26DA
VID
WH
ITE
GP SHORTAGES
primary care not only causes substandard
care for patients, but also has a wider finan-
cial effect, says RNZCGP president Samantha
Murton, a Wellington GP. “As soon as pri-
mary care is overburdened, the hospital
system has to pick up acute care, and that’s
costly, with patients having investigations
they don’t need.” GP shortages mean some
patients have to wait weeks for an appoint-
ment, or they may end up seeing someone
who’s not familiar with their history, which
disrupts continuity of care.BUMSONSEATS WON’T WORK
This year, 193 doctors began the general
practice training programme and 197 have
been accepted for 2020, but about 250-300 a
year are needed. Because most of the coming
retirees are older male doctors who’ve been
working full-time and many new GPs workonly part-time, more than one doctor is
needed to replace each one. Health Minister
David Clark told the Listener that funding
isn’t limiting trainee numbers. Murton says
Clark told college representatives last month
that more trainees would be funded if they
qualified for the training.
A bums-on-seats approach, allowing any
registered doctor to set up in practice as a GP
without specialist training, wouldn’t solve
the shortage, she says. “GPs are skilled in
dealing with multiple, complex conditions
at one time. That is what you are trained to
do. In a hospital, you do a variety of differ-
ent things and if you suddenly put up your
shingle, you may not be expert in 10 of the
20 disciplines we deal with each day. I’mdealing with paediatrics, geriatrics, endo-
crinology ... our training ensures everyone
is as skilled as they can be in each of those
disciplines. People who are untrained don’t
manage their uncertainty particularly well
and referrals to hospitals increase.”
It’s important for patients to keep using
their GP, despite the shortages. “As soon as
one of my patients turns up at an after-hours
service, I get money clawed back [from the
capitation payment] to pay for them going
somewhere else, because the money is tied
to the patient, not to the practice. It doesn’t
feel fair – it drives us all mad.”
By the time medical students graduate,
general practice is one of their top career
options, with 25% keen to become family
doctors, says Andy Wearn, an associate
professor who heads the University of
Auckland’s medical programme and is also
a GP. Students have an option to do three
months’ general practice in their first post-
graduate year, and this year, a compulsory
three-month community attachment was
added in the second post-graduate year.
But students who are keen on general
practice when they graduate often change
their minds after their first- and second-year
hospital runs as house officers, says Phillippa
Poole, a professor and head of the Univer-
sity of Auckland’s School of Medicine. It
happened to her. She was interested in pri-
mary care before being shoulder-tapped as a
house surgeon and introduced to specialist
physician training. “Someone said, ‘Come
and try it’, and I liked the work, the people,
the patients and the challenge. So you need
to reach down from senior staff to be role
models [in general practice].
“We can do all we can at medical school
to educate and orientate towards general
practice, but then, at the end, they’ve got to
apply for a job at a district health board as
a house officer doing medicine and surgery
in a hospital. You get into the four walls of
the hospital and it’s hard to imagine get-
ting out.”
She says although each group involved
in workforce training has its
own areas of interest, they
have to work together.
“Everyone needs to
be interested in gen-
eral practice, because
it’s healthcare for the
whole of New Zealand.
Everyone has to paddle
their waka in the right
direction.” lE
ntrepreneurial Kaitaia GP and
public health advocate Dr Lance
O’Sullivan says he wants to
make access to primary health-
care as easy as getting a McDonald’s
Happy Meal. He plans to establish
200 drive-through medical clinics by
the end of 2021.
O’Sullivan says it would break
down the access barriers of cost and
time and the clinics would be largely
staffed not by GPs, but nurses and
healthcare assistants providing “96%
of the care” a GP offers.
Although some health experts
have praised the plan, others have
cautioned it will be financially and
logistically challenging. O’Sullivan
says he’s bought the first clinic,
in Rotorua, which he hopes to
open in September, followed by a
second in Kaitaia in November.Dr Lance O’Sullivan
is pursuing a
healthcare systemthat’s good to go.
Phillippa Poole, Dr Samantha Murton and
Andy Wearn.Dr Lance O’Sullivan:
breaking down cost
and time barriers.“As soon as primary care
is overburdened, the
hospital system has to
pick up acute care, and
that’s costly, with patients
having investigations
they don’t need.”Drive-
through
clinics