DHBS must plan for after-hours care.

The College of Practice [Nurses.sup.NZNO] believes nurses working in after-hours services should be paid in Line with district health board (DHB) nurses working overtime. In its submission to the report of the After Hours Primary Health Care Working Party, the college suggests this could be subsidised by nurses being funded on an equivalent basis to GPs, through capitation fee or a fee for service, as well as through Accident Compensation Corporation (ACC) payments.

The working party was established earlier this year against a background of the closure of after-hours medical clinics in several cities. Its aim was to develop and recommend a national policy framework for after-hours care. The only nurse on the working party was Manawatu practice nurse and a member of the Independent Practice Association Council, Linda Dubbeldam. One of the working party's key recommendations was that DHBs, in collaboration with primary health organisations (PHOs) and after-hours providers, must plan the development of after-hours services for their districts, and that that planning should begin immediately. Another key recommendation was that accountability for providing 24-hours-a-day, seven-days-a week (24/7) primary health care (PHC) remains with the PHOs, which must demonstrate to DHBs they can provide such care.

The college, in its submission, called for close collaboration with the PHC sector, including the doctors, nurses and care workers concerned. "This should not be another 'top-down' policy making exercise."

NZNO's College of Emergency Nurses, while generally supporting the working party's recommendations, had concerns about the use of emergency department LED) triage processes to determine whether a patient had a PHC problem. "The college strongly rejects the assumption that the Australasian Triage Score (ATS) 4 and 5 are regarded as patients with PHC complaints.... The ATS category should not be used as a tool to decide the appropriateness of their presentation to the emergency facility," the submission stated.

No financial barriers

Where there are co-location models, ie after-hours services operating within or adjacent to an ED, the college does not want any financial barriers to consumers. Cost recovery should be by the DHB, PHO and the after-hours contractor. The working party also recommended that the Ministry of Health prepare an after-hours PHC planning and funding strategy, and that the ACC investigate paying for PHC services provided in EDs.

The working party believes future planning of after-hours services should be guided by three key principles:

* accessible to patients and their families/ whanau;

* effective service delivery; and

* resilient with sufficient resources to provide the service, so communities can be confident of ongoing after-hours services.

NZNO professional nurse adviser Suzanne Rolls said implementation of a national plan for after-hours care had to consider workforce issues, eg staffing levels, support for staff and education; the Location of services; and the accessibility of after-hours care. "The plan has significant implications for ED staff."

She said the working party had acknowledged that the expertise of NZNO's practice nurse and emergency nurse colleges was needed to ensure the successful implementation of the plan.

* The quarterly DHB Hospital Benchmark Information Report, which covers April to June 2005, released in Late November, showed ED staff were "maintaining performance", despite an increase in the number of serious cases.