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

Aims, To document and analyse the development of independent practitioner a ssociations and similar groups in New Zealand, Methods. A questionnaire was sent to the 30 independent practitioner associ ations in August 1998 and followed-up by a number of reminders. Results. The 28 respondents (93%) represent 97% coverage of the estimated m embership of independent practitioner associations and similar groups. Memb ership of: the 28 responding organisations ranged between seven and 340, wi th an average of 74 members and a total of 132 employed staff, Twenty-one h ad 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 case resources". They reported almost to tal implementation of computerised age/sex registers in their practices, Th ere was strong support for independent practitioner associations to manage the clinical activity of members, to move from historical to equitable, nee ds based funding and for formal patient enrolment. The majority of responde nts supported integrated and capitated primary care budgets but few support ed 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. Conclusion, Independent practitioner associations have made significant pro gress in increasing membership levels, in establishing a framework for mana ging clinical activity of members and in developing their infrastructure, i ncluding information systems. They have established a wide range of new rel ationships within primary care, with their communities and with primary and secondary care providers. In managing increasing amounts of public money t o achieve public goals, these groups may be developing a new model of clini cal governance, which could be of international importance.