March 2012
Guidance for District Health Boards
Free after-hours care for children aged under six years
Introduction
This guidance document has been developed to support district health boards (DHBs) in
their planning for the implementation of free after-hours care for children aged under six
years on 1 July 2012.
Individual DHBs have the best understanding of their local requirements and capacity and it
is expected that, in partnership with their primary care providers, local sustainable solutions
will be developed. This information aims to help clarify the intent of the policy and set
principles and parameters to underpin local implementation.
Background
On 27 October 2011, the Minister of Health Hon Tony Ryall announced the introduction of
free after-hours primary health care for children aged under six years on 1 July 2012.
The policy goal is to:
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help improve access to services through reducing financial barriers
address the national variability in fees for after-hours service provision for this
age group
reduce the numbers of young children presenting to Emergency Departments
with conditions that might be better treated by primary care providers
enhance child health outcomes.
Underlying principles
The following principles and supporting statements have been developed following
discussion with DHBs, General Practice New Zealand (GPNZ) and the wider sector. These
are offered as guidance for the local introduction of this service:
i.
Clinical continuity of care:
 the use of a regular primary care provider should be promoted to maintain
continuity of care and the ‘medical home’
 after-hours services should be available for children with clinical conditions,
the treatment of which cannot be safely deferred. Local public education and
communication programmes should support this
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ii.
after-hours providers should provide a clinical record of the consultation to the
child’s regular general practice as soon as possible, unless the parents object
to this
when telephone triage results in urgent referral to a hospital facility, the child’s
regular general practice should be notified.
The environment:
 flexible and extended opening hours offered by regular daytime general
practices may help reduce utilisation of after-hours clinics by families with
young children
 after-hours providers should act in ways that support the patient’s relationship
with their ‘medical home’
 the introduction of free after-hours care for children under six years must not
increase the cost for after-hours care for other age-groups.
National minimum requirements
1. All children aged under six years should be eligible for free after-hours primary health
care services. This should include both enrolled patients and casual patients, regardless
of their place of residence.
2. Free after-hours services must be available for most children under six years within 60
minutes travel time.
3. Coverage means the percentage of the total DHB domiciled population of children under
six years, having access to free after-hours care. Each DHB should strive for as high a
level of coverage as possible on 1 July 2012, with coverage increasing thereafter as
quickly as possible.
4. After-hours is defined as meeting the needs of patients “that cannot be safely deferred
until regular general practice services are next available”1. In general, after-hours means
those hours between 6pm and 8am on weekdays and during the 24 hour period over
weekends and public holidays. However local variations may be applied where these
better meet local needs.
5. After-hours care means the provision of ‘face-to-face’ primary health care services in a
practice or clinic setting. Telephone triage may be a component of after-hours services,
but it is not a substitute for the availability of face-to-face consultations, or a prerequisite.
6. As provided for in the PHO Agreement2 a General Medical Services (GMS) claim may be
made for the provision of free after-hours services for children under six years. Locally
1
Towards Accessible, Effective and Resilient After Hours Primary Health Care Services; Report of the
After Hours Primary Health Care Working Party. Ministry of Health, 2005
2 PHO Service Agreement Version 18
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negotiated arrangements, such as a percentage of capitation funding being paid to afterhours providers in lieu of GMS claims, may also be applied.
7. Discussions with ACC are underway regarding accident related presentations. Advice
will be provided as soon as possible regarding any changes to their current policy.
8. DHBs are expected to work with their local rural providers. Existing Primary Health Care
Rural After Hours Funding agreements with rural general practices will not change at this
time.
9. Engagement with local primary care and sector groups is essential. The development of
local alliances and clinical partnerships is strongly encouraged.
Reporting
10. DHBs are required to:
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confirm in their Annual Plans that they have a minimum of 60 per cent service
coverage for free after-hours care for children under six years as of 1 July
2012 and,
report progress against increasing this service coverage to as close to 100
per cent as practicable, as quickly as possible. This recognises that some
private providers may choose not to participate in this service.
Contact:
Gabrielle Roberts
Senior Advisor
Sector Capability and Implementation
Ministry of Health
DDI: 04 816 3548
[email protected]
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