Parmar ParmjeetNEWBORN ENROLMENT WITH GENERAL PRACTICE BILLFirst ReadingDr PARMJEET PARMAR (National): I move That the Newborn Enrolment with General Practice Bill be now read a first time. I nominate the Health Committee to consider the bill. I would like to start by acknowledging and thanking everyone who has been a part of discussions with me while I was drafting this bill and also since this bill has been drawn from the ballot.The purpose of my bill is to improve health and social results for infants by requiring that newborns are enrolled with a general practice and/or a primary health organisation before the newborn reaches 6 weeks of age. High rates of newborn enrolment with a general practice will reduce the risk of their falling through the gaps for immunisation and also allow for earlier detection of health and social issues. I want to acknowledge that a lot of work has been done to improve the enrolment of newborns with general practices but there is more that can be done to improve the enrolment of newborns with general practices as early as before 6 weeks of age which is the intention of my bill.I want to acknowledge the work that the Ministry of Health has been doing since October 2012. It has been pushing for newborns to be enrolled with a general practice soon after birth so that they can receive essential healthcare including immunisations on time. Yes we have seen some good progress as prior to this push from October 2012 fewer than half of newborns were enrolled with a general practice at 12 weeks—that is around 3 months of age. At the fourth quarter of 2015-16 77 percent of newborns were enrolled with a general practice within 3 months. This is based on children born between 20 February 2016 and 19 May 2016.The question is then about the possibility of getting more newborns enrolled with a general practice as early as before 6 weeks of age. To answer this question I looked at a lot of information and I would like to share the information about the number of women giving birth by birth settings. I looked at these numbers from 2004 onwards and what I saw was that around 97 percent of births happen in a maternity facility—a maternity facility could be primary secondary or tertiary care—and around 3 percent of births are home births. When I say home births they are not necessarily unplanned emergencies; there are some planned home births too. We also know that many home births are attended by at least one midwife.The point I am making is that we know where births are happening so we should be able to bring these newborns into the system. We should be able to get them enrolled with general practices before 6 weeks of age so that we can help them with immunisation calls and various other services they can be eligible for. As we know over the first 3 months of life infants and their families are eligible for a range of services including maternity care primary care immunisation and Well Child / Tāmariki Ora. Well Child / Tāmariki Ora services are expected to link families with primary care and immunisation services and also other services—for example for social services or housing support with the Ministry of Social Development. Or it could be a completely different kind of support needed—for example breastfeeding support or a general assessment of development and growth.Currently newborn pre-enrolment requests are sent to the nominated general practice through the National Immunisation Register. It is not currently possible for the responsible practitioner to ensure that the pre-enrolment request has been made to the nominated general practice before the newborn is discharged from care because the transfer of the information through the relevant electronic systems can take several days and can be longer for home births. But it is possible for the responsible practitioner to ensure that the information is entered into the relevant system before hospital discharge.The most common delays in the current preliminary newborn enrolment process occur when a general practice declines the initial request that comes through the National Immunisation Register or when the practice fails to act on that request in a timely manner. To fix this my bill proposes that before a newborn is discharged from maternity care the newborn's mother and any other family members be consulted and a pre-enrolment request be sent by the maternity carer on behalf of the newborn to the nominated general practice and so it is ensured that the request is entered into the maternity system. Then the general practice nominated as the primary healthcare provider is to ensure the pre-enrolment process of the newborn is actioned within 2 weeks and prior to the 6-week immunisation pre-calls and the immunisation event.The Ministry of Health's expectation is that all pre-enrolment requests are accepted by general practices but general practices are not required to do so and as far as I have heard general practices may decline a pre-enrolment request if they are not familiar with the family or if the family has a debt with the practice which is contradictory to the ministry's advice. To fix this and to allow general practices to be able to decline pre-enrolment requests my bill proposes that a nominated general practice can decline pre-enrolment only if it is working at full patient capacity or there is another good reason why enrolment cannot be completed when it receives a pre-enrolment request made on behalf of a newborn. In that case when the general practice is unable to proceed with the pre-enrolment request the nominated general practice should consult with the family and find another general practice that works for the family.But if the nominated general practice is unable to assist the family in finding another primary healthcare provider for the newborn it must refer the pre-enrolment request to the relevant district health board within the time line of 2 weeks. A district health board or primary health organisation that receives a referral in this way will then be responsible for assisting the family to pre-enrol the newborn with another provider prior to the newborn reaching 6 weeks of age.I want to acknowledge that while enrolment is a parental choice it is not a legal requirement. I know that newborns can make families really busy and they can lose track of time. As I have been through that twice as a mother of two I want to see that a system is able to follow up these families follow up newborns to ensure that they are enrolled with a general practice. As I said before we do not want to see them falling through the gaps for immunisation calls or the earlier detection of health and social issues. I believe that the 2-weeks time line for the nominated general practice to act on the pre-enrolment request is sufficient. I believe that all newborns should have the best possible start in their life. I believe that my bill will help us achieve better long-term outcomes for newborns throughout New Zealand and I highly commend my bill to the House. Thank you.