Photo: 123RF
- Retired accountant says primary health organisations have become overly corporatised and top-heavy, taking too much of the health spend compared to GPs
- GPs question whether there are "inefficiencies"
- PHOs say they are "crystal clear" about where funding goes
Top-heavy, overly-bureaucratic primary health organisations (PHOs) are siphoning off too much government funding before it gets to frontline GPs, according to an independent report by a retired accountant.
Murray Lilley told Nine to Noon his analysis of publicly available records for eight PHOs showed their overheads had increased by 70 to 100 percent in the last five years.
"If you go back 15 years, the average cost that these people took off from all sources of government funding was less than 10c in the dollar. Now, the same organisations are taking anywhere between 20 and 50 percent."
General Practice New Zealand, which represents PHOs, has criticised the report as "flawed" because it failed to recognise PHOs' function in serving population-based health needs, from mental health to smoking cessation.
But a group representing independent GPs and practice owners, GenPro, said many of its members shared the concerns highlighted in the report, which was sent to the office of Health Minister Simeon Brown before being "leaked" to many practices.
Possible 'over-reach' by PHOs in play - GP
Angus Chambers. Photo: Supplied
GenPro chair Angus Chambers, a Christchurch GP, said many practices were squeezed by rising costs and static income.
"There is concern that some of the resource that should be coming down to practices can get caught up in PHOs. And I probably agree there's a perception that there are some inefficiencies within PHOs. To be blunt, we do wonder if there's some overreach going on."
Chambers said the current regime also had potential for "conflicts of interest", with PHOs - which were both the funders and providers of services - buying up practices and competing with other GPs, who did not have the advantage of their tax-free charitable status.
"We probably see a distinction between very large PHOs, which are both a bureaucracy and a commercial entity, and some of the smaller ones which are highly focused on their enrolled population at the practices."
In some regions patients were unable to receive certain services unless practices consented to PHO employees coming in to deliver them, rather than using their own staff, he said.
"Some practices would prefer to have funding to do that themselves, but they are point-blank not allowed to."
Telehealth - a key part of the government strategy to relieve the pressure on primary care and championed by many PHOs - was "a useful adjunct" to care but not a cure-all, Chambers said.
"I do see telehealth as progressing - and that worries me because it is depleting the on-the-ground workforce. It lends itself to the quick and easy problems, leaving general practice teams to pick up the pieces at the end of it."
There was no evidence that telehealth decreased emergency department wait times ("it doesn't"), or produced faster access to first specialist appointments or quicker cancer diagnoses, he continued.
GenPro was concerned that patients in many regions were increasingly less likely to get "the option of seeing a doctor" under the current settings and resourcing.
PHOs 'set up for transparency'
General Practice NZ chair Dr Bryan Betty - representing PHOs - said Lilley's report ignored their role in population health.
Bryan Betty. Photo: Ross Giblin / Stuff
"One hundred percent of capitation funding for general practice gets passed straight through to practices, that's the baseline funding that everyone's talking about. However, PHOs are responsible for a range of other primary and community services."
PHOs "linked" those services into general practice, including programmes for mental health, diabetes, immunisation, sexual health, smoking cessation and community radiology, he said.
"But these come from separate funding streams and this has not been identified in the Lilley report. And that is a fundamental flaw, I think, because it leads to conclusions which aren't based on what's actually happening in the system."
Lilley's suggestion that PHOs were set up to avoid scrutiny was not correct, Betty said.
"PHOs are set up for transparency - as charitable trusts, they publish audited accounts and have governance boards. Those reports are crystal clear about where the money is coming from and where it's going to."
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