Prospect of middle-class flight real when VLCA fees drop to $8: Moodie

In print

Prospect of middle-class flight real when VLCA fees drop to $8: Moodie

Peter Moodie 2017
GP Peter Moodie wants to see fundamental changes to general practice funding, especially to VLCA
The question is, why should patients in a VLCA practice but not on a Community Services Card continue to attract the extra subsidy? The Governmen


Is it the intention of this Government to continue the strategy initiated when VLCA was introduced under the previous Labour Government to progressively undermine the economic model and sustainability of General Practice in New Zealand and thereby eventually insure the collapse of General Practice as we know it? If it is then they are going about it the right way. Is it PSAAP's intention to continuously facilitate this process? If it is then they are going about it the right way. I have to assume that both of these queries have to be answered in the affirmative as the alternative implies gross incompetence at the highest levels and a Minister who is incapable of managing the portfolio. 

Thanks Peter Moodie for being open & transparent. The risk of "middle class flight" is absolute and will liquidate Access practices like ours, that is a fact unless there is an urgent solution to this disaster.

The "White Knight" of PSAAP that Dr Malloy speaks of can be easily overridden by the minister so the situation is dire & we must find an answer before we get to this point.

As for the promised policy of "reducing the cost of GP visits", there's not much use in that when you've liquidated the Access practices. The patients have no GPs to see or medical facilities to attend. The remaining VLCA practices & EDs won't be able to cope...then what? Would new GPs come to the region to fill the void? Not likely!


People who argue that funding shouldn't follow the patient and VLCA should be left alone are not being honest or collegial. I'm sorry but too much energy has been given by some to try to preserve VLCA over the last decade by people who now must look around and see what a perilous state GPs and New Zealand patients now find themselves in.

Yes Bryan,"the gross incompetence at the highest levels and Ministers who were incapable of managing the portfolio" has long been discussed in the last 10 years. But we do have a Minister who has come in on a mandate for change. His Achilles heel I fear is the nonsense that has been fed to him by those hell bent on trying to maintain their crooked funding and untouchable VLCA empires. This shit-fight was not of David Clark's making.

Why can't my poor patients get VLCA funding? And why can't my wealthy patients get VLCA funding too like every competing VLCA practices that surround me. To deny my patients that would breach the commerce act - for good reason - it is a law to ensure fairness.

A half-arsed solution continuing VLCA would be a complete disgrace.

Actually I reckon petrol's a bit expensive - why don't the Government subsidise 80% of New Zealand's petrol stations to have $1 petrol and let the other 20% unsubsidised privately owned businesses compete - like they have done with Northland GPs? Incredibly thick idea when there is a severe shortage of GPs I would have thought... but never mind there are empires to be built and honest, protesting Access funded, once passionate GPs to be crushed...

So College here's your chance - if ever the stage was set for a plea for equity and proprortional universalism this is it...

Tim, VLCA was very much the creation of the previous Labour Government. It was patently obvious at the time of its introduction what its effects would be on non-VLCA practices and within months of its introduction these potential effects came into reality. I have no reason to tell you something of which you already have first hand experience. It is thus very much this minister's problem. He is the direct party descendant of the progenitor of the problem and continues with the same policy. There is no excuse and no escaping the responsibility. Is he going to stand up and lambaste the Clark Government and Pete Hodgson in particular for the devastating effects they had on General Practice? No, he is going to justify it and blame the Key and English Governments for not fixing it. In regard to those last two Governments he may well be justified in vilifying them but he should take a long hard look at what or who caused the issue in the first place. Maybe with a degree in theology he was praying for divine intervention of some sort. This fight may not be of his personal creation but it very much his responsibility - especially as it is this current Government's election promises which will ultimately bring about the financial collapse of many practices - something somebody with half a brain could see coming a mile away. As for PSAAP being some sort of "white knight" this just makes me want to puke. At no point has PSAAP concerned itself with the welfare and survival of General Practice - nor in fact promoted policies which may well have benefited many disadvantaged New Zealanders. PSAAP abrogated the responsibilities for ensuring the commitments Government had made to maintain the value of the funding were met. Had they lobbied hard and stuck to the undertakings in the original agreement maybe the situation for many practices would not be so desperate and maybe so many people would not be struggling to afford care. The aim of General Practice has NEVER been to make care unaffordable or a luxury. As for those who are "building empires" these are being built on the quicksand of Government funding and Ministerial ignorance.

Join the NZMA.  they are the only advocates for the business of general practice.  Fewer than 30% of GPs belong to NZMA.  But they are the only ones at the table on our behalf.  the PHOs are there on the behalf of the DHBs, they are not there in our interests.

Join the NZMA and lobby them hard.  

Kerry, Ring me and I will tell you how I was treated by a certaine group in response to my public pleading for equity and fair play by our representatives.


If you aren't angry then you have not been paying attention


I posted a common (which was removed) likening the actions and proposals of Ministry and the Minister to Harvey Weinstein. Whilst I did not and do not mean to imply that they are sexual predators, the idea that General Practice (and by extension our patients) are in some way victims of persistent and worsening abuse is not - in my opinion - misplaced. Ask yourself which is worse: to be coerced into an act which you do not like or want in order to gain an advantage and progress your career (which in no way either justifies the act or makes anything about it acceptable), or be compelled into a situation that progressively and continuously undermines and erodes the value of what you do and who you are? Something that devalues you to the point where you are literally worth less than a packet of cigarettes, hell, no, a quarter of a packet of cigarettes?


It was because of the courage of one woman who chose to stand up and speak out about Harvey Weinstein that others revealed their experiences. They did so not because they wanted counselling but because they want the abuse to stop. They did it because they cared about what was happening to others. It started with one voice and others joined. How many voices are needed before somebody pays attention? 


For the past 14 years successive Governments, Ministry and DHBs have devalued what we do and placed increasing burdens on us. How can what has been happening to General Practice not be equated with rape? Was it not rape because the victims did not speak out or complain? "Oh your Honour she said nothing so I assumed it was consensual". Maybe it was because you had your hand over her mouth and her supposed friends just wanted to keep you happy and told her to be quiet?


And now the current proposal to fix the abuse is to increase the abuse? Where are those who apparently care for General Practice? PSAAP, College, NZMA, PHOs where have you been? What have you said? What will you say? Do we mean so little to you? Do we mean so little to Government and to Ministry and the DHBs? Have you ever stopped to think of the implications for General Practice and for the people who work there? Have you bothered to think or ask how they might feel? And how can you expect a victim of abuse to actively encourage others to be future victims of abuse? Would that even be ethical? Don't think I am exaggerating because you have not heard the weeping. You have not been listening.

I agree, Bryan.  We are seen as "just a GP" by successive Governments, Ministry and DHBs, not to mention ACC (for 16 years since PHOs were established), even when we are Vocationally Registered with a specialist FRNZCGP qualification.  DHBs claim to consult with primary care but only consult PHO managers and ignore GP clinicians.

We are denied access to evidence based investigations and treatments or secondary services that junior staff in DHBs can order or refer to, yet are expected to diagnose, treat and or refer appropriately often complex problems in under 15 minutes as well as keep meticulous records that can survive HDC or DHB audits, all for a pittance. 

Both the NZMA and the RNZCGP did warn us in a rare "Red Letter" that this would happen and I am old enough to know that any subsidy prior to Capitation in the past has never kept up with inflation or even rises in GST.  

It is currently political practise to blame GPs for the surveys that indicate many people find GP fees too high when they are ridiculously low compared to a tank of petrol, the fees charged by hairdressers, veterinary, dental and optometry fees or the totally unjustifiable real estate commissions or the legal fees that prevents justice being accessed by anyone earning less than Kim Dotcom!