A new report focusing on New Zealand’s primary care sector—general practitioners (GPs) and their surgeries—warns the sector is at “a critical juncture” and facing “mounting pressures that threaten its sustainability and effectiveness.”
It was authored by Dr Prabani Wood, a research fellow at The New Zealand Initiative, who spent 15 years as a GP with around 8,500 patients before turning to research work.
She points out that specialist GPs are “highly trained doctors whose years of rigorous post-graduate training and hands-on experience enable them to manage complexity through specialist knowledge that comes from practice, not just textbooks.”
That expertise leads to earlier interventions, which produce better outcomes for patients and save money for the healthcare system by reducing unnecessary testing, preventing hospital admissions, and managing conditions before they become severe.
But because primary care providers are seen as merely the first stage of treating many conditions before referral to a specialist (who are also seen as having more knowledge than a GP), the current funding model doesn’t reflect reality, the report argues.
Instead, family doctors should be viewed—and funded—as specialists in providing broad, complete care.
“They have expertise in treating the whole person and managing overall health,” the report says.
“In this view, primary care doctors are highly skilled specialists,” whereas secondary and tertiary medical experts such as cardiologists, dermatologists, and orthopaedic surgeons are “partialists” who “support primary care doctors when specific expertise is needed.”
Approximately 90 percent of medical problems are managed effectively within general practice, and GPs “excel in managing complexity,” Wood says, arguing that it, therefore, makes sense to spend more money on the sector.
She cites Oregon’s Patient-Centred Primary Care Home program, which found $13 in savings for every $1 increase in primary care expenditure.
Two U.S. studies also found that for every additional ten GPs per 100,000 population, there are 15 fewer deaths, 40 fewer hospitalisations, and an average increase in life expectancy of 52 days.
“GPs want to do more to help patients avoid being admitted to hospital. There is funding to provide acute services in primary care, but it is often insufficient to cover the costs of providing this care,” the report says.
Doctors are also not paid for 45 percent of the work they do, Wood says, as the funding model pays per consultation, yet face-to-face patient contact takes up only 55 percent of a GP’s time.
“Non-contact clinical time accounts for 31 percent,” she explains.
Snapshot Into a GP Career
The Royal New Zealand College of General Practitioners (RNZCGP) Your Work Counts survey found:- 14 percent of GPs were working continuously for 14 days.
- 15 percent were working all weekend days.
- 18 percent were completing at least one 50-plus hour week.
- 2 percent were consistently working beyond 60 hours weekly.
Unsurprisingly, the College’s latest biannual workforce survey found that the proportion of the medical workforce in general practice has declined from 37 to 25 percent since 2000.
The situation has been worsened by the minimal growth in workforce numbers—in 2022 there was a net increase of just 15 GPs.
“What is frustrating is that successive workforce surveys have been painting the same picture for the last two decades, and little effective action has occurred in response from healthcare policymakers,” Wood says.
As a result, Health NZ is projecting a shortfall of 1,792 full-time equivalent (FTE) general practitioners by 2033.
The RNZCGP workforce report found that currently, 11.5 percent of adults and 7.6 percent of children reported missing necessary GP visits due to long wait times.
That’s going to be exacerbated by the fact that 64 percent of GPs intend to retire by 2032, and current training numbers of 200 GP registrars annually fall short of the 300 required to sustain existing numbers.
General practice heavily relies on an older workforce: the immediate retirement of GPs aged 65 and over would leave approximately 725,000 patients without a doctor.
The effect of these pressures is that 61 percent of Primary Health Organisations (PHOs) report having GP practices at risk of closure, and nearly 60 percent are restricting access to new patients.
“Bringing in more GPs from overseas or training more GPs domestically, while helpful, is insufficient without tackling the fundamental issues driving existing practitioners away from the profession,” Wood says.
Funding Not Keeping Pace With Costs
The report notes that from 2009 to 2022, the consumer price index rose about 30 percent, while funding for primary care increased by about 21 percent.“This 9 percent gap means less money in real terms for providing the same care. This gap is even higher for practices that serve a higher proportion of high-needs patients.”
- Establishing pay parity between GPs and hospital-based medical registrars.
- Funding non-clinical administrative time.
- Adding supplementary payments for complex patients and chronic conditions.
- Increasing funding for teaching and ongoing professional development activities for specialist GPs to be on par with hospital specialists.
- Revising the obligation on GPs to provide 24/7 care to better reflect modern healthcare delivery models.
- Including performance incentives linked to health outcomes and patient satisfaction.
“Years of underfunding and under-valuing GPs have led to significant shortages and access issues, particularly affecting underserved communities.
“This is not a well-paid professional diatribe about needing more money. There is simply not sufficient funding to pay for the increasing needs of our populations,” Wood says.
