The GP’s conundrum

So the senior doctors are going on strike.

The planned strike action by nurses was called off at the eleventh hour, and teachers had rolling strike days earlier this year. And recently there’s been some talk in the comments on our website (nzdoctor.co. nz), about whether GPs should, or could, strike. This was prompted by a discussion at South GP CME on the workforce crisis.

The general consensus is GPs can’t strike. That’s because many are not employees and, as owners or contractors, they would be hurting their own practices, but also because GPs don’t want to jeopardise their patients’ health.

The feeling is something needs to be done, however. The workforce is tired and burned out, edging closer to retirement and/or looking at greener pastures in the UK or Australia.

Australia must be overflowing with GPs from other countries. Not quite

Is it really greener on the other side?

Media in the UK say some GPs are seeing up to 60 patients a day, despite the British Medical Association setting 25 as the upper limit and recommending GPs redirect patients after they hit that number.

The RCGP says GPs are seeing an unprecedented number of appointments this year amid workforce and workload crises, and it’s highlighting years of woeful underfunding.

The Liverpool Echo and other titles tell of a local father, 40, who died of advanced cancer after not being able to get a GP appointment for six weeks.

In my homeland of Northern Ireland, which is second only to Scotland in number of GPs per 100,000 registered population in the UK, the headlines paint a similar picture. GPs describe a “relentless workload”, many say they are retiring or nearing retirement, patient numbers are increasing, the population is ageing, patients are more complex, funding is inadequate...

Straining GP practices are handing back their NHS contracts to the Department of Health, which needs to find a new GP or group of GPs to take over.

The number of practices has fallen by more than 9 per cent in the past eight years, according to BBC Northern Ireland, with 17 practices having handed back their contracts this year, or given notice to do so. The local health trust is running four practices for which no new owner has been found.

GPs say they broke their contracts because of financial pressures, retirement, staffing and recruitment problems, including staff emigrating to Australia.

So to Australia, which must be overflowing with GPs from other countries.

Not quite.

The same problems are facing the so-called Lucky Country. It’s getting harder to get a GP appointment, practices are closing their books, patients are clogging up hospital emergency departments having been unable to see a GP. More practices are charging for appointments as the federal government Medicare rebate no longer covers the full cost of a consultation, and fewer medical graduates are choosing general practice as a career.

Earlier this year, the Victorian and New South Wales premiers called on the federal government to overhaul the ailing primary care network, saying state-run hospitals were too often acting as a safety net amid a shortage of GPs.

The crisis in primary care is a global problem. The same issues, particularly around staffing and funding, are plaguing primary care in many of the countries New Zealand likes to compare itself to, no matter the political leanings of the current governments.

It makes you wonder why so many governments in so many countries have focused their healthcare funding elsewhere.

Solutions will take more than just throwing money at the problem or tinkering around the edges. And more than a three-year government term.

The entrenched issues facing primary care require money, yes, but more than that a long-term investment and commitment to both the current and future workforce.

What appears to hinder general practice is a lack of one voice to speak for it – there is no one union representing the interests of the majority, the way the Association of Salaried Medical Specialists does. The sole negotiating tool, the PHO Services Agreement Amendment Protocol group, has been at an impasse for more than a year, with no sign of revival. We await with interest to hear how the new General Practitioners Aotearoa is going, in uniting many voices.

The sector needs to work together if it wants to have its voice heard by those with the power to decide change. And this is the time to do it – an election on the horizon amid a healthcare crisis the average voter fully understands.