This page outlines what the patient can expect from the Electives care process, from when a health problem first develops to the time the problem is either resolved or under control.
The patient pathway
The patient pathway is the time from when you develop a condition needing treatment to the time the problem is either resolved or under control. This flow diagram outlines the basic steps in the Electives care process.
*Your priority score is an assessment of your level of need and ability to benefit compared to other people.
When a problem first develops
If you have a condition you think may need treatment you should first see your primary care provider such as your GP, nurse, Māori health provider, optometrist or physiotherapist. They will assess your condition and discuss the best options with you, including whether to refer you to a specialist.
The specialist may be from a public hospital or you could be referred to a private specialist if you are prepared to pay for a private consultation.
Being referred to a specialist
If you are referred to a specialist at a DHB public hospital, the DHB’s local clinical staff will first assess how urgent your referral is. DHBs have different ways of deciding about urgency, but the levels are broadly as follows:
- further specialist assessment is needed immediately
- further specialist assessment is needed urgently
- further specialist assessment is needed semi-urgently
- the further assessment requested is for a routine condition and not urgent
- further assessment by a specialist is not needed.
The hospital should inform you and your GP (or primary care provider) in 15 calendar days or less about whether you will see a specialist.
How long will you wait to see a specialist?
If you do need to see a specialist, DHBs should provide your appointment within 4 months of the day the hospital received your referral. Your GP (or primary care provider) will continue caring for you while you wait for your specialist appointment.
Sometimes you will be asked to get some other tests done (eg, blood tests) before seeing the specialist.
Your first visit to a specialist is called a First Specialist Assessment (or FSA). Sometimes a Non Contact First Specialist Assessment (ncFSA) occurs. This is where a specialist assesses you on the basis of your records and test results without you being present. There could even be a consultation over the internet. The specialist will then develop a Plan of Care for you and give it to your GP (or primary care provider). This may include preparation for surgery or other treatment, or a long-term management plan if an elective procedure is not the best option for your condition.
What the specialist will do
The specialist will assess your condition and recommend the best option of care for you.
There are a number of possible outcomes depending on how urgent your condition is and what resources the hospital has available.
- The specialist may arrange for more tests to be done before the best decision can be made.
- You may be prescribed a course of medical treatment (eg, drugs) after which you may need a follow-up appointment.
- It may be decided the best thing for you is surgery. If this happens you will be given a priority score to determine how quickly you will receive the surgery. Your priority score will depend on how urgently you need it and how much you will benefit from it compared to other people. The DHB will determine whether it can provide treatment, depending on your priority score and available resources. If it can, treatment should be given within 4 months of confirmation it is available.
- If your condition is not yet urgent enough that you need specialist care within 4 months, but it may get worse, you may be given the status of Active Review. This means the hospital must re-assess you at least every 6 months for up to 18 months. If your condition does not get any worse you will be returned to the care of your GP (or primary care provider) and advice will be given to them about what to do if your condition gets worse.
- The specialist may decide that a service is not available to you, even though you would benefit from it. If this happens, you and your GP (or primary care provider) will be informed, and they will discuss with you your best options of care.
How long will you have to wait for treatment?
If the DHB confirms it can provide treatment, it should provide that treatment within 4 months. However, if you are waiting for surgery and your condition gets worse, you should see your GP (or primary care provider) to have your priority score reassessed.
What does it mean if my referral was declined?
Health resources are not unlimited and we have to make decisions to give one patient priority over another. This is not new or unique to New Zealand. Our aim is to be fair in the way people are treated. Decisions about who gets access are based on each person’s level of need and ability to benefit, compared to others. Those with the greatest priority get access first.
If your referral was declined, you will be sent back to your GP (or whomever referred you initially) who will continue to monitor your condition. From here, there are a number of options to consider:
- you may benefit from other health interventions, such as physiotherapy, weight loss management and exercise programmes. Please seek advice from your GP about what alternative care options may be suitable for you
- you are entitled to seek a second opinion, or provide further information in your referral if you believe the original referral did not adequately describe your condition
- if your condition changes, you may be re-referred for an assessment, and may go on to access publicly-funded care.
If you don’t agree
If you don’t agree with a decision that you will not be given a publicly funded FSA or treatment, you should talk to your GP (or primary care provider) who will explain why the decision was made and what options are available to you. These may include referral to a private specialist for treatment, or a clinical review of your condition, either by the original specialist or by another clinician (a ‘second opinion’). You have the right to ask for a clinical review, but the original decision may still stand.
You should also check that all information has been given to the specialist, including the impact your condition has on your life.
DHBs often have a process for addressing patient concerns – please visit your DHB’s website.
If your condition gets worse
If at any time your condition worsens you should see your GP (or primary care provider). They will ask the specialist to reassess you, which may mean your priority score for treatment changes.
Using the private system
You may choose to see a private specialist and/or have the surgery done privately, but you will need to pay for this yourself or through your private health insurance.
A private specialist may offer you surgery in a public hospital if you don’t want to pay for private surgery. If this happens you will be given a priority in the same way as someone who was referred to a public specialist. Some hospitals may still require you to see a public specialist.
Still want to know more? Visit the Questions and answers page.