Most GP, nurse, and nurse practitioner services are currently funded by ACC via the Cost of Treatment Regulations, on a fee-per-visit basis. GPs have indicated they'd like to see a more flexible approach to the way we work together. We agree and want to explore this collaboratively with the primary care sector.
We want to build a framework that develops our relationship with General Practice. We want to move from a transactional model to a way of working that supports innovation and improves access as well as outcomes for patients. The framework will also ensure quality and consistency of care.
Partnership with national bodies
We're partnering with General Practice New Zealand, Royal New Zealand College of General Practitioners, and the New Zealand Medical Association to engage with General Practice.
Together, we've created a set of principles to guide this process and form the foundation of our future relationship:
- Be person and whānau centred – organising and funding services around patient needs
- Improve partnerships with providers and work in a way that's fair and in good faith
- Promote health and injury prevention with a focus on improved equity, access and outcomes
- Value the comprehensive care and continuity delivered by General Practice teams
- Harness primary health workforce skills to drive for quality
- Align ACC with the Government’s health strategy, enabling innovation and integration.
The current system
ACC currently purchases most GP, nurse and nurse practitioner services via the Cost of Treatment Regulations on a fee-per-visit basis.
The regulations ensure transparency around patient entitlements and provide for regular reviews of the rates paid for treatments. The regulations provide specific rates for visits, treatments, and imaging by provider type, eg GP or nurse, rather than service. In the context of general practice, the Regulations cover GPs, nurses and nurse practitioners as providers.
Rural general practice and urgent care services are purchased through contracts.
What the Cost of Treatment Regulations are
ACC operates under legislation set out in the Accident Compensation Act. Under the Act, ACC is liable to pay or contribute the amount stated in a contract or agreement.
Where no contract or agreement exists, payment is made under regulations. Rural general practice and urgent care clinics have separate contracts with ACC, however, the rest of general practice doesn't. Therefore, as per the legislation, most general practice providers are paid under regulations.
Why we should explore an alternative
GPs have indicated they'd like to see a more flexible approach to the way we work together, and we agree.
Together, we'd like to create a relationship framework that:
- Enables us to collaboratively assess needs, determine priorities, and proactively plan for improved patient outcomes.
ACC’s Health Sector Strategy focuses on greater collaboration and partnerships with providers to improve patient outcomes. Effective planning for outcomes requires a process to assess needs, determine priorities, and build treatment pathways with resources to match. The current regulatory framework restricts the collaboration necessary to do this.
- Supports innovation in General Practice with integrated inter-disciplinary delivery models and enhanced clinical pathways.
The Cost of Treatment Regulations limit innovative practice and business models. The Government wants to maximise the scope of the general practice workforce, and pursue innovation and integrated ways of working. Currently, general practice can only deliver services for ACC against a fixed price schedule for specified treatments provided by specific clinicians.
- Provides visibility of service quality and outcomes for ACC patients in primary care.
Under the Cost of Treatment Regulations, we lack visibility of service quality or consistency of care in general practice. A lack of data around service quality inhibits our ability to identify gaps in service provision, or where investment in workforce capability would be beneficial.
We'd value your input to help us design a new relationship framework that will help us to collectively improve care for our patients.
Using the feedback form, please tell us what:
- do you value in the current way of working?
- are our biggest opportunities to change the way we plan and fund services?
- barriers to change do you think we need to be mindful of? How could we manage them?