The document discusses the changing landscape of general practice ownership in New Zealand and proposes the idea of GP co-operatives. It notes that PHOs are increasingly becoming owners of practices through purchases. This raises conflicts of interest as PHOs are meant to advocate for practices but are also becoming competitors. The document proposes that groups of local practices cooperate through a GP co-operative model. Practices would aggregate their populations to a total of 20-50k patients. They would cooperate on IT infrastructure, quality measures, performance benchmarking, and community engagement. This could help owner-operated practices better compete in the changing environment. Examples of similar cooperative models currently operating in New Zealand are provided.

1. The Case for GP Co-operatives - An
idea for GP owners
Dr Jonathan Simon,
GP West Auckland

2. The geography of practice ownership is
changing:
- Who are the new owners?
- What are the options for current practice
owners?

3. Radius ( variable ownership stake)
East Tamaki Healthcare( 100% ownership)- group of
practices that have taken over PHO function.
Peak Health (100% ownership)
Southern Cross Primary care( 20% ownership)
PHO/MSOs -Midland Network, South link
Health( present in Auckland), Compass (
variable)
DHBs ie West Coast ( 100%) ownership
Community trusts

4. Funding to practice through PHOs only, mixed ownership models Independa
nt,Community Trusts,MSO/PHO, DHB, Corporate

5. - who is looking after the interests of the current
practice owner?
- The PHOs ?
- What if the PHO is also buying practices? is the
PHO advocate or competitor?
- Whose money are they using to buy the
practices?
Four Questions:

6. Large practices have always been able to do much
of the PHO work themselves.
Cosine PHO – Karori, is a good example
- Can you do it a lower cost?
- A good PHO has 20-25% fixed costs
Some PHOs have fixed costs of 30-40%
- What are the fixed costs of your PHO?

7. In a recent survey in New Zealand Doctor ( 4th
June 2014)
• 83% of GPs had not seen PHO financial statements
• 68% of GP would like to have more say in how the PHO money is spent
• 88% of GPs do not know how much their PHO has in cash reserves
• 58% do not think it reasonable for PHO to use reserves to purchase
practices
• 59% of GPs see a danger that practices owned by their PHO will placed
in direct competition.

8. - How do owner-operated practices compete in a
new environment that will increasingly be
determined and funded based on performance?

9. Co-operate with a group of local practices. Co-
operate when it makes sense and compete
where competition is appropriate.
Work to incorporate PHO/MSO functions into your grouping
Do this yourself or use MSO services from corporate or
PHO/MSO services

10. Aggregate a group of practices to a total
population of 20-50K
Co-operate on It infrastructure, quality,
performance, benchmarking,community
engagement, out of hours/urgent care
Plan to include other health professionals as the
concept develops
What are the elements:

11. 1. define a common purpose: For
patients and for business
2. Accept a co-operative framework
3. Critical mass ie 20-50K
4. Collective Intelligence ie DrInfo
5. Community Building is interface
with community and hard to
reach.
The 5 C’s (Health Foundation, London)

12. Build this around a project eg after hours/urgent
care
Go and talk to your PHO about renegotiating an
MSO contract with them and do more for
yourselves and your patients

13. Does this occur?
Yes, and here is are some examples

14. East Tamaki Healthcare: in South Auckland has
become a PHO and in West Auckland has 4
practices using Procare as a postbox.
NHC in West Auckland, uses Waitemata PHO as a
post box for its 4 practices.
In Mid central, 4 practices have a virtual
amalgamation.
Coast to coast health is a group of practices that
have an MSO arrangement with Waitemata PHO
For some practices, the answer is amalgamation.

15. here is a publication from
Comprehensive Care
(MSO) behind Waitemata
PHO on the North Shore
They have partners
including 4 NHC practices
Coast to coast healthcare:
A group of practices
around Wellsford 13K
patients

16. Coast to coast healthcare is a group of practices, GP
owned with salaried practitioners who have a
partnership relationship to their PHO and do some
PHO functions themselves
As Coast to Coast is owned by Dr Tim Malloy who is
also the Chair of the Waitemata PHO/Comprehensive
Care and President of the RNZCGP
This approach seems to have significant endorsement!

17. Future model- PHO gone; direct relationship between groups of practices
, corporates and GP MSO organisation
.
IT platform manages clinical and financial risk, quality outcomes and populati
on health; practices manage personal health. Over time this platform ma
y include other health professionals.