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SECTION 88 Update
				
				
						Postnatal Module 
				
		
		It is important to note the postnatal period of care has 
		changed.
		
				It is now SIX WEEKS.
		
		
				In the original draft of the new Notice, the Ministry of Health proposed the 
				period be reduced to four weeks. We are advised they received many 
				submissions from consumers and midwives concerned the shortened period 
				would result in a lack of care in the period between the discharge by the LMC 
				and the commencement of care by the well child provider.
		
		
				
						As a result, the Ministry followed the submissions and set the period 
						at six weeks.
				
				
						
								It is important to note the women can now 
								only be 
						
						
								discharged at six weeks, 
								not at four weeks as 
						
						previously.
				
		
		
				
						• 
						Depending on circumstances, this may not necessarily mean the LMC is 
				
				expected to provide additional visits. 
				
						• 
						Depending on the care required by the woman it may be possible for 
				
				the visits to be spread over the longer period. 
				
						• 
						Alternatively, strictly speaking, while it is possible to "discharge" a 
				
				woman after 4 weeks of care, if the woman subsequently requires 
				services from the LMC in the 5th and 6th weeks, the LMC is obliged to 
				provide care under the notice, even though the woman has effectively 
				been discharged. 
				
						
								If this option is chosen, it is suggested the LMC should 
								at least phone the woman before the actual discharge at six weeks to 
								ensure no further care is required.
						
				
		
		
				
						The section requires: 
				
		
		
				• 
				A detailed clinical examination of the baby within the first 24 hours 
		
		following birth 
		
				• 
				A detailed clinical examination of the baby within 7 days of birth 
		
		
				• 
				A detailed clinical examination of the baby, as defined in the Well Child 
		
		Tamariki National Schedule before transfer to a well child provider 
		
				• 
				A postnatal examination of the women at a clinically appropriate time 
		
		and before transfer to the woman’s primary provider
		
				
						The visit requirements specified in the section are: 
				
		
		
				• 
				A daily visit if the woman is receiving postnatal inpatient care 
		
		
				• 
				A home visit within 24 hours of discharge from the maternity facility 
		
		
				• 
				Between 5 and 10 home visits (and more if clinically required) 
		
		• 
		
				A minimum of 7 postnatal visits in total
				
						Postnatal Referrals – Well Child Providers 
				
		
		The section requires the LMC to transfer the baby to a well child provider: 
		
				• 
				The transfer must take place before six weeks from birth. 
		
		
				• 
				The LMC must give a written referral that meets guidelines agreed 
		
		
				between NZCOM and well child providers before the end of the 4
				th 
		
		week following birth 
		
				• 
				Plunket and some other well child providers like to receive the referral 
		
		as early as possible so they can make sure they provide the first visit in 
		the fifth week following birth.
		
				
						The timing of the discharge and the referral may well mean both the LMC 
						
								and the well child provider are providing care in the 6
								th 
								week of postnatal 
						
						care. The Ministry of Health do not see an issue with this and believe it 
						could lead to greater collaboration between the providers.
				
		
		
				
						Postnatal Referrals – Primary Care 
				
		
		The section requires the LMC to transfer the woman and the baby to a primary 
		health provider (usually but not always a GP) before discharge at 6 weeks.
		
				There must be a written referral to the woman’s GP before discharge. The 
				referral must follow the guidelines agreed by NZCOM and The Royal College of 
				General Practitioners. We are advised there has been a working party, 
				sponsored by the Ministry of Health, operating since April to set the 
				guidelines. Although the guidelines were meant to be ready by 30 June, we 
				have not yet sighted a copy.
		
		
				As soon as the guideline is available, we will circulate it to members. 
				We are aware some women, when asked “who is your GP?”, do not provide a 
				GP name. It is suggested the best question to ask is not “Who is your GP?” but 
				“To which GP do I send the referral ?” This question, it has been shown, is 
				more likely to elicit the required information.
		
		
				
						If the woman still does not provide the name of a GP, the LMC must 
						provide detail of the primary providers in the area.
				
				
						Second and Third Trimesters 
				
		
		It is possible, if unlikely, the LMC may not be entitled to payment for some 
		woman who register with them towards the end of the second trimester but 
		then transfer on to another LMC shortly thereafter. 
		
				• 
				If the woman registers with the LMC after the end of the 26th 
				week of 
		
		pregnancy, the LMC may not claim any of the first or second trimester 
		fees. 
		
				• 
				If the woman changes LMC before the start of the 31st 
				week of 
		
		pregnancy, the prior LMC cannot claim any of the third trimester fee.
		
				
						
								So, if a woman registers with an LMC in the 27
								th 
								week and then 
						
						
								transfers to another LMC before the end of the 30
								th week, the LMC w
						
				
		
		
				ill not be entitled to receive any payment for services provided 
				during that period.
				
						
								
										It appears the common view is this should not be an issue as it is most 
								
								
										unlikely such a scenario would occur.
								
						
				
				
						Claims Processing 
				
		
		We were advised on Friday 6 July, HealthPAC could accept claims. We 
		submitted a claim that day. We have now been told that while HealthPAC can 
		receive claims, they cannot yet process the claims.
		
				Members should therefore note and be prepared for delays in payment. As 
				previously advised, we expect very few claims will be paid over the next week 
				which will mean, potentially, a substantially lower payment to members in the 
				last week of July.
		
		
				We will keep pressing HealthPAC for prompt payment and will advise any 
				progress as soon as possible.
		
		
				
						Vodafone
				
		
		
				Vodafone have been making substantial changes to their computer systems. 
				As a result they have been unable to action some requests and the accounts 
				are delayed.
		
		
				This means you may receive statements showing balances are unpaid. This is 
				not correct – all accounts received and paid through this office are as up to 
				date as is possible and the payments will reflect on your next statement.
		
		
				Also, if you have received a letter from Vodafone demanding payment or your 
				account will be terminated, please ignore the letter. Apparently these were 
				sent in error.
		
		
				
						Tony Mansfield 
						Chief Executive