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The management of primary care services within the community in New Zealand is currently shifting towards the implementation of primary health organisations (PHOs) and capitation funding. Capitation funding is considered necessary to allow primary care organisations to allocate resources in the most efficient and effective manner.1,2 The funding formula incorporates a population-based allocation of resources for primary care providers, with the capitated revenue for PHOs determined on the basis of the demographic composition of their patient population as listed on enrolment registers. Key determinants of population need will include age, sex, ethnicity and deprivation index. High user health card (HUHC) and community services card (CSC) status will be used in determining funding and patient fees under an interim funding formula.3
PHOs must have an auditable process to confirm patient details provided on patient registers. Initially, patients who are already on PHO practice registers, with the exception of casual patients, will be considered to be enrolled.4 Until now there has been no formal definition of a registered general practice patient. Patients have usually been considered 'registered' with a practice if they have consulted on a regular basis. A patient contacting a PHO for treatment when not enrolled with that PHO will be considered a casual patient. The maximum period of time that a patient can be enrolled without contacting their PHO for service or reconfirming their desire to be enrolled is three years. The National Health Index (NHI) number of each patient will enable the Ministry of Health to identify duplicate enrolments with more than one PHO. Previous research by the authors has indicated that at least 10% of general practice patients with a recorded NHI number will consult at more than one practice. This is almost certainly an underestimate of patient mobility between practices, since not all patients have a recorded NHI number.5
Monitoring of enrolment registers will not only require active management of practice management systems by practice staff but improvements in information systems for coding and recording of patient data. Patients who have moved away, died or ceased to be patients of a practice should be removed from the practice register, but this is not always the case. Practice staff are not always informed of patient movements. Most registers record details of casual...