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After four and a-half years, agreements are almost finalised for after-hours health care for more than 100,000 patients in the Dunedin and Taieri-Strath Taieri areas.
Patients are not likely to notice any change in their care, however, as Dunedin Hospital's emergency department will continue to provide the cover from 11.30pm to 8am, something it has been doing on an "interim" basis since mid-2004.
Otago District Health Board chief operating officer Vivian Blake said agreement had been reached on the terms of contracts with two primary health organisations, Well Dunedin and Taieri-Strath Taieri, along with the student health services for the Otago Polytechnic and the University of Otago.
Under the contracts, general practitioners in the participating organisations will make a payment to the board based on the practices' enrolled population.
She said the amount of the contracts was confidential and she was not prepared to indicate a general total.
The contracts, which are backdated to last January and will run for two years with a right of renewal for a further six months, were delivered to the various organisations before Christmas.
Two contracts were yet to be returned, but she believed this was simply a formality.
Mrs Blake said the issue had lingered for such a long time it would be good to have certainty over it.
There had "not really" been controversy over the matter, but if a health care provider was not able to provide a service and somebody else picked it up, then it was reasonable not to expect that service to be provided free. Other boards had entered into similar relationships, she said.
The emergency department took over the "graveyard shift" for many Dunedin patients after Dunedin Urgent Doctors and Accident Centre stopped its service covering those hours in August 2004, citing concern about the safety of family doctors working long hours, lack of patient demand, and financial loss.
Then, in October 2005, doctors serving Mosgiel, Taieri and Strath Taieri stopped covering the late shift.
There have been concerns over who should pay for the service, with the board contending that if it provided care through the emergency department for relatively minor conditions it was effectively paying twice because it was already paying doctors to provide that cover.
Well Dunedin chief executive Sandy Baines said her organisation, which covers 29 practices and about 80,000 patients, had reached agreement with the board in principle, but was still negotiating with some practices on a few minor points and hoped these could be "brought to a close" by the end of the month.
Practices' main concern had been that their patients were getting good support.
It would be "fantastic" to finally have something in place, she said.
Ms Baines said one of the good things about the arrangement with the board was that information would be gathered to see if patients were attending the department when they could be treated during the day. That information would be conveyed back to the PHOs to establish if further education was required.
Taieri-Strath Taieri PHO manager Megan Barrett said sometimes people were not sure if a condition was urgent they could use, for guidance, the national healthline service, which has registered nurses providing a 24-hour advice on 0800 611-116.
She said the PHO was pleased with the way the negotiations had worked out. It was not simple to get several different groups to agree.
The PHO appreciated that working the "graveyard shift" was "extremely telling on GPS when they are still having to run clinics the next day".
• Patients who are enrolled with Mornington PHO are not part of the new formal arrangement as they have access to an on-call doctor after hours.