General practices around the country are increasingly putting up the 'full' sign.
Video / NZ Herald / Getty
GPs around the country are increasingly putting up the “full” sign. And in a new piece of research, some say they are only taking on hassle-free patients.
Some GP clinics which are nearly at capacity say they are selecting which patients they enrol, raising concerns they could be discriminating against some groups or excluding difficult patients.
A survey of 220 general practice staff in New Zealand found four out of five had stopped or limited their enrolments over the previous three years.
Some staff reported they had selectively enrolled patients by refusing those with high health needs - a practice known as “cream-skimming”.
Associate Professor Mona Jeffreys, an epidemiologist at Victoria University, said previous studies had focused narrowly on how many practices were open or closed, without considering how many had limited their enrolment and how.
In 2022, 45 per cent of surveyed general practices had limited their enrolments.
“That’s where we’re really concerned about what’s going on,” Jeffreys said. “Because there is no fixed criteria that says what practices should do.”
“Some are only taking family members, some are taking people who are new to the area. But some are making decisions based on health, which means that people who have … poorer health are less likely to be enrolled because practices know there is a greater burden.”
Jeffreys noted some clinics had the opposite approach and actively sought to enrol high-needs patients in a bid to boost their funding.
“So I’m not trying to criticise all practices or tar them with the same brush. There’s a whole range of stuff going on. But what we really want is some kind of consistency. So if you can’t enrol everybody, then there needs to be some kind of criteria to make things fair.”
Her study, published in the New Zealand Medical Journal today, found 79 per cent of respondents either limited their enrolments or closed their books between 2019 and 2022.
Dr Primla Khar, who works at a practice in Papakura, said her workplace reopened its books this year and was one of a minority of clinics in South Auckland accepting new patients.
Huge population growth in Papakura and demand for healthcare meant the doctors had “succumbed” to the decision, she said. The result had been “a bit of a nightmare” as the roll grew beyond 6000 patients, placing significant pressure on staff.
Papakura-based GP Dr Primla Khar said her practice was swamped when it reopened its books to patients this year. Photo / Jason Oxenham
Her clinic would never select patients based on their age, ethnicity or gender, she said. It would “go against everything we believe in”.
She joked: “If I had known we could select our patients, I think I would only have half as many.”
Khar said her clinic occasionally made exceptions when enrolling patients, but not based on their health needs. They would take on patients because they already had family enrolled, or because they were elderly and would have to travel a huge distance to get to another GP.
GPNZ chairman Dr Bryan Betty said he did not believe “cream-skimming” was a major problem in New Zealand and the main cause of inequity in primary care was understaffing.
Betty said clinics usually did not completely stop new enrolments but restricted them to family members of patients or a defined geographic area.
“The fundamental issue is capacity,” he said. “Practices reach a point where it just becomes unsafe to take on more patients.”
GPNZ chairman Dr Bryan Betty.
Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics, and social issues.
