A life-changing condition left undiagnosed illustrates the pointy end of the GP workforce shortage. MARY ARGUE reports on a scarcity crisis that will require a multi-faceted fix.
When Jane [not her real name], received a diabetes diagnosis earlier this year, she said it was a welcome relief.
“It’s taken two years, and it’s been stressful with so much time off work – trying to explain to your boss, ‘I’m just not well’, and you can’t get any answers.”
By that time, she had spent years trying and failing to find the answer to her ailments at Greytown Medical Centre [GMC].
The “absolute exhaustion” was so debilitating she could no longer drive and felt her job was in jeopardy.
“In the four years I was enrolled, I saw six GPs [general practitioners]. I would start the ball rolling with tests and call for a new appointment, only to find out the doctor had left.”
Jane points to this “revolving door” of GPs as a reason for her delayed diagnosis – which finally came after enrolling at another practice where she received full diagnostics and four consecutive appointments with the same doctor within a month.
Other GMC patients and residents have raised similar concerns about the workforce shortage at the practice.
At a meeting in March, the medical centre came under fire from patients frustrated at the difficulty in seeing a doctor and, the then two-to-three week wait time for appointments.
At the time, the medical centre admitted it had been struggling to recruit staff, and since the end of last year had been juggling appointments between one part-time GP, three nurse practitioners, and online health care service Practice Plus.
The meeting highlighted the difficulty of finding staff amid a global GP shortage, which the region’s general practice provider – Tū Ora Compass Health – said is “often more challenging in regional and rural areas”.
Tū Ora chief executive Justine Thorpe confirmed at the end of last month that recruitment efforts for clinical staff are ongoing at Greytown’s general practice, but said the addition of an extended care paramedic – managing acute and same day appointments – has received “very positive” feedback.
Thorpe also noted that one of GMC’s nurse practitioners has increased their hours from 1.5 days to four days a week, and said the medical centre will be holding another public meeting next month.
However, she declined to comment on concerns raised about a lack of continuity of care.
For Jane’s part, the medication she is on a month after her long-delayed diagnosis has been life-changing.
“I have sat in the doctors and cried and felt so utterly full of despair. It was such a relief to finally hear, ‘We know what this is, and we can move forward’.
“I’m no longer in chronic pain. Having a diagnosis has turned my life around.”
General Practice New Zealand [GPNZ] chair Dr Bryan Betty maintains continuity of care is a big predictor of better outcomes.
“Seeing the same practitioner is often quite an important predictor in terms of health and what actually happens, so that is a really important thing.”
He said in its absence, practice management systems are key.
“Making sure everything is logged in the right way so that you can know the past history and medications they might be on and the problems they’ve had is very important, especially when there are workforce shortages.”
The current workforce shortages, Betty said, have been decades in the making, and the service needs urgent investment to address the critical scarcity of family doctors.
It’s a position outlined in a 2022 report from the General Practice Owners Association of Aotearoa [GenPro] grimly titled: ‘On the Brink – saving New Zealand’s family doctor service’.
GenPro chair Dr Tim Malloy said the nation’s primary care service is at a critical crossroads, and patients are at risk due to an “unprecedented exodus” from the service – driven in large part by retirement and underfunding.
A 2020 GP workforce survey found half of practice staff intended to retire in the next decade, with 14 per cent in the next two years. Meanwhile, the Sapere Research Group’s review into GP capitation [per person funding] concluded practices are underfunded, with a 9 per cent increase needed just to stand still.
Malloy said the current climate has left many New Zealanders either unable to enrol in a general practice, or facing unpalatable wait times – a reality familiar to many in Wairarapa, where the books are currently closed at four [Martinborough, Kuripuni, Whaiora, and Masterton Medical] out of the seven general practices.
The region’s largest clinic, Masterton Medical, told the Times-Age in April that it was four GPs short and wasn’t accepting new patients until
the vacancies are filled.
But a solution is unlikely to materialise overnight, with GPNZ stating its disappointment in the 2023 Budget, which it said offered little to address the “desperate and growing situation” of people unable to access the care they need.
Betty said the organisation is still lobbying for a funding model that addresses, among other issues, rurality, with the organisation clear that a five per cent funding uplift is “not anywhere near enough to address the cost pressures on general practices”.
Betty said solutions to the GP workforce shortage – which developed over the past 20 years – will require a multi-faceted approach and a coherent strategy, with sustainable funding model paramount – “especially for rural areas”.
“There is a need for more practitioners to be trained in NZ. We need to encourage medical students who come from rural areas to take up medicine.
“We know if you come from a rural area you tend to go back into a rural area,” Betty said.
“Secondly, we need to open up to overseas trained doctors. There have been some issues in terms of immigration and we need to free that up.
“It’s going to take time to sort out. There are a lot of discussions on the national level about how to try and address the issues we’re facing.”
In the meantime, Betty said general practices will need to follow Greytown Medical Centre’s example and embrace multi-disciplinary teams and robust management systems.
“Having practitioners who can do different things is actually a good thing and something we should really develop in the country, something that we should be proactive with.”
