Time is running out for overbooked, underfunded and burnt-out GPs

In a post-election article published last year, I asked if the new Government would act on its campaign cries of supporting a “health system that’s in crisis”. This year, its Budget fell short in a number of areas, with the provision of training for only a further 25 new doctors per year over the next four years. 

It’s also unclear if these new doctors will eventually take up permanent positions in our desperately under-resourced primary care sector. We currently have one of the lowest ratios of medical training for population in the OECD; it’s a major issue and cash won’t immediately remedy the shortage. Last year’s Budget funded training for an extra 50 GPs, but it will be well over a decade before the first graduates are ready to serve on the frontlines. The current Government has committed to developing a business case for a new medical school at Waikato. That’s badly needed. However, it will only be greenlit by the Government if the cost benefit analysis is viable, and again, it will be a long time before there is a graduating class. 

In the meantime, if a New Zealander has a worrying cough, how quickly could they get in to see their general practitioner? It’s unlikely to be the same day. It might not be the same week. It could take a month, or even six weeks, according to various surveys over the past two years. 

GPs are overbooked, underfunded, and struggling to meet demand. Many practices are no longer accepting new patients, so some people aren’t even registered with a family doctor. 

But the cough is getting worse, a decision needs to be made. Will they go to the A&E, where they’ll pay more and wait longer? At least they’ll be able to see a doctor. Or will they do nothing and hope the cough gets better on its own? That option doesn’t cost anything, but if their health keeps deteriorating, they may end up in hospital with pneumonia. 

Pressure building up throughout the health system

This is the dilemma for patients, but it’s far from simply an individual problem. Pressure on the primary healthcare sector cascades through our health system. Since the pandemic, wait times to see GPs have been the number one barrier to accessing healthcare, with over 20% of people – a million Kiwis – put off by wait times, according to 2022 data. The result is increasing pressure on A&E departments and hospitals, which puts people with health emergencies at more risk. 

Last month, an overflow of patients at North Shore Hospital’s emergency department saw them being treated in corridors, which the hospital’s director described as “compromising quality care” and “a contributing factor to uncivil behaviour and potential violence”. Meanwhile, in February there were 60,000 New Zealanders overdue for their first appointment with a hospital specialist. Residents of a first-world country should not be facing these difficulties in accessing care.

Our health system is overloaded – and GPs are struggling at the coalface, ready to throw in the towel. There is an ongoing shortage of GPs, as there has been for at least five years, and the job is so tough that attrition rates are high. Early retirement looks very appealing when you’re under enormous pressure every day, with no end in sight. 

Changes to the funding model for general practice will be at least a year away, if not more. But they are on the horizon, which is positive. The cost of running a general practice far outstrips revenue – the gap is between 10% and 20%, according to 2022 analysis by Sapere. Even a 10% bump in funding would be too huge a number for the Government to swallow in one gulp. They could take a transitional approach, but that’s unlikely to keep pace with increasing demand. 

Attracting and retaining more GPs

Even if the Government miraculously found another 20% in funding for every GP clinic, simply throwing money at the issue won’t resolve it. We need to tackle this problem from more than one angle.

In the meantime, the doctors we do have are leaving for other countries. We import 1,000 doctors a year, but most do not stay in New Zealand – and local GPs also leave for higher pay and better conditions. We need to incentivise all our doctors to remain on our shores, whether it’s through a training bond agreement, student loan reductions, or bonding immigrants to work here for a set period of time before they can leave for Australia. 

We may simply need to pay more at the doctors

Changing funding for general practice is challenging. The sector needs more money, and the money needs to be shared around differently. That will involve a close study of equity issues, and not everybody will be happy with the outcome.

Some people simply cannot afford to pay more to see their GP, and after wait times, the biggest access barrier is the cost of a consultation. For those who can afford to pay more, prices are likely to rise. We have taken low-cost healthcare for granted for decades. GPs have been underfunded for so long that higher consultation costs may be inevitable. Costlier consultations will probably be very unpopular, but they may be the only way to keep the primary healthcare sector from falling into dysfunction. 

Another approach is to increase the multi-disciplinary approach, where more tasks are delegated to nurses, nurse practitioners and nurse prescribers. This would provide lower-cost healthcare professionals for certain jobs, freeing up GPs to focus on the most-skilled work. The GPs I work with haven’t reacted warmly to this model; they worry that less-trained staff would lack the knowledge to deliver a comprehensive service to patients, and might not have the context or experience to spot more complex issues.

Can New Zealanders continue to expect world-class healthcare without paying more – either as a user or through taxes? Perhaps not. We cannot ask family medical practices to keep operating at 110% of their budget and capacity. And we certainly can’t be surprised when new doctors don’t want to sign up for more of the same.

We need a radically different funding model, which will require significant analysis, support and planning before it can be implemented. Although it’s not going to happen with Budget 2024, it is promising to see that the new Health Minister is signalling big changes in the future. Let’s hope we can take the pressure off GPs, easing the overflow into our A&Es and hospitals, and make it easier for all of us to get an appointment at the family doctor.