Sign-ups may have to be forced: GPs

By MARTIN JOHNSTON and FRANCESCA MOLD

Patients must be forced to sign on with doctors if the Government's health plans are to work, says a large doctors' group.

Compulsion is necessary to enable doctors to pick up illnesses early, says Integrated Primary Care Services, which represents more than 90 general practitioners and other health workers in West Auckland.

"You can't do any population-health work unless you've got the population known," said group chairman Dr Lannes Johnson.

"We know only half the number of diabetics have been diagnosed in New Zealand. I would like to do something about that."

He said the flipside of compelling patients to affiliate with a doctor or group such as his needed to be at least some degree of Government subsidy for all patients' visits, plus financial disincentives "to people jumping around."

The group expressed these views in a submission on a Government discussion document, The Future Shape of Primary Health Care. Submissions ended last week and the Government will finalise its strategy by October.

It plans to extend bulk-funding of doctor visits based on a population formula that takes account of regional factors such as ethnicity, poverty and disease prevalence.

Medical groups generally support the document's aims as long as there is more funding but some women's groups fear the document signals worse health care for the poor.

A senior Health Ministry official, Dr John Marwick, said it was not planned to force affiliation with a Primary Care Organisation (PCO) - the non-profit associations of doctors and other health workers that will handle their Government funding.

But compulsion might become desirable in future if the people who did not enrol were those who could benefit the most, he said.

Most doctors agree that enrolling patients is a step forward.

Taumarunui GP Upali Manu said: "It means we know our patients and we feel responsible for their health.

"If they don't come in for checkups when they should, we know it is up to us to chase them up."

The College of GPs and First Health, a group of 260 GPs throughout the North Island, believe it is vital that enrolment is done locally.

College chairman Dr Ralph Wiles said affiliation would succeed only if patients were encouraged to sign up with a doctor or practice rather than the much larger PCOs.

First Health spokesman Dr Jonathan Simon said it was unlikely New Zealanders would accept compulsory affiliation.

Women's Health Action executive director Sandra Coney and Auckland Women's Health Council coordinator Lynda Williams said the funding system proposed in the document could produce an unfair, two-tier system: "capitation" or population-based bulk-funding for the poor, and a continued right for doctors to charge wealthier patients for each visit.

They said that would encourage underservicing of the poor and overservicing of the rest.

But Dr Marwick said that had not happened with the 18 per cent of GPs who were already bulk-funded for subsidised patients.

The long-term plan was to bulk-fund the whole population for a broad range of primary-care services, including doctor visits, pharmaceuticals and laboratory tests.