In every other country where GP specialists have declined to perilous numbers, the health system has become overwhelmed. Photo / Matthew Kay
In every other country where GP specialists have declined to perilous numbers, the health system has become overwhelmed. Photo / Matthew Kay
Opinion by Samantha Murton
OPINION
There is a saying that our heart is where our treasure is.
As the Royal New Zealand College of General Practitioners publishes another workforce survey highlighting the steady decline in general practitioner numbers, it is hard to imagine that our heart is beating for our communities and their healthcare.
Some may dismiss this as the viewpoint of a general practitioner who is protecting their patch, but my reality is, I work in a practice that paid for a social worker for 20 years before they became funded, we have as many nurses as doctors, one training to be a nurse practitioner, we have a counsellor, a health improvement practitioner and a community support worker, and we run group wellbeing sessions championed by our Pasifika receptionist.
This is about the team, valuing every member and their area of expertise.
Our general practice team works hard to improve the outcomes for our patients as we struggle to meet their needs and be financially viable. We are run by a charitable trust so we are not even trying to make a “profit”, we’re simply trying not to make a “loss”.
The primary care strategy of 2001 was an excellent document with lofty and significant goals that were set to make a difference to the country. Since that time, the number of specialist general practitioners, experts in delivery of medicine in primary care, has reduced from 37 per cent to 25 per cent of specialist doctors in New Zealand.
While the wider general practice team has increased in that time, so has the population.
The complexity of conditions has exponentially increased, and we are all living longer.
Health outcomes have not substantially improved while the cost of health care and hospital services have increased significantly.
As there is a net reduction in total investment in general practice and primary care, the money is going elsewhere.
Twenty years on, and the 2019 Health and Disability Review strongly reiterated that the focus of our health system should be on primary care and community.
If our treasure is in primary care, it feels like the ship carrying that treasure is being allowed to sink. Much of the treasure will be lost forever, and the cost of refloating what’s left is far more than stopping it from sinking now.
As health reforms continue, I am often alarmed by comments that seemingly attach little value to medical expertise.
I am all for a broader primary care team but the focus on health professionals who are quicker to train, while delaying an increase in general practitioners, suggests a belief that medical expertise is replaceable.
Personally, I cannot see the economics or patient benefits to having a multitude of people involved in someone’s care while losing the expertise of those able to manage a multitude of conditions.
Specialist-trained medical professionals have the significant breadth and depth in medical knowledge, so that when patients present with a random cluster of symptoms, or multiple interacting conditions this expertise and experience can diagnose, investigate, treat and direct the care and services required.
Specialist general practitioners are in short supply, and set to get so much worse if drastic action is not taken now.
There are simple strategies that, if committed to and implemented now, could prevent any more loss and grow our national treasure: medical care in the community.
Samantha Murton.
In my experience, most people talk glowingly about “their GP”. However, the system does not recognise that same value.
For every specialist GP trained, there is a saving of $139m to healthcare.
Specialist GPs providing care to patients for 12–15 years achieve a 30 per cent reduction in out-of-hours care, a 28 per cent reduction in hospitalisations, and a 25 per cent reduction in mortality.
Globally, and in all our healthcare strategies, healthcare systems that are cost-effective and save lives focus on primary care and community.
If from tomorrow, every medical student did a minimum six-month run in general practice, if every PGY1 or PGY2 did not get general scope status unless they spent a minimum of three months in general practice (preferably longer), if GP registrar training was funded for three years, a Fellowship qualification attracted an increase in remuneration, ongoing professional development for GPs was funded like every other specialty, non-patient facing time was valued and funded, if patient funding was flexible, so businesses had some autonomy to deliver the services their patients needed then general practitioner numbers would increase, and we would create a thriving primary care system.
In every other country where GP specialists have declined to perilous numbers, the health system has become overwhelmed, and a sudden sharp focus has gone into restoring the balance. Let’s get on with it now.
Let’s put our treasure where the heart of medical care is meant to be: in the community.
- Dr Samantha Murton is president of The Royal New Zealand College of General Practitioners and Wellington-based specialist GP
