Why are Doctor's appointments so scarce and so costly?
We at Flagstaff Medical Centre feel it is important that you know that we don't want it this way.
We wish we did not have to charge so much, and that we had all the staff that we need to see you when ever you need us.
But we don't, and we can't.
HERE IS WHY.
The Government controls all our income streams:
The Government pays General Practice an amount per enrolled patient, for us to look after your health needs. It is called Capitation and this brings us about 65% of our income, and for many practices across New Zealand it is much lower. It is based on a historic and assumed number of consultations per year, which grossly underestimates the actual workload undertaken by GPs.
This used to be a far higher percentage, which was sufficient for our staff to be paid well for the work they do, and to maintain or grow the practice premises.
However the Government funding has fallen below CPI/Inflation for all but one of the last TWENTY years, (and Medical inflation runs at twice the rate of normal inflation). This is despite knowing that to spend a dollar on General Practice, saves many times that in the hospital system. Both our previous governments have commissioned reports that tell them EXACTLY the state of General Practice and the massive funding boost that is required (Moodie 2021 and Sapere 2022 reports) and still they do nothing. The Sapere report of 2022 suggests that GPs are now unpaid for half the work that we do, and that our funding needs to increase up to THREE times its current level. The OECD nations spend on average about 12 percent of the health budget on General Practice whereas New Zealand only spends about a quarter of that.
Increasing Costs:
Costs have skyrocketed as you know, including rising mortgage interest rates (and therefore the rent), computer/IT costs, compliance costs, utilities and medical supplies. The ongoing Pay Equity work shows clearly that our receptionists and Practice Nurses are underpaid (compared to hospital staff), and yet we are yet to see the Government fund us to meet the difference.
The Government also limits our fee increases, and yet we must do this to cover the 30% shortfall and remain viable.
We are unable to charge more for children under 14years old or for community card holders, and so those of you outside those groups effectively have to subsidise the rest. This is not fair for any of you.
Our business is running at a loss, so to remain solvent we must do two things. Sadly, we may need to increase fees, and we will need to cut services further.
Shortages of General Practitioners (GPs) and Nurses:
Our waiting times for routine appointments are already 2 weeks or more, and even longer in other Practices. We have been short-staffed by 2 GPs but we may not be able to replace these- because of our lack of funding AND because New Zealand is short of Specialist GPs.
Half our nation's GPs will be retiring in the next 10 years and we are not training enough replacements. Funding General Practice properly will at least retain those we have, and make General Practice attractive again to young doctors.
Lack of Appointments:
We keep many appointments free for use on the day. We will only double book our GPs if it is an emergency, so if there are no appointments available, we are sorry. Every one of us has been close to burn out and we will not let our staff get overworked if at all possible. If we burn out, we and you are even worse off again.
Increasing Unpaid Workload:
The other reason GP appointments are scarce, is that a THIRD of our day is now spent doing 'paperwork'; such as answering emails, queries, renewing scripts, checking results, writing referrals, and acting on hospital letters. For many of us, we still spend many UNPAID hours per week doing this in our own time, that should be spent with our families. We simply must charge for these services where we are able.
The funding is also based on a 15 minute appointment, which many of you know is grossly inadequate for the care you need and the work required. GPs are often running late, missing breaks and meals, in order to do what we can within such time constraints. We are grateful when people book a half hour when they need more time, although we must charge accordingly.
General Practice is at crisis point.
General Practitioners are the Medical Speciality that does everything; from birth to death we diagnose almost all medical conditions and manage them ourselves. We manage increasingly complex medicine, and we can hold all your conditions together, knowing which affects the other. No other speciality can do this. Much work that used to be in-hospital has been shifted to General Practice, without funding to match the increased workload.
Do you realise, that our generation now faces the possibility of not having a GP in the next 10 years? Our health system will collapse if the current trajectory of poor funding continues. If GPs were to stop working even one day per week, the extra load on the health system would be untenable.
We are sorry that this affects you and your care, and we as a profession are lobbying hard for things to change.
You may wish to complain loudly and we hope that you do; but please not to our staff who are all working hard within the constraints discussed here. Aim this at the politicians who can (we pray!) make a difference.
We will hopefully remain
Yours faithfully
Flagstaff Medical Centre.
We at Flagstaff Medical Centre feel it is important that you know that we don't want it this way.
We wish we did not have to charge so much, and that we had all the staff that we need to see you when ever you need us.
But we don't, and we can't.
HERE IS WHY.
The Government controls all our income streams:
The Government pays General Practice an amount per enrolled patient, for us to look after your health needs. It is called Capitation and this brings us about 65% of our income, and for many practices across New Zealand it is much lower. It is based on a historic and assumed number of consultations per year, which grossly underestimates the actual workload undertaken by GPs.
This used to be a far higher percentage, which was sufficient for our staff to be paid well for the work they do, and to maintain or grow the practice premises.
However the Government funding has fallen below CPI/Inflation for all but one of the last TWENTY years, (and Medical inflation runs at twice the rate of normal inflation). This is despite knowing that to spend a dollar on General Practice, saves many times that in the hospital system. Both our previous governments have commissioned reports that tell them EXACTLY the state of General Practice and the massive funding boost that is required (Moodie 2021 and Sapere 2022 reports) and still they do nothing. The Sapere report of 2022 suggests that GPs are now unpaid for half the work that we do, and that our funding needs to increase up to THREE times its current level. The OECD nations spend on average about 12 percent of the health budget on General Practice whereas New Zealand only spends about a quarter of that.
Increasing Costs:
Costs have skyrocketed as you know, including rising mortgage interest rates (and therefore the rent), computer/IT costs, compliance costs, utilities and medical supplies. The ongoing Pay Equity work shows clearly that our receptionists and Practice Nurses are underpaid (compared to hospital staff), and yet we are yet to see the Government fund us to meet the difference.
The Government also limits our fee increases, and yet we must do this to cover the 30% shortfall and remain viable.
We are unable to charge more for children under 14years old or for community card holders, and so those of you outside those groups effectively have to subsidise the rest. This is not fair for any of you.
Our business is running at a loss, so to remain solvent we must do two things. Sadly, we may need to increase fees, and we will need to cut services further.
Shortages of General Practitioners (GPs) and Nurses:
Our waiting times for routine appointments are already 2 weeks or more, and even longer in other Practices. We have been short-staffed by 2 GPs but we may not be able to replace these- because of our lack of funding AND because New Zealand is short of Specialist GPs.
Half our nation's GPs will be retiring in the next 10 years and we are not training enough replacements. Funding General Practice properly will at least retain those we have, and make General Practice attractive again to young doctors.
Lack of Appointments:
We keep many appointments free for use on the day. We will only double book our GPs if it is an emergency, so if there are no appointments available, we are sorry. Every one of us has been close to burn out and we will not let our staff get overworked if at all possible. If we burn out, we and you are even worse off again.
Increasing Unpaid Workload:
The other reason GP appointments are scarce, is that a THIRD of our day is now spent doing 'paperwork'; such as answering emails, queries, renewing scripts, checking results, writing referrals, and acting on hospital letters. For many of us, we still spend many UNPAID hours per week doing this in our own time, that should be spent with our families. We simply must charge for these services where we are able.
The funding is also based on a 15 minute appointment, which many of you know is grossly inadequate for the care you need and the work required. GPs are often running late, missing breaks and meals, in order to do what we can within such time constraints. We are grateful when people book a half hour when they need more time, although we must charge accordingly.
General Practice is at crisis point.
General Practitioners are the Medical Speciality that does everything; from birth to death we diagnose almost all medical conditions and manage them ourselves. We manage increasingly complex medicine, and we can hold all your conditions together, knowing which affects the other. No other speciality can do this. Much work that used to be in-hospital has been shifted to General Practice, without funding to match the increased workload.
Do you realise, that our generation now faces the possibility of not having a GP in the next 10 years? Our health system will collapse if the current trajectory of poor funding continues. If GPs were to stop working even one day per week, the extra load on the health system would be untenable.
We are sorry that this affects you and your care, and we as a profession are lobbying hard for things to change.
You may wish to complain loudly and we hope that you do; but please not to our staff who are all working hard within the constraints discussed here. Aim this at the politicians who can (we pray!) make a difference.
We will hopefully remain
Yours faithfully
Flagstaff Medical Centre.