Health Minister Simeon Brown has announced a spate of funding boosts aimed at beefing up NZ’s primary care practices. How important are these? We have some Hawke’s Bay practitioner reactions.

It seems the Government has recognised the reality that overstretched capacity at the primary care level simply spills over into even more expensive – and preventable – hospital visits. 

Our GPs and their complement of nursing and other caregiving services are – and should be – the primary gateways into the health care system. Inability to access these services in a timely manner leads to many preventable ED presentations or to illnesses simply remaining untreated, with conditions worsening and more costly care ultimately required.

According to the Government announcement, GP teams (including urgent care teams) deliver 24 million ‘patient encounters’ a year, compared with 1.4 million ED visits and one million outpatient visits a year.

But these practices have been chronically understaffed and underfunded. 

Minister Brown’s initiatives seem to address needs that have been identified repeatedly:

• 100 clinical placements for overseas-trained doctors to work in primary care.
• Incentives for primary care to recruit up to 400 graduate registered nurses per year for five years.
• A $285 million uplift to funding over three years for general practice from 1 July, in addition to the capitation uplift general practice receives annually.
• An increase in the number of training placements for doctors at medical schools by a further 25 each year, meaning 100 more doctor training places will be added over the course of this Government.
• Up to 50 New Zealand-trained graduate doctors a year to train in primary care settings.
• A new 24/7 digital service for all New Zealanders to be able to access online medical appointments.
• Up to 120 training places for nurse practitioners specialising in primary care.
• Accelerating advanced tertiary education for up to 120 primary care registered nurses.

More detail on each initiative here.

The Government’s media release promises these benefits:

• New Zealanders will find it easier to get appointments when they need them, because general practices will take concrete steps to improve access. This might include things like extended opening hours, access via e-consults, and same day appointments for urgent care needs. 

[The latest New Zealand Health Survey found 25.7% of adult New Zealanders reported being unable to access their GP in a timely manner and 18.5% of children experienced difficulty accessing GP services.]   

• Patients will get better care for long-term conditions, which means they are less likely to need to go to hospital in the future. Reducing cost growth in the hospital sector is an explicit objective of this funding.
  
• Funding for outcomes that support Government priorities and targets will help improve childhood immunisation rates and support earlier detection and better treatment of cancers. 

The primary care funding boost will be doled out to practices over three years at $95 million per year, starting July 2025. 

Local practitioners BayBuzz asked to comment generally expressed ‘wait and see’ caution … cash support is welcome and overdue, but it’s a slow drip relative to need.

Said the clinical director at one major HB practice: “Any injection of funding into Primary Care is welcome, but without the detail, it is difficult to know what impact this will have on service delivery. We look forward to learning more about the funding available and how it will benefit the community and their access to primary care services in Hawke’s Bay.”

Another HB practice was skeptical: “It’s nice to see that the problems for primary care have made it onto the government radar after multiple rounds of reports demonstrating a 13% underfunding generally in primary care over the years, in some cases 300%; especially knowing that every $1 spent in preventative care in primary care saves $14 in secondary care. 

“We are yet to see how the increased funding is going to be allocated or accessed and so it is difficult to comment fully. It would be a shame if it were to follow the same pattern as the NHS where it has led to significant problems and worsening of access through poorly thought out and applied targets.

“We look forward to hearing more about this investment, hopefully through co-design with general practice and not hearing about it via the press.”

From a retired HB GP: “Like most of the Government’s announcements, the devil is in the detail. Sounds promising, albeit that it’s come very late. I’m not quite sure of the reason behind the timing, as General Practice has been struggling for years. I’ve long advocated that the problem with ED overcrowding is due to lack of accessible, and most importantly, funded primary health care. One of my fervent hopes is that cash strapped Kiwis will be able to afford to see their primary care team more often.”

And from a senior health executive: “Absolutely, this is long overdue, and they need to do even more. Primary care has been neglected by successive governments, bizarrely in my view more by Labour-led governments who seem to be suspicious of General Practice because it is a ‘private business’. You will not make progress in his [Minister Brown’s] other priorities unless you really invest in primary care. The other significant announcement he made was about increasing localisation which is again very positive.”

With $95 million per year in Minister Brown’s boost for general practices, that’s about $4 per ‘patient encounter’ or on average $95,000 for each of NZ’s approximately 1,000 general practices (of course these vary from solo practices to large group practices). 

Is that enough to materially improve access to or the depth of care for the 95% of NZ adults currently enrolled in the system?

National GP advocacy group General Practice NZ called the measures “a vital first step”. “We have long called for greater investment in general practice to address growing pressures. While there is still a lot more to do, today’s announcement certainly makes us feel heard,” said GP and Chair of GPNZ, Dr Bryan Betty.

“When people can’t see their GP in a timely manner their health can deteriorate which can lead to more serious conditions and increased pressure on hospitals. This funding acknowledges that primary care is a critical part of the solution.”

Finally, from Irihāpeti Mahuika, CEO of Health Hawke’s Bay: “HHB welcomes the recent announcements of extra funding for primary care services. A well-funded and well-staffed primary care system improves the wellbeing of our community and takes pressure off hospitals and emergency departments. We look forward to having further details on these announcements in the near future.

The general consensus … Better stay tuned!