Simeon Brown revealed plans for a 24/7 online GP service six weeks after becoming the health minister. Photo: Calvin Samuel / RNZ
The government has further delayed putting its 24/7 online GP service out to a public tender, despite being warned about the risks.
Documents show the promise of an open procurement process was also one of the main justifications used for not holding one in the first place.
Simeon Brown - who had replaced Shane Reti as Health Minister in January - revealed the plans for the 24/7 GP service six weeks later as one of several public health interventions.
The government at that time was under severe pressure over the health sector being in "crisis", including frustrations over staff shortages and burnout, underfunding of hospital maintenance, and staff cuts.
Unlike Healthline, which only offered over-the-phone advice, Brown said the service would be staffed with doctors and nurse practitioners able to prescribe medicines and order tests.
He said it would begin operating from the middle of the year, giving little time for the procurement process Health NZ was yet to carry out.
Despite being billed as a "new" service, it was basically the same as that already being offered by various General Practice (GP) groups - an online way to book a video-call GP appointment - but it would be listed on the Health NZ website and subsidised to provide nationwide, round-the-clock access.
The documents released to RNZ under the Official Information Act show that instead of the usual procurement approach where the government publicly tendered for services, specific providers were invited to take part.
A ticked box in a "procurement exemption" form showed a "high or extreme risk" to value for money of using this approach, but three mitigations would reduce that risk to merely "moderate":
- Health NZ would set subsidies and fee limits for the scheme equally for all providers, by analysing the similar schemes already offered by GPs
- All providers initially approached by Health NZ would be invited to take part, rather than one being selected over others, ensuring fair treatment
- Providers not approached by Health NZ would soon get the opportunity to join through an open tender process
The exemption document repeatedly referred to this second phase of the process, saying "this [procurement] opt-out allows time to secure services while we run a proper open procurement process to find suitable providers".
Notes indicated Health NZ was pushing ahead with this unusual approach because of requests from higher up.
"The early start and therefore use of the opt out is that this has been requested as it is one part of a government initiated primary care tactical action plan."
That initial paper from November envisaged a start date in December, with the aim of having contracts signed by February or March from the follow-up open procurement - at most, three months later.
In reality, Brown announced the official launch of the service on 1 July following a "pilot" starting in May. This matched the timeline set out in the rest of the documentation provided to RNZ, which pointed to an open procurement running from July to August - again, shortly after the initial approach.
But Health NZ now said the open tender process was being further delayed to early 2026.
"Timing for the open procurement process is now expected early 2026 to coincide with the later launch date of the service. It will also allow us to review how the service is operating ahead of inviting new providers to participate in an RFP process."
RNZ sought clarification of what was meant by the "later launch date", but the response only referred to the November procurement exemption form. Subsequent questions about why the open market approach had been further delayed by at least six months went unanswered.
The government announced a 24/7 online GP service earlier this year. Photo: 123RF
Providers identified in 'desk-top review'
Health NZ had initially rejected RNZ's OIA request, saying the documents would affect "commercial negotiations" despite all providers being offered the same subsidy and co-payment fee limits. RNZ lodged a fresh request after the service's launch.
The 170 pages released showed $22 million was budgeted for the first year of the service. That had since been revised up to $100.9m over the four years to 2028/29.
Officials in November had identified 11 possible providers after a "desk-top review" of GPs and health professionals already providing such services. That list later expanded to 13, but only eight ultimately put themselves forward for assessment by Health NZ managers.
Those eight met the requirements and all were approved, including: Bettr Online, CareHQ, The Doctors Online, Emergency Consult, MedOnline, Pocket Lab, Tend, and Practice Plus.
They were evaluated against a list of requirements by a panel of four managers who carried out reference checks and interviews, but final decisions were made by one "Living Well, Life Course Director" based on their advice.
The providers were offered three-year contracts which could be terminated for poor performance, changes in government direction, or "convenience".
Whakarongorau Aotearoa, Ka Ora Telecare, National Hauora Coalition, and Well Revolution were also invited - but declined to take part.
Advertising, subcontracting, and Māori health inequities
Responses to the prospective providers' questions in March showed the service was forecast to reach about a million New Zealanders a year, though demand for overnight care was expected to be low.
Subsidies and patient co-payment fee maximums would each be increased by $10 for calls between 10pm and 8am.
Providers were told they could market the service as long as they coordinated their messaging with Health NZ "particularly prior to the potential announcement in July".
Subcontracting would also be allowed if the provider got prior written consent from Health NZ.
Some providers raised concerns the subsidy and fee structure could make the online service cheaper for some patients than seeing their regular GP, encouraging them to switch permanently. Officials said the fees were designed to balance affordability with continuity of care, but stressed that adjustments might still be made and they were open to suggestions.
The draft contract also named reducing Māori health inequities - including meeting Māori-specific requirements - as an overarching aim of the service. The coalition parties campaigned on health services being provided on need rather than race.
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