With about 10,000 patients not enrolled with a GP in Taranaki, and almost half of the nation’s general practice doctors retiring in 10 years, things are looking dire. This has been acutely felt in Waitara of late, but local GPs are banding together with creative solutions to take on patients both now and into the future.
When 4000 Waitara patients farewelled their last doctor in autumn, a Maori health organisation already stretched to the brim took on the extra load.
Tui Ora clinical director Dr Bernard Leuthart’s team of two full time and one part time doctor were struggling to give adequate and timely care to its 4600 patients on its books.
“It’s beautiful work, general practice,” Dr Leuthart says. “But there hasn’t been a strong focus on what we’ve been asking for, for years.”
A recruitment drive by Tui Ora to encourage doctors out from the big city hospitals into community health, delivered one full-time equivalent and another part-time doctor into open arms.
It was just in time for the hauora (wellbeing) focused clinic to expand its presence in Waitara, almost doubling its patient load to 8600, with added patients from the Waitara Health Centre.
Waitara Health Centre’s last remaining GP had just resigned and its previous owners Omnihealth were forced to remove their presence from the practice.
“It’s madness,” Omnihealth managing director Mark Wills says of the lack of support for GPs from government level.
He’s been frustrated there is a mismatch between the well-qualified doctors trained overseas who have immigrated but haven’t been able to get into general practice here where they are so desperately needed. Especially for a nation that relies on 40 percent of its workforce coming from overseas, according to the Medical Council of New Zealand.
The problem is a nationwide and complex one, but has been acutely felt in Taranaki, particularly in northern New Plymouth where general practices have been shutting their doors, doctors have been reaching retirement, and not enough students have been showing interest in replacing them.
“It’s a difficult position to be in,” Dr Leuthart from Tui Ora says. “We always try to respond where we can.”
Despite not physically being able to take on more patients, his clinic, and many others, will do so anyway out of moral obligation.
“We try to respond to urgent need, whether it’s a mum who’s just arrived with her child, or a prisoner who’s just been granted bail, we will tend to say yes, we will take them, because it is hard.”
It means GPs will inevitably work longer hours to cope with demand, or there will be unavoidable lags in patients being able to get in to see their doctor.
“There are lots of factors behind that, including lots of pushdown from secondary care into primary care,” Dr Leuthart says.
“Hospital clinics are discharging patients with long-term conditions onto GPs, who have less capacity for managing those patients over time. It’s become harder to do.”
Just released Census data shows the Taranaki population is growing, sitting at 126,015 as of 2023. In the same period, the number of patients on Pinnacle Health’s books, the largest provider of healthcare in Taranaki overseeing 30 clinics, has reached 116,386.
The number of doctors working in Taranaki hasn’t increased at scale.
There are Te Whatu Ora GPs and other private GPs in Taranaki servicing some of the population.
But doctors spoken to by Live say, and the numbers suggest, a shortfall of at least 10,000 patients, despite best efforts, who still aren’t enrolled with a doctor.
An accepted reasonable GP to patient ratio by many in the sector is one full time equivalent GP for every 1,600 patients, figures from the NZ Medical Council show.
Their last workforce survey showed Taranaki has 65 full-time equivalent GPs. But for a population of 126,015, Taranaki needs 78.75 doctors to keep that healthy GP to patient ratio. That means 13 more full-time equivalent GPs are needed now. And more for when our current stock of GPs retires, especially as our region continues to grow.
AN AGEING POPULATION
It’s not only the GPs who are ageing — patients are living longer and with older age comes increasingly complex health needs.
Patients with debilitating chronic conditions are suffering from a loss of independence due to a range of issues whether it be gynaecological, orthopaedic or joint arthritis. Specialists are sending patients back to their GP to be managed long-term, but without adequate resource.
“The system is squeezed,” the Royal New Zealand College of General Practitioners (RNZCGP) medical director, Dr Luke Bradford says. “In the old days patients would just come in for a chest cold and be prescribed a round of amoxycillin and away they’d go. Now we’re dealing with much more complex needs.
| “Patients with concerning or debilitating symptoms are having to wait several weeks to see their GP and that is having “massive life impacts”, Dr Bradford says. “There are then further delays having them seen within the secondary care system. |
“We know that for every $1 you spend on a GP, you save $14 on the secondary health system (hospitals and specialists) and the health budget needs to be reprioritised towards primary healthcare.”
WHERE ARE THE YOUNG DOCTORS?
The scope of the GP has changed over time for various reasons. There are many factors at play here.
There’s been a dwindling workforce due to a lack in focused funding to encourage medical students into general practice and keep them there.
It’s no longer routine practice for medical students to do work experience in general practice. The increased paperwork and a lack of remuneration have made general practice less attractive.
As such, not enough medical students have been choosing to specialise in general practice, and the tap to bring in doctors from overseas was turned down during the covid pandemic.
The government has responded by adding 300 new registrar placements a year to stem the falling ratio of GPs to patients. Plans for a proposed Waikato University medical school are still up in the air. It was hoped it would sharpen the focus on rural and regional community health. If it goes ahead.
FUTURE FOCUSSED
The average age of general practitioners in New Zealand is now 54, meaning a mammoth 45 per cent of the national GP workforce is due to retire in the next 10 years.
“Four years ago that figure would have scared the living daylights out of me,” CareFirst Group chief executive Leigh Sampson says. CareFirst has clinics in Moturoa, Westown, Merrilands and now too, Bell Block, in response to growing demand.
As of this winter, CareFirst is stepping foot into the Bell Block community to help meet the urgent need felt by a lack of GPs in Bell Block, Strandon and Waitara. It’s establishing three full-time GPs in a new clinic space at the Working for Health occupational health service on Corbett Rd, Bell Block.
Working for Health owner Jessica Clout is thrilled to be sharing facilities with CareFirst. She says most of her occupational health clients aren’t enrolled with a GP or find it takes too long to travel from their workplaces in industrial Bell Block to head into town for a doctor’s appointment.
“Those who have immigrated to New Zealand to work or moved from out of the region are more highly represented as we have had a shortage of available GPs taking on new patients for some time,” says Jessica.
CareFirst has a healthy ratio of 20 GPs for its 22,500 patients, which at 1125 patients to a doctor on average, is better than the national average but is still a challenge.
“We’re very fortunate, we have worked really hard and gone without some things to be able to invest in our clinical staff.”
CareFirst is taking in fourth, fifth- and sixth-year medical students from Auckland University for work placement, to get more students GP experience. Their Grow Your Own programme has seen 10 GP registrars be taken on as employees and become permanent GPs with the group, working under supervision within clinics as they gain their hours.
“This is one of the things we’re doing to help New Plymouth and the country with the looming GP shortage,” Sampson says.
Another initiative is CareFirst’s involvement in a pilot project with the Medical Council’s NZREX certification process, where qualified doctors from non-English speaking countries can sit the New Zealand medical exam and gain supervised employment from participating general practices. The usual process is for registrars to spend two years in a hospital before they gain supervised work experience in general practices.
CareFirst has a French doctor currently employed undertaking their community placement with them, and a Fijian doctor on the pathway and they hope to take on more. Sampson adds that a lot of NZREX doctors are not working because they haven’t been accepted into placements.
A TRUST ISSUE
Complimentary services, community nursing, nurse practitioners, nurse prescribers, and Telehealth consults, all alleviate some of the workload from GPs. These services are most helpful for a familiar patient who has a complaint they don’t need to be physically seen for, such as a follow-up. Skilled nurse practitioners and prescribers are particularly valuable, especially for after-hours and emergency care.
But for continuity of care for patients, and for the varied and complex health needs that patients have now, many still require in-clinic contact with a GP.
“There is a large number of Maori patients who are unenrolled for many reasons,” Dr Leuthart says.
“There’s a long grief in Taranaki between Maori and the state that’s 200 years old, and the hurt and lack of trust in a Pakeha system.”
Enrolled at the Westown clinic alone, there are 300 – 400 mental health clients under Te Whatu Ora contracts, and many of the 4600 general practice patients have varying needs exacerbated by unhealthy, overcrowded homes, malnutrition, and addiction issues.
Mental health is estimated to make up 40 percent of GP appointments across the board.
Tui Ora patients are charged a subsidised fee of $19.50 per 15-minute visit, as opposed to the standard $50 general practices charge for those who don’t hold community services cards.
“Still, people are reluctant to book the double appointment necessary and spend $40, even though they need it,” Dr Leuthart says.
In those 15-minute patient slots, there will be a list of issues to deal with and the GP must ask the unfortunate question of “which one is the most pressing today?”