Patients in New Zealand’s urban centres are increasingly struggling to find a GP, and those who are enrolled are waiting up to four weeks for a routine appointment.
While GP access has long been an issue in rural regions, the problem has now crept into city centres.
“We know there are issues with general practice in Northland, Hawke’s Bay, South Taranaki, and South Auckland,” General Practice NZ chairman Dr Bryan Betty said.
“But what we are starting to see is the access problems moving into main centres like Wellington, Christchurch, which traditionally haven’t had big issues.
“We are now seeing closed books in a number of major cities across New Zealand. And that’s a new phenomenon.”
In Auckland, nearly 40 per cent of GP clinics have closed their books, according to the Healthpoint website. In east and west Auckland, half of GPs are not taking new patients.
Shortages were worse in Wellington, where half of clinics were full. And in Christchurch, 70 per cent of clinics were either closed or restricting new enrolments.
GPs still see urgent cases, especially children, but shortages and huge demand mean wait times are growing.
To measure primary care delays, some clinics look at a doctor’s third next available appointment (which is considered the most accurate way to measure the next available, routine check-up).
Dr Samantha Murton, who works at a low-cost, trust-run clinic in Wellington, said she and her colleagues tried to ensure this was no more than two days away.
“Two years ago, our third available appointment was a week away. It’s now four weeks away.”
Dr Murton, who is president of the Royal NZ College of GPs, said her clinic had around 3500 patients for two GPs. The recommended “safe” level - which ensured that doctors had time to check results, make referrals and other key tasks - was a maximum of around 1200 to 1300 patients per GP.
If patients can’t see their GP in a reasonable timeframe, it has a knock-on effect for the rest of the health system. They can get sicker, and are more likely to call an ambulance or end up at emergency departments, where shortages are at crisis levels.
Patients with acute conditions don’t get continuity of care.
“People end up in hospital with gout because it’s so painful, they can’t walk or do anything,” said Dr Murton. “It’s actually very much a treatable in the community condition. But when you’ve got no availability for acute appointments when someone’s got a flare-up then it gets out of control very fast.”
Patients who are unable to get appointments are increasingly being referred to telehealth services. The Government has expanded telehealth and virtual appointments to address demand in rural regions during the winter months.
Those services can also become stretched. When the Herald used an app, only after-hours appointments were available that day and the next day. They were charged at $90 for a 15-minute adult appointment.
Dr Betty said telehealth could be helpful for one-off, “transactional” appointments but was not a sustainable solution for treating long-term, chronic conditions like diabetes or heart disease.
There are multiple factors behind the GP shortage and growing wait times, which have been decades in the making but were accelerated by Covid-19.
The main problem is that New Zealand has a growing, ageing population and a shrinking, ageing GP workforce. By 2030, a third of the current GP workforce will have retired.
This country depends heavily on foreign-born doctors - a pipeline which was turned off abruptly when the country closed its borders for the pandemic.
Graduates are often attracted to better-paying jobs overseas or in other specialties.
According to a survey of RNZCGP members, senior GPs (10 to 15 years’ experience) earn around $160,000 a year. Hospital specialists with similar experience earn between $218,000 and $250,000.
There are also more patients with more complex needs and chronic diseases which cannot be dealt with in a typical 15-minute appointment.
In a speech last month to GPs, Health Minister Ayesha Verrall acknowledged that GPs felt stretched, overworked, and under-funded and that many of them felt burned out.
“It is clear we need to do things differently to address these issues,” she told the GP23 conference.
She outlined a plan to shift the health system’s resources over time to preventive healthcare. She also hinted at changes to the capitation system, which is how GP clinics are funded.
Addressing GP shortages will take time. The gaps can’t be filled by foreign doctors alone, because there is a global shortage of GPs and competition is tough.
Medical school placements are being increased by 50 a year but only a small number go into general practice, and it takes a total of around 11 years of studying and training to become a GP.
That means in the short-term, GPs need to look elsewhere to address rising demands. One focus is on multi-disciplinary teams, in which nurse practitioners, clinical pharmacists, psychologists and others are brought in-house to lighten GPs’ loads.
Primla Khar, a GP at Papakura East Medical Centre, said more patients had been presenting with mental health problems since the Covid pandemic.
“It is impacting loads of people. So they’re coming in with a shopping list basically. And if they have another problem, you can’t deal with the mental health part in two minutes.”
Her practice opened its books earlier in the year but then had to close them again two months ago because they were “bombarded” with new patients.
On a typical day, Dr Khar’s appointment book was full when she arrived in the morning. That workload rose by another 50 per cent during the day as she saw urgent cases triaged by nurses.
During her lunch break, she placed her lunchbox on her desk and checked test results and other administrative work.
“I have just finished work and I am smashed,” she told the Herald this week.
“Every day I threaten my nurses,” she added, half-joking. “I say, ‘I think this might be my last day of work today’.”
Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics, and social issues.