LISTENER AUGUST 10 2019her blood-test results, email her doctor for
advice or book appointments. “It’s been
amazing. I like to know what’s going on
and now I’m so much more aware. It’s no
longer a case of the doctor is the boss and
they tell you what to do. You can read the
notes and say, ‘I don’t understand this, tell
me more.’ Before, they talked, you listened
and you did what you were told. I didn’t
worry about that at the time because I didn’t
know any different.”
WAVE OF RETIREMENTS
The crisis in New Zealand’s GP numbers is
being driven by a wave of retirements of
older doctors, with 47% of the 5000-strong
workforce indicating they’ll retire within
the next decade, a generational change that
has seen younger GPs working fewer hours
as they balance work and parenting duties,
a population that’s getting older and sicker,
and a specialist training scheme that hasn’t
recruited or trained enough family doctors.
But Des Gorman, until December the
executive chairman of Health Workforce
NZ, says the two biggest problems are
reduced productivity among GPs – he says
since 2001, the average GP has given up one
working day a week – and the capitation
system by which general practice is Govern-
ment bulk-funded, according to the number
of patients on practices’ books. “It means the
incentive for GPs is to enrol as many people
as possible who’ll never come and see them,
then close their books. If I get $500 a year in
bulk funding, I’m winning if I see you only
GP CRISIS
once, but I’m winning even more if I don’t
see you at all. I get money if I don’t have
to do anything. The best thing you can say
about capitation is that it hasn’t protected
productivity in general practice. The worst
you can say is that it has aided and abetted
a dramatic fall-off in GP availability.”
It’s a system that has a racist effect, he
says. Although higher funding is available
through the Very Low Cost Access Scheme
to practices with 50% or more patients
with high needs, other doctors are cherry-
picking enrolments, he says. “If you come
along to enrol and say you’ve got diabetes,
asthma and chronic obstructive pulmonary
disease, I say, ‘My book’s full, I’m very
sorry.’ And you don’t enrol people
who are old and sick. Why on earth
would I enrol you if you’re a fre-
quent flyer?”
He says capitation was meant
to be associated with publishedquality measures for practices that would
drive choice, but those hadn’t happened.
“The general practice community wouldn’t
have a bar of it,” says Gorman.
Since 2001, when the payment system
was introduced, New Zealand has had a 70%
increase in specialists per head of population
and a relative drop in full-time-equivalent
(FTE) general practitioners, partly because
of the reduction in hours worked. In 2001,
the country had 85 FTE GPs per 100,000
people. It now has a national average of 73
and Australia has 110. In the same period,
on-call and after-hours work has dropped
from an average 10 hours a week to four.
“We now have a whole generation choosing
general practice on the basis that a full-time
week is three and a half days.”
In 2015, a Medical Council survey esti-
mated that areas with the fewest doctors
per capita (Counties Manukau, Taranaki,
MidCentral, Waitematā and Hutt) had only
two-thirds of the GP coverage per 100,000
population compared with those with the
most (Southern, Auckland, Capital & CoastDr Harley Aish, far left, and professor
of medicine Des Gorman.Dr Hayley
Scott, left,
with patient
Eileen Joyce.A Medical Council survey
estimated that areas
with the fewest doctors
per capita had only
two-thirds of the GP
coverage per 100,000
population compared
with those with the most.