Letter to NAPTOSA - Update on the Family Practitioner Nomination and Specialist Referral

Over the past few weeks, the Scheme had several engagements across the country with members and stakeholders relating to the introduction of care coordination, specifically the Scheme’s new rules relating to the nomination of family practitioners and specialist referral.
The communication you received previously, states that members are required to nominate a Family Practitioner (FP) by 2 April 2015.

The Board of Trustees carefully considered the feedback received during the member and stakeholder consultations, and decided to postpone the implementation of the full initiative for the duration of 2015. This will allow for the ongoing member and stakeholder engagements to be completed.

Therefore, the 30% co-payment that was to be implemented from 02 April 2015 will not be applied and a rule amendment to this effect will be submitted to the Registrar of Medical Schemes.

Also, the implementation of Specialist referral by a nominated FP has been postponed and for Ruby, Emerald and Onyx members there will therefore be no changes on 02 April 2015. Specialist referral arrangements currently in place for Sapphire and Beryl members will continue unchanged.

Care coordination is very important to improve health outcomes, while containing healthcare costs and contribution increases. Irrespective of the postponement, the Scheme is encouraging members to continue nominating a FP to realise the associated benefits.

The Scheme will continue to have engagements with you as a stakeholder on how care coordination will be introduced into the GEMS environment.



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