The development of independent practice associations and related groups in New Zealand

Independent practice associations (IPAs) have become an important feature of New Zealand's primary care system in the past two years and now represent nearly 60% of general practitioners. This survey was undertaken to document this important development. To determine the extent of the development of IPAs, their goals and barriers to achieving these goals, their policies, financing and contracting development.

Questionnaire sent to 42 IPAs and related groups in October 1994 with a supplementary questionnaire in April 1995.

There were 34 responses, representing the views of 1263 general practitioners. Most important goals were "achieving better health outcomes for patients", "making better use of primary care resources" and "improving the health of the community you serve". Significant barriers to achieving these goals were "lack of time" and "lack of clear RHA policies". There was little support for financial risk sharing or for members personally retaining savings from budget holding. Although there had been significant progress with budget holding considerable frustration was expressed about contracting relationships with RHAs.

The survey shows that general practitioners are seeing IPAs as ways of achieving professional goals, better quality health care and improving health status outcomes rather than as a means of personal gain. However, protecting and advancing the status of general practice was also important. IPAs expect to move progressively into both budget holding and managed care with the gradual assumption of secondary care services purchasing. This has important implications for the future of RHAs including the need for them to adopt a more strategic purchasing role.