The 20 million consultations: A number to remember

We continue the myth that, if you really, really need help, the New Zealand health system can step up. And I feel it is a betrayal to admit it, but lately I’ve seen and heard enough to know this is not always the case any more; that the gap between what the system perceives to be high need and what the public perceive is no longer easily bridged.

Sure, if you have an acute injury, are bleeding profusely from an open wound and your heart has stopped beating, you will get help. But you might not be so lucky if you have a condition that makes life a constant misery but is not actually killing you.

As one GP commented recently: “A patient of mine who is a consultant gynaecologist is very distressed to be spending the bulk of her time declining referrals instead of helping women with pelvic pain, menorrhagia and fertility problems.”

It is not an ambulance that sits at the bottom of the cliff; rather it is general practice perched on another precarious ledge, where it continues to provide those 20 million consults a year. Think about it:

• 20 million – it is the tonnage of silt deposited by Cyclone Gabrielle on the flood plains of the Hawke's Bay.
• 20 million – it is the combined populations of Paris, New York and London.
• 20 million – it is the estimated number of lives saved globally in the first year of COVID-19 vaccines.

I have seen 20 million, 20.5 million and 21 million cited as relating to general practice visits a year. But pinning the number down is not easy, as reporter Fiona Cassie exclaimed to her colleagues while researching our cover story.

In her words: “Bloody hell…no wonder we are in a pickle…Te Pae Tata has two interpretations of the 20 million in the same document.”

On page 49: “There are over 20 million primary care encounters each year spanning aged care, midwifery, a pharmacy, Whānau Ora, mental health, district nursing, allied health, and primary care, delivered by a mix of private, public and NGO entities.”

On page 62: “Around 2.5 million New Zealanders visit urgent care clinics each year, there are up to 20 million visits to general practices, and around 1 million visits to hospital emergency departments.”

Former health minister Andrew Little used the 20 million in a speech in June last year. Strangely, former National health minister Bill English also used it in a speech back in 1998.

The RNZCGP has quoted 20.5 million patient contacts in its statements - likely taking into account the increasingly virtual nature of some consults, and a letter from primary care organisations regarding the impact of pay parity cited 21 million contacts.

I’ve settled on 20 million even though the true figure likely exceeds this. It is easy to remember and that is important.

Shout it out, shout it loud until every health manager, specialist colleague and, most importantly, the incoming government, has committed it to memory.

It’s what they stand to lose if they choose to forget.