The 2022 Sapere report, commissioned by the last government, looked at the capitation formula with the goal of addressing fundamental problems and finding a way to better respond to health need.
Unsurprisingly, it found the status quo revenue was below the likely true cost of delivering care.
The capitation system pays practices according to the number of people enrolled with Primary Health Organisations (PHOs).
The Sapere report argued the formula should be based on age, sex, ethnicity, deprivation and morbidity as this would give results adequately co-related to health need.
This would mean for practices serving many high-need patients, an increase in capitation funding of between 34% and 231% would be needed.
For most practices, the median increase required would be between 10% and 20% of their 2022 capitation funding.
These are not amounts any government, no matter how much it might say it sees primary care as the backbone of the health system, was keen to rush into finding.
Health Minister Simeon Brown says his government has given the largest-ever funding boost to GP clinics last year and a further $120.6 million with this year’s funding package.
Dunedin GP and palliative medicine doctor David McKay describes the offer as being the choice to practices as not being between a good option and a better one, but between half a loaf and crumbs and a quarter of a loaf, depending on the practice.
He says the funding increases do not meet the consumer price index (CPI) changes, nor do they cover increased patient acuity, workload, and some types of GP-led patient care, such as palliative care.
Mr Brown said GP clinics overwhelmingly voted in favour of the new funding package but Dr McKay said it was a pragmatic response to very limited alternatives, rather than genuine endorsement.
This month the capitation formula change for the first time in more than 20 years to include multimorbidity, rurality, and socioeconomic deprivation, but no weighting for Māori, who die on average seven years earlier than non-Māori.
But while it seems most general practices will be better off under the new funding package, there have been some anomalies.
In Wānaka, for instance, there has been confusion and concern about the impact of the way rurality has been classified.
It is hard to understand why this could not have been avoided.
Mr Brown has been emphasising the significant benefits to rural communities from the changes, insisting they will ensure patients in small rural towns are valued as much as those in our major cities.
Ward 10a secrecy
Health New Zealand Te Whatu Ora needs to stop the secrecy about what has been going on at Wakari Hospital’s beleaguered Ward 10a.
If the ombudsman visited the unit in mid-March and early April raising serious concerns, it beggars belief that last month when we raised questions about patients being moved out of the ward there was stonewalling from HNZ.
We knew Ward 10a was supposed to be being refurbished, but in June HNZ could give no assurance about the work going ahead.
The 12-bed ward is a secure unit which provides treatment and rehabilitation services for people over the age of 18 with an intellectual disability who have been convicted of criminal offences, or who demonstrate behaviours assessed as posing a serious risk to themselves or others.
We established last month patients had been moved out but we were not told why or where they had gone to.
Secrecy about the reasons for the closure of Ward 10a has served nobody well and only added to the trauma and uncertainty for families of patients in wards 9a and 10a.
Mental Health minister Matt Doocey says he has been briefed on the patient mistreatment allegations, but we wonder how long ago that occurred.
Has he known about these concerns for months, and if that is the case, why has he not spoken out before now?
The sooner proper light is shed on this sorry affair the better.
