Kyota. I'm Chelsea Daniels and this is the Front Page, a daily podcast presented by the New Zealand Herald. Our primary healthcare system stands at a critical juncture. At least, that's the latest from the New Zealand Initiative. The think tank has released a review this morning into the country's primary care system. It argues that the current system faces mounting pressures that threaten its sustainability and effectiveness. So, with the vital role that gps play in our everyday healthcare,
what are the challenges facing our family doctors today? On the front Page ends a research fellow doctor Prabani Wood joins us to dive into another part of our health system in crisis. Can we start with a bit of your background, Brabani and how you came to become a GP.
So, yes, I did my medical school training in Oxford and then moved to New Zealand twenty years ago now with my husband who's also a doctor, and I've been a GP in New Zealand now for just over.
Fifteen years now.
My path into general practice was convoluted, and I think a lot of that is due to the fact that general practice is still undervalued even.
Within our own medical profession.
We don't get much exposure to it as medical students, and there's still a few people in hospital medicine that probably looked down on it. So I did quite a few years of work in hospital specialties before deciding to make the move into and we care, and I'm glad I did. It's the best career I really do think going in medicine, but it's also probably the hardest.
What is the role at the moment of a specialist GP in primary care?
So I think it's important and to use that term specialist GP to begin with. You know, we are specialists in that we undergo the same and rigorous postgraduate training that all medical specialists do. We sit exams and we are accredited by our college, the Royal New Zealand College of GPS.
As specialist GPS.
We really need to know a lot about everything that could possibly go wrong with a person, both in terms of physical health and mental and emotional health. So we are there to diagnose, investigate, treat and manage conditions. We're also there to work out when we need to investigate the further and refer on to our hospital colleagues. And we're also there to prevent things from happening, you know, picking up diseases early and preventing them from getting established.
So therefore you're trying to keep our patients healthy and this overall saves the health system money. It makes sense, right if you're picking up things early.
And I guess that's why it's so important to have a regular GP that you have that relationship with, because they can pick up on those tiny nuances.
I gets one hundred percent, and I think that's what we're forgetting to talk about and acknowledge.
At the moment.
General practice isn't general practice without that continuity of care. I don't think I can stress that enough. What we do as specialist GPS is.
Very, very broad.
We've got to have a high level of expertise and a very broad scope. You know, a study has shown that general practice is the most complex specialty in medicine based on how much you need to know and how little time you have with each patient. It's it's very broad and you have to keep applying your knowledge.
Keep up to date with new medicines and new treatments.
But you're always then applying that knowledge to the patient in front of you, and you're following them through their life course. So you're adapting your knowledge to each patient that you see, and that's how you get those efficiencies. Exactly as you said, you know, if you know you as a GP, know your patient, and especially in the context of a chronic health issue, every time you see them,
you don't have to start from scratch. Patients really appreciate that it must be so frustrating to have to keep telling your story over and over again each time, and you can get right to the nitty gritty much more quickly and pick up on things and subtle changes much more readily.
What are the critical issues facing the sector at the moment.
It all comes down to a lack of funding and recognition of the importance of the work do. The sector's been under this funding pressure for many, many years, so the critical ways that's manifesting are a major issue. With workforce attrition, more and more gps are leaving. We've known about a large section of our workforce being coming up to retirement. We've known about that for a long time. About forty five percent of gps had acknowledged that.
They would wish to retire within the next ten years.
But there are also mid career gps that are leaving simply because the terms and conditions under which we are working as gps are getting worse, and we're seeing more fragmented roles as well, so as more roles in telehealth come up, or roles in urgent care, for instance, so people are leaving traditional GP roles for those instead.
Every single dollar must still have a bit outcomes for patients. More money going in must mean more results coming out. But under Labor we saw more money and worse outcomes, longer wait lists and declining service levels, which is simply unacceptable. Since being in office, this government has been taking action and we're getting results. We've reinstated health targets because what
gets measured gets done. We're doing more operations. Last year, the health system carried out of one hundred and forty four thousand elected procedures, ten thousand more than the previous twelve months. We're moving resources back to the front line, cutting wasteful bureaucracy.
What needs to happen to the current funding model? What should be done to kind of fix it to make sure that those gps stay where they are in, stay put, and encourage new gps to train into the specialist area.
There's quite a few things, but fundamentally, first of all, in theory, the computation model makes sense, you know, having some payment to have a patient enrolled under your practice, but the model needs to reflect the needs of each patient more readily, so to take into account chronic health issues, for example, which aren't funded properly. So the funding needs to reflect the needs of the patients that we're looking after. That's first and foremost, so then we're able to actually
give the care to our patients that they need and deserve. Secondly, in terms of what's happening with our workforce as GPS, in general, your job is sized according to how much time you're spending seeing patients. It doesn't really take into account the amounts of time you spend doing vital, non patient facing work.
And the amount of.
That work has really increased, I've noticed it over the last few years. So in general, a recent survey by our college showed that for every four and a half hours and seeing patients, we generate around three and a half hours of non patient for facing time, and that's for following up on investigations you might have ordered, sending
referrals and following up on referrals. So it's all vital, vital work, but in general that's not funded, and if you're a GP owner, you would generally have to fund your employees to carry out that work, but then the practice loses money for it. So we've got to change that, and we've got to acknowledge the vital non patient work and pectation work that we do and also support gps
with their training costs, their ongoing professional development. Just as the hospital specialists are funded, it would be nice to have a similar setup for gps as well, so that in itself would make the career more attractive for people training to become doctors. And then finally, it's increasing exposure for medical students into general practice. I mean, I know when I was training, I probably spent less than ten percent of my time in general practice, and I think
that's true for New Zealand trainees too. So getting medical students exposed and spending a good amount of time working in general practice would encourage more people to come into the amazing profession.
Right So, at the moment, just the face to face patient time is funded and all of that extra work isn't funded. I mean, that doesn't seem to make sense. And also you said training in hospitals is funded, but extra training as GPS isn't funded.
No, we have to fund it ourselves.
Yeah, it's just the way it's the way it's been in New Zealand for some time. I think because as GPS and GP practice are their own small businesses, so all your costs have to come out of your own pocket. The hospital specialists are under a specific collective agreement through the union.
Essentially that.
Allows them to have some funding for their own professional development for instance, because.
Obviously it's important.
You know, you go to medical school, you do your postgraduate training and get your qualifications, but it doesn't stop there. You're always learning and we've always got to update ourselves and that costs money.
I read in a report that in Northland alone, preventable hospital visits cost over two point seven million dollars a year, with more than five thousand emergency visits that could have been avoided with early local doctor care. So should we get better at saving and redistributing that funding. It seems to me like that funding can then go towards GPS and those non face to face contact hours.
Absolutely, I think, you know, I'd love to get stuck in and look in more detail into alternative funding models. I have to do that in the future, but it makes logical sense to me that any money that's saved by general practice from patients not having to attend the emergency department, that saving could.
Then be fed back into a primary care.
So we're not asking for new money, but we're asking for the money that we're saving to come.
Back back to us.
And that would absolutely make sense to look at things like that in that way.
And the cost of going to see a GP is out of reach for a lot of keyways. Some might have thought that telehealth appointments might be cheaper alternative, but it costs around the same regardless of how long your appointment is or what form. What do you make of that?
Yes, the only way.
You can incentivize is by reducing the cost right for the patient.
You know, when gps haven't been.
Funded well enough to be able to afford to give the care to the patients that they need to provide, they've had no alternative but to increase the fee that they charge their patients.
And it's awful you're in that position.
And yes, it means many patients aren't able to afford to go and see their GP. So it's only by funding gps appropriately so they don't have to charge the patients as much that you can incentivize the patients to go and see their GP, and then you know, valuing that continuity of care. So that could be a specific target if we're looking at targets. So seeing how well we established relationships with our patients is another way to encourage people to go and see their GP.
GP's books are full in many parts of the country, Waiting time to see a GP are unacceptably long in many places, and the failure of primary health care to meet the basic needs of people is one of the if not the most important factors leading to pressure on EDS. Because what do you or I do when we can't get to see our doctor and we're worried about our health. We go to the ED. That is all we can do.
And your report talks about the issues with aging it infrastructure. Our inzed i've seen has reported this week that health end Z is pausing one hundred and thirty six digital projects. But do you want to see more investment being made in modernizing our health sector?
Absolutely, it's long overdue.
I think there are moves to do this, but we can't work in a system where we don't have access in real time to vital information for our patients. You know, as I mentioned in my report, as a patient, you'd expect that if you moved to a different parts of the country for work and you were lucky enough to be able to enroll with a new GP, that your notes would get through and come through easily to your
new but that's often not the case. If you went to a physiotherapist for an injury and that was lodged through ACC, you would expect that your GP would get those that information and the ACC number, but that's not the case. There's simple things that could be done whereby information is more readily shared, both within primary care but
also between primary care and the hospital. Often hospital IT systems don't talk to each other, so hospitals in different regions their IT systems don't talk to each other, and then also then don't talk to you primary care. We've got some shared electronic records in different parts of the country, but there's not one uniform record.
Yet and PRA Bannie, if you could talk directly to Health Minister Simeon Brown, what is the one thing you'd like to get him started on tomorrow.
First of all, his announcements of increasing some funding to primary care is great. It's a great start, but I would love for a real focus on reorientating our health system around the foundation of good, well funded, well resourced primary care. So build our health system around that and a bottom up approach rather than the top down approach which is hospital first and then primary care is kind of as an after thought. We are the backbone of
the health system. So despite the issues that I've talked about with our workforce and lack of funding, we're still in primary care. In general practice are seeing twenty one million.
Plus patients a year. But the more and more stretched.
We are, the more pressure then gets put back into the hospital system, and the only way to relieve the hospitals is to improve the funding and resourcing of primary care.
Thanks for joining us, Probanni, thank.
You, thank you for having me.
That's it for this episode of The Front Page. You can read more about today's stories and extensive news coverage at enzedherld dot co dot nz. The Front Page is produced by Ethan Sills and Richard Martin, who is also a sound engineer.
I'm Chelsea Daniels.
Subscribe to the front page on iHeartRadio or wherever you get your podcasts, and tune in tomorrow for another look behind the headlines.