State Of General Practice In New Zealand: “We Have A Problem”

Three members of the GPNZ Executive Committee recently put pen to paper regarding the state of general practice for a guest editorial in the New Zealand Medical Journal Te ara tika o hauroa hapori.

Specialist General Practitioners Bryan Betty, Les Toop, Jo Scott-Jones open with “if general practice fails then the health system fails” and quickly move to their core statement, “we have a problem”.

The group go on to comment that the system has not delivered equitable outcomes to sectors of the Aotearoa New Zealand community, especially for Māori and Pasifika communities, the system is not providing population health outcomes that meet expectations and the system is not providing its workforce with working conditions that are attractive or sustainable.

Les Toop, Professor of General Practice Emeritus, University of Otago says while the situation was reliably and repeatedly predicted years ago, there is still a way forward.

“We need to regain adequate staffing levels, with an interdisciplinary workforce which is more reflective of our society, and has the capacity, capability and connections to deliver accessible, high-quality care in partnership both with communities and with the wider health and social care systems.”

Dr Jo Scott-Jones, co-author and Clinical Director at Pinnacle Midlands Health Network agrees that solutions lie in rebuilding the workforce but adds there are other systemic changes needed to increase the attractiveness of the work.

“The proportion of GPs is falling, while our population is aging. Not enough young doctors are choosing a career specialising in general practice. This leaves a stretched workforce dealing with growing complexity.

“Workforce data shows rising stress and burnout, and we’re even starting to note early exiting before retirement age.”

Together, the authors declare the traditional model of 15-minute consultations – and the associated funding model – as past their use by date.

“Today GPs are facing increasingly complex demands. With the aging population we are supporting more people to live with multiple conditions. Beyond this, we are also seeing more social issues taking a toll on health, like older people dealing with loneliness and everyone trying to cope with the increased cost of living,” says Dr Scott-Jones.

The editorial also examines the impacts felt from general practice being treated as the ‘backstop’ for other parts of the system.

“Secondary care has raised referral thresholds, and despite this their waiting lists still grow longer and longer. We know while people are waiting for hospital and specialist interventions they use general practice at a higher rate, further adding to capacity pressure in the system,” says Professor Toop.

The analogy of the perfect storm is used by the authors as the document the intertwined issues faced by general practice.

“The end result is what the public are experiencing right now – ringing for a routine appointment and hearing they now have to wait weeks not days to see their doctor, or moving town and finding there are no practices with the ability to take them on as a new patient,” says Dr Scott-Jones.

“The Aotearoa New Zealand public and health workforce deserve better.”

The trio say some important things need to be done differently to achieve more equitable health outcomes, calling for a framework through which high-quality sustainable general practice can deliver to all New Zealanders, and which addresses long-standing inequitable health outcomes.

“Equitable access and outcomes, a sustainable workforce, and fit-for-purpose funding is what we at GPNZ are naming as our priorities for the future Government,” says Professor Toop.

“Primary and community care can offer solutions and deliver innovations, there is a huge appetite for change and GPNZ is ready, willing and able to partner with central agencies to start making things happen.”

The editorial will be published in Vol 136 Issue 1582, available 15 September 2023.

See www.journal.nzma.org.nz for more details.

© Scoop Media