Existing GP workforce ‘need to work harder’

A109 Light Utility Helicopter flight with mayor Gisborne City from the air in November 2023.

Opinion

A new report on funding for general practices has highlighted what has been a growing risk — the pressure on the country’s front-line doctors.

Prof Des Gorman, who co-authored the report Lifeline for Health: Meeting New Zealand’s Need For General Practitioners with Dr Murray Horn, says the country needs to train more GPs urgently and incentivise the existing workforce to work more hours.

While a layman might believe that his call for doctors to work harder is unfair, Professor Gorman has the statistics to support his contention that the accountability free funding for general practice is fuelling the decline in GP work hours and the significant increase in the GP-to-population ratio.

Primary health organisations and their general practices are paid according to the number of people enrolled — not the number of times they see them. This varies from $470 a year for a preschooler to $509 for a pensioner with high health needs. That is on top of extra cash for specific services like vaccinations and fees charged to patients.

Prof Gorman says the model is flawed because human behaviour will be to enrol as many people as possible who will never come in and see you and to make yourself unavailable.

And in terms of fee-for-service, human behaviour dictates you will want to decrease the contact times to increase the throughput, which is totally undesirable as well.

The report contains a number of recommendations, including establishing a working party to develop ways to encourage GPs to delay retirement and work longer hours, ramping up international recruitment efforts and establishing a contestable pot of extra capitation funding to target communities missing out on health care.

The report also wants to see the number of medical students increasing annually to 600, the introducing a Doctor Of Medicine degree and ensuring graduates have a career pathway in New Zealand.

GP Bryan Betty, chair of General Practice New Zealand, agrees that the funding regime is not fit for purpose and says workforce shortages of both doctors and nurses in primary health are hurting patients.

The model was focused on age predominantly and not deprivation, comorbidity and the other factors that really impact on health.

College of GPs President Samantha Murton says family doctors are working harder than ever, but added there were very few health problems that could be fixed within a 15-minute appointment.

It all adds up to a worrying situation for the general public who want to believe that they can get a doctor when they need one.