From the Guidelines
Starting a general practice in New Zealand requires careful planning, prioritizing regulatory compliance, business structure, and quality patient care to ensure long-term sustainability and minimize morbidity, mortality, and improve quality of life. When establishing a practice, it's crucial to understand the regulatory requirements, including registration with the Medical Council of New Zealand and obtaining a practicing certificate, as outlined in good practice guidelines which include validity, reliability, reproducibility, clinical applicability, clinical flexibility, clarity, multi-disciplinary process, review of evidence, and documentation 1. Key considerations include:
- Establishing a business structure, such as a sole practitioner, partnership, or company, and securing appropriate medical indemnity insurance
- Selecting a location based on population demographics, existing healthcare services, and accessibility
- Investing in premises, equipment, and initial operating costs, which can range from NZ$200,000-500,000
- Implementing practice management software, such as Medtech or MyPractice, to handle patient records and billing
- Hiring necessary staff, including practice nurses, receptionists, and potentially practice managers
- Understanding the funding model, which operates under a mixed public-private system where practices receive capitation funding from Primary Health Organizations (PHOs) based on enrolled patients, supplemented by patient co-payments
- Ensuring compliance with the Health and Disability Commissioner's Code of Rights and privacy legislation
- Developing a business plan that addresses financial projections, service offerings, and growth strategies to ensure the practice's long-term sustainability in New Zealand's unique healthcare environment.
From the Research
Key Considerations for Starting a General Practice in New Zealand
When starting a general practice in New Zealand, there are several key considerations to keep in mind. These include:
- Understanding the local healthcare system and the role of general practice within it 2
- Recognizing the importance of biculturalism in healthcare and the need to provide culturally sensitive care 2
- Being aware of the different funding models and reimbursement schemes available, including the fee-for-service model and government reimbursement for provision of general medical services 2
- Developing strategies to overcome barriers to guideline use and implementation, such as lack of recognition or user-friendly formats 3
Clinical Practice and Guidelines
Clinical practice guidelines play an important role in general practice in New Zealand. Studies have shown that:
- General practitioners may not regularly use guidelines to support decision-making regarding patient care due to various barriers, including lack of recognition or user-friendly formats 3
- Effective implementation of guidelines requires more than just endorsement by policy stakeholders and passive dissemination strategies, but rather an understanding of the issues facing general practitioners and their attitudes to guideline use 3
Enrolment and Emergency Department Use
Enrolment with a general practice is associated with subsequent use of the emergency department in Aotearoa New Zealand. Research has found that:
- Those not enrolled with a general practice are more likely to be young, male, Asian, and socioeconomically deprived, and may use the emergency department as a substitute for primary care 4
- Enrolment status is a significant predictor of subsequent use of the emergency department, with those not enrolled taking longer to access emergency department services 4
Rural Hospital Medicine
Rural hospital medicine is an important aspect of general practice in New Zealand, particularly in rural areas. Studies have highlighted the need for: