Summer Survey: What did your colleagues say about general practice in 2023?

“We survive on the strengths of our own intense effort and stubbornness”

Disillusioned, undervalued, forgotten, nervous and concerned – these are just some of the words respondents to our summer survey used to sum up how they felt at the end of 2023. But there were also expressions of hope and positivity.

In the “final word” section of New Zealand Doctor’s Big 23 Sizzling Summer Survey, we asked for our readers’ thoughts, and we got a range of feedback and ideas – as well as well wishes (thanks from the team).

Some were concerned about what the new Coalition Government’s policies might mean for health and equity; another wonders whether the parties would keep their pre-election promises and invest in health “given desire for tax cuts and an enlarging fiscal hole”.

“I’m hopeful things will get better long term for health but in the short [term] esp. with the current Govt I have grave concerns about equity. I’m hopeful things won’t get worse...,”one GP says.

Another is hoping the Coalition Government sticks to campaign promises and increases funding for general practice: “Just sick of the broken promises and have little energy to beg or continue in the current funding environment.”

Another GP says: “The new minister of health can turn around many of our country’s health woes by valuing and consulting general practice by diverting funding from irrelevant bureaucracy to restore resources and mana to general practice and the ancillary professions (such as psychologists).”

While another echoes this feeling, saying: “The health system is broken. Let’s hope now that Shane Reti is in power that they can begin to fix it.”

A few say they have never felt more disillusioned, forgotten, or undervalued in general practice.

One says: “I…wish we would take action so that the rest of the medical community and the general public would gain some understanding of what we do and how we contribute. But we do not seem to have a body which can guide us in collective action like the medical specialists’ union. Without that, I have very little hope for our future.”

Another writes: “I feel totally forgotten and undervalued as a GP. We are always fully booked. No time for paperwork, increasing complexity of patients we care for, public system wait lists are dreadful and many referrals are declined. Even patients who have probable cancer diagnoses are being told they will have to wait three months for spots. We have been told new NASC [needs assessment and services coordination] referrals face a 12-month wait for assessment – they will be dead before they are seen. There is only so much begging I can do on patients’ behalf. I have never seen it so bad. My best friend was a GP, and she has retired and is very happy. Food for thought.”

One GP, who describes themselves as near burnout, says Australia is looking pretty attractive: “[More than] 10,000 patients depend on our practice. People will die if I walk away. My conscience is all that is still keeping me here. 30 years a GP, and this is the worst I have seen.”

Another GP echoes the pull of Australia, saying they will immigrate there in 2025 if things have not improved. While another GP writes: “We are very depressed and cannot take much more of this. My practice is running at a loss.”

A practice manager says: “It feels like the health system is on its knees through no fault of people on the front line. The NZ public, and those working in the system, deserve MUCH better.”

Many respondents felt a lack of interest from Te Whatu Ora and the Ministry of Health to adequately address the issues facing the sector.

“We survive on the strengths of our own intense effort and stubbornness. MOH and TWO have left us to wither and die,” one GP writes. “Under Andrew Little this felt a deliberate approach to break the sector and rebuild in a new untested philosophy of community ownership. They were dreaming a dangerous dream for the public and for health.”

Another GP says: “We do so much profoundly important work, why are we treated with so much apparent contempt by politicians and funders?”

One GP says there has been too much lip service to the role and value of general practice “but no one prepared to actually put the money into boosting/revitalising”.

Some respondents provided ideas for solutions to fix the problem, with one GP saying the sector needed functional and practical collaboration at every level, and to listen to grass-roots organisations.

Another GP says: “We need to have a good hard look at all the factors negatively influencing productivity and try seriously to ameliorate them.”

One GP called for less neoliberalism in healthcare. “No longer a vocation. Have a public debate about public healthcare and if NZers want it – then fund it!”

A further GP comments: “I think we should continue to be positive about the great work NZ general practice is undertaking. Negativity produces a downward spiral.”

But there were some positives – with some saying they loved their job as a GP and that general practice “is still a great profession”.

“I really love being a GP, but it is an increasingly hard job to pull off without being personally diminished by the unremitting effort required to do it properly.”

Another says: “I love being a GP, I care for my community and my patients. I would love GPs to feel appreciated and that their voice is heard.”

One GP who is choosing to retire early, says: “I have loved my job. I feel so grateful to have done general practice and think I made the right decision. But it has just become too difficult and I am retiring in March, before I hit 60, to have a life.”

Another sums it up like this: “I love general practice for the diversity, the continuity of care, the relationships with colleagues and patients, the flexibility of working hours, the lack of management layers and competition within secondary care departments. But it is hard not to envy my hospital colleagues the income, the increments in pay for seniority, the unlimited sick leave, the paid non-clinical time, the sabbaticals, the conference leave/CME budgets, paid teaching time and the confidence that comes of knowing a small area of medicine intimately rather than all of medicine generally. I would be very bored being a ‘partialist’ rather than a generalist but wouldn’t mind the work conditions.”

And a final word to a secondary care clinician who offers some solidarity: “I really feel for my colleagues in general practice – I know how tough some of you are doing it. Hugs.”