Bryan Betty: Getting the basics right in GP care forms my Christmas wish list

General practices deal with most of the population, but there are major challenges. Photo / Matthew Kay

Opinion

OPINION:

International research shows any company or organisational change needs to get two fundamental things right in order to succeed.

Firstly, a clear vision as to where they are heading, and secondly, a culture that employees believe in and want to follow.

The recent health sector reforms have had me thinking about the changes we need to see implemented within general practice that would help the community where I work.

When I’m seeing patients at the Cannons Creek, East Porirua clinic where I have worked for the past 16 years, it is easy for me to identify the gaps in the system that need to be plugged so that the patients we see receive the best health care and have the best outcomes.

As we approach the end of another year, my wish list is reasonably straightforward:

1. Enough funding to ensure those who can’t afford medical care, can. Approximately 50 per cent of our patients find it difficult to pay, so our practice subsidises their access.
2. Enough funding to employ enough specialist general practitioners, nurses, and allied health staff to service the needs of a highly-complex, deprived population.
3. Easy access to pathways for social support and hospital-based services.

About 90 per cent of the community members that our practice serves have high needs.

Patients have three times the rates of Type 2 diabetes compared with national rates, three times the rate of heart disease, and twice the rate of severe mental health concerns.

All these are compounded by social issues such as housing.

All international research shows that having a well-functioning and accessible general practice service contributes to increased life expectancy, saves the health system money, and protects hospitals and emergency departments from overcrowding. Covid-19 has also exacerbated the problem.

In New Zealand, 94 per cent of the population is enrolled at a general practice.

In 2020, general practice had over 20.5 million contacts with patients, and that number is expected to rise to 23m contacts in 2030.

Our workforce is known for providing cradle-to-grave care - but how many are missing out because of rising costs and long wait times to get an appointment?

Around the country, patients can wait up to two to three weeks to get an appointment with their general practice, and around a third of practices around the country have had to make the call to close their books to new patients due to demand.

One of the reasons I chose to become a specialist GP was because it allows me to get to know my patients and their whānau, rather than just their immediate health concerns.

Specialist GPs get to use their skills as diagnosticians and medical detectives to really get to the cause of someone’s health issue.

It isn’t always a physical ailment that can be seen with the naked eye.

No two days are ever the same and no two consultations are ever the same, and that certainly keeps the job interesting, challenging, and rewarding.

But with an exodus of around 50 per cent of our current GP workforce approaching within the next decade (mainly because of retirement), it has never been more important to keep encouraging more doctors into this profession.

We need to make sure that we can continue to provide our comprehensive, complex, and timely care.

If you were to ask me what general practice will look like in five years’ time, I would struggle to answer, and that is worrying.

We need to get the basics right. That is what my Christmas wishlist is about.

Like every other country, we need to have a sustainable and well-functioning community medical service.

If that fails, we end up worsening inequity and not seeing improvements in the health outcomes of our patients.

No medical professional or system should want to see this happen.

- Dr Bryan Betty is medical director of the Royal New Zealand College of General Practitioners.