22 Apr 2021

'Fund primary care': GPs demand more from health system reforms

5:53 pm on 22 April 2021

The public and doctors hope general practices will be cheaper and easier to access once the health reforms come into effect.

Doctor measures blood pressure of patient.

Photo: 123RF

The government yesterday announced a major shake-up to the country's health system with one entity called Health New Zealand to replace all 20 DHBs.

Over the past few years, emergency departments have sometimes reported being overwhelmed; some have gone into "code black", telling people to stay away unless they were really in an emergency.

Some of this demand is non-emergency issues that people cannot afford to pay to see their GP for.

Former hospital worker Sunisha said her doctor husband used to work in the emergency department. She said on nights and weekends when after-hours doctors cost more, EDs filled up.

"So much of what comes through isn't actually an emergency, and all of those resources that are used to address those patients could be used elsewhere. And likewise the patients ... wait for six hours for something minor."

Other Aucklanders said they were generally well served by their GPs, but some put off going because of the cost.

"They should put the price down in general. A lot of people avoid going [to a GP] because they don't want to pay money," one said.

"Maybe it should be a means-tested thing - free if you earn under a certain amount," another said.

"It could be possibly that they have to work more than one job and they're not able to go the GP during normal working hours, and going to [an after-hours medical centre] is going to be two or three times more expensive, so I can understand why they'd go to a hospital."

Aside from knowing that things will change, GPs know very little about how it will change. Two doctors said: "The devil is in the detail".

However, they are optimistic the shake-up will be good for them, and therefore, good for patients.

A GP who practises in South Auckland and Christchurch, Dr Api Talemaitoga, said he hoped general practice would be prioritised more.

"In my view, decisions have tended to be hospital heavy. If we're serious about a focus on keeping people well and out of hospital, we need to fund primary care."

College of GPs medical director Dr Bryan Betty said it was necessary to rebuild a system that was failing on a lot of levels.

He said general practices were under "immense pressure" at the moment.

"That's both from workloads, what's happening, and the way general practices are remunerated. Again, we don't have details of what that looks like in terms of the reforms at this point. We would certainly expect general practice and GPs to be part of the discussions on what this new system looks like over the next 12 to 24 months," Betty said.

Talemaitoga, who is also the chair of the Pasifika GP Network, said doctors needed to think outside the box to increase equity, like being open late or offering live video consultations.

"It's not just the cost [that's a barrier] - it's the opportunity to visit your GP. That's where virtual platforms are really important, or opening extended hours as people do their double shift at the factory and there's just one car at home," Talemaitoga said.

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