New Zealand Listener – August 10, 2019

22 LISTENER AUGUST 10 2019

GP CRISIS

W

hen Taupō GP Dave Nixon

retired in 2017, he was

burnt out with fatigue and

burning up with frustra-

tion at the bureaucracy in

which he was forced to practise. “If I’d

stayed, I would have died,” he says. “It

was miserable because of the load, and

knowing there was no light at the end

of the tunnel. You always felt you were

going backwards.”

A large part of the problem was

bureaucratic patient-compliance

targets, for such things as vaccina-

tions, cardiovascular risk assessments

and mammograms. “It’s time-

consuming, and although there’s a

financial reward for meeting targets,

it barely pays for the labour to do it.

It sounds good and well motivated.

The trouble is, the ones who are going

to gain the most are those who don’t

come in for a free check, so you get

the ‘worried well white’ turning up

all the time and the high-risk people

aren’t getting assessed. We all know

people in low-decile societies have the

poorest compliance rates, so someone

in Epsom will be able to get their

targets much easier than someone in

Tūrangi.”

When the targets are met, they

just get harder, he says. “The more a

system is regulated, the more you are

doing tasks that you don’t see value

in, the less pleasure you get from a

job and the less reward you get from

the job, so the less you want to stay

in a job. If people then don’t go into

general practice, you have higher

patient-doctor ratios and the whole

thing is on a spiral, and that is what

is happening now. It’s an endemic

issue with society, not just general

practice.”

Nixon says he started seeing

patients at 8.30am every day, never

had lunch and got home at 7pm

every night. The doctor who replaced

him lasted 18 months before leaving.

“It was too much.” The practice was

in the top 10% of earners because it

received extra funding for its low-

decile population, but saw “huge

numbers” of patients.

Because people were waiting longer

to see a doctor, they’d often turn

up with a shopping list of multiple

issues. That led some GPs to restrict

‘If I’d stayed, I would

have died’

“We can’t practise

like we did in the past

and we do have to

make changes. But the

GP-style consultation

is the most efficient use

of health resources.”

A fatigued GP tells how frustration with

bureaucracy made him mad and miserable.

Part-time

GP Dr Dave

Nixon: “You

always felt you

were going

backwards.”