After Hours Powers
I read today that Auckland’s largest after-hours clinic, White Cross Ascot A&M, wishes to get out of it’s arrangement with Auckland DHB that freezes the amount of co-payment they can charge for after-hours visits. The fact that the agreement was signed in November last year and has only 4 months to run, illustrates the frightening speed with which a service can become sub-economic. As usual the DHB wishes to fiddle while Rome burns:
“The board paper says officials will talk with other interested parties about other ways of providing A&M services after hours during the week, at weekends and on public holidays.”
What a great solution! Let’s go and find people with no facilities and much less expertise to provide the service, instead of negotiating with the current provider.
There is no doubt that White Cross will probably be struggling with its provision of late-night (10pm to 8am) service. The night shift is very unpopular with staff and is expensive to run. With the increasingly poor economic outlook, patients become more inclined to suffer the long wait in public emergency departments and more reluctant to pay the extra fees. The throughput of the night shift will have dropped off in recent months and made the service very marginal.
However, it is also certain that White Cross really does not want to increase the co-payment. After all, this would only serve to reduce the numbers coming through at night still further. They would much prefer to negotiate a substantial hike in the payment Auckland DHB is providing to keep the co-payment low. They would probably really like to make the co-payment lower, if they could.
I suspect all this story represents is two parties maneuvering, prior to the commencement of re-negotiating the contract in November. It would be a complete disaster for Auckland emergency department and, possibly, Middlemore, if White Cross closed their doors at 10pm. Emergency departments use the “quiet” time between midnight and 6am to empty out the ED prior to the days influx. They also have the lowest staffing rate at this time. Even a 10% increase in the number of cases between 10pm and 8am would stifle this emptying process and leave the ED vulnerable to even more bed-block.
Auckland DHB: You know you are not going to set up a whole new A&M subsystem, so quit wasting time with useless reports. White Cross: You know you don’t want to kill demand by charging more, so suck it up and negotiate in good faith. Everyone wants this to work, guys, so MAKE IT WORK!
Disclaimer: I have never worked for Auckland DHB or White Cross. I don’t own shares in White Cross.
Disclaimer: No managers were harmed in the writing of this blog. But they could have been…
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Sep 4 08 11:03 pm
Please excuse the rant, but:
It’s such a strange situation that for years emergency department care has been gearing toward decreasing hospital admissions, and increasing outpatient management of acute medical problems- and despite this evolution in acute care, very little has gone in to the provision and support of the ‘first-line’ of acute care, i.e. A+M/GP after-hours care.
How many times have we (medical/nursing) all had to admit ‘well’ patients for intravenous antibiotics, investigations, or some other relatively simple task that could be managed as an outpatient. Even worse with children, where the ‘well’ children we admit are often behavioural ‘pains-in-the-ass’, running all around the ward throwing toys etc.
I hear you… Feel free to rant here anytime.