Patients worry about rise of corporate-owned GP clinics, but they say judge us 'on the outcomes'

The traditional family doctor who knows you and your medical history (and probably your mum as well) is increasingly being replaced by corporate employees and video screens.

Lower Hutt resident Annette Campbell-Orpin is enrolled with High Street Health Hub, one of 65 clinics owned by Green Cross Health.

She and her husband both have chronic health conditions - but neither has a regular GP.

"You're constantly explaining why you are on certain meds, you're explaining your condition," she said.

"You wonder if they even stop to take a look at your notes.

"You know you've only 15 minutes and they're just rushing you through because you're no longer a patient - you're revenue."

While everyone knew about the GP shortage and the pressure on primary care, patients still needed to be "treated like people", she said.

"I fear one day there's to be a big stuff up or a mix up where it may actually cost someone their life."

Christchurch mum Georgie Hanafin (a producer with RNZ) has to make regular appointments because both she and her 11-year-old son need prescriptions for ADHD medication.

However, they rarely see the same doctor twice - or even one in the same city.

"When I want to get a repeat for his prescription, we go to the doctor, we sit in front of a TV screen and we get videoconferenced by a doctor in Wellington, who's never met him.

"He's autistic, so he's already at a disadvantage in that he's not going to trust anyone going near him if he doesn't have a relationship with them."

Georgie used to belong to Linwood Avenue Medical Centre.

"And it was great. They knew everyone, you had the same GP, and if you couldn't get your GP, you got the one in the next room - but they still knew who you were."

That changed after the practice was bought by the corporate provider, Tend, she said.

"Every time I go there it's a completely different person. I have to explain the disabilities again, I have to provide context and background. It's traumatising every single time that you have you go in.

"It's also expensive, because if you need anything like a medication change or anything mental health wise - they need you to come back again and again and again."

Corporate ownership increasing

The number of doctors working in GP-owned practices has dropped from 73 percent in 2015 to 64 percent in 2022, while the number employed by corporate-owned clinics doubled in the same period to 14 percent.

Former head of the senior doctors' union, Ian Powell, a long-time critic of corporate ownership, said the drive to boost profits for shareholders could create "perverse incentives".

"What can happen is the pressure is on to reduce the time for patient consultation in order to increase the number of patients who are enrolled with the practice, in order to get more funding through the capitation system."

Capitation is the annual government funding for each enrolled patient, which rose 14 percent this year - but followed decades of underfunding.

A survey released this week by the General Practice Owners Association, GenPro, showed the financial position had worsened for one in four in the last year, with 18 percent making a loss.

GenPro chair Angus Chambers, said some were simply shutting their doors.

"Some of which would be GPs retiring, nobody wants to buy their practice so they've just closed it down, others have mergers, sometimes people have closed because it's not viable."

Continuity of care was being lost, which was deeply worrying because it was key to early intervention and reducing hospital admissions, he said.

"I think it can be brought back. The model will change, but it requires deliberate choice and funding."

Even with the Budget bump this year, primary care's share of funding was still half what it was most OECD countries, he said.

More than half of practices were currently looking for doctors, and competing with telehealth providers, which had a massive cash injection from the government to bolster hard-to-staff regions.

"It's a vicious circle, isn't it? You can't get a GP rurally so they take one out of rural and put them into telehealth. It doesn't actually improve anything, in fact it makes it worse, because the care that telehealth provides is not as good quality."

Judge us on outcomes, corporates say

Green Cross medical director Dr Kim Hurst agreed that continuity of care was important - but given the nationwide shortage of 485 GPs, practices needed to provide it in a different way.

"So for example, if I'm off shift but there's a paramedic or nurse practitioner or nurse prescriber who also knows that patient well and has been part of their care journey, they can provide continuity when I'm not available."

Data from the College of General Practitioners showed GPs working in corporate-owned practices had the same workload as those in GP-owned practices, she said.

"We have to offer good working conditions or we wouldn't have doctors wanting to work for us."

Tend said its patient satisfaction rating of 95 percent showed its model was working well.

Chief medical officer Graham Denyer denied there was any pressure to shorten consultation times or grow at the expense of care.

"Every practice, whether you're GP owned or not, has to be financially viable and offer quality care to patients, and those things are not mutually exclusive."

In fact, Tend's scale allowed it to offer patients a greater range of services and support, he said.

"'Corporate' is generally talked about as a dirty word in the general practice environment in New Zealand but I really disagree. I think that corporate general practice organisations - or in fact any general practice large or small - should really be judged on the outcomes."

Tend encouraged patients with complex conditions to see the same GP or another practitioner in the team at every appointment, and that option was "absolutely available".

"But for people with straight-forward problems like a UTI or a cough or a cold, they can be seen the quickest by whoever is available."

Using a multidisciplinary team (including nurses, pharmacists, healthcare assistants and mental health professionals), ensured patients saw the right clinician for their particular need, and kept doctors' expertise for complex cases.

The hybrid approach of both online and in-clinic appointments allowed patients to get same-day care when they needed it, while use of AI notation ensured whoever saw the patient had immediate access to their record.

Health NZ says work continues to increase access

Health NZ director of living well, Martin Hefford, said he was encouraged by the GenPro findings that most practices have not had to reduce services or opening hours, and that many were still accepting new enrolments.

"However, we are concerned by the number of practices that are increasing fees or are starting to charge for services that were previously free to patients.

"There is a lot of work underway to strengthen primary care, so all New Zealanders receive timely access to quality health care."

As well as increasing funding and workforce development, and targeting more resources to clinics caring for high-needs patients and those in rural areas, the government was introducing a new national health target for more than 80 percemt of people to be able to see a primary care provider within one week, to take effect from July.

Regarding business model, general practices were independent businesses, he said.

"Health NZ is committed to ensuring that all New Zealanders have access to quality, accessible primary care, regardless of ownership structure. However, we are aware of developments in the sector and continue to engage with stakeholders to understand the impacts of these changes.

"In areas where general practice is less viable, such as parts of the West Coast, Health NZ has stepped in to directly fund and support services. This remains an option where needed to ensure continuity of care and uphold equity of access.

"We continue to work with the sector to strengthen workforce capacity, funding models that meet need and ensure that ownership models, whether corporate or small independent businesses, support the health and wellbeing of New Zealanders."

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