SCDHB

Statement from Chief Executive Chris Fleming:

South Canterbury District Health Board has recently reviewed the scores used to allocate rural funding across general practices in South Canterbury.

This review has long been signalled to general practices and all were asked to complete self-assessments looking at their own eligibility for funding.

In Temuka, two of the three general practices rated themselves as falling below the threshold to receive rural funding. They were informed that their current rural funding arrangement would continue until January 1, 2012, and would then cease.

In Geraldine, both practices assessed themselves as above the threshold to receive rural funding and this was reaffirmed through the review. Rural funding for Geraldine practices will continue.

South Canterbury District Health Board sought the advice of the Rural GP Network, who have endorsed the process that we have taken.

We have since been notified that practices in Temuka and Geraldine are planning to no longer provide after-hours services from July 1. Given the fact that funding is to remain under current arrangements until January 1, 2012, there is no financial justification to cease services so promptly.

The provision of after-hours services is a core part of the primary care agreement between the district health board and general practices. South Canterbury District Health Board, South Link Health (the organisation that holds the contract for GP services on behalf of local GPs) and the individual general practices are obliged to ensure appropriate first level primary cares services are available for all residents.

We want to find an urgent resolution to this issue, one that works for the community, the general practitioners, and the district health board. We are working with South Link Health to attempt to find this. We understand South Link Health are seeking an urgent meeting with the practices involved, and we have asked that they delay making any decisions for at least a month to allow these discussions to take place. 

There is enough time for everyone to work together to find solutions and the district health board is open to reviewing the scoring if there are factors that were not taken into account in the original review. We are also open to working through arrangements to ensure appropriate after-hours services are provided across our district.

Background

The Rural Ranking Score was developed by general practitioners in 1995 as an objective measure to allocate rural funding. The original purpose was to sustain an appropriate level of GP care in isolated and rural communities.

To be eligible for rural funding under the Rural Ranking Score, a GP is asked to score a number of factors relevant to his or her practice. These national criteria include the travelling time from the surgery to the nearest major hospital; on-call roster obligations; responsibility for major trauma in their community; travel time to their nearest GP colleague; travel time to the most distant practice boundary; and whether the GP holds regular off-site clinics.

 There are four sources of government rural funding and these are:

-          Rural bonus - the Rural Ranking Score determines the allocation of this funding.

-          Reasonable rostering, rural recruitment and retention, and the Minister's rural after hours funding.  For these three sources of funding the Rural Ranking Score simply determines eligibility for funding.

In the review process, the South Canterbury review panel:

• Accepted the Automobile Association travel times as the measure for travelling time to the nearest major hospital.
• Required that on-call ambulance arrangements must be on a routine, rostered basis to qualify for points allocation. The only notified on-call arrangements with St Johns Ambulance within South Canterbury are in Waimate, Geraldine, Fairlie and Twizel.
• Agreed that the on-call duties are based on the number of general practitioners in each on-call group/district regardless of whether or not all GPs are on the on-call roster. Nurse practitioners are not counted in the on-call roster.
• Agreed that the allocation for points for travel time to most distant practice boundary is consistent within practice localities.

                      i.        Twizel and Fairlie practices could have patients more than 60 minutes driving time from the practice and be the closest practice for that patient.

                    ii.        Geraldine and Waimate practices could have patients between 30 – 60 minutes driving time from the practice and be the closest practice for that patient. However, over 60 minutes would either reach another practice or be outside the SCDHB boundary.

                   iii.        Temuka practices are all within 30 minutes drive time in any direction of another general practice or the SCDHB boundary.

• Noted that a peripheral clinic must be outside of the regular practice locality (e.g. neighbouring township) and be available for patients to book appointments.