‘Triaging’ to fill GP gap
Prioritising high-need patients by phone eases loads
Acommunity mindset change is needed to rethink the way people interact with family doctors to tackle the national shortage of them. That’s the view of Whanganui Regional Health Network chief executive Jude MacDonald.
New Zealand currently has about 72 to 74 general practitioners (GPs) per 100,000 people, compared to Australia which has around 118 per 100,000 people.
“So we have an underlying shortage,” the Royal New Zealand College of General Practitioners medical director Dr Bryan Betty said.
“If there aren’t enough GPs, people’s health worsens, which costs the health system a lot more money and puts additional pressure on hospitals.”
The General Practice Owners Association (GenPro) chair Dr Tim Malloy said people were waiting weeks to see their family doctor in many places in New Zealand.
“General practice had been struggling with historic underfunding and is also struggling to attract staff, as doctors no longer want to specialise in general practice and, like nurses, are better paid if they choose to work in hospitals or in Australia,” Malloy said.
GenPro is a New Zealand association made up of over 400 general practices and urgent care providers, formed in 2020 to address the decline of general practice and ensure the sustainable continuation of highquality family doctor services for all New Zealanders.
MacDonald said “triaging” was the best tool to tackle the lack of GPs.
Triaging is a medical practice activated by a lack of resources, which includes prioritising high-need patients.
“You might see not your family GP but another key member who then confers with the doctor if required, or can manage your issue directly.”
MacDonald said this could be a practice nurse, nurse practitioner, or health coach, all of which were capable of doing acute assessments and determining what a patient needs.
“Our community is struggling because everyone is used to seeing their own doctor on a given day, but it’s just not possible right now.”
MacDonald said many Whanganui practitioners were now providing a phone-in service where a nurse would then help determine how to best have a patient’s health needs met.
“We are also seeing an increase in people turning up at Whanganui Accident and Medical (WAM) during the day because they can’t get in with their own practice in a timeframe they believe they need.
“You might think you need to be seen today when you actually don’t need to, and then there are others who don’t want to make a fuss but they need to be seen urgently.”
She said WAM was a valuable service.
“It is meant to be for urgent matters but there are many people using it as their general practice because it’s the only access they have to primary care.”
Te Oranganui chief executive Wheturangi Walsh-Tapiata said the sector had been lacking in GPs for a number of years.
“Enticing young people to come live and be a GP in Whanganui is an ongoing challenge,” Walsh-Tapiata said.
“Not only at Te Whatu Ora Whanganui but as a community.
“We’ve had a number of doctors who grew up in Whanganui who want to return home, and that’s really exciting.”
We have a high percentage of Māori working at our clinic, so when we’re looking for staff we’re looking for a fit who can have meaningful relationships with the whānau who come in.
“She said a focus was upskilling nursing staff and doctors to train as GPs.”
There was no easy solution to the issue, Walsh-Tapiata said, and solutions needed to be long-term.
“We can’t just think about a doctor for now or even next year, we’re talking about five to 10 years down the track.”
She said this meant getting involved with students for summer internships and other opportunities at Te Oranganui.
Macdonald said there was not enough allocation of resources in primary care to support doctors to become GPs.
“The worst case scenario is the trend continues as it is with GPs retiring and nurses gravitating
towards hospitals because of the higher pay rates, and we continue to run down our workforce.
“Rural and provincial New Zealand need a hand up and they need it now.”
Betty said it took between 11 and 14 years to become a specialist general practitioner in New Zealand.
He said this included a six-year basic medical degree, two years minimum as a junior doctor in hospitals, and then specialist postgraduate training.
The general practice postgraduate training scheme is a three-year programme.
“We should be training around 300 doctors to become GPs just to sustain current numbers, but we’re currently training less than 200 a year.”
He said about 40 per cent of NZ’s doctors came from overseas.
“And because of Covid-19, there are no doctors coming in from overseas.
“There’s always been a shortage of GPs in smaller towns, but now it’s nationwide, which puts extra pressure on provincial and rural areas, including Whanganui.”
Betty said because of the shortage, students had more options for where to carry out their post-graduate studies.
“If you tell them to go to
Because of Covid-19, there are no doctors coming in from overseas. Bryan Betty
Whanganui while they’re based in Auckland and have family in Auckland, they have the option to stay.”
The number of students doing postgraduate study has been consistently just under 200 for several years now, but this year is the worst in 6 years, he said.
“Up to six weeks ago if students chose to do specialist GP training they would get paid less than hospitalbased training.”
Meanwhile, these students have study debts of up to $100,000, he said.
“The Government has recognised this and now they’re starting to introduce the same pay for GP training as hospital training, but it might be too late to see the effect this has for next year’s students.”
He said there needed to be more incentives for students to become GPs, and more exposure to general practice in the very hospital-focussed medical training.
A 2020 workforce survey found 36 per cent of GPs planned to retire in the next five years and 58 per cent in the next 10 years.
It said forty-three per cent of family doctors are aged 55 years and older.
“Until primary care doctors and nurses are paid as much as their overseas and secondary colleagues, general practice will be in crisis,” Dr Malloy said.
“The situation is dire. While the Government is investing billions in new health bureaucracy, it has lost focus on essential front-line services which keep people well in their communities.”