Yesterday, behind closed doors in Invercargill, the Southland board voted against the one Otago-Southland PHO proposal recommended by chief executive Brian Rousseau to replace the existing nine, opting instead for one for each province.
A week earlier, the Otago board had supported Mr Rousseau's proposal.
That decision was kept secret until after yesterday's Southland meeting to avoid any suggestion Otago could have had undue influence on the Southland deliberations.
Otago board chairman Errol Millar said last night the Southland decision had always been a possibility and "you can't cry over spilt milk".
He was disappointed some of the financial gains from having one PHO might not be realised and he was unsure how proposals like handing over funding for community medicines might work with two PHOs.
He was also unsure whether most general practice owners' preferences for one PHO would be much of an issue.
Health Minister Tony Ryall had made it clear GPs must have the right to choose their PHO and there would probably be some "jockeying for positions" between the two proposed PHOs.
That could mean some Otago GPs might be aligned with the Southland PHO and vice versa.
He did not believe the two-PHO proposal would adversely affect the relationship between the two boards and their ability to work together on other issues.
Speaking after yesterday's meeting, Southland chairman Paul Menzies said support from GPs was one of the greatest risks in the decision.
"It's certainly a challenge."
His next step on the question would be to ask Mr Rousseau to do his best to ensure the outcome agreed by the board worked.
Mr Menzies, Tahu Potiki and Katie O'Connor were the only three members of the Southland board to speak in favour of one PHO in the hour-long public discussion.
Dot Wilson was undecided and members Karen Goffe, Neville Cook and Kaye Crowther all spoke for a Southland PHO.
Susie Johnstone, Sajan Bhatia and Tim Ward were not present.
Mr Menzies said the board had come down in favour of the "community capital" invested in PHOs.
A week ago, none of the Otago board members present voted against the one-PHO proposal, but Judith Medlicott, whose husband was formerly involved with the Mornington PHO, abstained.
Tahu Potiki and Susie Johnstone, who serve on both boards, were not at the Otago meeting.
The Otago board also passed a fall-back motion that it would proceed with one PHO for Otago if Southland opted for a separate Southland structure.
Reference was made to the lobbying which had preceded yesterday's Invercargill meeting, with Mr Rousseau saying there had been a flurry of letters coming to the board from PHOs wanting the two-PHO model and organisations supporting them.
The board had also been threatened with a judicial review over the process it had followed, he said, but the board's legal advice was that there was no requirement for public consultation on the matter.
PHOs had been given ample opportunity to present their cases.
None of the letters addressed any substantive benefits from having two PHOs instead of one, he said.
