Emerging clinical governance: developments in independent practitioner associations in New Zealand

To document and analyse the development of independent practitioner associations and similar groups in New Zealand.

A questionnaire was sent to the 30 independent practitioner associations in August 1998 and followed-up by a number of reminders.

The 28 respondents (93%) represent 97% coverage of the estimated membership of independent practitioner associations and similar groups. Membership of the 28 responding organisations ranged between seven and 340, with an average of 74 members and a total of 132 employed staff. Twenty-one had appointed a chief executive officer or general manager. The respondents' most important goals were "achieving better health outcomes for patients" and "making better use of primary care resources". They reported almost total implementation of computerised age/sex registers in their practices. There was strong support for independent practitioner associations to manage the clinical activity of members, to move from historical to equitable, needs-based funding and for formal patient enrolment. The majority of respondents supported integrated and capitated primary care budgets but few supported capitated budgets for separate general medical services, laboratory and pharmaceutical services. Important recent initiatives include a wide range of integration projects and increasing involvement of local communities.

Independent practitioner associations have made significant progress in increasing membership levels, in establishing a framework for managing clinical activity of members and in developing their infrastructure, including information systems. They have established a wide range of new relationships within primary care, with their communities and with primary and secondary care providers. In managing increasing amounts of public money to achieve public goals, these groups may be developing a new model of clinical governance, which could be of international importance.