More medical staff needed to realise plan

More doctors and nurses are needed to fulfil the plan of keeping people out of hospital by expanding primary healthcare. But some say too little is being done to supply the extra staff.

General practitioners have traditionally been the heart of primary care, with nurses as their helpers. The Government wants to change this so that the two work as part of a team, with nurses commonly taking a more prominent role than now.

In future, patients will more commonly see a nurse for straightforward checks and be referred to a GP for complex conditions. This is already happening at many clinics serving Maori or poor areas where fees are lower.

But nurses say the changes are too slow, especially in permitting a wider range of nurse practitioners to prescribe drugs.

GPs, for their part, have felt bruised and neglected by changes, such as their virtual exclusion from maternity care. Their representatives are opposed to the proposal to expand nurse prescribing rights.

Research and anecdote depict an ageing GP workforce, with many planning to leave and some having difficulty selling their practice.

At the other end of the career, medical students and first-year doctors express far less interest in becoming a GP than in the past, citing student debts averaging $65,000 at graduation and GP pay that is low relative to other specialty areas. However, the numbers in training continue to well exceed the annual intake of around 55 Government-funded registrars, the excess paying their own way or being sponsored. The Health Ministry takes this to indicate continuing strong demand to be a GP.

Medical Students Association president Jesse Gale said undergraduates enjoyed general practice and more were needed in the profession. It was a shame many who would have chosen a career in general practice were being forced by high debts not to do so.

"Wherever you look, it's a shrinking workforce and a growing need. It's a crisis."

Medical Association GP council chairman Dr Peter Foley said: "In the new team environment we need well-trained nurses and well-trained doctors and we are short of both. The number of GP training positions is insufficient for replacement."

A discussion document by the Health Workforce Advisory Committee's medical reference group (MRG) in May also urges increased training placements and more state money for the programme - plus the shifting of some tasks from doctors to nurses.

It names key reasons for doctor shortages, including: high student debt; shorter working hours; increasing numbers of women doctors, who want a better work/life balance; and the rising demand for healthcare, especially as the population ages and new technologies are developed.

GPs earn on average $139,500, according to a Waikato University study, although it may not be representative. It shows a drop from 1998 and a recovery that started in 2000 and accelerated after the big increases in primary care funding from 2002-03. Specialists commonly earn over $170,000 by mid-career in public hospitals and more in private practice.

The ministry rejects the views of general practice doomsayers.

 

New Zealand has 70 GPs per 100,000 people in 2002, compared with Britain's 50 and Belgium's 210, the most.

Chief adviser, general practice, Jim Primrose acknowledged rural shortages, which were being addressed by schemes like providing locum (relief) doctors and recruiting rural students to fill the extra 40 medical school places offered from last year.

The ministry also put an extra $289,000 into GP training last year and has spent $1.3 million since 2002 on post-graduate training for nurses.

Associate professor Judy Kilpatrick, of Auckland University's nursing school, said she was disappointed by the slow progress in nurse-prescribing rights, which was restricting primary healthcare. There were just 16 nurse practitioners and only one, in South Auckland, was prescribing independently.

She partly blames continuing opposition from doctor groups for the delay.

Medical Association chairman Dr Ross Boswell said independent nurse prescribing put patients at risk because nurse practitioners spent fewer years than doctors in training and supervision for prescribing drugs.

He said nurses already prescribed antibiotics to treat urinary tract infections, for instance, but discussed each case with a doctor, who took overall responsibility.

GP shortages

The number of active GPs has fallen from a high of 3191 in 1999 to 3006 two years ago.

In one survey, only 9 per cent of first-year doctors said they wanted to be general practitioners.

Another found that while 52 per cent of GPs were self-employed and work full-time, only 27 per cent expected to be doing so in 2008.