1. Rural Ranking Score Update, Draft Position Statements and the Rural Proofing tool 2011 Jo Scott-Jones NZRGPN chairperson

2. Aims of today Understand why the RRS is being reviewed. Become aware of the process taken up to now to reassess the score. Seek feedback on the principles the NZRGPN has used in developing a preferred model.

5. History.. 1995 original score developed to implement a fairer way of distributing rural bonus to areas of need rather than simply rural defined areas.

6. Current Rural Ranking Score Travelling Time from the Surgery to Major Hospital Major hospital within 30 minutes 0 Major hospital within 30-45 minutes 5 Major hospital within 45-60 minutes 10 Major hospital within 60-90 minutes 15 No major hospital within 90 minutes 20 Distance from Surgery to Major Hospital (km): On Call Duty 1 in 6 10 1 in 5 10 1 in 4 10 1 in 3 20 1 in 2 30 1 in 1 40 On call for Major Trauma Not on call for Major Trauma 0 On call, but with double-crewed road ambulance with at least one paramedic (at all times) available within 30 minutes 5 On call, with other ambulance arrangements 15 Travelling Time to Nearest General Practitioner Colleague at Place of Work 0-15 minutes 0 15-60 minutes 5 over 60 minutes 10 Distance to Nearest General Practitioner Colleague at work (km) Travelling Time to most distant practice boundary Under 30 minutes 0 30-60 minutes 5 over 60 minutes 10 Regular (at least once monthly) Peripheral Clinics No 0 Yes 5 Discretionary Points The District Health Board may at its discretion award additional points to General Practitioners in areas where the recruitment and retention of General Practitioners is difficult. No General Practitioner may have a score of greater than 100 points.

7. History…… PHCS 2001 – changed paradigm for primary care from provider to practice Change in health policy direction – new models of care, devolution and regionalisation

8. NZRGPN identified issues Each doctor has a population with the same level of need Each doctor provides the same type of service Doctors will work together to provide afterhours cover efficiently Funding is doctor based not practice based Nurses are not directly involved in service provision Changes in ambulance level services in communities Alternative arrangements for after hours care Disincentives to reduce after hours rosters Time based travel disputed – changed roading arrangements “Gaming” of peripheral clinic services Distance to nearest colleague not reflecting real issues of isolation Discretionary points inconsistently applied

9. History…. 2007 MOH call for revamping of RRS – working party setup 2010 engagement with NZRGPN again to effect change

10. Progress 2010 – 2011 Revisit the original purpose of the RRS. Design a new score which better captures rurality in an objective way and which better reflects the reality of rural general practice and the current policy environment. Gather a range of information from practices to enable extensive modelling to take place. Test developments and thinking with a small group of practices. Provide summary updates to members/practices through standard publications such as Network News and seek feedback. Keep the Ministry/DHBs informed of progress and the likely impact of the “exclusions” being modelled. Present work done to date to members at the AGM (March 2011) and consider feedback and revise modelling where appropriate.

11. Progress 2010 – 2011 cont. April 2011 provide a briefing paper to members and rural general practices summarising the AGM presentation and ensuing discussions. Provide opportunity for feedback. Remodel and revise score on basis of feedback. Contact all practices in the “grey area”. Submit preferred model to MOH/DHB along with rationale for “exclusions.” Circulate in confidence preferred model to members copied to all rural general practices. Awaiting 3 way meeting between the Network, MOH and DHB to discuss preferred model and to review implications.

12. NZRGPN Position Statements After hours care Seasonal variation Obstetrics Teaching Isolated and small practices Community engagement

13. Feedback.

14. Thank you for listening