The announcement that nurses and NPs can join GPs in claiming government subsidies for non-enrolled patients is prompting an online backlash from GPs.
Chief Nurse Jane O’Malley announced on Friday to the NZNO College of Primary Health Care nurses conference that registered nurses, nurse practitioners and pharmacists will from the end of the year have access to the general medical services (GMS) subsidy.
Health Minister Tony Ryall is shortly expected to release details on how and which nurses and NPs will be eligible for the $28 million funding stream.
GMS subsidies are available for consultations with patients who are either not enrolled in a primary health organisation (PHO) or when an enrolled patient is seen away from their normal general practice.
An online news article on the announcement on the NZ Doctor website has sparked abacklash from GPs including concern it would lead to increased “claw backs” from general practices whose patients visit another practice or health practitioner.
Along with cries about the move leading to more competition and fragmentation of health services there are online comments that the announcement would ensure a GP crisis as “no young doctor in their right mind would touch the profession now”, a call for a GP strike, questioning whether the ministry had “marbles for brains” and a backlash against the minister. “This is all about a minister who has not so hidden hatred of general practice doing everything he can to destablise it.”
Cathy O’Malley, the Ministry of Health deputy director general, for sector capability and implementation, joined in the online discussion with a ‘clarification’ that the GMS subsidy extension was intended to support general practices and other PHO-contracted providers who already have nurses, doctors and clinical pharmacists working in their team.
“The extension of GMS to suitably qualified health professionals will be limited to those working in those settings and the business rules will be carefully written to ensure there is not a fragmentation of service.”
“This is not new money or new work, just a shift which will allow practices to determine who does what work in their team when it comes to casual patients, and to claim accordingly,” said O’Malley.
Cathy O’Malley, who also spoke to the conference pointed out that the GMS subsidy was only a small part of the total $780 million plus primary health care funding that nurses were already able to access including, technically being able to enroll patients and receive capitation funding. The only other doctor-only subsidy was the rural subsidy which there was still ongoing work on.
Speaking to Nursing Review during the conference Rosemary Minto, chair of the College of Primary Health Care Nurses said it would be interesting to see the response of GPs to the announcement because of the potential impact on their capitation funding.
She has since joined in the online debate pointing out that NPs, like herself, were mostly working with GPs either as employees, partners in business or salaried alongside them.
“I resent the assumptions made in these comments that NPs want to fragment the health system,” she wrote. “This hysteria reminds of the suffragette movement- society didn’t collapse when women got the vote and the health service wont disintegrate with this announcement.”
When talking to Nursing Review Minto also responded to Cathy O’Malley’s comments that NPs were already able to access the vast majority of primary health care funding.
“It is not the access to the money that is the problem it is the ability to influence the way the money is spent within the practice or PHO,” said Minto. “And that’s the frustration for nurses – we know the funding is there but we don’t have the ability to direct where it goes,” she said and that was particularly true at the PHO level.
