By Ruth Hill of RNZ

Nine out of 10 family doctor clinics plan to increase their fees - if they have not already just done so, according to a new survey out today.

The General Practice Owners Association (GenPro), which carried out the survey, said primary care was "in crisis", squeezed by rising costs, high patient demand and staff shortages.

GPs receive annual "capitation" funding from the government for every enrolled patient, with some variation according to age. The analysis shows patient co-payments have risen at a faster rate in recent years.

Its August survey of 244 practices - a quarter of the total number in New Zealand - found:

• 89 percent had recently increased or were about to increase fees
• 70 percent were in a worse financial position than a year ago
• 83 percent worried about their long-term viability

GenPro chair Dr Angus Chambers, a Christchurch GP, said nearly 60 percent of practices reported vacancies for doctors and nurses.

"So people can't go to see their GP or they have to go to the emergency department.

"The other side of it is it's actually going to cost the system more in the medium and long term, as we know that investment in primary care saves money and saves lives."

Independent analysis by accountancy consultants Grant Thornton, commissioned by GenPro, found government funding increases had fallen short of cost pressures 10 times in the past 20 years.

This year's four percent increase represented the largest shortfall in 20 years.

Workload had increased, with patient attendance up more than 20 percent in the 10 years to 2022.

Chambers said the government had "consistently dishonoured" its own own contractual commitment through primary care organisations, to "maintain the value of general practice funding".

"If the government had followed the agreed and independent methodology for assessing cost increases, funding for general practices would be $102 million a year higher - it's the minimum to honour their commitment.

"As a result patients are paying the price through higher doctors' fees and lost access to their general, urgent, mental health care."

Patients suffering

The prospect of higher GP fees is daunting enough - but the biggest barrier for many patients is just getting an appointment.

Lower Hutt support worker Michael has not seen a GP in more than 10 years and is no longer enrolled anywhere.

"There was always a three- to four-week wait time [to see a doctor], so I gave up. Then my one closed down and I got an email saying they would update information where to go, but they never did."

His client, Riana, who was blinded after being shot in the head at 18, was thrilled to have finally got an appointment with an eye specialist after months of waiting.

She said she usually waited two weeks to see a GP.

"You're only there for like five or 10 minutes and then you're out. [It's] no good."

Clinics relying on locums

The doctor shortage is set to get worse, with half the country's GPs set to retire within six years.

Northland GP Dr Kathy Bakke will be 70 on her next birthday but does not know who will replace her.

There was evidence that people with the same doctor over several years lived longer, healthier lives, she said.

"But gosh, I don't know how to do continuity of care when I have somewhere between six and 12 locums cycle through here every year.

"Patients don't like seeing strangers, but hey, a locum is better than not having any doctor at all."

Bakke's practice - like nearly one in four (24 percent) nationwide - has closed its books to new patients to maintain good care for those it already has.

According to the survey, slightly more general practices were accepting new enrolments - 36 percent compared with 29 percent in 2023.

However, some in the sector have suggested that could be partly driven by funding shortfalls, with practices forced to enrol more patients "to make ends meet" - despite increasing wait times.

Forty-one percent of practices had reduced services in the last six months (better than 54 percent the year before); about 70 percent were now charging for services that were previously free, like specialist referrals.

Wellsford GP Dr Tim Malloy said there had been multiple reports in recent years warning of the crisis in primary care, particularly the ageing workforce.

"The workforce issues that we have been confronting for the last 30-odd years are currently coming home to roost and our system is failing," he said.

"As a consequence, the recovery period for our workforce is going to be significant. You cannot train someone to deliver urgent after hours care in rural New Zealand overnight."

Training a GP takes at least 11 years.

Malloy's practice shut its overnight doctor service in March, and he said there were many other regions that lacked adequate after-hours cover.

"We have shifted the acute care to the urgent care services and then ultimately to the emergency departments in the hospital. And at the end of the day, that will translate into patients dying."

Health minister promises action

Health Minister Dr Shane Reti, a former GP himself, acknowledged the long-standing pressures on primary care.

"It has been a challenge for many years over multiple governments and is one I am absolutely determined to make inroads on."

Government actions included:

• 25 new training places for GPs this year
• A business case for a third medical school
• The largest GP training cohort ever of GP registrars (about 230) completing training.

Reti said it was vital to look at new ways of working, including telehealth, admin technology and other health workers (such as paramedics, nurse practitioners and healthcare assistants) to "support" general practice.

Meanwhile, Reti said he had asked Health NZ to explore "a targeted international GP recruitment drive".

Revamping the funding model was also under consideration.

"For several years GPs have asked for structural change to the capitation formula so that funding better follows patients and aligns better with patient complexity. The 2022 Sapere report is quoted as a key document. I agree with its findings and have already tasked HNZ with developing an implementation plan."