With patient wait times becoming “dangerous”, Katikati Medical Centre has closed its books to new patients.

The town’s medical centre has joined other general practices across the country in turning away new patients due to poor funding.

Katikati Medical Centre put a post on its Facebook page early this month letting the community know of its decision and why.

Clinical director and GP Vicky Jones said they were frustrated at having to do this, but their patient wait time was six weeks for a routine appointment.

“This is not okay, this is why we have closed our books. We need to be able to provide a service to those patients already registered with us.”

Their decision was essentially due to “a lack of Government investment over many years – resulting in chronic underfunding to general practice making it hard to recruit and retain staff”.

She said the wait time was becoming dangerous and they’re not alone in having these long wait times.

“We worry that people will have important diagnoses delayed or simply not come because it just feels too hard.

“Especially if they can’t even enrol! We are very frustrated.”

Jones said many GPs across the country were quietly quitting and doing fewer sessions or moving into niche private areas as pay, terms and conditions did not compare to their hospital peers, and they were behind Australia.

GP Vicky Jones says primary care needs to be better funded to keep the population healthy. Photo / Anna Menendez

GPs get funding from capitation (a per-registered-patient payment that varies depending on age/sex) and from patient co-payments.

“If capitation increased and we could pay all our staff comparably to Te Whatu Ora, more staff – nurses, doctors and admin – would be enticed back into general practice work.”

Last year the Government’s capitation funding for family doctors increased to 4% and many GPs across the country said this was too low to meet cost pressures.

“What choice do medical centres have but to put up co-payments if they want to stay in business?” Jones asked.

There is a limit on the amount GPs can put up co-payments every year.

Fifteen minutes of consultation time – the standard for medical practices across New Zealand – was not enough, Jones said.

“Trying to manage complex patients in 15-minute blocks, manage their labs and referrals, look after them intensely for the year or two it takes them to be seen by secondary care clinics and then manage fallout when they are discharged too early, has led to high numbers of GP burnout.”

There was also administration such as completing forms, prescriptions, lab results, referral letters and speaking to peers or hospital staff.

“Fifteen minutes is simply not enough to be doing all these tasks. GPs are therefore doing a lot of this work in their own unpaid time.”

Jones said with very long wait times, they worried that people would have important diagnoses delayed or simply not come because it felt too hard.

GenPro (General Practice Owners Association) chairman Dr Angus Chambers said communities would be facing the loss of their medical, injury and mental health care from GPs.

“We will not only see closed books but practices closing,” Chambers said.

“Closing books is a difficult decision for many practices as they do not like the idea of people in their communities not being able to access general practice healthcare.

“This is both an ethical decision as well as a pragmatic one. Ethically, if you enrol too many patients it gets harder to deliver quality care and wait times get longer. You can deliver on the promise of looking after your patients well. Pragmatically the workload from too many patients gets overwhelming, GPs get burnt out and they may leave the practice if they are not tied to it.”

Commercially speaking it made sense to enrol as many as possible, he said.

“You still get the capitation even if you provide a poor service. We do see some services around the acting like this.”

Another aspect was poor workplace planning which had contributed to staff shortages alongside poor funding, he said.

Dr Angus Chambers said poor funding for general practices will mean not only closed books but also practices closing. Photo / George Heard

Health New Zealand responds

Health New Zealand Te Whatu Ora living well director Martin Hefford said their data showed they continued to experience high rates of patient enrolment.

“We recognise that primary care is managing workforce and resourcing constraints, resulting in some being unable to enrol new patients. However, despite these pressures, enrolment has remained at around 94% of the New Zealand estimated population.”

Primary healthcare organisations were working with general practices to encourage enrolment based on capacity constraints and local priorities, he said. Health NZ was monitoring which general practices had closed books.

Health NZ reviewed capitation funding in line with costs yearly.

“This year’s annual uplift was 4%, with a 7.76% increase in average allowable fee increases, giving a combined average 5.88% total revenue increase. This matches the independent estimate of general practice services' cost growth over the past 12 months from Sapere Research Group.”

Initiatives were under way to increase the GP workforce including an accommodation allowance for trainees, increasing the number of GPs trained per year to 300 by 2026 and funding for practices offering community-based placements for post-graduate year one and two interns.

Grey Power weighs in

Grey Power national vice-president David Marshall said Grey Power remained “extremely concerned at the significant decline in medical services nationally, and especially the under-investment in primary care”.

“We acknowledge the challenges that general practice is facing with the need to close books, and appointment times being extended. However, we are concerned that many seniors learning of the appointment delays may postpone seeking an appointment and remain unwell for too long, leading to potential acute events, hospital admission or death.”

Katikati has the highest number of seniors among Western Bay of Plenty towns and Tauranga Hospital is more than half an hour’s drive away.

Marshall said access to timely medical care was critical for community wellbeing.

Looking ahead locally

Katikati Medical Centre has instigated plans to help the local situation.

It has started a GP triage, trialled last year, for those who need to see a doctor urgently. Patient concerns are either managed by phone or they are brought in to see a doctor in person that day, or they have an appointment made semi-urgently or routinely depending on their problem.

The centre also has two locum doctors working for them for two months and Dr Andrew Cox will return in April. They’re actively trying to recruit more GPs.

“We need more doctors, simple. And we very much want doctors,” Jones said.

“The Government just needs to put their money where their mouth is and fund primary care [with] what it needs to keep our population healthy. Enough of this ambulance at the bottom of the cliff medicine.”

For a list of alternate providers for patients in the area see www.katimed.co.nz