Enrolment

A small number of patients have been identified as showing 'Unknown ethnicity' in NES, which is the source of information for capitation. The practice PMS shows the patient ethnicity, however for this small group of patients, the ethnicity is not carrying through to NES.

Practices are asked to update the ethnicity information in NES. Pinnacle will provide a list of the patients with 'Unknown ethnicity' to practices monthly, via the practice the PHO / HealthLink folder. The first NES 'Unknown ethnicity report' will be sent to practices on Thursday 28 March. Reports will then be sent each month on the 10th of the month.

A number of practices have already updated ethnicity based on lists sent out last year and may find they have only a small number of patients to update. 

How to update patient ethnicity in NES

Bring the patient demographic and the NES demographic information onto the PMS palette. Update ethnicity in NES based on the ethnicity listed in your PMS system. NES may have different options for ethnicity than your PMS - we suggest you select the closest match to the information provided by the patient and update all ethnicities as identified by the patient. If you need any assistance on updating a patient’s ethnicity in NES, please contact our Practice Systems Support team. 

Please see the links and files section below for the following supporting documents.

• Enrolment requirements for contracted providers and primary health organisations (PHO Services Agreement – Referenced Documents – Te Whatu Ora - Health New Zealand).
• Eligibility to enrol with a primary health organisation (Te Whatu Ora).

To formally enrol a patient a practice must:

• ascertain that the patient wishes to access most of their care from your practice
• get the patient to sign an enrolment form - enrolment must take place via a signed form (see files and links below)
• provide the patient with information about what enrolment means - this is found on our patient facing website, see link below.
• update the PMS system - the enrolment date on the PMS must match the date the patient signed the enrolment form.

By using the current enrolment form template provided in the files and links section below practices can be assured they meet the Te Whatu Ora mandatory requirements. Our templates are set up as Word documents that you can insert your own practice information into.

Patients are advised that:

• your practice will become their preferred provider of general practice services
• your practice will hold the funding for their primary health care
• they have been provided with information about where personal information is sent and how it is used, please see the patient health information privacy statement in the related resources below.
• they can only be enrolled with one practice at any one time.

Note: If the patient is unsure whether they are enrolled at another PHO/practice ask them to phone freephone 0800 458 448 to request the information.

• Deceased patients must be removed from the register as soon as the practice is aware of the death.
• Any person who is eligible for publicly funded health services can choose to enrol. For information regarding who is eligible refer to the eligibility documents, refer to the Ministry of Health website link below.
• Each person aged 16 years and over must complete and sign an enrolment form.
• Where a practice receives a request for the transfer of records by another practice (and all the conditions of transfer are met) the practice must forward the records within 10 working days of receipt of the request.
• Patients who have an overseas address must be entered on the PMS system as casual patients.
• If a practice receives notification from either the patient , the prison or some other government department indicating that the patient is in jail they should dis-enrol the patient for the period of time they are incarcerated (and get them to enrol again at a later date).
• A practice cannot refuse enrolment on the basis of health status, anticipated need for health care or any other form of discrimination as defined in the Human Rights Act 1993.
• All registered patients must be enrolled - practices should not have registered patients who are not enrolled but can have registered patients who are recorded as declined to enrol.

The National Enrolment Service (NES) has been developed to provide up to date national enrolment and identity data.

The NES provides:

• a patient register used by all general practices
• a centralised register with real-time patient enrolment status to establish more timely payment calculations for enrolled patients
• an up to date data set to ensure accuracy of Capitation Based Funding (CBF) calculations
• validated NHI and up-to-date patient demographics, supporting accurate identification of patients and clinical safety
• validated addresses using eSAM service, supporting accurate assignment of deprivation-based funding
• processing and payment cycle reduced from 3 months to 1 month
• health identity and enrolment web services integration with PMS, creating a seamless experience for the user when interacting with national services.

A copy of the signed enrolment form must be retained.

We recommend they are scanned into the PMS patient notes or a hard copies kept (filed in alphabetical order) for audit purposes.

If scanning enrolment forms these need to be retrievable in a legible manner. ALL INFORMATION MUST BE LEGIBLE, INCLUDING SIGNATURE AND DATE.

The patient health information privacy statement is published on our patient facing website.

The statement is also available to download under files and links at the bottom of this page, along with a poster which you may wish to display in your practice. 

Information for patients on primary health organisations, how your practice is connected to one and the benefits of enrolling can also be found on the patient website, under information for patients.

Individuals are free to dis-enrol at any time. The practice can only terminate an individual’s enrolment if:

1. there is genuine concern that the relationship between that individual and the practitioner is severely compromised or fee for service deductions over the preceding six month period consistently demonstrate that the provider is no longer the patients preferred provider of ongoing First Level Services
2. there is no record on the patient notes that within the previous three years they have either consulted with the provider or indicated that they wish to remain on the enrolment register
3. the patient emigrates or dies
4. the patient has enrolled with another provider and requested transfer of notes.

For number 1 above, practices must follow the required process to dis-enrol patients - refer to the enrolment requirements for contracted providers and PHOs link below.

For all dis-enrolments an auditable documented record must be kept - e.g. document in the PMS patient notes or Medtech F3 enrolment notes screen.

We've included a breakdown of Dr-patient relationship letter template below in the files and links section. 

• If you do not see the patient for three years they must have their enrolment updated by completing a new enrolment form, or through an auditable contact. See links and files below for more information on Auditable Contact and an Auditable Contact Checklist.
• Each time you see a patient and an invoice is created the three year period is effectively reset. Therefore a patient who is seen on a regular basis is not likely to have to complete another enrolment form.
• The date of last consultation is used by HealthPACs information system use to judge three year eligibility.
• When the NES extract is submitted to HealthPAC there are two dates recorded, the date of enrolment and the last consult date (from the accounts field). To ensure the patient is eligible either one of the dates has to satisfy the three year rule (has to be within the last three years)
• the enrolment date on the PMS 'should only be updated' when the patient signs an enrolment form. The date entered into the PMS system should be the date the enrolment form is signed.

Doctors may experience difficulties in their relationship with some patients, which may lead to negative outcomes for both doctor and patient. Wellington barrister Gaeline Phipps discusses what’s needed to safely end a patient-doctor relationship (see NZ Doctor link below 'I think we should see other people': How to divorce your patient').

KEY POINTS

• Doctors sometimes cannot effectively treat a patient and adequately meet the needs of their other patients.
• A number of steps are required before ending the patient–doctor relationship, including consideration of the range of potential impacts on the patient.
• Doctors are required to consider the most sensitive way possible to convey the decision to end the professional relationship.

Ending patient relationship, standard letter – behaviour related. See the template linked below.

Each person 16 years or over to complete and sign own form. See the below 'Request to have medical notes transferred' file.

We recommend regular checks on your enrolment process.