Fall In Primary Care Enrolments Highlights Pressures On General Practice

Severe funding pressures on primary healthcare providers are making it harder for people to enrol at a general practice, many of which have closed their books to new patients, says the General Practice Owners Association (GenPro).

GenPro estimates the number of people not enrolled in primary healthcare grew by 123,000 people in the first quarter of this year, meaning 290,000 people are not enrolled with their local GP.

The estimates are based on new Health New Zealand Te Whatu Ora data showing primary care patient enrolments falling from 96.8 to 94.4 per cent of the New Zealand resident population in the first quarter of 2024.

“We think that about half of general practices have closed their books to new patients. Without significant change to the way general practices are funded and regulated, we’re concerned that more and more people will not be enrolled with a local GP,” said Dr Angus Chambers, Chair of GenPro.

Next week Te Whatu Ora will likely confirm a four percent funding uplift for general practices, which pays for about half the cost of a patient consultation.

General practices are constrained from increasing copayments, which pay for the other half of patient fees, by regulations no longer fit for purpose.

The result from many years of cost increases outstripping incomes, combined with a GP shortage, means many general practices have become financially unsustainable, closed, or reduced their services.

Coupled with a growing and ageing population, and higher community health needs, demand for primary healthcare is outstripping supply.

Closure means that communities lose access to mental health, injury and general health care, which is particularly hard in areas where there are no accessible alternatives.

The poor policy settings that are increasing non-enrolment are disproportionately impacting Māori, with the Te Whatu Ora report showing patient enrolment at only 83.9 per cent, a full 12 percentage points lower than other ethnicities.

“The current general practice funding model is broken, and the four percent uplift nowhere near adequate.

“About one in three practices surveyed last year were losing money. Fixing the situation will require investment to retain the shrinking workforce, attract doctors to general practice, and recognise the quality and continuity of care they deliver,” Dr Chambers said.

GenPro wants a greater percentage of the $30 billion health budget to be directed to frontline services in primary care. It also seeks an urgent review of regulations which restrict general practices from adjusting their copayments.

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