Cancer patient says she couldn’t see GP for six weeks amid workforce ‘crisis’

Wednesday, 6 March 2024

One in five New Zealanders say that time taken to get an appointment with their GP is too long, making it the most commonly reported barrier to visiting a GP. Why is this happening?

General practice is an integral part of our health system. But some of those working in it say it’s a system on the brink of collapse; with GPs burning out, closing their books, and critical workforce pressures. Hannah Martin reports in this three-part series.

Lifting a cardboard box, Amelia* heard a pop and felt intense pain spread through her chest.

The metastatic breast cancer patient called her GP, but said she was told the next face-to-face appointment was six weeks away.

In “unbearable” pain, Amelia later went to an emergency department, where she was diagnosed with a possible pathological rib fracture (caused by disease, rather than injury).

Amelia, who lives rurally, said it has become typical to face weeks-long waits to see a GP. And she’s not alone.

The New Zealand Health Survey found roughly a million New Zealanders (21%) were missing out on seeing their GP – most commonly because it takes too long to get an appointment.

In some parts of the country, as few as one fifth of GPs in that region are currently enrolling new patients, Healthpoint data shows.

General practitioners support the population through all manner of ailments and are the first port-of-call in the healthcare system.

Training would be compressed into four years at a future Waikato medical school which will be "a fantastic legacy for New Zealand", National Party leader Christopher Luxon said. (First published July 6 2023.)

But some on the frontline say it’s a system on the brink of collapse, owing to a “not-fit-for-purpose” funding model, growing complexity of patients’ needs, and escalating pressure to do more for less.

And, “if we collapse, people will die”, one GP warns.

A patient experience survey from May 2023 by the Te Tāhū Hauora Health Quality and Safety Commission found 30% of people could get an appointment that day, or the next working day, and 42% within a week. More than a quarter waited over a week.

Having a doctor to see was another issue altogether.

Nationally, just shy of half of GP practices (46%) were not enrolling new patients, according to Healthpoint records.

Tess* moved houses six months ago from Upper Hutt to Carterton, an hour north.

She tried to enrol at the local medical practice, but said she was told they weren’t accepting new patients.

Tess kept her enrolment at her old clinic, 60km away, because she didn’t want to forgo having a GP, but said this was “not ideal”.

“It’s so frustrating.”

A critical issue was “workforce, workforce and workforce”, Dr Tim Malloy, a rural GP of 37 years based in Wellsford, said.

“There aren’t enough of us, and it’s getting worse.”

Two decades ago, 40% of New Zealand’s doctors were GPs. Today, they represent 25%.

Aotearoa has a “desperate” shortage of GPs, and a number of recruitment and retention issues that are contributing to burnout at “unprecedented levels”.

The most recent workforce survey, from 2022, found 37% intended to retire by 2027, and 55% by 2032. Among specialist GPs, 64% intended to retire by 2032.

If all 425 GPs aged 65 and older retired today, approximately 725,000 Kiwis would be left without a doctor, the college states.

Hauora Taiwhenua (Rural Health Network) recently released its first rural general practice stocktake, finding just over half of respondents (53%) were open for new enrolments.

Close to 28% were partially closed, and 18.5% of rural GPs were totally closed to new patients.

Almost half (49%) had to reduce or stop health services because of staff numbers or vacancies, such as GP consults, general nursing, after-hours care, walk-ins and seeing non-registered patients. Two had stopped all services.

And the length of time a vacancy at a rural general practice was advertised ranged from one week to more than 104 weeks (two years) – 30 weeks on average.

Tauranga GP Dr Luke Bradford said general practice is a “phenomenal role” – they’re an integral part of the community and walk people’s life journeys with them.

It’s “hugely rewarding”.

But when medical students look at general practice compared to hospital specialists, who have protected learning, teaching and non-contact clinical time, a definite end of hours and tend to have a higher salary base, it “can be difficult to persuade people of the brilliance of the career”.

A barrier to doctors choosing general practice was lack of exposure during training, both during medical school and post-graduate intern years, the college said, meaning doctors don’t get enough “worthwhile experience to be able to make this career choice”.

Dr Tim Malloy says he is ‘worried like hell’ what will happen to patients when New Zealand’s ageing GP workforce retire. (File photo)

Furthermore, increasing amounts of non-contact clinical work means the average GP is effectively working for free for one day a week, college workforce data shows.

Growing complexity and demand, and decreasing numbers of doctors to carry the load also add to workforce pressures.

In 2022, nearly a third of GPs (31%) would not recommend general practice as a career, up from 14% in 2020.

Many were holding on because of their passion.

“Most of the doctors I know should have retired, but haven’t because they want to help,” Malloy said.

Despite the issues, GPs love their work and their commitment to their communities “is an honour”, he said.

Of 22 GPs in Malloy’s service, more than a third are aged over 67: “We couldn’t provide our care without them.”

Doctors don’t go to work to put barriers in place for people, Malloy said.

“The very fact that people can’t see you in the first place isn’t something we enjoy… I think it’s disgraceful.”

But there’s not an easy, overnight fix.

As the skills required take years to achieve, “what we can do is salvage what we’ve got”, Malloy said, by retaining the current workforce, remunerating them fairly, and funding them adequately.

As demand for medical care increases and the supply of specialist GPs decreases, the college expected to see the trend of GPs closing their books to new patients intensifying and enrolled patients waiting longer to see their doctor.

Māori were already less likely to be enrolled in practices, so were more likely to be unable to find a general practice that will enrol them, they warn.

And already, rural practices face difficulties recruiting new staff, which would be made worse by overall decline in specialist GPs, the college said.

Health Minister Dr Shane Reti says, as a former GP, he is very aware of the pressures facing general practice.

Health Minister Dr Shane Reti said as a former GP he was “very aware of pressures” on the sector and on individuals, and was “frequently reminded of these”.

“There are certainly some big discussions for me to have with Cabinet and with officials around how we tackle all this,” he told Stuff – acknowledging GPNZ recently brought forward a “very useful” paper which discussed some options.

“From here on, I’ll be interested in action.”

Reti said there were some “green shoots”: the memorandum of understanding for a third medical school in Waikato to grow more doctors; and the fact the sector currently had the “greatest cohort of GP registrars coming to it”.

While that was part of a solution towards workforce issues, “I understand there are other parts of retention and remuneration we also need to collaborate on”.

“We all want a sustainable solution for primary care providers – we know what a vital role primary care plays in health.”

In the meantime, what worries Malloy, is “when I retire, and my colleagues go with me ‒ what’s going to happen to New Zealanders?”

“I’m worried like hell that we won’t be able to give people the care they need.”

Part two of this series will be published on Thursday.

* Amelia and Tess are not their real names.