14 May 2024
Opinion as featured in the New Zealand Herald.
We need to stop asking the question, “How long is the wait time to see your GP?” Instead, we need to ask the question, “How long is the wait time to access your primary care team?”
While many perceive primary healthcare as the backbone of our community, readily available at all times, the stark reality reveals otherwise. Healthcare resources are finite, leading to significant shortcomings in serving our population adequately, and the reality is this is only set to get worse.
Martin Hefford, director of the national agency’s living well division, stated in a webinar last week that the system currently lacks about 200 GPs. He projected this shortage could increase up to 1000 by 2033 due to factors such as an ageing population and rising healthcare demands, despite a record intake of 234 GP trainees this year. Compounding these challenges is an ageing workforce, with 37 per cent of GPs planning to retire within the next five years.
In addition, healthcare needs are becoming more complex. GP visits have surged by 2.2 million since 2008, and the strain on the system is evident as one in three practices (34 per cent) are no longer accepting new patients, marking a fourfold increase since 2019.
By 2028, projections indicate one in every five individuals will be 65 or older, signalling a significant demographic shift. Additionally, by 2042, one in three children is expected to identify as Māori, who experience higher health inequities. These changing demographics also coincide with a rise in complex health issues, especially among the elderly, who often need multiple medications.
Lifestyle factors are also impacting health, with three in 10 New Zealanders having a BMI over 30, contributing to increased rates of diabetes, cardiovascular diseases and certain cancers. Moreover, mental health is a critical issue, with one in four young adults experiencing significant psychological distress.
As each GP typically manages around 1500 patients, with up to 1000 less GPs, this could leave approximately 1.5 million New Zealanders without a primary care provider. Therefore, the GP workforce crisis represents a critical issue that demands a significant rethinking of our approach to delivering primary care.
So, what should we do? Well, we need to make the GP role more appealing to new doctors and improve their working conditions. Because who wants to be a GP in a sector that’s in crisis?
Therefore, the first step must be to appropriately value our current workforce. We need to improve working conditions and raise funding for our current GPs to prevent burnout as resources dwindle. Additionally, we need to encourage those nearing retirement to stay in the workforce. We should consider implementing a retention strategy that makes continuing to work a viable option for GPs.
GPs also need to be empowered to delegate less complex health issues to other qualified providers, without being penalised at a funding level. The primary care model will have to evolve towards a hospital-like structure, where GPs supervise a team of clinicians, providing guidance and oversight instead of being on the front line at all times.
Of course, many GPs already operate in this way, even when the financial incentives do not align with this form of care delivery. Despite these efforts by individual practitioners, the significant disparities in healthcare funding across fragmented primary health organisations (PHOs) remain a pressing concern, with some PHOs creating barriers that lead to unequal access to healthcare services, underscoring the need for systemic change.
For instance, one PHO in Auckland might provide patients with free sexual health checks, post-natal check-ups for mothers and mental health support, while another in the same city offers none of these funded services. Given the funding influence of PHOs, such inconsistencies perpetuate a postcode lottery in healthcare access.
Another example is the role of health improvement practitioners (HIPs) and health coaches, with funding provided by Health New Zealand - Te Whatu Ora to PHOs, who hold the purse strings on community allocation. Instead, this funding should be directly accessible to front-line primary healthcare providers, enabling them to allocate resources in the best interests of their communities and patients.
The public also has a role to play in alleviating the strain on GPs. Not every sniffle requires a visit to the doctor. There are also many other skilled health professionals who can provide care, including nurse practitioners, nurses, pharmacists, physiotherapists and mental health coaches, among others.
But the public needs to choose alternative care providers and the Government needs to provide adequate funding to support a clinical teams model without GPs being penalised for diversifying their workforce.
If the Government is genuinely committed to resolving our primary healthcare crisis, it must foster the right operating environment and put the right incentives in place. This involves shifting the focus from the question, “How long is the wait time to see your GP?” to “How long is the wait time to access your primary care team?”
This change underscores a move towards a more collaborative and efficient primary care model which can be sustainable into the future.