Family Doctor Services Struggling As Hospitals Poach Nurses

Family doctor services are struggling to attract and retain nurses, as they compete with a growing pay gap between their nurses and those employed in the country’s hospitals.

New Plymouth’s Devon Medical Centre has lost two nurses since the start of the year, with Director Dr Pat Leary saying the nurses left as they got paid more elsewhere.

Dr Leary says in both cases it was a situation of “money talks”.

An Employment Relations Authority (ERA) ruling in December last year significantly increased the pay disparity between nurses employed in general practice and those employed by Te Whatu Ora. The pay gap now stands at between 22%-27%, depending on experience. It was previously up to 5.4%.

GenPro Chief Executive Philip Grant says the pay gap is creating huge challenges for essential family doctor services throughout New Zealand and it is making it incredibly difficult for general practices to attract and retain nursing staff. It means patients increasingly can’t access some services or are having to wait longer to get an appointment with their family doctor team.

“Our member survey in late 2022 found that nearly half (46%) of family doctor services had lost at least one nurse in the previous three months and half of all practices had a current vacancy for one or more nurses.

“You can’t blame nurses choosing to work in hospitals, rather than a family doctor practice, when they get paid $20,000 more in a hospital position,” Mr Grant says.

“The government has just funded a significant pay rise for hospital nurses, what we need is for them to level the playing field and do exactly the same for family doctor services so that they can deliver the essential front-line services families need.”

Mr Grant says advocating for pay parity and pay equity for general practice nurses is the Association’s key focus.

Dr Leary says his medical centre cannot compete with the pay gap, as it is constrained by non-negotiable government funding as well as by a government-imposed cap on patient fees. “We simply can’t put up our fees any more in order to pay our nurses more, even if we wanted to.

“The reality is we have a limited market and the hospital part of the market is funded to be able to pay more. While that continues, we will see a shift of nurses within the market,” Dr Leary says.

“The issue is not just money, as it takes time and effort to take on a new graduate, train them and for them to get the broad range of knowledge and skills to be a good practice nurse. Unfortunately, as in our situation it is often really great younger nurses who are going to respond to the financial incentive to move.

“We already have an aging workforce of both nurses and doctors in General Practice closing in on retirement. Without the lifeblood of younger graduates being retained we are going to compound this problem,” he says.

GenPro’s member survey was undertaken between October and December 2022 (before the December 2022 ERA ruling) and attracted 185 responses from general practices throughout the country. It found current workforce shortages and underfunding is impacting on service delivery.

“We knew the situation was difficult, but the survey has reinforced exactly how hard it is for family doctor services,” Mr Grant says. “More than half of our practices (53%) have reduced service levels due to the workforce shortages and a significant number (36.5%) have completely withdrawn some services altogether.”

Mr Grant says it’s also difficult for families and whanau, with 55% of practices having closed their books to new enrolments.

“The challenging situation means that vulnerable and high needs communities are missing out on subsidised health care from a general practice and that will be placing additional pressure on urgent care clinics and already overwhelmed hospital emergency departments. We have winter approaching which the experts are predicting will be particularly challenging with respiratory disease, pneumonia and on-going COVID cases. The government is looking to family doctor services to help manage that demand but without essential nurses there will be a huge gap in services.”

The survey found that nurses are leaving general practice to gain better pay within hospital services, relocating domestically or internationally or, exiting primary care altogether due to stress and heavy workloads.

Many surveyed described the workforce situation as ‘desperate’.

The results back GenPro’s On The Brink report released in November 2022, which highlighted the precarious state of family doctor services due to workforce shortages and underfunding and recommended a nine-point action plan to ensure its future sustainability.

On The Brink: Saving New Zealand’s family doctor service can be downloaded here: https://www.genpro.org.nz/docs/onthebrink.pdf

The Government Review into General Practice funding can be downloaded from the Department of the Prime Minister and cabinet website here: https://dpmc.govt.nz/publications/proactive-release-future-capitation-funding-approach

GenPro’s Open Letter to the Minister can be downloaded here: https://genpro.org.nz/docs/openletter21-nov-2022.pdf

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