KEY POINTS:
The recent squabble between Labour and National over the review of GP fees took everyone by surprise, including GPs themselves.
The debate was triggered by the release of National's health document (which did not mention the issue).
But when questioned Tony Ryall said National would knock Labour's fees control system on the head. This was just the opportunity that Labour needed to pounce, with Helen Clark announcing it was grossly duplicitous. The political debate and point-scoring continued from there, with the GP fees issue receiving huge attention.
It was a shame that most of those who leaped in to comment didn't bother to check their facts first.
For a start, let's be completely clear - despite what certain politicians and media commentators continue to say, there is no overall cap on GP fees, and never has been.
It is true that fewer than 300 practices nationally have voluntarily signed up to the Very Low Cost Access scheme, which requires practices to agree to a maximum co-payment in return for higher patient subsidies.
The vast majority of practices, however, do not receive such high subsidies, and do retain the important right to set their own fees. Only if their annual fee increases for a standard consultation are higher than a threshold set by the District Health Boards are they referred by their DHB to a fees review process.
By August this year, 84 per cent of the few practices referred to this process had had these increases upheld, hardly evidence that the predominant general practice model has capped fees.
The fees review process is expensive and bureaucratic and has produced a tremendous amount of ill-feeling in the general practice community. There is a high cost to both the DHB and the reviewed practice.
The resources spent on it would be far better spent on patient care. It's time to end this farcical system and restore the system of trust which has worked well in the past.
Secondly, the suggestion that GPs will raise their fees unduly in the absence of some kind of government control is baseless. As the Ministry of Health's own research demonstrates, GPs have a long-standing track record of keeping their fees at reasonable levels, and passing increases in patient subsidies through to patients.
Consumers Institute surveys have shown that where the Government has committed extra funding, GP fees have reduced appropriately over the past few years.
A Ministry of Health spokesperson was quoted in 2005 as saying: "We are delighted to see GPs complying with Government policy to keep fees down" - and this covered a period before the restrictive Fees Review process was introduced.
In the past, GPs have voluntarily worked with the Government to further its aims of improving access to care. The under-6s subsidy is a good example.
While there was never any contractual requirement not to charge fees when introduced in 1997, the vast majority of GPs kept their fees free for under-6s for some years after that despite the subsidy failing to keep up with inflation.
Its also important to remember that GPs, in the main, run their own businesses. Unlike DHBs, they cannot move into deficit and then expect the Government to bail them out. As well as the usual business expenses, such as rent and wages, they are facing higher costs, including the recent substantial increase in practice nurse wages and an extra week's holiday for staff.
Unlike hospital doctors, GPs must also fund their own costs such as their annual leave, sick leave, superannuation, and their continuing medical education. Modern general practice must now offer so much more than the primary care of the past, and the capital costs of the technology required for this care and good record-keeping systems are not cheap.
If we want to continue to have a good supply of doctors in general practice in the future, it is essential that their businesses remain viable. Research shows that GPs are becoming a scarce breed in New Zealand. Many medical graduates, with huge student debts, are more interested in higher-paying specialties, or working overseas.
The NZMA General Practitioner Council strongly supports the Government's aims of improving access to primary health care and affordability of care, but ultimately it is the Government's responsibility to ensure this by providing adequate subsidies. We are pleased that the current Government has made this a priority over the past five years, and has introduced annual Consumer Price Index adjustments to these subsidies. However, it is important to acknowledge that that there are many situations where the CPI will grossly underestimate the real cost increases.
With patient subsidies funding about half of the true cost of the service, it cannot give the Government the right to dictate the entire fee. We are firm on this. The issue is too important to become a political football for next year's election, just because promoting lower fees is popular with voters.
Whoever is the next Government can be confident that patients will be protected if they do away with the draconian fees review process that allows for no discretion at the local level.
Such a sensible political move would remove the disastrous ill-feeling that has been created within the primary sector, save DHBs and general practice much-needed dollars, yet still allow review of the few practices that truly do need to have their fees re-evaluated.
* Dr Peter Foley is chairman of the New Zealand Medical Association.
