Criteria for a Site Notice
Click to download application - Site S88 Notices
Applicable 126.96.36.199 (p.3) and
Clauses Schedule 9 (p.73)
Wording - “From 1 May 2000 all Notices will be specific to a named General Practitioner operating at a specified medical premise with the following exceptions only:
Practices with a high general practitioner turnover (such as Accident and Medical Clinics or Specialized Primary Care Clinics). The terms on which a Notice will be issued and will operate in a practice with a high General Practitioner turnover are as specified in Schedule 9 of Part B.” and
“The practice shall establish that:
- It has a high General Practitioner turnover by virtue of the nature of its operation such as an Accident and Medical Clinic or a Specialist Primary Care Clinic;
- It meets the criteria specified in Clause 8 of Part A (or that it was a practice that was in existence prior to I May 2000 and held a Current Notice issued to it by the Health Funding Authority); and
It will provide at all times 24-hour cover. Any new practice will be required to submit to an audit by the Health Funding Authority or its nominated agent to establish satisfactory provision of cover prior to a Notice being issued.”
Under normal circumstances, Section 88 Notices are issued to GPs rather than practices or organizations. In limited circumstances, however, a site notice for a specified number of FTE positions may be issued to an organization.
Aside from the normal population needs criteria (as outlined in section 2.1.1) two other criteria must be satisfied.
- The site must have a high turnover of GPs. Accident and Medical centres normally fit this criterion. The definition of “high turnover” has not been established.
- The clinic must provide 24-hour cover for its patients. Again, there is no clear definition of exactly what this means. One interpretation of this requirement is that the clinic must remain open 24 hours a day. An alternative view is that the clinic need only make appropriate arrangements for its patients to be referred to medical services after it has shut its doors. It should be noted that Whitecross has a site notice that covers all of its clinics. Only a small number of these clinics are actually open 24 hours a day.
Consideration is also given to the question of the clinic's existing funding arrangements when assessing applications for a site notice. Most existing clinics are already funded for GP services (either through the Section 88s of GPs who work there or by way of a capitated contract).
Where the existing funding arrangements are not cancelled, the approval of a site notice will effectively increase the number of Section 88s in the local area by the number of FTEs specified. In these instances, the GP/Population ratio in the area must be considered.
Past examples that illustrate this point:
- Organisation A applied for site notices for its clinics in Mangere and Pakuranga. Until September 2000, these clinics had belonged to an IPA that had a capitated contract. Therefore, both clinics were previously funded for GP services. The application was approved as one form of funding was substituted for another. Both clinics were still required to meet the normal high GP turnover and 24-hour care criteria for site notices.
- In mid-late 2000 an application was received for a site notice from Organisation B, in Botany Downs. The clinic used a large number of local Section 88 holding doctors to work shifts at the clinic in order to help fulfill their obligation to provide after hours care for their patients. The clinic also employed two permanent full time GPs (who also had their own notices). Although Organisation B met the GP turnover and 24 hour care criteria the Section 88s of the two full time GPs had to be cancelled – otherwise the application would have been considered as a new Section 88 for the area. Nothing more was heard from Organisation B after this advice was passed on.
Many practices view a site notice as a way to simplify administration or as a way to increase Practice Nurse hours available to them.
Site notices are sometimes issued to Student Health Centres. These clinics provide a service to a captive population and non-students cannot access their services.
The FTE’s under a Site Notice cannot be moved or transferred in the same way as individual notices.
Procedures for Issuing Site Notices
Applicants must specify:
- The address of their site.
- The number of FTEs they have historically employed at the site (and therefore the number of FTEs being sought for the notice).
- Details of any contractual arrangements the site (or GPs at the site) currently has with the DHB for the provision of medical services.
- A list of all GPs (and their NZMC numbers) that will be, should the application be successful, working at the site and claiming under the site's notice.
Once all this information has been gathered confirmation of the FTE levels should be obtained from HealthPAC - Wellington (in the case of Section 88 claiming GPs) or staff in the NRA office (in the case of clinics that were formerly capitated).
The Contract Administration Team must check the credentials of the application against the criteria for site notices and prepares a memo of recommendation to the DHB.
If the application is declined, the Contract Administration Coordinator prepares a letter to the applicant outlining the reasons for the decision. The letter refers to the particular requirements of Schedule 9 that have not been satisfied.
If the application is approved, the Contract Administration Coordinator writes a letter outlining the conditions of the site notice. This letter covers issues such as the maximum number of FTE positions, and the actual doctors that have been approved to work under the notice.
This approval letter is forwarded to the Agreement Administration Team of HealthPAC - Dunedin, who will attach it to the documentation she sends to the NRA (for the provider) after allocating a new contract number.
The most significant site notice, in terms of the number of FTE positions, was issued to a Group that has 11 clinics in Auckland and Whangarei. It is actually a site notice working from a Schedule of the contract and allows it to claim for approximately 61 FTE positions spread across all its clinics and claims can be submitted using the organizational contract number.
The Group is required to notify the NRA whenever they employ a new GP. The NRA then forwards the name and NZMC No of the GP to HealthPAC - Dunedin who in turn will make sure that HealthPAC is kept informed. HealthPAC will load the doctor's details into their system thereby allowing claims for their work to be made under the organizational contract.
A Site Notice provides for liberal audit access. The funder can access the site (without prior notice) to establish
- the number of practitioners working at the practice and the identity of those practitioners
- the requirement for provision of 24 hour care is being complied with