GENERAL PRACTITIONER SCHEME

Dominion, Volume 34, Issue 126, 21 February 1941, Page 8

GENERAL PRACTITIONER SCHEME

Benefits To Be Made Available From The Beginning Of March FREE OUT-PATIENT TREATMENT ALSO Doctors To Receive Annual Capitation Fee Of 15/- For Each Person On Panel The intention ui the Government to introduce the general j>rac titioner service tinder the Social Security Act. on March 1 was announced last night by the Minister of Health, Mr. Nordtntyer. J- rec out-patient treatment at hospitals is also to be made available liom the same date, .and the Government expects that the pharmaceutical benefits will be in operation by April 1. Regulations dealing with the provision ul medical benefits were also gazetted last night. Provision is made for the payment from the Social Security Fund of a capitation fee of 15/- a year to every doctoi who agrees to provide the prescribed benefits. 1 his fee will be paid in respect of every person on a doctor's list, including children. In consideration of the receipt of this sum the doctor is required to give all necessary medical care to those persons he has agreed to accept oti his list and who live within three miles of his surgery. Special arrangements are made for the payment of a mileage allowance in the case of persons living beyond that distance from the doctor s surgery. Mr. Nordmeyer said the general practitioner service now to be provided would extend still further the principle of social insurance. He appealed to the public to co-operate with the medical profession and not to make unreasonable demands. The Minister explained that legislation would be introduced at the coming session of Parliament to ensure that doctors serving in the armed forces were guaranteed in the first year after their return to practise not less than the income which thev earned from their profession during the last complete year before departure.

The Social Security Medical Benefits Regulations, 1.94.1, which were gazetted yesterday, come into force to-

day. The benefits under the regulations, however, will not be available till the date which the Minister of Health has decided. The regulations generally sei out the scope of the medical benefit* to be provided, that is, medical services which can be provided by an ordinary general practitioner. They do not include maternity benefits which are al ready provided for, the administration of anaesthetics for which a separate fee may be charged, nor specialist services. These specialist services are defined as those which “involve the application of special skill and experience of a degree or kind that general medical practitioners as a class cannot reasonably be expected to possess.’ Specialist Fees.

Before lbe general practitioner who claims to be a specialist in certain brandies of medicine may charge his patient for Hie services which he renders, he must first inform the patient that he proposes to charge for these services, as they are outside the scope of the regulations; and, secondly, obtain the patient’s consent. . Further, he cannot claim any specialist fee unless he complies with at least one of three conditions :~

(a) That he has held hospital or other appointments affording special opportunities for acquiring special skill and experience of - the kind required for the performance of the specialist services in question, and has had actual recent experience in performing services of a similar kind. (b) lie has had' special academic or post-graduate study of a subject that, comprises the specialist services rendered and has had actual recent experience in performing services of a similar kind; or (c) That he is generally recognized by other practitioners who have direel personal knowledge of his work as having special proficiency and experience in a subject or subjects that comprise specialist services rendered by him. Filling in of Card.

A patient who desires to lake advantage of the services to be provided must first procure tin application card, which he will complete and take to the doctor of his choice, if the doctor is willing to accept him lie will countersign tlie card and be responsible for .sending it Io the local Medical Officer of Health. Tlie signing of the card by tlie practitioner constitutes an agreement by him to attend and care for the patient, and lie is responsible for the free treatment of that patient from that date.

In the .case of children a separate card is to be filled in for each child on a special children's card to be provided, and where adults are incapable of making application this application may be made on their behalf by an other person. The patient is required under the regulations to notify the medical officer of health of any change of address, and if lie fails to do so may be charged such amount, as has been wrongly paid to the doctor on whose list his name appeared. Practitioner’s I‘arl.

y practitioner who Is prepared to work under the scheme is required to provide and maintain suitable surgery and waiting-room accommodation; to be in attendance for consultation and treatment of patients at his surgery or elsewhere at regular times; to visit any patient "whose condition of health is such that it is impossible or in expedient for him to visit the medical practitioner at his surgery”; to visit any of his patients in hospital wberi the rules of the hospital permit him to do so, and where the patient requires the service which he as a general practitioner is capable of affording; to prescribe such drugs and appliances as may be required for Idle treatment of any patient.: to issue free of charge medical cert Hie les or recom mendatioiis required for the purposes of the Social Security Act; to keep clinical records of the history of bis patients and of bis treatment of them; to answer all reasonable inquiries made by the Medical Officer of Health with respect to tiny prescriptions, certilicates, or recommendations which he has issued. Drugs in Emergency. Provision is also made that the doctor shall supply to the patient in the case of emergency such drugs as may lie required, and in this connexion he is entitled to claim the cost from the patient till pharmaceutical benelits have been provided, in which case be will be paid from the Social Security l-’inid The regulations set out in detail tile provisions that have to be made where the practitioner who has agreed to ae Cept patients under the scheme cm ploys tut assistant or engages a part ner. Generally the obligation is upon the practitioner to give personally such benelits as be Ims undertaken to do "except where he is prevented from doing so by urgency of other professional duties, temporary absence from home or other reasonable cause." The medical practitioner is also obliged to make all necessary arrangements for securing the proper treatment of his patients in cases where he is unable to give treatment personally If he lias any standing arrangement in this matter he is required Io notifi the Medical Officer of Health The doctor agreeing to cure tor the

patient who engages any deputy or assistant is responsible for compliance by that deputy or assistant with the requirements of these regulations. Where two or more medical practitioners prxcti.se in partnership treatment may at any time be given by one or other of the partners to any patient on the list of tlie practitioner instead of by Um practitioner in person 'it reasonable steps are taken to secure continuity of treatment. The regulations detail tlie procedure to be followed where the patient desires to shift from one doctor’s list to another, where tlie patient removes from one place of residence to another, where the doctor himself desires to have a patient removed from bis list, and where the doctor desires to terminate all his agreements under the Act. In this latter case he must give three months’ notice of his intention so to Tlie regulations make special provision for dealing with tlie case of doctors who are serving with His Majesty's Forces either within New Zealand or overseas. Provision is made lioiv for a simpler method of transfer of patients from the list of the practitioner who is attending them to that of the doctor who returns to his practice.

The regulations provide that where any person entitled Co receive medical benefits desires to make a complaint about the service rendered by tlie practitioner of ills choice, tlie complaint, must be made in writing to the Medical Officer of Health who may dismiss it as trivial or submit it for decision to a special committee to be set up by tlie Minister pursuant to Section S 3 of the Social Security Act. With the prior consent of the medical practitioners concerned the Minister may at any time publish a list or lists of tlie names of medical practitioners who have entered into agreements under these regulations.

Every medical practitioner who tuts agreed to provide medical benefits in accordance with these regulations is entitled to receive from tlie Social Security Fund for every person on Ins patients’ list, a capitation fee at the rate of 15/per annum. This applies to every person on his list including children. He is required, in consideration of tlie receipt of this sum, to give ail necessary medical care to those persons whom lie has agreed Io accept on his let and who livtwithin three miles of his surgery.

An interesting procedure is followed for mileage arrangements Instead of paying the doctor special mileage, tor each visit which lie makes to a patient, tlie regulations provide that the doctor is to be entitled to .-in annual amount of 2/- for each mile beyond three, that tlie patient’s residence is distant from l.ie doctor's surgery. In no ease will mileage be paid beyond 2(1 miles from his surgery. It is further provided that in eases where the doctor is required to travel more than 20 miles he nuiv charge a mileage fee from tlie 20-mile limit to th. patient's home, and this fee is recoverable from Hie patient himself or from any person responsible for his maintenance. It is expressly st-t out that nothing tn the regulations affects tin* Minister's power to make special arrangements in connexion with certain areas or cer tain classes of persons conferred upon him by Seeti.m 82 of the Social Security Act as extended ny Section 15 of the Finance Act. < No. I>, 15MO.