GP crisis: ‘They are too busy to fight this’
A GP shortage across the country means having the comfort and continuity of care of your local doctor is a thing of the past for many New Zealanders, all while locum costs soar in rural areas. Bridie Witton and Piers Fuller report.
Getting to the GP is a ‘‘logistical nightmare’’ for Tina Gurleyen. She moved to taki from Lower Hutt in April, but all Ka¯piti Coast practices are full. She has to take the day off work to make the 80km round trip to see her old GP.
‘‘I can go to taki on an emergency basis if I need to, but if I need to get serious medical care I would have to go to Levin or Palmerston North,’’ she says.
Meanwhile, 71-year-old Lynne McLaughlin is ill with emphysema, a chronic inflammatory lung disease. But she won’t be able to see a GP at her medical centre in Wainuiomata, Lower Hutt, for more than two weeks, and will head to the emergency department if her condition worsens. ‘‘It is just ridiculous,’’ she says.
The difficulties the two women face point to a major general practitioner shortage across the country that is expected to worsen.
On average, GPs are 53 years old and nearly half are due to retire over the next decade. But there aren’t enough doctors coming through to replace them, says Dr Bryan Betty, medical director of the Royal College of General Practitioners (RNZCGP).
New Zealand relies on overseas doctors to fill the gaps. Forty-six percent of rural GPs were trained overseas, while the figure is 39 per cent across the country, according to the college. But the pandemic has added uncertainty around staffing the sector.
‘‘There is a shortage of GPs, there is no doubt about that. There has been an underfunding of the training of GPs and there is a shortage in the number of GPs coming through,’’ he says.
‘‘That has been exacerbated by the fact that there is difficulty getting overseas locums in. It is a real issue there, because we are very reliant on locums.
‘‘Over the next 10 years, 40 to 50 per cent of GPs will be retiring. The workforce is very stretched. We have a growing population, and we have increased complexity in terms of the demands of GPs.’’
Covid added further strain to the system, with many practices reporting they were close to breaking point when the co-payment system broke down as virtual consultations picked up. Practices had to wait for invoices to be paid, instead of getting payment right after an appointment.
‘‘There is fatigue at the moment. It has been a very tough year, and it has led to these cumulative issues,’’ Betty says.
Rural areas are particularly hard-hit – especially the West Coast, Northland and East Cape, Grant Davidson, chief executive of the Rural¯O GP Network explains. He has 50 vacancies for long term employment, and many more for short term locums.
His solution is to better fund postgraduate clinical training, which is funded through DHBs or organisations like the RNZCGP, as well as ensuring the flow of overseas-trained doctors.
‘‘In the long term we need more doctors to be trained and in the short term we need to make sure that the barriers to getting overseas trained doctors are reduced,’’ he says.
But exactly how wide the gaps are, or how wide they will become, isn’t fully understood. There is no gold standard, and the Ministry of Health doesn’t monitor the ratio of patients to GPs – although it says New Zealand needs more.
The average sits at one fulltime GP to 1400 people. Higher-needs areas should have around one fulltime GP to 1000 people, because they will be more likely to visit them, Betty says.
He has often pointed out the importance of a patient seeing the same GP for one’s long-term health. A GP who sees you regularly will be better placed to notice any changes over time.
McLaughlin agrees, finding it ‘‘unsettling’’ to see a different doctor when she gets an appointment.
‘‘I am going to a new doctor who knows nothing about me,’’ she says. ‘‘But I am too sick to care what doctor I see.’’
¯ A OWellington medical centre owner, who did not want to be named, says the practice was ‘‘barely keeping our heads above water’’. It wasn’t able to take on any new patients and had an extensive wait list.
‘‘The thing is that there are a lot of GPs that are retiring,’’ she says. ‘‘No-one wants to train to be a GP because the pay is not as high as working in hospitals.
‘‘There is a limit to how many people we can cope with. There are more mental health issues coming up now, and in younger patients including children.’’
The practice was also taking a lot of flak, facing five complaints in the last week – a first in its 30-year operation. A lot of it had to do with closing its books to new patients, which conflicted with the practice’s purpose, but it was taking a toll.
‘‘We are not in the business of not helping people,’’ she says.
‘‘You get the feeling like ‘I don’t want to do this any more’. We are all struggling. There is a crisis looming. A lot of GPs are sucking it up because they are too busy to fight this.’’
The GP shortage comes as many DHBs also grapple with filling holes in their staffing using locums. In some cases those people stepping in are being paid up to $3000 a day, quickly eating into the health budget.
As high as daily locum rates are, in some cases it can be the most cost-effective way health boards can get important procedures done.
The Sunday Star-Times asked a number of
‘‘There has been an underfunding of the training of GPs, and there is a shortage in the number of GPs coming through.’’ Dr Bryan Betty
DHBs to provide figures on how much they spend on locum specialists across several departments including: general surgery, orthopaedics, enterology, gynaecology and obstetrics, ophthalmology, urology and cardiology. Many smaller DHBs do not offer all of these services.
They were also asked to provide total internal spend on specialists in these departments for comparison.
While larger DHBs serving populations of more than half a million people could reduce locum bills to almost zero, in some cases, some smaller DHBs had to outsource entire departments – usually because they struggled to employ permanent staff.
The Association of Salaried Medical Specialists says that although they appreciated the role locums play, there is no substitute for permanent staff.
As the union for salaried senior doctors, ASMS does not cover locums, but does have an interest in how the workforce covers the load.
Chief executive Sarah Dalton said locum-use was so widespread that the organisation has proposed a project with the DHBs’ Technical Advisor Services to get a better sense of the way forward.
‘‘We become quite frustrated when we are maintaining that there are ongoing specialist shortages and DHBs tell us they can’t afford to appoint more staff, yet in many cases locum bills are very high. Most DHBs would agree that they’d rather be spending the money on permanent staff.’’
Dalton said rural hospitals tend to have more of a reliance on locums.
‘‘Some of those places like the West Coast, Tairawhiti, Northland, they can be really hard to recruit to. It’s not because people don’t want to live there, but it depends on their life stage. [It’s] either because they can’t recruit to permanent roles or sometimes their staffing is too small to fully cover the call rosters.’’
She said DHBs such as West Coast, which pays out more to locums than to permanent staff, were considering moving to a different model of care employing rural generalist doctors.
And she suggested a national strategy to ask specialists what would make it viable for them to move to rural hospitals.
‘‘Because really what patients need is continuity of care. They want safe care, and most people would rather know they got a doctor down the road, not over the mountains.’’
She said permanent staff provided better service planning, collegiality, and teaching.
‘‘It’s all of that good stuff you get through certainty and tenure, through working with the same group of people through a period of time.’’