KEY POINTS:
Patients in some districts are having to wait a week to see their GP, as the long-predicted crisis in the primary care workforce starts to bite in urban areas.
And the duration of a consultation has been trimmed, at times, to as little as seven minutes on average by some GPs struggling to cope with high numbers of patients.
GPs and their representative groups say the Government has been too slow to act to boost their numbers in response to a growing, ageing and therefore sicker population - and to an ageing GP workforce that has been largely static in size since the 1990s.
They say, too, that they have to care for increasing numbers of chronically unwell patients who are not accepted on hospital waiting lists.
And a new factor may be the universal state subsidies for GP care attracting more patients, or more-frequent visits.
"The crisis is upon us," said Independent Practitioners Association Council chairwoman Dr Bev O'Keefe.
The problems of patient access, previously restricted mostly to rural areas, was now a feature of city health care.
It would only worsen, as more than four doctors and nurses a week left general practice to retire or take up more attractive careers.
"We can't replace the doctors and nurses we're losing now, but retirements over the next few years threaten to overwhelm us."
She said the reduction in patients' fees as the Government made subsidies universal appeared to have increased use of primary care, compounding the access problems.
Doctors interviewed yesterday at clinics in Tauranga, West Auckland and the Hutt Valley, said they had stopped taking new patients because they could not serve them adequately.
Dr Colin Helm, of Tauranga, said he and many other GPs in the city had closed their books to new patients.
He had managed to keep average consultation times at 15 minutes - the typical duration in much of New Zealand - but some patients now had to wait a week for non-urgent visits. "They tend to be a bit aggrieved."
Dr Ross Ogle, also of Tauranga, said some of his non-urgent patients had to wait several days because his clinic had been unable to fill a GP vacancy, despite advertising for six months.
"I think every practice in town is looking for another GP," Dr Ogle said.
Dr John Lindsay, of Ranui in West Auckland, said he had to cut the average consultation to about seven minutes when he and the other GP in their practice were unable - until early this year - to find a third doctor.
Visits were now 10 minutes on average, but he would like to be able to extend them to 12-15. Some non-urgent cases had to wait until the following day for an appointment.
"We had our running shoes on," Dr Lindsay said of the two years when a third GP could not be found.
"We had to just squeeze in as many patients as we could, double-booking during the day. It was almost like being in the Third World."
The doctors could take little leave, a common problem among GPs who are practice owners.
Valley Primary Health Organisation chairman Dr Hans Snoek, of Lower Hutt, said a three-day wait for an appointment was common for his non-urgent patients after the closure of a nearby practice last year, which had added several hundred patients to his register. Most Hutt Valley practices had closed their books to new patients.
The Government has increased medical school placements and last year accepted the need for a big rise in GP training places, increasing the number of state-funded positions from February this year to 104, from 69.
Dr O'Keefe said these changes were good, but had not been made soon enough.
This had left overseas-trained doctors as the only immediate alternative, but they often stayed only short-term.
Health Minister David Cunliffe said the number of doctor training places had increased by 40 placements twice in the past four years.
"Those two increases brought the number of first year medical students to 365 this year."
The Government had put a huge effort into increasing funding to the primary care sector to ensure that patients and GPs benefited, but more work had to be done, particularly on the on-call rosters in rural areas.
DOCTOR COUNT
* In 1999, the number of active GPs peaked, at 3191.
* In 2006, the last year for which figures are available: the number was 3106.
* In 1999, New Zealand's population was 3,837,300.
* In 2006 it was 4,186,900.
Sources: Medical Council, Statistics NZ.
