In October 2013 the Ministry of Health announced a change to the way rural practices were to be funded. The previous rural funding streams of the rural bonus, workforce retention, after hours and reasonable roster (total national value of $13m a year; Canterbury value $1.43m for 2013-14) were combined into a funding pool. All DHBs that have rural practices received a proportion of the funding. The funding was allocated to individual DHBs taking into account their population demographics, remote rural issues and the historical share of existing rural funding allocation.
With the announcement came an expectation from the Ministry of Health that the funding distribution of these additional funds should be the responsibility of robust rural health alliances to decide how to allocate funding for rural subsidies. Alliances will replace the funding allocation tool the Rural Ranking Score, though its definition of a rural practice remains i.e. 30 kms or 30 minutes from a base hospital.
Given that the Canterbury health system already operates in an Alliance Framework, the CCN Rural Health Workstream was asked by the Canterbury DHB, as funder, to consider and recommend the establishment of a Rural Funding Service Level Alliance as a working group under the Rural Health Workstream.
A change to the approach for revising the Rural Funding Subsidies Formula
The proposed version of the rural subsidies funding formula that went out late 2016 did not achieve the required endorsement from affected rural general practices. As a result, the decision was made to rollover the current version until the next contract date in September 2017.
To date, a ‘funding formula allocation’ approach has been applied to revising the rural subsidies funding formula. This approach focused the discussion predominately on funding and the impact of any change in funding for individual rural general practices, rather than on the higher level principles.
The new ‘principles-based’ approach is consistent with the CCN’s recognised way of working, and is expected to enable a patient centric solution. A proposed set of principles will be developed and workshops held with key staff from all eligible rural practices to gain feedback and final agreement.
Since then, the next steps regarding the Rural Funding Subsidies in Canterbury have been considered by the Canterbury Clinical Network Alliance Leadership Team (CCN ALT). In April 2017, ALT endorsed a shift in approach. Instead of working to define a new funding allocation model, it has been decided to work collectively to develop and agree key principles which will underpin the distribution of the rural funding subsidies to eligible practices.
Once endorsement is received for the principles, the funders (Canterbury DHB and two PHOs) will correspond with rural general practices and offer revised rural subsidy funding contracts consistent with the principles agreed.
In line with this change in approach, the Rural Funding SLA was disestablished.
From May 2017, a Technical Rural Funding Group (as a sub group of the CCN Rural Health Workstream) is responsible for leading engagement with rural general practices and further refining the approach to the rural funding subsidies.