Application of Fees Framework for acute and urgent appointments in general practice

Pinnacle has received a letter from Martin Hefford, Director Living Well Planning, Funding and Outcomes at Te Whatu Ora, regarding the application of the Fees Framework to acute and urgent GP appointments. Te Whatu Ora has been asked to comment on situations where contracted providers are charging patients additional fees to access urgent appointments, such as same-day or acute clinics for enrolled patients. These charges are not always consistent with the Fees Framework set out in the PHO Services Agreement. In response, Te Whatu Ora has outlined its expectations around how fees should be applied to acute services funded through capitation. We want your feedback Pinnacle wants your feedback on Te Whatu Ora’s expectations around fees for urgent and acute GP appointments. Your views will help inform our advocacy and discussions with Te Whatu Ora. This issue may also be discussed as part of the PSAAP process, so you might also wish to share your feedback with your contracted provider negotiator. Please send feedback to Sarah Wotherspoon , Pinnacle senior administrator.   PHO services agreement requirements The PHO Services Agreement requires PHOs and their contracted providers to provide nationally consistent services for enrolled populations, and collectively to eligible persons, including First Level Services and Urgent Care Services. First Level Service: refers to services which improve health, maintain health, restore health and also importantly the coordination of care, including links with other primary and secondary services. Urgent Care services: refer to First Level Services which must be provided urgently because they cannot be safely deferred. The Fees Framework is designed to balance affordable access, provider autonomy, and nationally consistent policies such as free care for under-14s and CSC subsidies. This ensures all PHOs and their networks operate under the same obligations, and that the community knows what to expect. Te Whatu Ora expectations Te Whatu Ora expects the Fees Framework to apply to all standard GP consultations during business hours. This includes same-day, walk-in, and urgent appointments for enrolled patients. Additional standard charges (including disbursements) for urgent care are not consistent with the PHO Services Agreement. If additional charges exceed the agreed co-payment rules, the fees review process applies. Practices providing both standard GP services and urgent care are expected to apply the same rules.