Primary Health Care in Community-governed Non-profits: The work of doctors and nurses

Published online: 
02 August 2004

Summary

Aims

The National Primary Medical Care Survey was undertaken to describe primary health care in New Zealand, including the characteristics of providers and their practices, the patients they see, the problems presented and the management offered. The study covered private general practices (i.e. family doctors), community-governed organisations, and Accident and Medical (A&M) clinics and Emergency Departments. It was intended to compare data across practice types as well as over time.

Subsidiary aims included gathering information on the activities of nurses in primary health care, trialling an electronic data collection tool and developing coding software.

This report describes the characteristics of practitioners, patients and patient visits for six primary health care practices classified as community-governed non-profits. Other reports in the series describe private family doctors, Mäori doctors, after-hours activities and other types of practice, and will analyse differences in practice content that have occurred over time or that exist between practice settings.

Methods

A nationally representative, multi-stage sample of private GPs, stratified by place and practice type, was drawn. Each GP was asked to provide data on themselves and on their practice, and to report on a 25% sample of patients in each of two week-long periods. Over the same period, all community-governed primary health care practices in New Zealand were invited to participate, as were a 50% random sample of all A&M clinics, and four representative Hospital Emergency Departments.

Community-governed non-profits met at least two of these three criteria:

  • they had a community board of governance
  • there was no equity ownership by GPs or others associated with the organisation
  • there was no profit distribution to GPs or others associated with the organisation.

Medical practitioners in general practices, community-governed non-profit practices, and A&M clinics completed questionnaires, as did the nurses associated with them. Patient and visit data were recorded on a purpose-designed form.

Results

The results presented here relate to 44 practitioners (24 doctors and 20 nurses) employed at six community-governed non-profit practices. The findings include the following:

  • Community-governed non-profits served a young population, 19.4% of whom were Māori, 34.1% Pacific and 24.0% European, and 66.1% of whom had a Community Services Card.
  • Of patients attending non-profits, 23.2% were not fluent in English, and the majority lived in the 30% of areas ranked as the most deprived by the NZDep2001 index of socio-economic deprivation.
  • The mean number of visits to the practice over the previous 12 months was 6.8 for visits to doctors and nurses combined, 6.7 for visits to doctors, and 7.0 for visits to nurses.
  • GPs working in non-profit practices tended to be female, young and relatively new to general practice.
  • In total, over one-quarter of patient visits were longer than 20 minutes (18.8% and 41.6% for doctors and nurses respectively), and about half were between 10 and 15 minutes (59.2% and 34.7% for doctors and nurses respectively).
  • For doctors, by far the most frequent type of new problem was respiratory (16.2 per 100 visits), followed by skin problems and infections/parasites. For nurses the most frequent new problem was actions (6.6 per 100 visits), followed by respiratory (5.9 per 100 visits).
  • Overall, about a quarter of visits resulted in a test or investigation. Nearly 20% of visits resulted in a laboratory test, which were roughly evenly split between haematology, biochemistry and other lab tests.
  • A total of 67.3% of patient visits resulted in a prescription (75.2% for doctors and 53.1% for nurses), and a total of 77.2% of visits resulted in some other form of treatment (80.2% for doctors and 71.9% for nurses).
  • Overall, 65% of visits resulted in suggested follow-up within three months, and over one-fifth resulted in some form of referral.

Conclusions

Given the characteristics associated with private community-governed non-profits, this ownership form deserves further research and detailed policy consideration to explore its role either in providing more extensive coverage for low-income and minority populations, or as a preferred mechanism for providing care to general populations. The capacity of community-governed non-profit practices to serve diverse ethnic and low-income population groups highlights for communities, policy makers and purchasers the hitherto relatively undeveloped potential of this alternative system of ownership and governance to deliver care for under-served populations and shape the purpose and function of primary health care practices.

Disclaimer

The views expressed in this occasional paper are the personal views of the authors and should not be taken to represent the views or policy of the Ministry of Health or the Government. Although all reasonable steps have been taken to ensure the accuracy of the information, no responsibility is accepted for the reliance by any person on any information contained in this occasional paper, nor for any error in or omission from the occasional paper.

Publishing information

  • Date of publication:
    02 August 2004
  • ISBN:
    0-478-28234-6 (Book), 0-478-28235-4 (Internet)
  • HP number:
    3814
  • Ordering information:
    Only soft copy available to download
Back to top