In a week when PM Christopher Luxon and Health Minister Simeon Brown have been blowing their own trumpets about how supportive they are of GPs, and how they are offering “all New Zealanders” more “choice” in how they access primary health care blah blah blah…. Can we please have some context for the government’s hand-on-heart claims of caring about the health and well-being of ordinary “Kiwis”?
In the real world, the rising cost of going to the doctor means that many of those “Kiwis” cannot afford to receive the primary healthcare they need in anything like a timely fashion. As their medical conditions get worse, more and more people are ending up in over-crowded, under-staffed, poorly funded A &E departments. This is on top of the estimated 40% of New Zealanders who cannot afford the cost of the dental care they need, which is a prime reason why New Zealanders have relatively poor dental health compared to most other developed countries.
In many parts of New Zealand a visit to the doctor now costs $60 or more. Even for those with community card concessions, cost remains a major barrier to access to public health. Why is that cost rising so steeply? Well, the Luxon government stumped up last year with only a measly 4% rise in the “capitation” funding through which the state subsidises GP practices for the patients they treat. In real terms, this was a funding cut. As the NZ Doctor reported a fortnight ago capitation costs rose 6.4% in 2024, on top of the 5.88% rise the previous year.
Those figures are what it would cost GPs to maintain current services, not to deal with the unmet (and rising) health needs of a growing and ageing population. Cynically in mid 2024, the government also gave GPs the green-light to make up the government’s shortfall in capitation funding by hiking up the fees that GPs can charge their patients, by up to 7.76%.
That’s right. GPs practices under financial pressure were being told to extract higher user-pays charges from people already finding it prohibitively expensive to take themselves or family members to a doctor. Primary health care is in crisis, as are our public hospitals. There’s partly why one third of GPs have closed their books to new patients. Rising costs in primary healthcare were reflected last year in a harrowing survey conducted by the General Practice Owners Association (GenPro). The organisation surveyed 244 practices, (a quarter of the total number in New Zealand) and found this:
* 89 percent had recently increased or were about to increase fees
* 70 percent were in a worse financial position than a year ago
* 83 percent were worried about their long-term viability.
Despite that reality, the coalition government chose to short change GPs last year over the capitation subsidy, and invited them to gouge more money out of their patients. Keep that picture in mind the next time you see or hear Simeon Brown congratulating himself over what the government claims to be doing to meet the needs in public health.
Footnote One: Last year, even if every GP had charged in full – and had recouped in full – the entire 7.76% price rise that the government was inviting them to pursue, that would still have left primary healthcare short of the 6.4% capitation funding increase required to merely stand still:
Health NZ living well [!!] director Martin Hefford confirmed GPs will get 4% more funding and be allowed to increase their fees by 7.76%.“[This] gives a combined 5.88% total revenue increase,” he said.
On this evidence, the coalition government is not trying to improve the public health system. It seems to be actively engaged in undermining it, presumably so that it can then privatise the potentially profitable bits.
The government response
With that context in mind, what did Luxon and Brown unveil on Monday? Their primary healthcare assistance package contained three main ingredients:
1. An extra 100 placements for overseas-trained doctors to work in primary care. Until now, the on-the-job training required to bring foreign-trained doctors up to speed with New Zealand registration requirements was carried out under supervision in hospitals. These new measures incentivise this training to be carried out in GP practices, supervised by local doctors. Similar incentive payments will also be offered to GP practices to recruit up to 400 registered nurses a year, over a three year period.
Urban GP practices will get up to $15,000 for carrying out that training role, or up to $20,000 if it is a rural GP practice. BTW in passing…funny how on principle, the coalition government is dead against tagging extra funds/staffing to address lagging Māori health needs, yet it is more than happy to tag extra resources to meet the health needs in the rural electorates in which National Party heartland voters reside.
The foreign doctors input/training funds will be conditional on the participating GPs meeting certain extra conditions, such as, for example, opening their practices to new patients.
Footnote: Yesterday, Brown also announced a $34.2 million fund spread over five years, to train 60 more nurse practitioners specialising in primary health care. While welcome, it is another example of the government doing too little, too late – and even then only because the dire state of the public health system looks like being National’s key vulnerability at next year’s election. These announcements by Brown are best seen as a response to the perceived political need in the Beehive, not to the actual health needs in the community.
2. Health New Zealand will also be putting $285 million over three years towards general practice – on top of the capitation increase – but this extra funding will be linked to performance criteria. The money is not new money, but has been a re-direction of funds set aside in Budget 2024, potentially to support the emerging needs in public hospitals.
3. A new “practical” 24-7 digital service will also be set up, Brown says, to provide “all New Zealanders with better access to video consultations with New Zealand-registered clinicians.” This will be a for-profit service contracted out by HNZ to private providers. It will come at a premium cost akin to (or higher than) the extra costs charged at after hours/emergency clinics. Unlike Healthline, this service will offer more than advice – it will also offer diagnosis, prescriptions, the ordering of tests, and referrals.
So where will these extra GPs and nurse practitioners be found to staff this pricey 24/7 digital service? Presumably some will be from among those extra nursing /nurse practitioner recruits, and from GPs and nurses based here or overseas. If so, taxpayers will be co-funding (at least) the staff providing a for-profit service that only wealthy “Kiwis” will be able to afford. This speaks volumes about the government’s health priorities.
The operational details of the digital service (and its set-up costs) will be announced closer to the start date mid-year, but – in a revealing interview with RNZ’s Ingrid Hipkiss – Brown did not deny her contention that the cost could be over $100; this, for a consultation conducted merely on video, and not face to face. All week, Brown has been burbling on that this service will be open to “all New Zealanders,” and will serve to increase their “choices” in how they access the healthcare they need.
Dream on. To repeat: this choice will be available only to New Zealanders wealthy enough to pay the very sizable tab – and it will be staffed by scarce GPs and nurses diverted into doing shift work for a for-profit enterprise. Brown’s claim that he is offering this choice to all New Zealanders is indicative of the bubble in which Brown and the rest of this country’s wealthier citizens seem to be living.
Bill Fay & Yuck Revisited
In 1970 and in 197, the British singer/pianist Bill Fay released a couple of albums that only began to be widely known and appreciated around about 2015. Fay died a fortnight ago at the age of 81. After his career as a cult discovery belatedly took off, Fay recorded this sensitive version of the Wilco track “Jesus Etc.”
Anyone (like me) who caught the set by the UK indie band Yuck at the Laneway Festival in January 2012 would not have dreamed that 13 years later, lead singer and guitarist Daniel Blumberg would be onstage picking up an Oscar for the score he wrote for The Brutalist. Here’s the sweet melodic little song that was the closest thing to a hit that Blumberg ever had during his time with Yuck: