GP funding crisis: Three Rivers underfunded by more than 200 percent

The GP sector is in a crisis with practices such as Three Rivers, which serves a high-needs population, underfunded by more than 200 percent.

The public should not “tune out” when they hear the word crisis, says Dr Fergus Aitcheson, managing partner at Three Rivers Medical Centre.

“We need to be absolutely clear about the GP funding crisis. Without an urgent uplift to core capitation funding by a meaningful amount, people’s ability to visit a doctor in their community at a time and place of their choosing will likely become a thing of the past.”

Capitation funding is funding per registered patient and takes into account factors such as gender and age, but not ethnicity or deprivation.

GP core funding had lagged behind inflation for 19 of the last 20 years, Dr Aitcheson said.

Only this month Three Rivers made the decision to send patients to Gisborne Hospital or T-Lab for blood tests.

Dr Aitcheson said the relevant funding agreement dated back to 2008 and a request that the funding become inflation adjusted annually never happened.

Three Rivers met with T-Lab recently to discuss the payment schedule, but no agreement was reached.

“I’m not sure whether anyone would be happy earning today what they were paid in 2008, but we ultimately decided we could no longer do this work.  Three Rivers is desperately sad to have to pull out of this service, which was convenient for patients.”

Dr Aitcheson said having blood tests available on site captured those people unlikely to go elsewhere.

Twelve months ago, Three Rivers reduced its weekend hours and late night weekday hours in a decision it attributed to years of underfunding.

Some Gisborne GP centres offer no weekend hours. Dr Aitcheson said those centres would have considered the provision of those hours as not being financially viable.

“Three Rivers has always prided itself on being open 365 days a year, but we face the same cost pressures as the other practices.

“We are currently trying to get a clear estimate of exactly how much money we are losing by opening over these times to inform our planning.”

Dr Aitcheson’s “more than 200 percent” figure comes from the Sapere Report commissioned by the previous government to examine the funding of GP practices.

The report said the capitation formula for GP funding should be based on age, sex, ethnicity, deprivation and morbidity.

Previous analysis of general practice funding had relied heavily upon counting the volume of consultations with a general practitioner and underestimated the time needed for high-need patients which led to historical inequities.

The new approach would lead to significant new funding for high-need general practices.

“Responding substantively to issues of inequity in access to care will require significant workforce development, with increased numbers of clinicians and general practice support staff,” the report said.

“For very high-need practices, increasing the goal level of servicing to the higher levels we have modelled sees an increase in capitation revenue of between 34 percent to 231 percent.”

For most practices, the median modelled increase is between 10 percent and 20 percent.

In a March interview, Health Minister and former GP Dr Shane Reti said: “Fundamentally, general practice is broken and it’s been broken for a number of years.”