Dr Bryan Betty is a Specialist General Practitioner at Porirua Union & Community Health Service, a practice serving a predominantly high needs community in Cannons Creek, East Porirua. He is also the chair of General Practice New Zealand, and the former medical director of the Royal New Zealand College of General Practitioners.
What we need most in 2024 is investment to make general practice sustainable along with development of the primary care workforce to meet the growing demand for health care in the community – because that’s where people want and need it.
I cannot stress enough to our new government how urgent this is, because the biggest improvements in population health and the greatest value for health dollars comes from people having convenient access to high-quality general practice and primary care.
About 1000 rural and urban general practices, plus Māori and iwi providers, employ more than 5000 specialist GPs and approximately 10,000 practice nurses, as well as allied health roles such as physiotherapists, pharmacists and counsellors to deliver more than 20.5 million primary care consultations annually.
Every day, highly skilled general practice teams and primary care providers manage a range of health needs, from acute emergencies to chronic lifelong conditions such as diabetes and heart disease in the community. This requires understanding myriad health conditions, ordering and interpreting tests, prescribing, liaising with specialists and offering much-valued comfort and support.
When surveyed, New Zealanders continually cite access to their doctor and nurse at their local medical centre as one of their highest priories, and they’re on to something.
International studies show access to a high-quality continuous primary care is a key determinant of long-term health. A recent Norwegian study shows having the same GP for more than 10 years leads to fewer ED attendances and hospital admissions, better overall health and a longer life compared with those who don’t. A strong primary care sector is good for our health system and our people.
Sadly, problems for primary care have built in plain sight for decades and are reaching crisis point. It’s estimated 30% of practices have closed books. My practice in Cannons Creek, Porirua, had to close its books for the first time six months ago because of GP and nurse shortages, and we are still in that position. Anyone who has had trouble signing up to a practice or waited 3-4 weeks for an appointment will know the anxiety this causes. There are two key problems – workforce shortages and financial instability.
We have an acute shortage of trained GPs and nurses, with rates below international benchmarks. Half of our GPs plan to retire by 2030, and we aren’t training enough replacements. There’s also a gnarly pay parity issue for our nurses who complete the same training as hospital nurses but earn less, causing recruitment and retention problems that cripple service delivery.
Funding for general practice hasn’t kept up with the increasing complexity and demand of patients. Many practices are facing viability issues, they cannot employ enough staff (if they can find them) and can’t afford to develop services to address community need. These problems are felt even more sharply in our rural and remote communities. The lack of capacity means people often can’t access medical care in the community when they need it, driving extended wait times in emergency departments and clogged hospitals.
Much of the solution lies in finalising health system reform, which hasn’t yet focused on primary care. Primary Health Organisations (PHOs) work behind the scenes so you may not know what they do. I describe them as the “vital glue” linking up all parts of the health system to help create better care pathways, while also elevating the voice of frontline services to key decision-makers. PHOs, united and led by organisations like GPNZ, advocate for a strong, well-functioning health system that’s there for you when and where you need it.
The reform has left the future of PHOs unclear, but I consider them critical and look forward to shaping their role in partnership with the government, Ministry of Health and other national health agencies.
