Those who do manage to get a consultation with a GP seldom get assessed as a whole person, seeking professional advice on how to increase their health. Instead they are treated as a faulty biochemical machine, and their symptoms either masked with pharmaceuticals (eg steroid cream to suppress eczema) or dealt with by swapping out parts (surgery).

When was the last time a GP asked any piercing questions about your diet? Your housing situation? Your your state of mind? Your home/ work life balance? Your connectedness to extended family and neighbourhood? Your exercise habits? Potential environmental influences on your health? Yet there is peer-reviewed medical research that shows all these can be causative or aggravating factors in illnesses that are routinely written off as a simple body failure, and treated with drugs or surgery.

Perhaps the catastrophic lack of primary care you describe could be addressed by allowing people subsidized primary care visits to the healing practitioner of their choice, whether that be an allopathic (drugs and surgery) doctor, naturopath, chiropracter, herbalist, acupuncturist etc? Obviously to be eligible for subsidies the practitioner would need to hold a recognised qualification in their field, including the same studies in things like anatomy and physiology that allopathic doctors learn in basic medical training, and ideally significantly better studies in nutrition and environmental medicine than allopathic doctors currently receive.

But the problems of the GP workforce is reflected in many other aspects of life here, the fact, for instance, that politicians can’t even agree a strategy for pensions is plain crazy. I’ve been a baby-boomer all my life, politicians their advisors have had at least 50 years to make sure that my generation will not be a problem for society, but apparently, for politicians, even 50 years is not long enough notice to come up with a cross-party, generally agreed policy.

Primary health care in NZ is a mess, that it works at all is a tribute to the hard work and dedication of the professionals who work in the health system. . Midwifery services hived off in a very political take over, thanks to Helen Clark, the Community Card System, expensive to run and of limited if any benefit, the ACC adding it’s spoon to stir the mixture, political short-termism and dogma – for instance the National Party ruinous reforms of the 1990′s, a far too high fee structure for GPs which is a real impediment for the poorer population to get help, fees in primary health, but not for secondary, which creates problems for ED departments around the country, fragmentation of many bodies, Maori, charitable, trusts, DHB, the beginnings of corporate ownership etc. etc.

I don’t know the answer, though. There certainly won’t be any simple one. Some suggestions to get on with

PHOs and DHBs need to be rationalised.
Salaried GPs, with paid holiday leave, paid locums, paid study time, government owned premises and the promise of an adequate pension would attract a lot of younger GPs who will see some security in such arrangements.
Move fee-earning GPs to a full capitation system, with locums/holidays/pension entitlements,
Scrap the Community Card System
All GP consultations to be at minimal (token cost) and free in certain areas.
Much greater use of nurse practitioners.
Re-integration of maternity care throughout the country.

All this to be paid for by an increase of general tax revenue, I would favour an increase in income tax, a wealth tax, inheritance tax and a two-tier GST system, eg essential goods and services say 12.5% and luxury items (cars, watches, jewellery, travel, entertainment) a 25% GST), others can argue about the details. I look at it this way, an inefficient, fee for service, uncoordinated service, is costing this country hugely, nobody wants to pay tax, I know, but in fact, the country as a whole would likely gain financially and our health, particularly of the lower deciles, would massively improve. .

The whole medical system in crisis has just developed with a stronger and more intensive focus on money. Meanwhile in the dark DHB bat caves corrupt usage of public funds increased with no accountability thrives.

The DHB’s( in my opinion and through first hand experience) have cultivated an extremely inhuman way for the clinicians to view some of their patients. In reality we have no medico legal system in place ( the HDC does not function and frequently supports the violation of patients rights with their “toilet paper” responses and expensive lieawyer ) .
Working with the greedsters, many providers have lost sight of even the basic responsibility to provide appropriate medical services for patients, others cannot get funding for patients care or medical needs and do not rock the DHB gravy boat.
I am not saying ALL GP’s obey the DHB&PHO profit mantra, but when the corruption and greed is stacked so high to the top it takes a courageous GP (and a real doctor) to move against profit mongers .As more and more doctors get f’d in the A maybe more will see how wrong things are and want a real change.

People often wonder how the doctors in Germany could have done such terrible undoctorly things, well we can see they felt pressure to do wrong and did it . The pressure today is not fear for ones life, but a hypnotized state of apathy towards patients and fear of the HDC/govt scape goating them if they speak out.

At the same time the hopes of NZ youth to gain independence are crushed on a reduced wage which is even under min wage, the GP’s get a salary increase to secure their unquestioning loyalty to the profit mongers.

Getting onto the books of a GP with a good reputation is difficult. Most have closed their books and have a waiting list. There is always room on the books of the gps who are no good, have a bad reputation or are just plain obnoxious to their patients (sorry, I mean ‘clients’).

The good news is that we are getting some newer GPs from overseas who are smart, young and treat their patients well. The downside is that some of the Gps imported from overseas are the opposite but have not yet got a reputation locally to prevent patients from going on their books.

The lesson is to ask around and be prepared to do your homework before you move house. Be prepared to change doctors if you have problems. Once you have found a good GP, *only see that GP*. Don’t give into the pressure put on patients (I mean ‘clients’) at medical centres to see ‘any old doctor’. That causes loss of continuity of care. Locums *do not read the files of those they are seeing* and spend most of the consult taking history and ordering tests that have already been done. These visits are often wastes of time and money for all concerned.

Of course you could go to a Gp outside of the PHO, but it’s $60 a time to see them whereas the PHO fee for 15 minutes is $28.

Other weaknesses in the HBDHB system: the slow processing of test results with increasing delays in result delivery and increasing difficulty (almost an antagonism) in communications between pharmacies and Medical Centres (they still use fax machines rather than email!). The nationwide (and decades long) problem of prescription collections being tied to one pharmacy continues as a connected medical/pharmaceutical database remains in the ‘too hard’ basket.

There certainly is a crisis. GP training is not well funded, doctors take a big loss in income and conditions to train as GPs. They often have young families and mortgages at the time to consider GP training, and just cannot afford the financial losses to become a GP in an increasingly depressed workforce. This year HW Aotearoa are trumpeting the ‘increased funding’ for GP trainees, which is a net loss in conditions or money for any doctor working as a hospital registrat in 2012. I know doctors who will continue working as GPs untrained, because they cannot afford the loss in income to become a GP trainee.

The workforce of 50 somethings are under increasing pressure of devolution of services from secondary to primary care. MOH have all sorts of great ideas for things that GPs can take over from them, minor surgery, colonscopies, cancer treatment. They also want medical students at all stages trained mroe in prmary care AND all the advanced trainees is hospital specialities are to be required to train in primary care. How does a diminishing workforce manage all of this with no increase in funding, or space and facilities? Doctors who want to retired are selling their practices to foreign companies like Peak Primary
- so NZ health $ creating a profit for offshore agents. South health and Southern Cross also getting on the the act of buying up practices. But who will work them?

There is a huge crisis in Primary Care in NZ, and its going to get worse very soon.

*The NUHS is not to be confused with the Newtown medical centre.

What about asking questions to the
Chair of the PHO Performance Programme Governance Group
Helen Mason via the PHO Performance Programme Manager
Serena.Curtis@dhbsharedservices.health.nz