A new report into New Zealand's primary health sector spells funding issues and pressure. Photo / 123RF
A review of New Zealand’s primary care sector warns the system stands at a “critical juncture”.
The New Zealand Initiative report released today argues the “current system faces mounting pressures that threaten its sustainability and effectiveness”.
Report author, NZI research fellow, and GP, Dr Prabani Wood told The Front Page that general practice is still undervalued even within the medical profession.
“As specialist GPs, we need to know a lot about everything that could possibly go wrong with a person, both in terms of physical health and mental and emotional health. So we are there to diagnose, investigate, treat, and manage conditions.
“We’re also there to prevent things from happening, picking up diseases early and preventing them from getting established,” she said.
Funding is currently based on the face-to-face time with patients, Wood said.
“It doesn’t take into account the amount of time you spend doing vital, non-patient facing work and that the amount of that work has really increased. I’ve noticed it over the last few years.
“In general, a recent survey by our college showed that for every 4.5 hours spent seeing patients, we generate around 3.5 hours of non-patient facing time. That’s following up on investigations you might have ordered, sending referrals, and following up on referrals. It’s all vital work, but in general, it’s not funded.
“If you’re a GP owner, you would generally have to fund your employees to carry out that work. But then, the practice loses money for it. So, we’ve got to change that and acknowledge the vital non-patient work that we do.
“Also, support GPs with their training costs, and their ongoing professional development, just as the hospital specialists are funded. It would be nice to have a similar setup for GPs as well,” she said.
The review revealed in Northland alone, preventable hospital visits cost over $2.7 million a year with more than 5000 emergency visits that could have been avoided with early local doctor care.
“It makes logical sense to me that any money that’s saved by general practice from patients not having to attend the emergency department, that saving could then be fed back into primary care. So, we’re not asking for new money, but we’re asking for the money that we’re saving to come back to us,” Wood said.
Wood said we have known for some time that about 45% of GPs have acknowledged they wish to retire within the next 10 years.
“But there are also mid-career GPs that are leaving simply because the terms and conditions under which we are working as GPs are getting worse and we’re seeing fragmented roles as well. So, more roles and telehealth come up, roles in urgent care, so people are leaving traditional GP roles for those instead,” she said.
Last month, Health Minister Simeon Brown announced 100 clinical placements for overseas-trained doctors to work in primary care as well as incentives for primary care to recruit up to 400 graduate registered nurses per year for five years.
Health New Zealand will also provide a $285 million uplift for general practice, over three years from July.
Wood said this is all a great start.
“I would love a real focus on reorientating our health system around the foundation of good, well-funded, well-resourced primary care. So, build our health system around that and a bottom-up approach - rather than the top-down approach...
“We are the backbone of the health system. So, despite the issues with our workforce and lack of funding, we’re still in primary care. General practice sees 21 million-plus patients a year. But the more and more stretched we are, the more pressure that gets put back into the hospital system. And the only way to relieve the hospitals is to improve the funding and resourcing of primary care,” she said.
Listen to the full episode to hear more about the pressures facing our primary care sector.
The Front Page is a daily news podcast from the New Zealand Herald, available to listen to every weekday from 5am. The podcast is presented by Chelsea Daniels, an Auckland-based journalist with a background in world news and crime/justice reporting who joined NZME in 2016.
You can follow the podcast at iHeartRadio, Apple Podcasts, Spotify, or wherever you get your podcasts.
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