Full GP clinics enrol more patients after clinics bought by healthcare company
Corporate ownership of GP practices in New Zealand is growing rapidly. Many GPs welcome the change because it gives them financial certainty and lets them get on with their jobs. But some clinics say an ownership change led to new pressures.
GP practices that were bought by a corporate owner reopened their books to new patients despite struggling to care for their existing patients.
That led to a rush of new enrolments, creating more pressure on the staff and a rise in wait-times for patients.
Papakura East Medical Centre stopped taking new patients last year because it was at capacity, with about 6000 patients for four GPs, some of whom worked part-time. A source, who spoke on condition of anonymity, said that after Green Cross Health purchased the practice five months ago the books were reopened despite no changes being made to staffing levels.
The Papakura practice was one of only a few clinics taking new patients in South Auckland, and enrolments increased rapidly.
This added stress for the GPs and increased wait times for a routine appointment, the source claimed. Staff faced increased frustration and occasional abuse from patients who could not be seen by a doctor.
It was not an isolated case. The Royal NZ College of General Practitioners said some members had also reported being directed to take on more patients after a buyout by various healthcare companies.
GPs’ advocates say the recommended “safe” ratio is a maximum of 1200 to 1300 patients per doctor. This ensured doctors had time to check results, make referrals and other key tasks. The recommended number was lower for doctors with high-needs patients.
However, this recommendation was being revised to take into account the growing complexity of patient needs in New Zealand.
Papakura East Medical Centre is a Very Low Cost Access practice, which means its patients have high needs.
Green Cross Health general manager Wayne Woolrich said in a statement that the company sought to ensure staffing levels could support and sustain appropriate levels of patient numbers.
Each practice was reviewed differently depending on patient needs, demographics, location and other support services, he said.
Papakura East Medical Centre’s enrolments had risen by 300 since it was purchased, and Green Cross said this was “in line with clinical capacity”.
The company challenged the claims made about wait times, saying the average wait for a routine appointment was between three days and a week, which was comparable to other GP clinics.
Woolrich said leadership teams at each practice reviewed their books regularly to make sure they maintained a balance between patient access and workload.
Asked whether the decision was motivated by funding shortages, Woolrich acknowledged all GPs were facing financial challenges.
“With funding not keeping up with the increasing costs of operating a medical practice, and growing challenges to recruit and retain GPs and nurses, medical practices and urgent care centres across New Zealand are faced [with] decisions on how they operate to remain viable.”
Royal NZ College of General Practitioners president Dr Samantha Murton believed most privately owned practices would be cautious about not enrolling too many patients.
“If you are increasing volume to the point that staff are overwhelmed then that is not appropriate.”
She said practice owners could be put in a difficult position in areas where doctors were scarce.
“There are places where there might be 1800 people living in your community and getting other staff is really difficult but there is nowhere else in town. So you may have more patients than you can provide the services for.”
Corporate ownership of GP practices has doubled in the last decade in New Zealand, and 14 per cent of GPs reported in 2022 that they worked in a partially or fully corporate-owned practice.
Green Cross Health and Tamaki Health are the largest providers. Green Cross now owns 66 practices. Its growth has been rapid, doubling the clinics under ownership since 2016. Tamaki Health has 50 partially or fully owned clinics.
The changing ownership of primary care practices was being driven by a number of factors, including underfunding and understaffing.
Murton said a large number of GPs were set to retire in the next decade and the younger generation of family doctors may be more hesitant to take a stake in their practice.
“The people who are coming in young have families at a slightly later age, have two people working in their family, they’re buying a house and have a student loan.
“So the ability to buy into practice may be different from what it was years ago.
“I think we are a little bit more riskaverse and the corporates seem to have the capacity and the power to buy stuff up that we doctors may not.”
She said being bought out appealed to some GPs because a company could take over the financial risk and the non-medical parts of the job.