To start on a positive note, there have been a few glimmers of good news for general practice over the past months. First, money allocated in Budget 2022 has just started to flow into primary care, which will support more funding based on how many high-needs patients are enrolled. It’s heartening that both New Zealand’s major political parties broadly support strong funding for healthcare, so we don’t have the destructive funding flip-flops we sometimes see overseas.
There have also been much-needed boosts to international recruitment. In April 2023, nurses and doctors were among 32 health sector roles added to the Straight to Residency immigration pathway. It followed a new immigration pathway that was quietly launched in December 2022, and funding for a training scheme for nurse practitioners.
And finally, in October 2022 it was announced that first-year GPs would get pay rises, and specialist GPs would receive more funding to train GPs and host junior doctors.
The problems overwhelm the bright spots, which is a fitting metaphor for the job of GP itself. There was some damning proof in the 2022 Workforce Survey by the Royal New Zealand College of General Practitioners:
And according to the 2021 GP Future Workforce Requirement Report, there will be a shortfall of 300 GPs by 2031.
There is some low-hanging fruit that could be implemented to help alleviate some of the pressure on GPs.
More GPs would distribute the load, reducing the patient demand on each individual practitioner. That would hopefully translate into shorter waiting times for patients, lower rates of burnout for doctors, and less stress for everyone working at a practice. It would also provide succession options for older practitioners who would like to retire.
At a national level, the Future Workforce report estimated that training 100 extra GPs each year would significantly benefit the New Zealand economy. The report calculated it would produce a net gain of between $338 million and $800 million.
It would be fantastic to see all junior doctors spend time in a general practice setting to see the advantages before ruling it out as a career option. It has a degree of flexibility, community and sociability, but many junior doctors are dismissing it without full consideration.
I believe increasing post graduate time in general practice to six months or more, up from the current 13 weeks, would help recruit more GPs.
For this to work, funding must also increase for the practices that host and train the juniors. Under the new funding, each placement of a PGY1 or PGY2 doctor on a 13-week community-based attachment, a practice will receive $3,600. But that equates to $200 a week, or $40 per day; simply not a suitable rate of recompense in a developed economy. General practice owners will tell you this does not go nearly far enough to cover the real costs of lost revenue.
Currently there is no financial recognition for GPs who attain fellowship from the Royal New Zealand College. By adding a financial incentive, it will encourage more GPs to complete the GPEP programme and retain them in the specialty for longer.
The recent changes introduced to recruit more doctors and nurses from overseas are welcome, but this needs to keep gaining momentum. We must make the profession less stressful, so GPs don’t simply move here and then springboard themselves directly into better-paid roles in Australia.
Immigrants disproportionately move to cities, particularly Auckland, so we need to focus recruitment on bringing doctors to rural areas and incentivising them to stay. That type of incentive will also need to apply to local graduates, particularly since the problem of impending retirement is most acute in the provinces.
The recent pay increase for community nurses did not include those in general practice. That could easily be amended in Budget 2023, which would support staff retention and allow practices to pay nurses more. Otherwise, the risk is that nurses leave general practice to move into better-paid positions in public hospitals.
When patient demand begins to overwhelm general practices, or there are too few GPs to treat the people who want to see them, it becomes difficult for all patients to get appointments.
These patients often end up at our public hospitals or accident and emergency departments, because they need medical care they can’t access it at their local GP. This simply exacerbates the pressure our hospitals are already experiencing, leading to increased unnecessary costs for our economy. In the worst-case scenarios, patients who can’t see their doctor may put off seeking care for too long, and then require expensive treatments for more severe illnesses – or die prematurely.
This cascade of negative outcomes has no upside, so it’s imperative that we support GPs and try to take some of the weight off their shoulders. The result will be a boost to our economy, happier doctors, more positive outcomes for patients, and better health for everyone in Aotearoa.
