Académique Documents
Professionnel Documents
Culture Documents
New Zealand
general practice
1
Acknowledgements
Thank you to Martin London for the work he has contributed to this re-
source. Compiled originally by Lynn Saul and reviewed by Dr Sue Crengle,
Shahrazad Abdul-Ridha, Ian St George, Iain Hague, Sue Hancock, Joe
Scott-Jones and Dene Egglestone. Revised in 2005.
ISBN: 0-9582429-1-7
© The Royal New Zealand College of General Practitioners, New Zealand, 2005.
The Royal New Zealand College of General Practitioners owns the copyright of this
work and has exclusive rights in accordance with the Copyright Act 1994.
In particular, prior written permission must be obtained from the Royal New Zealand
College of General Practitioners for others (including business entities) to:
• copy the work
• issue copies of the work, whether by sale or otherwise
• show the work in public
• make an adaptation of the work
as defined by the Copyright Act 1994.
2
Contents
Introduction .............................................................................. 4
Section 1
Requirements to work in New Zealand
as a general practitioner ........................................................... 6
Section 2
General practice overview ....................................................... 15
Professional development ........................................................ 20
Doctor/patient relationship ...................................................... 24
Section 3
Health of New Zealanders ....................................................... 29
Health care sector overview ..................................................... 35
Regulatory requirements .......................................................... 39
Orientation to general practice ................................................ 45
Practice orientation ................................................................. 58
Appendices
Appendix 1: Subsidies ............................................................. 66
Appendix 2: Glossary .............................................................. 69
References ......................................................................... 70
3
Introduction
We set out in this resource first, the requirements you will need to
work as a GP in New Zealand. Second, a general practice overview
includes the sort of professional development a GP is expected to
maintain, and what is expected in this country of the doctor/patient
relationship. Third, the New Zealand health environment, with detail
on how the sector is structured, including the regulatory require-
ments that face each GP. Finally, templates which you may use when
your planning becomes more detailed. These offer questions you
will need answered.
4
The Medical Council of New Zealand provides resources that cover
important information for doctors. If you do not already have a copy,
we suggest you contact the Medical Council to obtain a copy of:
5
SECTION 1
Requirements to work in
New Zealand as a general
practitioner
1. Medical registration
2. Confirmed job offer
3. Work permit
4. Either work with a practice as part of a Primary Health Organi-
sation (PHO), or a Section 88 notice entitling payment of subsi-
dies for some patients.
6
Medical Council of New Zealand
Level 12
Mid City Tower
139–143 Willis St
P O Box 11 649
Wellington
Website: www.mcnz.org.nz
Email: If this is your first enquiry, firstenquiry@mcnz.org.nz
: Enquiry regarding current application, registration@mcnz.org.nz
Tel: +64-4-384 7635
7
medicine”, but must work within a collegial relationship and also
ensure appropriate continuing professional development takes place.
8
Special purpose scope of practice
Medical practitioners who are in New Zealand for defined or limited
reasons, including teaching, sponsored training, research, working
as a locum tenens for up to six months, or assisting in an emergency
or other unpredictable, short-term situation, will be registered within
a special purpose scope. This scope does not lead to permanent
registration. The practitioner must work under supervision, and the
Council must approve the institution where the practitioner works.
Qualifications
The Medical Council has prescribed in detail the qualifications for
the various scopes; the recognised academic institutions, and the
necessary training and experience for registration. There may also
be a requirement for an English language test. The full description
of the scopes and the details of the qualifications are obtainable
from the Medical Council, and are laid out in the New Zealand
Gazette No 120 of 15 September 2004, pages 2920 to 2928. All
medical practitioners must also hold an Annual Practicing Certifi-
cate (APC) issued by the Medical Council.
Work Permit
After a confirmed job offer has been obtained, a practitioner must obtain
a work permit from the New Zealand Immigration Service, which will
also require evidence of medical registration. The Immigration Service
9
has branches in New Zealand and around the world. Medical practitioners
are on a priority list for immigration into New Zealand to address long-
term skill shortages. For questions, including assistance with locating a
branch nearest to you, call the National Contact centre on:
10
Fax: +64-9-488 4284
Email: editor@nzdoctor.co.nz
Website: www.nzdoctor.co.nz
Locum employment
New Zealand has two Government-funded rural locum schemes:
NZ Rural GP Network
(covers Warkworth south)
P O Box 547
Wellington
Tel: +64-4-472 3901
Fax: +64-4-472 0904
Email: enquiries@rgpn.org.nz
Website: www.nzlocums.com.nz
11
Tel: +64-9-377 5903
Fax: +64-9-377 5902
Email: doctors-amb.nz@xtra.co.nz
Website: www.doctorjobs.co.nz
KIWIS Stat
Unit 1, 88 Hayton Road
Christchurch
Tel: +64-3-339 0335
Fax: +64-3-339 0598
Email: manager@kiwisstat.co.nz
12
The Canterbury Medical Locums Association
Medlab South
Christchurch
Tel: +64-3-363 0824
Fax: +64-3-363 0803
Locum List
Practice Manager, Dunedin Urgent Doctors and Accident Centre
Tel: +64-3-479 2900
Fax: +64-3-477 0194
Email: manager@urgentdocs.co.nz
Section 88
General practitioners working outside the Primary Health Organisa-
tions (see page 36) are required to hold a Section 88 notice to qualify
for subsidies. These are generally geographically restricted and new
section 88s are only allocated in areas where there is an undersupply
of doctors. The section 88s are being rapidly phased out however as
the overwhelming majority of patients will be treated in PHOs where
there is capitation paid quarterly for the patient population enrolled
with that PHO.
13
SECTION 2
General practice overview
14
In New Zealand, general practices function as teams. Most general
practices employ practice nurses and reception staff and a growing
number employ practice managers. Practice nurses play an impor-
tant role, providing health advice and services such as immunisa-
tion, screening, diet, diabetes and asthma care. Other staff such as
psychologists, social workers, physiotherapists may work in, or be
associated with, practices.
Self-employed GPs set their own fees for consultations and other serv-
ices, although under new funding arrangements there may be a cap
to the amount charged. Practitioners’ fees vary depending on the way
15
they are funded, their population, the cost of operating the practice
(rents etc.), factors relating to the consultation such as the time and
complexity of the consultation and the circumstances of the patient.
Referred services
Most laboratory tests and x-rays are free to the patient, but may be
associated with a budget held by the practice; check with your prac-
tice for details. Private radiology clinics charge for all tests under-
taken, unless they have been contracted to provide them by a local
District Health Board.
Medicines
Some medicines are subsidised in New Zealand. PHARMAC
(www.pharmac.co.nz), a government organisation, specifies which
medicines will be subsidised; these are listed in the pharmaceutical
schedule. Where there is more than one medicine with similar ef-
fects, the Government may subsidise only one brand (for more de-
tailed information see Appendix 1).
Computerisation
Almost all practices in New Zealand are computerised to some ex-
tent. Some have only reception activities such as an age/sex register,
daily log, and accounts on a computer, but increasingly practices
have fully integrated clinical notes, integrated lab results and clinic
letters, and email and internet access.
16
General practice workforce
As of March 2003, 2324 doctors reported their main work place as
general practice, this is 37 per cent of the medical workforce.2 A
considerable proportion of the New Zealand general practice
workforce was trained overseas; The Medical Council vocational
register at March 2003 showed that of a total of 13,094 medical
practitioners in all vocations 5270, or 40 per cent obtained their
primary medical qualification overseas.
17
Medical indemnity insurance is provided by:
The Medical Protection Society
Website: www.mps.org.uk
Tel: 0800 225 5677
Despite this protection from being sued, there are still a number of
investigations to which a GP can be subject, such as from the Health
and Disability Commissioner, or a coroner.
18
Professional development
19
tice Education Programme (GPEP). The Stage One programme in-
cludes both a 40-week course for registrars and a seminar programme,
each aimed at preparing candidates for the College’s Primary Mem-
bership Examination (Primex).
The exam has both written and practical components, and once
passed candidates have achieved Membership of the College.
Postgraduate years
FRNZCGP
20
Doctors who are registered within the vocational scope of general
practice are required by the Medical Council to undertake a
Maintenance of Professional Standards Programme (MOPS); the
College provides a MOPS programme for its members, currently the
only programme for GPs which is recognised by the Medical Council.
Practice accreditation
The College has a practice accreditation programme, Cornerstone,
whereby practice teams assess themselves against general practice
standards set out in the College publication Aiming for Excellence.
Teams of trained independent assessors – GPs, nurses and practice
managers – check the assessment findings, aiming at achieving the
optimum patient care in every practice. GPs also earn MOPS credits
going through the process. Full details are available from the College.
21
guidelines. Clinical guidelines are produced to help doctors and
patients make decisions about health care in specific clinical circum-
stances. The NZGG also maintains a website containing its own and
other New Zealand guidelines, and provides links to overseas sites:
www.nzgg.org.nz
Medical Journals
The key publications for GPs in NZ are:
22
Doctor/patient relationship
Patient-centred care
Good general practice in New Zealand is based on patient-centred
practice. In using patient-centred approaches the doctor moves be-
yond the pathophysiology of disease and explores the biological,
psychological and social components of their patients’ illnesses. Pa-
tient-centredness does not diminish the importance of biomedicine,
but assumes biomedical expertise and builds from it.
23
derstanding of illness in terms of their life setting and stage
of development.
3. Finding common ground: requires working with the patient to
develop an effective management plan by reaching agreement
about the nature of the problem and priorities, the goals of
treatment and the roles of the patient and doctor.
4. Incorporating prevention and health promotion: working
together to identify areas of lifestyle etc. that need strengthen-
ing in the interests of long-term physical and mental health.
Also monitoring recognised problems and screening for unrec-
ognised disease.
5. Enhancing the patient-doctor relationship: building effec-
tive relationships which encourage working together and can
assist in healing.
6. Being realistic: learning to manage time and energy efficiently
for the maximum benefit of patients.
FIFE
The acronym FIFE4 provides a guide to undertaking a patient-cen-
tred assessment.
F: Feelings “Do you have any fears and concerns I should know about?”
24
1. Consider the health and well-being of your patient to be your
first priority.
2. Respect the rights of the patient.
3. Respect the patient’s autonomy and freedom of choice.
4. Avoid exploiting the patient in any manner.
5. Protect the patient’s private information throughout his/her life-
time and following death, unless there are overriding public
interest considerations at stake, or a patient’s own safety re-
quires a breach of confidentiality.
6. Strive to improve your knowledge and skill so that the best pos-
sible advice and treatment can be afforded to your patient.
7. Adhere to the scientific basis for medical practice while acknowl-
edging the limits of current knowledge.
8. Honour your profession and its traditions in the ways that best
serve the interests of the patient.
9. Recognise your own limitations and the special skills of others in
the prevention and treatment of disease.
10. Accept a responsibility for assisting in the allocation of limited
resources to maximise medical benefit across the community.
11. Accept a responsibility for advocating for adequate resourcing of
medical services.
www.nzma.org.nz/about/ethics.html
Boundary issues
Boundary issues are very important in general practice, in particular
in rural communities where many patients will be your friends or
acquaintances. There is a need to set clear boundaries clarifying
what is acceptable to you and your profession. How you manage
25
boundaries will depend on the situation, the people involved and
your own style. Some ways of maintaining boundaries include:5
26
• The onus is on the doctor to behave in a professional manner.
Total integrity of doctors is the proper expectation of the com-
munity and of the profession.
• The community must be confident that personal boundaries will
be maintained and that as patients they will not be at risk. It is
not acceptable to blame the patient for the sexual misconduct.
• The doctor is in a privileged position, which requires physical
and emotional proximity to the patient. This may increase the
risk of boundaries being broken.
• Sexual misconduct by a doctor risks causing psychological dam-
age to the patient.
• The doctor/patient relationship is not equal. In seeking assistance,
guidance and treatment, the patient is vulnerable. Exploitation of
the patient is therefore an abuse of power and patient consent
cannot be a defence in disciplinary hearings of sexual abuse.
• Sexual involvement with a patient impairs clinical judgment in
the medical management of that patient. The Council will not
tolerate sexual activity with a current patient by a doctor.
27
SECTION 3
Health of New Zealanders
Cultural diversity
The main cultural groups in New Zealand are 80% European, 14.7%
Maori, 6.5% Pacific peoples, 2.9 % Chinese and 1.7% Indian. These
figures are from the 2001 census taken from the Statistics New Zea-
land website. Respondents may claim more than one ethnicity. Each
of these groups has a different place in the history of New Zealand.
Maori are the indigenous people of New Zealand arriving here from
around the 10th century A.D. Estimates of the size of the Maori popu-
lation at the time of European contact at the beginning of the nine-
teenth century range from 100 000 to 500 000.6 In the years follow-
ing contact with Europeans, numbers decreased dramatically to a
lowest point of 42 000 in 1896.6 From this time there has been a
recovery in Maori population.
Since 1960 people from the Pacific Islands have added to the cul-
tural diversity of New Zealand. The population from Pacific Islands
ethnic groups has grown sharply from 100 000 in 1981 to 262 000
in 2001.
28
New Zealand has received refugees from different areas of the world
since the 1930s. These include Indo-China (largest group), Poland,
Chile, Russia, East Europe, Assyria, Ethiopia, Bosnia and Somalia.6
Health status
(MSD 2004 social report, MoH 2004 Pacific Health Chart book)
Overall mortality rates in New Zealand have declined dramatically
over the last 50 years. In the period 2000–2002, life expectancy at
birth is 81.1 years for women and 76.3 years for men. Since the mid
1980s, gains in longevity have been greater for males than for fe-
males. With the decline in the infant mortality rate (from 11.2 deaths
per 1000 live births in 1986 to 4.9 per 1000 in 2003), the impact of
infant death on life expectancy has fallen. The gains in life expect-
ancy since the mid 1980s can be attributed mainly to reduced mor-
tality in middle-aged and old age groups (45–84 years).
Common diagnoses
(Portrait of Health Key results of the 2002/3 NZ health survey)
One in five adults aged 15–44 years have been diagnosed with
asthma. There was no significant difference between women and
men aged 15–44 years. In both females and males the prevalence
of asthma was significantly higher (about four times) in Maori and
European/Other groups, then Pacific people and Asian ethnic groups.
29
One in 10 adults have been diagnosed with heart disease. There was
no significant difference between women and men nor in ethnic groups.
One in 23 adults have been diagnosed with diabeters and its preva-
lence was higher in Maori and Pacific people than in the European/
Other ethnic group.
Maori also have higher death rates from sudden infant death syndrome
(SIDS), youth suicide, violence and motor vehicle crashes. Maori infant
mortality is significantly higher, 11.6 per 1000 compared with 5.3 per
1000. Maori and non-Maori differences in health are present in almost
every disease category as well as admission rates to hospital.9
Pacific people
Pacific people also have poorer health outcomes than the nation as
a whole. Life expectancy for Pacific women is 76.2 years, and for
Pacific males 68.8 years, around six years less than European New
Zealanders.8
30
services and also tackling the underlying social and economic con-
ditions that impact on people’s health.
Maori health
To understand the reasons for Maori health disparities it is important
to understand the history of NZ and the current patterns and social
relationships.
The Treaty was written in both the Maori and English languages but one
is not an exact translation of the other, so this has created different
expectations. Maori believed that greater recognition of Maori authority
was promised, whereas the government insisted that there had been a
full and complete transfer of sovereignty.6 In practice, power passed
very quickly from Maori to non-Maori. Grievances from the past continue
today around land, language, authority and self-determination.
Today the Treaty is used as the document that underpins the Govern-
ment’s relationship with Maori; it is reflected in all government strat-
31
egies. Some compromise has been reached around the differing
interpretations by defining principles inherent in the Treaty. The prin-
ciples most often applied to health are:6
32
The characteristics of whare tapa wha are:6
Focus Taha Taha Taha Taha
Wairua Hinengaro Tinana Whanau
(Spiritual) (Mental) (Physical) (Extended family)
Key aspects The capacity The capacity The capacity The capacity
for faith to commun- for physical to belong,
and wider icate, to growth and to care,
communion think, and development and to share
to feel
Themes Health is Mind and Good Individuals
related to body are physical are part of
unseen and inseparable health is wider social
unspoken necessary systems
energies for optimal
development
33
Health care sector overview
Minister of Health
The Minister of Health has overall responsibility for the health sys-
tem. The Minister determines the health and disability strategies,
powers with respect to District Health Boards (DHBs), making ap-
pointments to ministerial committees and professional regulatory
boards, and agrees how much public money will be spent on the
public health system.
Ministry of Health
The Ministry of Health has a number of key functions including
providing policy advice to the Minister of Health on all aspects of
the health and disability sector, acting as the Minister’s agent and
providing a link between the Minister of Health and DHBs.
34
services. There are currently 21 DHBs. The boards are made up of a
majority of members elected by the community and a minority ap-
pointed by the Minister of Health.
35
4. Increase the level of physical activity
5. Reduce the rate of suicides and suicide attempts
6. Minimise harm caused by alcohol and illicit and other drug use
to both individuals and the community
7. Reduce the incidence and impact of cancer
8. Reduce the incidence and impact of cardiovascular disease
9. Reduce the incidence and impact of diabetes
10. Improve oral health
11. Reduce violence in interpersonal relationships, families, schools,
and communities
12. Improve the health status of people with severe mental illness
13. Ensure access to appropriate child health care services includ-
ing well child and family health care and immunisation.
36
The new direction brings extra funding to primary health care, aiming
to provide lower cost primary health care to all New Zealanders. It is
being introduced gradually, originally over 10 years, but is now
scheduled to be complete in 2007, targeting those most in need; those
in low income groups, Maori and Pacific people, over 64s, and under
25s. All age groups will have full capitation by July 2007.
PHOs are taking different forms and have different funding arrange-
ments depending on the needs of their population. Some general
practice organisations (Independent Practitioner Associations) – see
page 21 – are joining or forming PHOs.
37
Regulatory requirements
Described in brief below are some of the most important Acts and
Codes you need to know about as a medical practitioner. References
are also provided for important Medical Council statements that pro-
vide more specific guidance on the various aspects of medicine.
The Office aims to promote and protect patient rights, resolve com-
plaints relating to those rights, and ongoing education of providers and
consumers. It is a key element in the new environment of consumer-
focused and consumer-accountable health and disability services.
38
For further information see www.hdc.org.nz.
39
• Legislative requirements about patient rights and consent (out-
lines the statutory provisions that allow a doctor to proceed with-
out obtaining informed consent).
www.mcnz.org.nz/about/forms/legislativereqpatientrights.PDF
This Code deals with health information collected, used, held and
disclosed by ‘health agencies’ and is a substitute for the information
privacy principles in the Privacy Act.
40
tient records, transferring patient records, retaining patient records,
storage requirements, destruction of patient records.
The Medicines Act and regulations control which products may le-
gally be distributed, the places where medicines may be manufac-
tured (through a licensing system), the importation and distribution
of medicines, as well as quality standards for medicines and for
packaging. It outlines the circumstances under which a person may
legally sell or distribute a new medicine. The general rule is that it is
an offence to distribute a medicine that has not received Ministerial
consent as notified in the New Zealand Gazette.
41
Mental Health (Compulsory Assessment and Treatment)
Act 1992
This Act provides for the compulsory assessment and treatment of
people who are mentally disordered, as defined by the Act.
42
Guidelines on transmissible major viral infections
The Medical Council encourages the testing of health care workers
and patients exposed to Hepatitis B, C and HIV. It also provides guid-
ance to health care workers infected with these viruses.
43
Orientation to
general practice
Demographic data
• Name of patient
• NHI number
• Gender
• Address
• Date of birth
• Ethnicity
• Registration status
• Registered/casual
• Principal care giver/next of kin
44
• Significant relationships
• Contact phone number
• Community Services Card
• Occupation
Consultation records
• The entry is dated
• Person making entry is identifiable
• The entry is legible
45
• Risk factors are identified and markers used
– Family history
– Smoking
– Alcohol, drug
– Blood pressure
– Weight/height/BMI
• Immunisations
– Last tetanus booster recorded
– Childhood immunisations
– Flu shots if indicated
• Referrals and responses are easily accessible in clinical records
– Laboratory
– X-ray
– Other tests
– Other health information
• Screening
– Cervical smears
– Mammograms
– Other screening according to national or local policies.
Prescribing
The MIMS New Ethicals Catalogue (equivalent of the British MIMS)
is published twice a year and carries the details of all agents which
may be prescribed, in addition to lists of agents available ‘over the
counter’ (OTC), i.e. directly from pharmacists without a prescription,
and The Medical Practitioner Supply Order List (see below). There
are also a variety of tables at the back with information such as
46
height/weight charts, management of common poisonings, tropical
diseases, etc. Available in book form, on compact disk and through
some practice management computer systems.
The medicines
The most commonly used agents tend to have one version, which is
fully funded. Either prescribe generically or choose Fully funded
agents marked with an S in the New Ethicals and a tick (✓) in the
Pharmaceutical Schedule.
Some agents, usually expensive ones like ‘statins’, the newer antide-
pressants or long acting beta-agonists or recently released ones like
angiotensin II inhibitors, are only subsidised if certain patient criteria
are met. These require ‘Special Authority’ (marked SA in the book),
and require submission of an application form and approval.
47
Medical Practitioners Supply Orders (MPSO)
There is a list of agents in the front of MIMS New Ethicals, which can be
obtained by medical practitioners on a special order form for personal
administration to patients in emergencies or to initiate treatment. Rural
practitioners may select agents from the main body of the book but
beware that you will be liable for any part-charges relating to the agents
and will have to consider passing that charge on to the patient.
Talk to the practice staff for information on where the closest services are.
48
Medical certification
As a GP you will be required to sign a range of medical certificates
such as sickness and death certificates.
49
advice, seek a consultant. To arrange admission, ask for the registrar
or house surgeon.
When seeking advice it is good to keep the patient beside you be-
cause inevitably you’ll be asked about something you haven’t thought
to check on. It also helps the patient to have the situation clarified for
them by listening to the call, though your technical conversation may
need translating afterwards for them.
Forms
This section includes a variety of the forms you will meet in your first
few days.
50
Practitioner Supply Order Form (F270)
This one is useful. You can use it to stock your medical bag from a
pharmacy. If you are a rural GP you are not restricted to the Practi-
tioner Supply Order in the front of MIMS New Ethicals but you need
to pay any charges.
ACC forms
ACC 45 – a form for registering the first consultation associated
with an accident. It can also be used at this time for referral for
investigations, therapy or specialist opinions. It is a quadruplicate
form with copies to:
1. ACC head office
2. the GP (keep in notes)
3. the patient (takes away), and
4. the one for referrals (give to patient or keep in notes if not im-
mediately needed).
ACC 41/ M 41 – for later referral for investigation etc. Triplicate form;
keep one for notes, give two to patient for the therapist to process.
Sickness Benefits
The main form is called Community Wage – Medical Certificate. Put
out by the Ministry of Social Development.
51
Practices will have their own ‘sick notes’ for employers.
52
health. See the booklet Medical Aspects of Fitness to Drive put out by
the Land Transport Safety Authority for further guidance.
The bag should be large enough to carry everything you need and be
well organised to enable items to be easily located. The bag should
always be kept in a secure location when not in your possession;
prescription pads should be kept to a minimum. Controlled drugs can
only be in the doctor’s bag if they are there for immediate use (with
the exception of diazepam). If controlled drugs are stored in the doctor’s
bag in case of an emergency use, there is a requirement for the bag
to be in a locked container bolted to the floor of the boot of the car.
53
• Sphygmomanometer
• Thermometer
• Tourniquet
• Lubricating jelly
• Spatula
• Alcohol wipes
• Range of needles and syringes
• Dressings
• Scissors
• Torch
• BM stix
• Protective device for mouth-to-mouth resuscitation
• Stationery:
– Prescription pads
– Letter writing paper
– Pen
– ACC forms
• Drugs for medical emergencies, minimum oral and injectable:
– Adrenalin 1/1000 or 1/10,000 inj.
– Aspirin tabs
– Atropine inj.
– Diazepam inj./rectal
– Ergometrine
– 50% Glucose/glucagon inj.
– Antihistamine inj.
– Local anaesthetic inj.
54
– Penicillin inj.
– Corticosteroid inj.
– Naloxone inj.
• Optional depending on the circumstances:
• Blood tubes:
– red top
– purple top
• Urine pots
• Laboratory swab
• Urine dipstix.
55
Indicators are divided into those that are required by legislation,
those that are considered essential by the RNZCGP and those desir-
able to provide high quality care.
56
Practice orientation
Aim to have this information ready on the day you start work, or
ideally, a few days earlier.
Practice profile
The philosophy of our practice is…
Funding method (fund holding, capitation etc.)
The demographic mix of the practice’s patients is…
The socio-economic mix is…
Specific regional problems (e.g. freezing work accidents, leptospirosis)
The specialist areas of this practice are (e.g. acupuncture, maternity)…
The hours of consultation are…
Length of an average consultation is…
The number of patients we see a day is…
57
Practice staff
Practice partners
Practice manager
Practice nurse/s
Receptionist/s
Others who also work from the practice premises (e.g. physio)
The nurse’s duties include (smears, taking bloods)…
Where rosters are kept
Physical environment
A map of the area is found…
Layout of the practice and where to find dressings, emergency equip-
ment etc.
The layout of the room: smear equipment, forms etc.
Day-to-day routines
The patients are greeted…
The patients get from receptionist to doctor…
The patients information/fee is communicated to the receptionist…
The bloods/specimens are collected at…
Procedure for turning alarm on is…
Procedure for turning alarm off is…
Practice processes
Our protocol manual is kept…
The telephone consultation protocol for this practice is…
Prescription procedure is…
58
Repeat pharmaceutical prescribing policy is…
Patient test results protocol is…
Procedure for referring patients to hospital (i.e. outpatients)…
Procedure for admitting patients to hospital…
Protocol for dealing with non-registered patients i.e. visitors, tourists is…
Instructions for all electronic equipment is kept…
Privacy officer
Infectious control officer
Code of dress
Fees
(This is confidential information, please keep it in the confines of the
practice.)
Our fee schedule is…
Minimum fees
How much discretion does locum have with fees?
Emergencies
The emergency equipment is kept…
The emergency procedure is…
The panic button is found…
Police number
COOP protocol (in event of armed confrontation)
Fire control officer
Evacuation drill
The acute mental health services contact phone number is…
59
After hours arrangements
On call
Always ensure that someone knows where you are at all times
A second GP to cover you on call outs is…
House calls
House calls are/are not part of the service offered to the patients of
this practice
Any limitations e.g. only during the day
Time set aside for house calls
Patients we see on house calls
List of the special needs patients
Protocol for night visits (Some after hours clinics send their doctor in
a taxi – so they get there, and they have a chaperone if needed. They
also carry a cell phone which has a quick dial to the clinic, the am-
bulance and the hospital.)
Notes
Computerised practices
Patient management system used
Computer password
The information held on computer in this practice is…
The information you will be expected to put on computer is…
The key person to help you with accessing the computer information is…
Manuals are kept…
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Manual practices
This is an example of how the patient notes are written (i.e. problem
list, progress notes)…
Recalls are written…
Follow-ups are written…
Results are written…
This is how the notes are organised…
Practice contacts
Name and phone number of :
Hospital
Physiotherapist
District nurse
Mental Health Services
Most frequently used specialists
Pharmacy
Investigations clinic (i.e. x-rays)
Laboratories used
Abuse contacts (e.g. women’s refuge, female solicitor, Children and
Young Persons Service, Doctors for Sexual Abuse Care, etc.)
Local self-help groups
Consumer advocate
Kaumatua
Iwi providers
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Forms
Include forms most often used; examples of completed forms can be
useful.
Ambulance
How to access ambulance
It takes …(time) to get an ambulance to the practice
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Ambulance officers – level of training
You will/will not be required to go to each ambulance call out
Other phone numbers you will need
The nearest GP support person is…
The emergency procedure is…
Emergency equipment
At practice:
• What is available
• Where kept
At home:
• What is available
• Where kept
At the local hospital:
• What is available
• Where kept
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Leisure activities available
Local takeaways/restaurant
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APPENDICES
Appendix 1
Subsidies
General medical subsidy (GMS)
Entitlement to this patient subsidy depends on qualifying for a Com-
munity Services Card (CSC) – except for children under six years.
There is a scale of subsidies according to age and CSC status.
A3 (Adult, no CSC) Nil
A1 (Adult with CSC) $15
J3 (Juvenile six years and over, no CSC) $15
J1 (Juvenile six years and over, with CSC) $20
Y3 & Y1 (ALL children under six years) $35
Medicines
From 1 July 2005 persons over 64, or under 25, or enrolled in an
Access PHO will pay at most $3 per prescription. Persons holding a
HUHC, CSC or Prescription Subsidy Card may get extra benefits.
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Accident Compensation Corporation (ACC) payments
Treatment for accident-related injuries is subsidised by Accident Com-
pensation Corporation (ACC). For consultations relating to accidents
(defined as injury resulting from an external force or from occupa-
tional overuse – as well as sensitive claims relating to sexual abuse
and its consequences), GMS is not claimed. Most practices add a
patient surcharge to make up the usual fee. If a consultation in-
cludes both an accident-related and non-accident issue you may
claim both a GMS subsidy and an ACC payment. ACC makes fur-
ther payments for various procedures (e.g. suturing, splinting, aspi-
rating) according to a schedule.
Maternity benefits
All maternity consultations in primary care are free to the patient by
legislation and funded according to a schedule of fees. A Lead Ma-
ternity Carer (LMC), e.g. GP, midwife or specialist, holds fixed fund-
ing for each pregnancy. The involvement of anyone else in the shared
care of a pregnancy involves the billing of, and transfer of, funds
from the LMC who holds the budget.
Immunisation subsidies
There is an immunisation subsidy available for immunisations.
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Capitation subsidies
Most practices are subsidised on the basis of a profile of their patients
as defined by an ‘Age/Sex Register’ which is analysed quarterly by the
Ministry of Health. These practices receive a monthly income based
on a capitation formula which may take into account not only the age
and sex of the patient, but also their community service and high user
health card status, deprivation index and ethnicity.
Rural bonus
There are a variety of additional funds that rural practices may re-
ceive depending upon their isolation. The Rural Ranking Scale de-
fines the degree of isolation of the practice, taking into account is-
sues such as distance to nearest base hospital, ambulance support
services, on call poster etc. Bonuses usually take the form of an an-
nual or quarterly payment to the practice.
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Appendix 2
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GMS General Medical Services
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RNZCGP Royal New Zealand College of General Practi-
tioners
Iwi Tribe
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References