Primary health care providers

Background

The Government places an emphasis on the broader multidisciplinary primary health care team – general practitioner, nurse practitioner, registered nurse, pharmacists, and other health professionals (such as physiotherapists, dieticians, psychologists, counsellors and occupational therapists) working together to enable people to have direct access to a range of primary health care providers. The health reforms aim to extend and develop this concept and increase the role of Māori providers.

The Government provides subsidies to lower the cost of general practice visits for people enrolled in a primary health organisation (PHO), usually through a general practice. You can be enrolled in only one PHO at a time. The practice in which you are enrolled will receive funding for you. Fees charged for general practice services, according to local arrangements between Health New Zealand - Te Whatu Ora and PHOs, are required to be published on local Health NZ websites. Most general practices operate as independent businesses and set their own fees for co-payments for consultations and other services such as writing repeat prescriptions without a consultation. The amount a general practices charges as a co-payment can vary between practices but is restricted and cannot exceed a set amount.

If you need to make a casual visit to another practice (for example, if you are away from your home area), and you do not hold a Community Services Card (CSC) or a High Use Health Card, you may be charged the full fee as a casual patient. If you are a CSC holder and visit a practice where you are not enrolled, you will be charged at the regular casual rate. Some practices have introduced a casual rate for CSC holders which is lower than the normal casual rate. You will need to check the fees with the practice.

As part of the Health Reforms, there will be reviews of the way primary care is structured and funded, which may alter some of the fees GPs charge. You can keep updated with the latest Health Reform updates at Future of Health (external link).

Currently, nurses at all three levels of registration (ie nurse practitioner (NP), registered nurse (RN) and enrolled nurse (EN)) practise in general practice at a level in keeping with their education and training.

In some cases, it is more appropriate for health care to be delivered by a primary care nurse working in general practice, rather than a GP. First Contact Funding to PHOs includes a Practice Nurse Subsidy.

The development of some services delivered through PHOs such as Care Plus, have enabled more effective use of nursing skills. The alliances established by Health NZ with PHOs will allow for more flexible use of PHO funding and more effective use of the skills of nurses in general practices.

If you are a casual patient (not enrolled at the practice you are attending) and a nurse sees you, they can make a claim towards the cost of the consultation from Health NZ and you may still incur a co-payment.

Nurse practitioners are highly skilled autonomous health practitioners who have advanced education, clinical training and demonstrated competency. They have the legal authority to practice beyond the level of a registered nurse as they hold a clinical master’s degree. They may be the lead healthcare provider for health consumers and their families/whānau.

Of the 500 NPs registered with the Nursing Council in 2021, the majority work in primary care or community health. They can make diagnoses and differential diagnoses, and order and interpret diagnostic and laboratory tests. They prescribe medicines within their area of competence with the same authority as medical practitioners.

The PHO Service Agreement between Health NZ and PHOs allows NPs to enrol patients, receive capitation payments and claim General Medical Services in the same way as GPs.