Beyond the headlines: Justin's views

27 March 2024

[Photo: Markus Winkler]

Justin Butcher, Pinnacle CEO, talks about the GP funding for pre-call and recall admissions and what it means for general practice, and updates on the PSAAP and upcoming negotiations. 

GP funding for pre-calls and recalls a good start – but then what?

While new funding announced by Te Whatu Ora’s National Public Health Service to support general practices in pre-calling and recalling babies for immunisations is a welcome step, it feels a bit like a band-aid on a gaping wound.

The announcement by NPHS national director Dr Nick Chamberlain at the General Practice Leaders’ Forum on 13 March, followed an earlier decision by NPHS to allow pharmacies to deliver all vaccines from six weeks onwards. That move, coupled with the lack of previous funding recognition for the work GPs already do in ensuring timely childhood vaccinations, created a sense of frustration about potential erosion of the role of GPs and general practice in a child's overall healthcare journey.

With the new funding, from 1 April, general practices will be paid $40 for every baby enrolled at the time of their six-week immunisation, irrespective of where the baby is vaccinated. An additional $40 (making $80 all up) will be paid for babies meeting high-needs criteria (Māori, Pasifika, Community Services Card, quintile five and rural). At this stage, the funding is until 30 June 2025. As of today’s date, we are still waiting on more detail and hope to pass this onto our practices as soon as we hear.

The new funding doesn't address the core issues leading to low vaccination rates, particularly among Māori and high-needs populations. The announcement acknowledges the importance of continuity of care and regular health checks, which is welcome as these are areas where GPs excel. However, low GP enrolment rates at four months, especially amongst Māori, highlight the need for a more holistic approach.

The latest quarterly immunisations statistics show childhood immunisation rates have fallen again to 81 per cent overall and 66 per cent Māori. An additional one-off fee of $40 in recognition of the work involved in identifying, and enrolling a newborn and encouraging immunisation is inadequate when you consider the costs involved. To make a real difference a broader strategy is needed. This could involve targeted outreach programmes addressing vaccine hesitancy within specific communities, coupled with increased funding for GP enrolment, particularly amongst high-needs populations.

Only a multi-pronged approach that addresses the underlying workforce, workload, and funding crisis in general practice can tackle the complex reasons behind low vaccination rates and vaccine hesitancy to build a strong, unified immunisation system for the future.

PSAAP and upcoming negotiations

The immunisations funding at a practice level isn’t significant – for many practices this will equate to no more than $200 to $300 a quarter and highlights the fee-for-service approaches that keep being rolled out in the absence of a functioning PSAAP (the PHO negotiation forum that looks at the back-to-back agreement). We have seen this disjointed approach before with pay disparity, equity adjustors for capitation and the list goes on and on.

Thankfully, the impasse that prevented this group from meeting for almost two years has been resolved, giving us the ability to return to joint decision making and partnership vs unilateral (Te Whatu Ora) decision making. We know the process isn’t perfect, and in many respects isn’t fit for purpose, but it’s better than nothing and will allow us to push the plight of general practice more strongly.

New Zealand is currently in a technical recession with the financial outlook not being particularly positive. We have been warned about the “austerity budget” and are starting to see the impacts of what is to come in the public sector redundancies. More than ever primary care will require strong representation. I'm pleased to share I've been selected as one of the four negotiators for primary care so will continue to advocate strongly for our practice network throughout the negotiation process.

Many of you won’t know that contracted providers (aka general practice) are also present at the meetings and have their own representatives at the negotiation table. These have generally been selected by the GPLF (General Practice Leadership Forum) which includes Genpro, Hauora Taiwhenua, PMAANZ, and the Colleges for general practitioners and primary care nurses alongside GPNZ.

Going forward, practices across the country will be asked to nominate who they want to represent them in this forum. There will be some more detail around this in the coming weeks, but our Board has asked Pinnacle leadership to offer representation and advocacy for you, our network. This is about choice and who you feel can best represent the needs of general practice, and you are free to choose whoever you wish. While we can’t speak for other providers in this space, Pinnacle will be providing this service free to our network. 

Along with other members of the leadership team, I look forward to getting out and discussing this along with many of the other challenges practices are facing over the coming months.

Ngā mihi,

Justin Butcher, Kaiwhakatere (CEO)