‘The devil is in the detail’ - cautious optimism over Simeon Brown’s telehealth ‘solution’

Tuesday, 4 March 2025

A multimillion-dollar performance-based uplift for GPs is the “most beneficial” part of a raft of new primary care measures announced by the health minister, according to a doctors’ leader.

Members of the medical profession have been giving their reaction to Simeon Brown’s telehealth “solution”, announced yesterday.

Brown says overseas clinicians may be contracted to help staff a new 24-hour telehealth service, announced among a raft of new measures to speed up access to GPs.

“This service will mean Kiwis can access primary healthcare from anywhere in New Zealand, 24 hours a day, seven days a week with the ability for GPs and nurses to also issue prescriptions or make referrals for lab tests,” Brown said.

They will provide video consultations with New Zealand-registered GPs and nurse practitioners ‒ some of whom may be overseas, Brown said.

“Many of them will be from New Zealand. Some of them may be GPs registered in New Zealand, but working offshore, able to support that service.

“This is a practical solution which expands access to primary care for Kiwis and will provide an additional service to ensure New Zealanders have more access to timely and quality care.”

Health New Zealand - Te Whatu Ora will run a procurement process to source the providers, Brown said.

Other new measures include 100 clinical placements for overseas-trained doctors to work in primary care and incentives for primary care to recruit up to 400 graduate registered nurses per year for three years.

Brown also announced Health NZ would provide a performance based $285 million uplift for general practice over three years, starting from July 1.

​Dr Angus Chambers, a Christchurch GP who chairs both the General Practice Owners Association and the General Practice Leaders Forum, said the $285m investment would be “the most beneficial” part of the package.

'But there might be fish hooks in it - some of the money might be targeted but there just needs to be a baseline funding uplift.'

Chambers said the biggest gain in general practice would be to retain existing GPs, with older ones 'retiring fast' and younger ones going into hospital work. Government also needs to address pay parity between GP and hospital nurses, he said.

Chambers said he is keen to see the detail of the telehealth programme, and overseas experience suggests such programmes do not necessarily reduce emergency department visits and other hospital services.

'The people who are really clogging up our system are the complicated ones with a lot of medical conditions.'

Dr Les Toop, a Christchurch GP and emeritus professor of General Practice at Otago University's medical school in Christchurch, said he was 'cautiously optimistic' about the announcement.

'The devil is in the detail. What will the 24-hour digital service look like, and what doctors are they going to use?

'It's important that it links back to people's GP, otherwise you lose the continuity of care.'

Toop welcomed getting graduate nurses into general practice 'but they are going to need a lot of mentoring and a support package put in place'.

He also said he was “not a fan” of performance targets, as they could lead to perverse outcomes and unintended consequences.

Leading GP Dr Bryan Betty, who is chairperson of national advocacy group General Practice NZ said it was encouraging to see extra investment and a focus on primary care, but said telehealth was really best for single simple issues, not long-term management.

“Face to face is still the way to deal with long term medical conditions in the community and we want to avoid fragmented care - we need to be really careful we don’t fragment the system.”

That could happen when virtual providers did not feed back patient notes to a patient’s regular general practice. Betty said only some telehealth providers passed on notes at the moment.

New Zealand is 485 GPs short, according to official figures sent to the previous health minister, Dr Shane Reti.

The General Practice Owners Association (GenPro) estimates about 290,000 Kiwis are not enrolled with a practice.

“There are concerns around whether this will drag workforce away from what’s already there,” Betty said.

The $285m was in addition to the capitation uplift general practice receives each year, Brown said.

“It will incentivise GPs to offer enhanced access, including keeping their books open to new patients, achieving key Government health targets such as increased immunisation rates, or supporting family doctors to undertake minor planned care services, and see patients in a timely manner,” he added.

“We know we will need more doctors. That’s why we are funding a new two-year primary care training programme for up to 100 extra overseas-trained doctors once they are registered to work in New Zealand.

“It makes no sense that overseas-trained doctors living in New Zealand are willing to work in primary care, but can’t, because there aren’t enough training opportunities.

“We hear the some stories of [doctors] driving Ubers when they should be actually practising medicine, which is what they've been trained to do, but they've trained in different countries,” Brown said.

The plan would build on a successful pilot in the Waikato to support GPs’ transition into general practices that need them most, he said.

Under the plan, GP practices and other providers outside hospitals will be paid an incentive to attract, recruit, and support up to 400 graduate registered nurses each year, starting from July, Brown said.

“Just over $30 million has been allocated over five years for this initiative. Primary care providers, including general practice, will receive $20,000 per graduate nurse in rural areas, with those in our cities receiving $15,000.”

Brown made the announcement at the weekly post-Cabinet press conference on Monday.

During questions from reporters, Brown dismissed the voices of healthcare workers in a survey run by their union, the Public Service Association, as the union “simply trying to oppose what this government is trying to do to make health care more accessible”.

“I think they had about 1000 responses - there’s like 90,000 people work for Health New Zealand, so it’s a very small number of people in a self selected survey.”

Prime Minister Christopher Luxon then stepped in to say: “We want to get rid of the bureaucracy, and we have to.

“We have more workforce in the frontline parts of our system, and yet we're getting poor results, and so we need those results to be stepped up. And the reality is, we know we've got a low performing organisation, and we need to turn it around.”

Luxon denied that the poor results could be attributed to cuts to non-clinical roles.