NZ almost 500 GPs short, briefing reveals
Monday, 27 May 2024
A briefing to Health Minister Dr Shane Reti shows a severe shortage of doctors and funding in primary care.
Avoidable hospitalisations for babies and toddlers jumped 35% last year.
Nationally, 24 practices have had to reduce or stop services after hours or urgent services because they can’t keep up with costs and patients.
New Zealand is 485 GPs short, with this number expected to grow to a shortage of between 753 and 1043 doctors in the next 10 years.
New Zealand “will struggle to train or bring in enough international medical graduates to meet this demand.”
The primary sector needs an investment of between $353 million to $1.36 billion, depending on preferred solutions, to address the unmet need across the country.
This is according to a briefing, released under the Official Information Act, that was prepared by Te Whatu Ora for then incoming Health Minister Dr Shane Reti in January.
Reti is often quoted calling the general practice system “broken” and “not fit-for-purpose”.
In March, he pointed to work beginning on setting up a third medical school and record numbers of GP registrars as “green shoot”, but added: “I understand there are other parts of retention and remuneration we also need to collaborate on.”
A review of the primary care, including urgent care, funding model completed in November 2023 informed a rapid injection of $17m (on an annual basis) to stabilise after hours primary care, he said.
The aide-mémoire says “moving care closer to home, bending back demand growth for specialist services, [and] supporting wider community services (e.g. rest homes and residential care) relies on community based clinical capacity that general practice teams provide.”
It also points out that gaps of 14.4% to 16.3% remain for registered nurses in primary care.
Funding for primary care should be better targeted and doctors should be better incentivised to stay on, the briefing suggests.
At least 250,000 Kiwis aren’t enrolled with a practice and 1,034,000 people said they struggled to access GP services because of cost in the 2022/23 – double the number of the previous year – while a further 541,000 people found cost to be a barrier.
The impact of this, according to the report writer, is pressure on hospitals, emergency departments, specialist consultations and immunisation rates.
There was a 35% increase in ambulatory sensitive hospitalisations for children under four between 2022 and 2023, for example, while ambulances were attending 11% more callouts in 2023 than in 2019.
Another briefing provided to the minister in December revealed that 24 practices and clinics in Canterbury, Southern, Hawke’s Bay and Mid Central that provide after-hours or urgent care experienced closures or reductions in hours in 2023.
This was because of a mix of rising costs, changing and complex case mixes, the inability of patients to access general practices, and workforce shortages.
A review of urgent care and after-hours services will be completed by June 2024 and ACC is working on a review of primary acute care for accidents and injuries.
Previous budgets are paying dividends now, but these may not last.
Budget 2022 allocated $37m over four years for workforce development, resulting in increased salaries for registrars and a subsequent 4% (239) rise in training numbers.
It also funded 20 more places for rural trainee doctors and 100 nurse practitioner training places in 2024.
“However, analysis indicates that we need more than 300 GPs to enter the training programme each year to replace those exiting and to keep pace with demographic change,” the January briefing says.
Funding allocated to create 600 new non-medical roles to support primary care teams will run dry in the 2025/2026 financial year, leaving a $61m per year gap.
Finance Minister Nicola Willis is expected to set out less that $3.5b for new spending across public services in the 2024 Budget.