Access to Primary Care in New Zealand: A Critical IssueAccess to Primary Care in New Zealand: A Critical Issue The research highlights a concerning trend in New Zealand’s healthcare system: the increasing difficulty of accessing primary care through general practitioners (GPs). Reasons for Book Closures: Six key reasons were identified for GP practices closing their books to new patients: 1. Labor shortage: Recruitment and retention of GPs and nurses is a major challenge. 2. Underfunding: GP practices are insufficiently funded to meet the growing complexity of patient needs. 3. High workload and burnout: Underfunding and staff shortages have led to increased workload and burnout among healthcare professionals. 4. Impact of COVID-19: The pandemic has increased workload, caused staff shortages, and heightened concerns about infection control. 5. Concerns about quality of care: Due to the shortage of staff and increasing demand, many practices were concerned about the quality of care they could provide. 6. Lack of space: Limited physical space in practices hindered enrollment of new patients. Consequences of Book Closures: The closure of GP books has significant consequences for the overall health system. Individuals may experience: * No or delayed access to primary care * Deteriorating health status * Undiagnosed or untreated diseases * Reduced or no preventive care Proposed Solutions: To address the crisis, the research suggests several solutions: * Short-term: Increase investment in primary care and training for healthcare professionals. * Long-term: Consider alternative models of care that better meet the needs of New Zealanders. Call for Reform: The researchers emphasize the need to reassess the current model of primary care in New Zealand. They suggest exploring innovative approaches, such as involving nurse practitioners in patient enrollment through community organizations. The research concludes that it is time to implement improvements in primary care to ensure accessible and affordable healthcare for all New Zealanders.
The first point of contact for health care for New Zealanders – the GP – is becoming increasingly difficult to reach, to the detriment of the overall health system.
Our new research shows that 80% of GP practices in Aotearoa New Zealand stopped taking new patients (also known as closing the books) at some point between 2019 and 2022. While the pandemic has exacerbated the problem, it is not the only cause.
The main reasons for not enrolling new patients included staff shortages, high workload and staff burnout, financing problems, concerns about the quality of care, and insufficient physical space.
This can lead to people having no or delayed access to primary care, deteriorating health status, undiagnosed or untreated diseases, and reduced or no access to preventive care for many.
In the short term, the government should consider investing more in primary care and training doctors and nurses. But in the longer term, New Zealand needs to consider whether the current model of care is working, or whether there are alternative models that better meet the healthcare needs of New Zealanders.
An entry point into the health care system
There are approximately 1,000 GP practices in Aotearoa New Zealand. Although they are privately owned, they are largely funded by the government.
Being registered with a GP practice means lower consultation fees, centralisation and management of patient data and higher levels of preventive care. Registered patients also have a team that can take responsibility for prescriptions, referrals to specialist care and subsequent follow-ups.
If someone cannot register with a specific practice, many of these parts of primary care become much more difficult to access.
We interviewed 17 people (including GPs, practice managers, academic researchers, a nurse practitioner and a national leader of a GP practice) and conducted a survey, which included 227 people (including practice managers, GPs, practice owners and administrative staff). The responses revealed six key reasons why practices closed their books.
1. Labor shortage
A shortage of GPs was cited as one of the main reasons for closing the books. As one survey respondent explained:
Recruitment and retention of staff, especially GPs and nurses, is the main problem. Almost no applicants, and the few who do, have multiple offers to choose from because there are so many vacancies.
There is a growing number of GPs reaching retirement age. And while 50% of New Zealand GPs are overseas trained, COVID restrictions have made it harder to recruit from other countries.
There is also a significant pay gap between GPs and nurses and those in secondary and tertiary care (hospital staff and specialists). As a result, fewer medical students choose primary care compared to other fields.
2. Underfunding of general practices
There is also insufficient funding for GP practices. They are partly funded through a formula based on the number of people registered and their needs. But many in primary care feel that the model does not adequately reflect the complexity of the conditions that many patients have.
As one of the interviewees told us:
Per-patient funding does not reflect the required workload. It is problematic, especially for patients with high needs.
3. High workload and burnout among staff
Underfunding and staff shortages have increased the workload of current staff, resulting in burn-outs among staff in general practices.
As one of the respondents wrote:
GP practices are having to take on more and more work, including work that used to be done in hospitals. The paperwork has also increased. So there is more work, but a serious decline in the number of healthcare workers (especially GPs) to do this work.
4. The impact of COVID-19
The pandemic had both direct and indirect consequences for healthcare. The workload of GP practices increased with the rising number of sick patients. Together with an increase in patient demand, additional precautions were needed to treat COVID-19 patients.
The pandemic has also resulted in staff shortages due to staff or family illness. The border closure enforced during the pandemic exacerbated existing staff shortages in New Zealand due to its heavy reliance on overseas-trained medical professionals.
5. Concerns about the quality of care
With the shortage of work and increasing demand, many survey participants were concerned about the quality of care they were providing to their patients. Practices closed their books to ensure they could still provide care to clients, even though this was not the best business move.
From a business perspective, there is a disincentive to close your book. But at some point, patient care has to take priority over financial gain.
6. A lack of space
The final reason given for the increase in closed books was a lack of space in current practices.
Our research participants noted that there may not be enough rooms for examination and treatment. In some practices, patient waiting areas were also limited. In some cases, staff worked in shifts to fill the available workspaces.
The road to better primary care
When it came to improving primary care, 95% of respondents to our survey said better funding was needed, 91% called for support for equal pay between GPs and hospital nurses, and 89% called for equal pay for GPs. Some 77% called for an increase in the number of medical students and 85% called for more recruitment of foreign doctors.
In addition to increasing funding, policymakers should ask whether there are other models that could help meet New Zealand’s needs. For example, could nurse practitioners work with community organisations to enrol patients so they at least have somewhere to go?
Given the ongoing issues around access and affordability, it is time to look at what improvements are needed in primary care in Aotearoa New Zealand.
This research was completed with Nisa Mohan, Maite Irurzun-Lopez, Megan Pledger, Mona Jeffreys, all from Te Hikuwai Rangahau Hauora – Health Services Research Centre of Te Herenga Waka – Victoria University of Wellington.
Jackie Cumming receives funding from the Health Research Council of New Zealand and the Marsden Fund. This research was funded by a Lottery Health Research Funding Grant. She also conducts research on behalf of a range of Health New Zealand/Te Whatu Ora and Pacific Perspectives. She is a member of the Kāpiti Health Advisory Group.
/Courtesy of The Conversation. This material from the original organization/author(s) may be at a moment in time and edited for clarity, style, and length. Mirage.News takes no institutional positions or sides, and all opinions, positions, and conclusions expressed herein are solely those of the author(s).
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