Three Lakes Medical Clinic general practitioner Dr Cate Mills (centre). Photo / NZME
The Lakes area is feeling the effects of a general practitioner shortage that is "reaching crisis point" around the country with practices keeping their books shut tight to new patients.
However, some say health professionals are already "limping through the crisis" as the bite of the shortage sees patients waiting up to two weeks for an appointment.
The Doctors medical centre Bay of Plenty regional nurse manager Wendy Dillion said the practices across the region, including in Whakatāne were being impacted.
"There is a GP shortage across our Bay of Plenty medical centres which is not limited to our network.
"Winter is always challenging with more people needing medical care and health practitioners becoming unwell. We have noticed the GP shortage growing significantly in the last five years and it is reaching a crisis point."
Dillion said the practice aims to see patients for a routine appointment at least three days after the booking, but recently with the shortage, patients can be waiting up to two weeks.
The only saving grace for Rotorua was there were places across the country where the situation was worse, a Rotorua Area Primary Health Services (RAPHS) spokesman said.
Burnout among GPs had jumped to 30 per cent of the workforce, up from 22 per cent in 2016, according to a recent Royal New Zealand College of General Practitioners survey.
In the Lakes District Health Board area, more than one-third of GPs scored between 7 and 10 on the burnout scale, reflecting a national picture of stress in primary care.
The same survey found almost one-third of general practitioners across the country intended to retire within the next five years and almost half intended to retire within the next 10 years.
The spokesman said practices in the area were busier than ever before, in part due to the Covid-19 pandemic. In the months after lockdown, the number of consults RAPHS practices held grew by 30 per cent compared with the same months in 2019.
"What is clear is that for a community such as Rotorua with a very high level of poverty above national averages, the impact of socioeconomic disadvantage affects the health of the community, and this results in higher demand for services in both hospital and community services such as general practice."
The primary health network needs another 11.5 fulltime equivalents GPs to operate at a caseload of one GP to 1300 patients. Regardless, RAPHS practices deliver about 1250 consultations in general practice to the community every day.
"Practices do not wish to restrict their enrolments, however, this becomes necessary if the caseload per clinician becomes too high and extra staff are unable to be recruited."
Despite The Doctors stating it was taking up to two weeks, the spokesman said national patient experience survey results show 45 per cent of people can get an appointment on the same or next day and at least 80 per cent can get care when they need it.
The spokesman said this was higher than the national average.
"It is imperative that primary care be adequately resourced and supported so that general practice services are more sustainable than the current model."
One practice that has had its books closed for years is Three Lakes Medical Centre. General practitioner Dr Cate Mills said there were no vacancies at her practice currently but she could feel the effects of the shortage nonetheless.
"We haven't been accepting new patients for a long time now because we really want to focus on looking after the patients we've got well, and them having good access to us when they're sick.
"We know the crisis is coming looking at the statistics of retiring GPs over the next few years. We know it's going to get worse."
Mills believed there weren't enough young doctors specialising in general practice because the pay wasn't attractive to young students who needed money to cover their student debt.
Pinnacle Midlands Health Network medical director Jo Scott-Jones said it was a chronic issue that was made worse by Covid-19 as 60 per cent of the rural sector workforce were overseas graduates.
"That just reflects that it's harder to get New Zealand medical graduates to move to rural areas.
"700,000 people live in rural New Zealand and it's the biggest city outside of Auckland if you took it as a single community. I struggle with why people don't want to work in these rural places."
There could be many factors causing burnout but Scott-Jones sensed the shortage was the main driver.
"People are having difficulty getting away and having decent breaks because there is a sense of 'who's going to come after me - what's my succession plan' when there are no doctors coming into the country and it's hard to attract people to come out to rural areas."
Royal New Zealand College of General Practitioners medical director Dr Bryan Betty said the shortage was "reaching crisis point" driven by burnout, underinvestment and reliance on overseas graduates who couldn't get into the country due to border closures.
Betty said about 40 to 50 per cent of the workforce were overseas trained.
"We're very reliant on overseas graduates in New Zealand and obviously with Covid that has dried up a supply of doctors coming into the country."
Primary health organisations are funded by DHBs to deliver primary health care, mostly through general practices.
Betty was hopeful upcoming health reforms would hold good news for what he believed was the backbone of the health system.
"The funding structure does need to be thought about very hard. Patients with multiple comorbidities need to be dealt with in a slightly different way within the system - certainly, the profession is asking for a review of what is happening in this space.
"At the end of the day the backbone of the medical system in New Zealand is general practice and frontline medical care and if it's under-resourced, there's absolutely a problem."
The reason the Bay of Plenty was experiencing a shortage was that "nowhere is protected" from the effects, said New Zealand Medical Association general practice council chair, Vanessa Weenink.
"How long can you be in a crisis before it becomes normal and accepted?
"Part of the problem is we have been in a crisis for the past five years and we're limping along ... and nothing has completely fallen apart, but we're not employees so we cannot go on strike or negotiate for pay and conditions as hospital doctors do."
Weenink said there was no short-term solution to what she described as a really complex issue.
"I think one thing that would help is patients understanding the situation because what adds pressure to an already overworked and stressed workforce is feeling like we're not serving our patients who we genuinely love and want to look after."
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