SECTION 88 CHANGES

PRIMARY MATERNITY SERVICES NOTICE UPDATED: WHAT DOES IT MEAN IN REAL TERMS?

Pursuant to Section 88 of the New Zealand Public Health and Disability Act 2000, the Primary Maternity Services Notice 2007 has been updated by the Government to implement the $85 million that was allocated to primary maternity services in the 2020 Budget.

Following a public consultation period from September to November 2020 and considerable input from the College, the notice has now been gazetted and is a substantial improvement on the previous consulted version, indicating the Ministry has taken the College’s feedback on board and responded accordingly.

The updated Primary Maternity Services Notice 2021 replaces the 2007 notice in its entirety, and will be implemented on 29 November 2021, once IT systems have been adapted to enable claiming under the new notice.

Whilst the revisions to the notice don’t provide the ultimate solution to the overarching issues currently facing the midwifery profession, the improvements do acknowledge aspects of primary maternity care that have long been undervalued and overlooked.

The most significant changes to the notice are as follows:

• A single-service payment for consultation during pregnancy - where the midwife is not the woman’s LMC - has been introduced (e.g. early pregnancy advice and care, but woman does not register).

• A payment for registration with an LMC is now claimable.

• Fees for each trimester of antenatal care will now be claimable and paid at the conclusion of each trimester, rather than paid as lump sums at the end of the second trimester and/ or with the labour and birth fee.

• The second midwife fee will become a permanent fixture under the updated notice.

• Payments for care provided to women who have experienced a miscarriage will now be easier to access.

• A missed birth fee for rural midwives will be claimable.

• A transfer fee for all midwives (urban or rural) for ambulance transfers will be claimable. TRAVEL PAYMENTS Although this section of the notice has not yet been gazetted, the revisions at time of writing are explained here. Final details will be published on the Ministry’s website in due course.

Payments in recognition of travel costs will be structured differently under the new notice and will be claimable for each period of care: antenatal, labour/birth and postnatal. Payments will be graduated according to degree of rurality and level of urban accessibility (UA) in line with the Government’s recent review of its previous classification system (which dated back to 1992).

The six new classifications apply across all modules of the notice and payment will be determined by the woman’s address: • Major, large or medium urban area • High urban accessibility • Medium urban accessibility • Low urban accessibility • Remote

• Very remote

(Stats NZ, 2020)

Due to urban sprawl, the introduction of these new categories may mean some areas, which were previously deemed rural or semi-rural, may now attract a lesser fee, thus affecting the payments midwives receive following the implementation of the new notice.

ADDITIONAL CARE SUPPLEMENT

This section of the notice - a new module - is also yet to be finalised and will be published on the Ministry’s website along with associated fees when completed, so that it can be adapted readily as required.

The original proposed changes to the notice suggested midwives could only claim payment for additional care if the midwife completed a greater number of antenatal and/or postnatal visits. The College submitted extensive feedback stating this alone would not be a fair measure of extra work.

The revised notice will therefore contain a module called the Additional care supplement, which will be claimable per period of care (antenatal, labour/birth and postnatal), according to a list of criteria, which will be graded as low, moderate or high.

At time of writing, criteria for claiming through this module will include:

• Acute call-out

• Māori, Pasifika or Indian ethnicity • Refugee status • Conditions requiring consultation and/or attendance at multidisciplinary meetings • Home visits

• Early labour assessments

The business contribution payment will continue this year and the College has actively advocated for it to continue every year, until there is a new contract model in place for LMC midwives, however this is a budget-by-budget decision, with no guarantee that it will continue to be paid annually at this stage.

Whilst the revisions to the notice don’t provide the ultimate solution to the overarching issues currently facing the midwifery profession, the improvements do acknowledge aspects of primary maternity care that have long been undervalued and overlooked. Celebrating each step toward midwives receiving fair and equal pay for work done is vital, and the College hopes members can appreciate every development as a victory for midwives and the whānau we all serve.

The Ministry is currently hosting maternity stakeholder information sessions throughout the country and encourages midwives to attend. A pre-recorded webinar will also be made available for those unable to attend the meetings. square

The Ministry is currently hosting maternity stakeholder information sessions throughout the country and encourages midwives to attend. A pre-recorded webinar will also be made available for those unable to attend the meetings.

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