictates our futures.  There are no second chances here.    

There has been heartening support from  all sections of main stream  general practice  for IPAC’s position on PHO formation.  For IPAC to do its job of strongly negotiating a truly equitable contract with the Ministry of Health, it must have the backing of general practice and its IPA constituency.

Doug Baird
Deputy Chairman
IPAC.
Publish Date : 27/02/2003
Author :  IPAC