Health boss says ‘chronic underfunding’ must prioritise primary care

Health providers are struggling to meet increasing demand for services, and say more money upfront may help with better outcomes in the long run.

This comes as most general practices are considering fee increases, people are waiting longer for elective surgery, while some patients are queueing for hours to get a same-day appointment.

Tāmaki Health chief executive Dr Lloyd McCann says there is “massive demand” for services at clinics such as Local Doctors Ōtara, where people arrive as early as 6am to be at the front of the line.

“One of the unfortunate consequences of that we're seeing is that a number of our patients will turn up very early to get to the front of the queue as far as the front of the queue is possible to ensure that their wait time is minimised so that they can get the healthcare they need.”

Labour Party health spokesperson Dr Ayesha Verrall said the health system was being “strangled” by cost cutting measures and services were doing the best they could.

“Those queues exist because they're meeting a need that's not meant elsewhere and that means that there needs to be more services at that low cost end of the spectrum for people to get the care they need.

“That stream of funding is under review by the government and it may be that it doesn't survive, and that's really troubling to those particular types of practices, lots of union health practices around the country, because a lot of people depend on them for their access to care.”

Health Minister Dr Shane Reti said they were looking at ways to address challenges in the sector, but he admitted it would not be a quick fix.

“I think the GPs are doing it tough. I think they have been for a period of time.

“This situation didn't just come up in the past nine months, nor will it be fixed in the next nine months.

“There's issues around recruitment, there's issues around retention, there's issues around remuneration, and fundamentally, we just don't have enough primary care doctors.”

Photo/File

Reti said the government was working on making it easier to recruit doctors from overseas, along with having separate facilities for acute and elective surgeries and spreading the workload across other roles.

“We should also look at those allied professionals who can help reduce the burden on GPs, nurses are able to do some parts of what general practice does.”

Speaking to William Terite on Pacific Mornings, Reti said using more advanced technology could also be an option.

“What role can telehealth play? What role can artificial intelligence play for appointment triaging and for in-box management?

“For example, there's some evidence that GPs may be spending hours of non-clinical face-to-face time, just managing their inbox. Well, if we can use some smart technology to reduce that, so there's more face-to-face time, that gives us more capacity.”

Putting funding where it is needed most

Capitation rates, or how much clinics are funded per patient, increased by four per cent earlier this year, but McCann said New Zealand needed to demand more for primary care.

“If we invest in this component of the sector, there are actually huge savings on the table for the sector downstream, so we'll be able to reduce spend in hospital and secondary care, the broader societal benefits are also going to be significant.

“If people are not sick, they'll be able to look after their families, they'll be able to go to work. It's a no-brainer really.”

The coalition government has committed $16.6 billion across the next three years towards health, with $531 million going into primary and community care.

Reti said it was the “single biggest increase in health ever” before the dire overspend of Health NZ Te Whatu Ora was revealed, leading to the board being sacked.

“Unfortunately, that's now balanced by one of the scariest debts that the previous minister had responsibility for, the $1.4 billion that unravelled and was revealed to us around about March this year. That's creating a challenging situation which the Commissioner is working his way through.”

McCann said funding had been an issue for a long time.

“The bottom line though is, and it's not just this government, we have chronically under-invested in this part of the sector.”

He said the government was capable of coming up with funding, such as their $600m u-turn on funding for cancer treatment, adding that investment for frontline services should be a priority.

“If we're not able to get people into the system and to the right clinical team and clinician in a timely manner, all of these cancer drugs in the world are not going to make a difference to their outcomes.

“So it really is about fixing the front door and ensuring the money is getting to this component of the sector rather than to other areas because what we'll see is downstream savings and broader societal benefits as well.”