Is there a GP in the house?

17:00, Aug 22 2014

Already a lesson in patience, going to the doctor in Taranaki looks like it's just going to keep getting harder. Blanton Smith reports on how visits to your GP are set to change.

Rebecca Kapernick doesn't have to be told to know Taranaki has one of the lowest ratio of general practice doctors in the country.

"Every medical centre I call say they are not taking new patients and there's no offers to be put on a list either," the New Plymouth mother says.

Visiting franchise-like accident and medical centres isn't for everyone, she says, as you see a different GP every time and no rapport is built.

"I walk out of there each time feeling unsatisfied, it's very frustrating that I cannot seem to get ‘in line' to be with a family GP."

It's a frustration Opunake people are also dealing with after the sudden departure of their American GP Mitch Feller from their medical centre earlier this month. And though the small town has always struggled to get a doctor to stay in town, the retention of general practitioners is increasingly an issue confronting the rest of Taranaki.


Recently established in New Plymouth, Dr Paul Riley still has spaces on his books and acknowledges there is a shortage of GPs in New Plymouth.

Ministry of Health guidelines say a doctor-to-patient ratio of 1:1500 is safe, which is "about right for a fulltime doctor," he says.

"Once you start taking on more you dilute your ability to attend to patients. If you get more patients than you can cope with it gets hard."

On the surface, Taranaki looks to be OK. With a population of 109,608 and 73 registered GPs in the region there is a ratio of 1 doctor to every 1501 people.

But broken down by districts, Taranaki's ratio is not so impressive. New Plymouth is doing OK with 1:1225, Stratford not so healthy on 1:2268 and South Taranaki is in poor shape with 1:3269.

The ratios do change. As many as 10 locums, doctors filling in for others, work in Taranaki at times. But their numbers fluctuate.

The issue of high doctor - patient ratios is felt in hospital emergency rooms, ED, where people turn for help instead of their GP.

"More people use the ED in Taranaki for low-level care than anywhere else in the Midlands region," says John Macaskill-Smith, chief executive of Midlands Health Network, the Primary Health Organisation (PHO) responsible for allocating government funding to the majority of Taranaki's GPs.

"It is free to the user to attend ED, yet costs the health system at least four times the amount to provide a consultation in the ED than what primary care is funded for a consult."

Midlands and the Taranaki District Health Board (TDHB) are working to reduce this type of thing and increasingly refer patients back to GPs depending on their illness, he says.

But sometimes that is not an option. Margaret Langton's family is enrolled at the Opunake Medical Centre and are former patients of Feller and it is Langton who is spearheading the move to get Feller back.

Earlier this week her son got sick with what she thought was a chest infection. She couldn't get into her GP, so went to the medical centre in Hawera. But she couldn't get in there either and so, despite wanting to pay, was forced to take the free care option available at the Hawera Hospital ED.

"I thought it was poetic," she said.

It doesn't look like it will get any easier to see a doctor in the future. Or could it?

There are questions about how the future will look, Macaskill-Smith says, as the newer generation is not interested in working alone. There are also more female GPs who, in many cases, are seeking part-time roles, as well as wanting to be employees rather than taking the risk of owning and operating a small business.

Another big issue facing the region is an ageing population and an ageing GP workforce.

"Across the whole Midlands region, an ageing population, growth and a higher prevalence in long-term conditions, will double demand on the health sector between 2014 and 2025," Macaskill-Smith says.

"At the same time, the average age of our GPs and nurses is also increasing, and we are set to lose around 30 per cent of our work force during the same period due to retirement."

He says Midlands is well aware that in the short term "age, illness or other uncontrollable changes could cause a significant localised primary care access issues for patients."

In other words, a doctor shortage. But they are working with the TDHB to mitigate that, Macaskill-Smith says. People may simply have to readjust their expectation around what going to the doctor means.

"Continuing to run a system where every patient is offered largely the same option - a 15 minute face to face appointment - while demand grows is not sustainable," Macaskill-Smith says.

Changes made need to put patients in contact with their GP not push them away.

A move to online with medical records is one proposed idea and telephone and email appointments are all options being looked at, he says.

Taranaki's sole independent general practitioner Keith Blayney, has his own ideas. He says owner-operator practices are proven to encourage retention of doctors and should be promoted.

They need to be. Taranaki may have one of the highest ratio of solo operators in the country with 50 per cent of GPs running their own clinic but just eight years ago it was 79 per cent.

"I think that the reduction in owner-operator GPs has been one of the major reasons for the high turnover and inability to attract and retain permanent GPs to South Taranaki."

New Plymouth and Stratford have a larger number of solo, or small practices, but "if they were forced to amalgamate, I would expect to see a significant exodus of GPs and a real shortage start in New Plymouth," he says.

He is also scathing of current funding schemes as unfair and discriminatory.

Funding under the PHO scheme is based on two formulas: General Primary Care for most practices and Very Low Cost Access (VLCA) for those with high needs patients.

For both formulas, money is allocated to the practice where a patient is enrolled and given out four times a year regardless of whether the patient turns up once a week or once a decade.

Under the general scheme the amount a practice gets for a patient depends on age, gender and health status and fees charged range from $30-45 for an enrolled adult. VLCA funding, on the other hand, is a formula that caps fees at $17.50 but the amount a practice receives for a patient is higher.Whether you are rich or poor, if you are enrolled at a VLCA practice you get cheap doctor's visits. The reverse is also true if enrolled at a general centre.

Blayney opted out of the PHO scheme because of philosophical objections to population-based funding. He says health care has three elements; quality, timeliness and cost,

"Unfortunately you can't have all three."

He chose quality and timeliness and sacrificed a large amount of government funding. Consequently his patients must pay more.

"Government subsidies for high-income, low-needs patients, just because they live in a particular area and attend a VLCA clinic, is unfair and creates an even greater disparity for low-income/high-needs patients in "ordinary" PHO practices, and even more so those attending independent practices like ours," he says.

With election-year promises of increased access to cheaper health care, demand on GPs will increase, he says, worsening existing issues around workload and time spent with patients.

"And this exacerbates GP shortages."

New Plymouth: 54

Hawera: 7

Stratford: 4

Inglewood: 3

Oakura: 3

Waitara: 1

Eltham: 1

Opunake: 0

Bell Block: 0

Manaia: 0

Urenui: 0

Okato: 0

Total: 73


*Only doctors registered in Taranaki are included. 

Taranaki Daily News