A prominent Northland GP is predicting primary healthcare will fail, putting people's health at risk, if nurses' pay parity is not established soon.
Dr Tim Malloy, a general practitioner of more than 30 years, believes the roughly 11 per cent wage gap between district health board nurses and general practice/primary care nurses will cause longer GP wait times, lower quality healthcare and potentially clinics closing down.
Malloy's comments come after nurses across the country went on a 24-hour strike from 8am Monday to protest the roughly $7600 annual pay gap general practice and primary care nurses saw in comparison to equivalent colleagues who worked with district health boards.
The same pay gap was also seen among administrative staff.
It was the second strike action organised by the New Zealand Nurses Organisation (NZNO), which was planning another 24-hour strike later in the month if the situation wasn't resolved.
According to NZNO industrial advisor for primary care Chris Wilson said primary care was losing nurses "hand over fist", with reports of practices advertising nursing positions and only receiving one applicant, who was often not sufficiently experienced.
Malloy, a co-owner of Coast to Coast Health Care which services many Kaipara residents, echoed Wilson's comments and said an imminent resolution to the pay parity issue was crucial.
"The consequences of not settling in the next month or so, in my opinion, the pressures on our workforce will be such that our ability to retain our current workforce will be constrained and our ability to recruit to our workforce equally constrained, " he said.
"So the net result is our ability to continue to provide comprehensive general practice services will at the very least be compromised, if not impossible."
In a statement on Monday, the Ministry of Health said it was not appropriate for the Ministry to comment on wage rates agreed between private employees and employers.
While they acknowledged the pay gap existed, the spokesperson said the responsibility of negotiation rested with the employer (practice owner), while the Ministry was responsible for ensuring any impacts of the strike action was managed with minimum disruption to public health services.
This was at odds with the view of some general practice owners, who believed their funding models were too restrictive and required an injection of funding from the Government to make up the 11 per cent.
For the majority of general practices in Northland, they receive funding from the Government in order to provide healthcare at a reasonable price. In such practices, paid through the Very Low Cost Access (VLCA) scheme, children under 14 years old have no charge, while those older can only be charged $19.50.
Malloy had a wealth of experience in such debates, having been the inaugural chairman of the New Zealand Rural General Practice Network and the Royal New Zealand College of General Practitioners' Rural Faculty.
With 25 staff currently paid less than their DHB counterparts, Malloy faced an almost $200,000 annual bill to establish pay parity. However, he argued because general practice owners had no option to increase their fees, they had no ability to increase their staff's wages - despite having every desire to do so.
"It's all very well saying the employer is responsible ... but when the employer has no ability to manage their own income, as is the case with many practices who are subsidised by the Government ... we are then not able to alter our fees to accommodate the increase in costs it represents."
Even if it was possible, Malloy said he would prefer not to increase patient costs for people who already struggled to pay the current rate.
"The reality is that the only other option is for [the Government] to increase the amount of subsidy that they pay us in order for us to meet this increased cost, it's really simple maths."
Another key issue was how the level of funding was determined. According to Malloy, the funding was decided by a formula which calculated how often a person saw their GP annually, broken down by factors such as age, gender and ethnicity.
However, Malloy said the formula was based on decades old data, which did not account for New Zealand's ageing population who attended GPs more often, or the increasing complexity of modern medical problems.
Malloy warned that such demand on an already stretched sector would cause doctors to make errors, leading to poorer health outcomes - something which would be minimised by a healthy nursing workforce.
"When I started in practice, you had 10-minute appointments and that was to get through huge number of people, I was seeing 75 people a day.
"If I tried to do that with today's problems, I can absolutely guarantee you I would be practising unsafe medicine and I would be making mistakes.
"If your amount of time you have to spend is greater in order to provide quality care and your utilisation demand is going up, you need the workforce to deliver that."
Malloy speculated that if the pay parity issue was not addressed, primary healthcare would "fall over", with patients forced to wait weeks for appointments, receive a lower quality of healthcare and eventually overload hospitals which were already at capacity.
"If you've got two kids who need their vaccines tomorrow, the reality is they're going to have to wait a week because we don't have a nurse to give the vaccines and we're too busy dealing with everything else."
Northland DHB chief executive Dr Nick Chamberlain, who was the national DHB representative in the current negotiations around pay parity, was a strong supporter of equal pay and was confident a resolution could be found.
"From a Northland perspective, I fully support the principle of pay parity across the health and wider public sector and I am working very hard with our Ministry of Health colleagues to progress this."
Whangārei general practice co-owner Dr Andrew Miller agreed with Malloy, saying general practices were confined by funding restrictions.
"You've got a Government that's willing to restrain your ability to charge people and they won't match the costs of a wage increase ... so they are asking private businesses as such to take a drop of income," he said.
Given the range of roles primary care nurses often performed, Miller believed having this issue unresolved was a disservice to the nurses and the industry as a whole.
"If they continue to do this, more than anything it's demoralising and insulting."
Phillip Balmer, the chief executive of Northland's primary healthcare entity Mahitahi Hauora, said the pay parity issue needed to be addressed immediately - citing instances of new mothers and new Northland residents being unable to register with a GP.
"The model and the access issues are dire. People get sicker and they die, or they go to hospital and they can't get access to care and nurses have a really significant role in supporting our patients and managing their care."