Budget boost sought to close practice nurse pay parity gap


Budget boost sought to close practice nurse pay parity gap

Nurse with stethoscope
Seventy per cent of primary health nurses surveyed by NZNO says they are considering leaving the sector because of pay gap with DHB colleagues.
"Nurses are saying they didn’t get parity last year and the gap is now only exacerbated and they are not prepared to continue to be undervalued in thi


The University of Waikato study of Practice incomes over the 2013 - 2017 period showed that despite working harder and Practices increasing revenue, the incomes of Practice Principals (the GP owners) fell by 20% over the same period. This was simply a snapshot in the midst of declining incomes due to inadequate funding. Frankly this request for such a substantial increase is effectively pricing these Practice Nurses out of the market. And where has the NZNO been in all of this? Has it protested previously about the inadequacy of funding for Primary Care? Not a word. General Practice cannot afford this as much as it would like to.

This Government did NOT increase funding for DHBs to cover the increase in wages for the nurses, this has to come out of their usual funding and hence the deficits will simply grow. If they did not fund the DHBs they sure as hell aren't going to fund Practices. I expect the DHBs will have to look at how they can limit their wage costs, as will Practices. Unfortunately General Practice cannot devolve its workload to others as DHBs do to General Practice....and without adequate funding. Much like NZMA, the College Of General Practice and PHOs have done nothing to improve the sustainability until it is too late (actually they haven't done anything yet), so NZNO has done nothing to ensure the survival of the service until the service can no longer afford the costs of employment of its members. At no point does General Practice say that the Practice Nurses and other staff members aren't worth it, they just can't afford what is being asked for. We as General Practitioners don't get any "seniority funding" or recognition either, nor are we ever likely to. Welcome, unfortunately, to our World. How is that for equity and equality?

We would actually LOVE to double our nurses pay !. But yes the money has to come from somewhere.

Maybe ask the esteemed architect of our somewhat Stalinist Simpsonian Primary Healthcare strategy to provide some of her Vote Health for non-DHB nurses instead of hiding it outrageously in a cachectic and calorie deprived capitation system.

And then there is our failing maternity service - also designed by economists and accountants. The two seriously brain-injured neonates I have had in the last few months are testament to the failures of the Clark LMC-led maternity system. The families are the losers, not us.

In my experience, paying the Practice Nurse and Receptionist above award rates pays dividends in retention, loyalty and standards of care.  To have the best nursing staff in primary care recognises their value in helping reduce ED and secondary use but our Governments (and DHBs) have a long history of undervaluing General Practice and failing to understand that supporting primary care is the key to keeping those expensive health costs down, preferring the glitz of a new hospital.

Without a boost in Capitation or Practice Nurse subsidies from the Government those of us with essentially non-viable practices are left with four options to fund pay parity:

  1. Increase patient fees;
  2. Reduce Practice Nurse hours or numbers;
  3. Accept less income for the GP to retain practice sustainability;
  4. Reduce patient services (such as shorter consultations).

Option 4 is counter-productive to improving General Practice value, attractiveness as a career and in countering burnout.

Option 3 has the same negatives although I find less income is less stressful than inability to meet patient need.

Option 2 can sometimes be worth considering, such as working four days so one is comfortably busy but better off financially (particularly if the nurse is earning more than the GP!).

Option 1 is a necessity if one is able to, as it reduces unnecessary demand and patients adapt and soon realise that a quality GP consultation is actually worth far more than a haircut (let alone the eyewatering fees my wife pays her hairdresser), a pack of cigarettes, a tank of petrol etc and should be far more than a vet, accountant or lawyer’s fee.

So, David Cark, unless your Government wants higher GP fees, fewer graduates training in General Practice and more people attending EDs and presenting late for more expensive secondary or tertiary care, you need to ensure there is funding for improving Practice Nurse parity.

Couldn't agree more with all the comments above.

Another reason, among many, to separate primary care funding from DHB funding.