7 years after the introduction of the "Primary Health Care Strategy" and PHOs it appears that the media and the general public still do not know what PHOs are and what their functions are. This $115 million was supposedly earmarked for projects to improve health care. These projects need the approval of the local DHB before spending can occur. So this begs the question as to what has happened to these so-called services? Have they been approved but have not occured? Have they yet to be approved? The truth is that PHOs are no more than a funding conduit. They cost in excess of $32 million a year to run. Nobody seems to understand how they work. Now they have $115 million in accumulated funding - funding they were never meant to accumulate! This is not GPs stashing money - and to imply this is offensive - it is bureaucratic structures failing to deliver on their tasks. Sounds a lot like the DHBs themselves.

What a sloppy bit of journalism this is, firstly the article states “Locally-run GP clinics have built up a $115 million treasure chest..” . This amount is for all PHO’s nationwide not just the wellington region (where the dom is the local paper) and most of it is for Auckland PHOs who because of their size would need the extra working capital as #5 Anthony points out. Then there is a quote from Capital PHO chairman Richard Tyler who “..said taking a snapshot of PHO bank accounts was meaningless. ‘PHOs get their money up front for services they are expected to deliver over the year’”. Since this is not refuted or even discussed later in the article by Tracy you have to ask what’s the story. Where is the comparison against the cash flows these organisations deal with yearly? About $6.4 million for ‘clinics’ in the wellington region sounds tiny compared to their annual health dollar spend, but we don’t know because it not considered relevant to the article or maybe it would make the article irrelevant!

How dare they. I mean what they're doing is known as "saving" or "investment". They should be borrowing money and getting into debt like every other government agency! If they were paying vast amounts of interest the banks then maybe the PHOs wouldn't have this fiasco with a surplus!

So, PHOs have, after seven years of operation, built up two or three months worth of working capital ...? Sounds like the Trustees and Directors of these non-government organisations have been doing a good job to me.

And some of the money is in investments, rather than left earning no interest in an organisation's transaction account...? Again, what's the story here?

The problem is that several PHO's are managed by 'professional' health services organisations. One of these organizations may run multiple PHO's. These companies are who the DHB's work with on public health projects, and who recommend/decide on health project costs, time frames, staffing etc and implement the projects. They therefore are where the funds are deployed and responsible for them. The DHB's fund them directly as they manage the PHO anyway. Interestingly some of these 'organisations' (companies?) shareholders are GP's. All this leads to a disconnect where what the public/PHO-boards desire and what actually happens diverge. Firstly because they do not run the health services delivered in the PHO and secondly because the management provider is influenced to do projects that are similar across the PHO's rather than what is highest priority across all PHO's thereby saving money, even though the costing will be done based on a single PHO implementation. The public face of a PHO is not necessarily who is truly responsible for it. PHO's can come and go (in fact any funding body structure politically implemented past or future)the people running it all stay the same, isolated from public opinion.

Seeing as they have so much stashed away, could we give them less next year and keep the community adult education classes alive? After all, that only costs $15 million per year in total.

The article suggests that your GP or her/his clinic is hoarding public money. It is the PHO that is holding onto the money. A PHO is the layer of management above the GP and beneath the DHB. GP's do have some involvement in the running of a PHO, but not much.

Simple solution - take the $115 million back, give it to the DHB's and suddenly they are $5 million in the black.

This article is deeply offensive to GPs. GPs have not stashed any money from PHO funding. GP clinic are given capitation funding from PHO's but have no connection to any reserves that PHO's may have accumulated. This is shoddy journalism and frankly I'm appalled with the insulting implication this article makes to my profession.

Dr Andrew Miller Whangarei

Shame on you Stuff! What a misleading disgraceful headline. It is not the GP's nor their clinics that are holding (not wasting) the money but the PHO's, a completely different entity. The GP's are not seeing a cent.