New Research Reveals Previously Hidden Pressures On New Zealand General Practices

A groundbreaking study from the University of Otago Centre for Health Systems and Technology (CHeST), in collaboration with General Practice New Zealand (GPNZ), has shed new light on a concerning healthcare trend with far-reaching implications.

Quantifying and understanding the impact of unmet need on New Zealand general practice looks at what happens when people have a genuine clinical need for specialist health care but cannot get it. Simply stated, unmet health needs are jeopardising patient health care and straining general practices.

“The study shows more and more New Zealanders are unable to access specialist care in a timely way, leaving GPs to manage these complex cases without extra resources. This not only affects patients, who suffer from delayed treatments, but also puts immense pressure on GPs, making it harder for them to provide quality care,” says Chair of General Practice New Zealand and Porirua-based Specialist General Practitioner, Dr Bryan Betty.

Using a combination of qualitative and quantitative research, the study reveals a number of concerning findings.

Decline in access to referred specialist service– between 2018 and 2022, results of the population-level quantitative analyses show that the risk of being declined at prioritisation – following initial GP referral – significantly increased over time. There was a 5.2 per cent increased risk of being declined per year.

Equity and regional disparities – females experienced significantly increased risk of being declined, while in general Māori and Pacific peoples had slightly lower risk of referral declines. Data indicated regional disparities with some areas severely underserved, leading to unequal access to healthcare.

Impact on patient care – patients are experiencing delayed treatments and poorer health outcomes, exacerbating health inequities and putting additional pressure on already stretched general practices.

Overburdened GPs – the management of patients with unmet needs increasingly is falling on GPs, who are operating without additional resources. This causes significant stress and risk for healthcare providers, impacting their ability to deliver comprehensive care and increasing burnout and potential exit of the profession.

Financial implications for patient and practice – patients face multiple costly visits to the doctor and multiple prescriptions to manage conditions while waiting for specialist treatment, plus the associated travel costs and time off work to attend appointments. Some practices are choosing to waive fees for patients requiring multiple visits and absorbing the cost into the practice, while others do not waive fees but have patients with large outstanding accounts, implicitly waiving fees.

“This study provides further evidence on the current state of primary care in New Zealand. But it isn’t just numbers; the study findings represent real people whose health is suffering due to systemic shortcomings.,” says Dr Bryan Betty.

It highlights the urgent need for government funders to recognise and address the multiple pressures and complexities of general practice.

“It’s a challenging read,” says Dr Betty.

“I see my peers quoted as feeling completely out of their depth or using family members addresses on the referral to get their patient around the ‘postcode lottery’ of health. But by far the worst is GPs openly talking about having to manage people into their graves.”

GPNZ is committed to working with Manatū Hauora and Health New Zealand | Te Whatu Ora on solutions that improve patient outcomes and alleviate the pressure on general practices.

This new research complements GPNZ’s previous work on securing sustainable general practice, placing more evidence behind the need for a new funding model to tackle inequity and recognise all drivers of demand and complexity, in combination with funding initiatives to expand, develop and value a multi-disciplinary primary care workforce, with support for technology as an enabler.

The research will be shared widely as part of GPNZ’s ongoing advocacy for equitable health outcomes, sustainable general practice and an enhanced role for Primary Health Organisations.

“We’ll be ensuring this research gets into the hands of those who are looking in great detail at the future funding for general practice.

“We must see a substantial change delivered in Budget 2025.”

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