Some general practices say they may be forced to shut their doors for good tomorrow thanks to surging costs associated with Covid-19.
They've been hit by a double whammy of expenses from preparing for the Covid-19 pandemic, followed by a plunge in income as the country goes into lockdown.
One practitioner called the situation "chaotic", saying the practice was running at a "massive loss".
"I have worked [the] last 16 days. This is going to potentially sink practices. Government assistance is a must at this point," said the GP, one of several whose comments were collated by member organisation General Practice New Zealand.
The Ministry of Health is meeting this afternoon with the General Practice Leaders' Forum, which includes GPNZ, NZ Medical Association representatives, the Primary Health alliance, the New Zealand Nurses Organisation, the Royal New Zealand College of General Practitioners (RNZCGP), Primary Health Alliance and the Rural GP Network.
RNZCGP medical director Dr Bryan Betty said cashflow had dropped significantly across the sector after the college called for general practices to move to 70 per cent virtual consulting one week ago.
Around 1000 practices changed things in 24-48 hours, which Betty said made him incredibly proud.
But it has also had severe repercussions for some in the sector. Between 30-40 per cent of general practice income is from co-payments from patients, Betty said. Much of that money wasn't coming in now and it was crucial GPs received immediate support from the Ministry of Health and the Government.
General practices were the essential service on the frontline in fighting Covid-19, Betty said.
If nothing was done to help them there would be staff layoffs and GP closures coming - but he believed health authorities recognised what was happening and would offer support.
"We need immediate support to make sure the sector remains operational."
GPNZ chairman Dr Jeff Lowe was also hopeful about the outcome of today's meeting, saying the ministry had been very supportive and was listening.
Practices had undergone a huge transformation in the past fortnight, he said.
"There's been a tsunami of activity in the lead up from going from alert level 2 to 3 and then quarantine in 4."
The public had been preparing for lockdown by getting last-minute health checks and repeat prescriptions, with the surge in activity meaning some general practices had taken on more staff at the beginning of last week to deal with the increase. Staff in self-isolation were also being paid in full.
Other costs had shot up - among them buying perspex screens, hiring portacabins, buying scrubs and personal protective equipment. GPs also moved rapidly from the majority of appointments being face-to-face to mostly online or via phone, with associated costs including buying laptops, tablets, handsets and licensing for virtual consulting.
Practices had set up Covid-19 assessment centres, trying to ensure the usual patients could be seen and flu jabs given without mixing those people with other patients with respiratory or Covid-19 symptoms.
Then, in the latter half of last week, everything went quiet, Lowe said.
"Whilst the flu vaccine was still ongoing, there's been a drop-off in people presenting for acute illness, people with accidents because they're not out playing sport or as active," he said.
Routine and preventive care appointments were also fewer, from nursing clinics to routine medical certificates needed for driver's licences, immigration applications and Ministry for Social Development requirements. Even mental health appointments had fallen, while procedures such as infusions and skin lesion removals had all but stopped.
"As a result, cashflow through practices has dramatically dropped in the last few days ... by 20, 30, even 50 per cent in some cases," Lowe said.
One practice told GPNZ it was $80,000-$100,000 over budget thanks to staff costs, buying IT equipment, communications and logistics, then being hit by a drop in consultations and no payment of co-payments.
Another reported that since the lockdown started they took in $0 over Thursday and Friday - despite the team being constantly on the phone to patients giving them advice and support, which they could not charge for.
Another said practices were cutting staff hours, particularly for nurses. "If we lose this workforce from general practice we will never get them back."
The NZ Medical Association had surveyed members over the weekend regarding the wage subsidy for struggling employers. A number of GPs had said they were applying, Lowe said.
Some practices with small margins had told GPNZ they were about to fold, Lowe said. Long-term underfunding of general practices had already left practices vulnerable; "this just pushes them right over the edge".
"We've had stories of practitioners saying we're not going to be able to survive this so they're better to close the doors on Monday.
"The situation for them is dire, it's desperate, and the need for support is now."
Thankfully, Lowe said, the Ministry of Health appeared to be listening.
"We need to make sure as we emerge from lockdown that after that there will be enough viable practices with the staff and infrastructure to be able to reignite and pick up another tsunami of activity."
Meanwhile the public should know: "GPs are still open for business but we may change the way we're interacting ... to protect you, the public. Following the lockdown is still critical - stay in your bubbles."