Sustainability of General Practice Report

In August 2015 the Minister of Health established a sector-based Primary Care Working Group to provide him with advice on:  

• ensuring affordable, equitable access to sustainable general practice
• general practice workforce sustainability
• shifting services closer to home. 

The Minister has now authorised the release of the Primary Care Working Group’s final report which can be accessed from General Practice New Zealand’s (GPNZ’s) website at www.gpnz.org.nz.  The final report is informed by direct contact with over 600 people involved in general practice services through 11 consultation forums conducted between Whangarei and Dunedin in September 2015, as well as an online survey. 

Our particular focus sought solutions to the anomalies and perverse incentives that have developed in the funding for the Very Low Cost Access (VLCA) general practices.  “It appeared to us that correcting those problems naturally leads into a proposed revision of the First Contact capitation formula itself.  There was almost universal agreement that there needed to be changes from both those within VLCA practices and those not part of the scheme” said Dr Peter Moodie, Chair of the Primary Care Working Group. 

The report recommends that the current VLCA funding be reallocated to an enrolled patient level, rather than being allocated at a practice level.  The Primary Care Working Group found the lack of targeted support for people with high health needs and low incomes in the existing funding formula is a major problem for both patients and general practices. 

This was matched with an acknowledgement that a small number of practices with populations of very high unmet needs (for example refugee populations) were different in kind from most other general practices and might need a different, and significantly higher, funding regime.  There was a view from some that more individually based funding approaches might undermine community owned practices which provide a wider range of services than usual general practice.  There was a very general acknowledgement that practices, particularly those with substantial Maori, Pacific and populations with high health needs and/or low incomes, required more Government funding than they receive today. 

There is an expectation that general practices will make the investments, in both workforce and facilities, which will be needed for new models of care, therefore the importance of financially sustainable general practice is paramount.  Financial sustainability and workforce sustainability are intimately linked.  Financial sustainability has an impact upon the ability to pay clinicians, and the ability of practices to compete in the recruitment of clinical staff.  Practices struggling to maintain viability of service provision to populations with unmet need also struggle to offer terms and conditions which attract and retain clinical staff. 

The final report, summary of the themes from the consultation forums and background material can be accessed from GPNZ’s website at www.gpnz.org.nz.