Primary Health Organisations: passing the enrolment audit
GPs must take steps to ensure only eligible enrolments are made to the Primary Health Organisation register; invalid enrolments can prove costly when District Health Boards claw back the funding. Barrister Hanne Janes outlines ways for GPs to better pass the enrolment audit
MPS has received a number of requests for assistance from GP members following enrolment audits. It is clear there are two distinct areas of the enrolment system that are causing members difficulties: one relates to eligibility for enrolment, and the other concerns actual enrolment processes.
The issues relating to each practice’s audit is entirely fact-specific, so this article is a general commentary only.
Getting it right
Why should GPs be concerned about enrolment audits? Because for many, extrapolation of random audit findings across their entire Enrolment Register has proved very costly indeed when their District Health Board (DHB) seeks recovery.
Health providers are required by the Ministry of Health (Ministry) to take all reasonable steps to ensure that only eligible people are enrolled and included in the practice’s Primary Health Organisation (PHO) Enrolment Register. Currently, the Ministry, DHBs and PHOs are making a clear distinction between “invalid” enrolments (defined as no validly signed enrolment form at date of audit) and “ineligible” enrolments, in respect of whether extrapolation occurs or not.
Current and future policy
Importantly, GPs should be aware that the Ministry’s enrolment policy is regularly evolving, with input from DHBs, PHOs and providers. While it would be expected that a GP’s PHO would communicate changes in enrolment policy to them, it is nevertheless the GP’s responsibility to ensure they are aware of the current enrolment requirements and that their practice is compliant.