Friday, January 15, 2010

Is there a problem with GPs?

I am hoping to attract MacDoctor's attention and expert input. Health is not a sector I have studied in any depth. So I stand to be corrected on the following conclusion.

Waiting in the surgery with my poorly (that's an old-fashioned term for sick) daughter days back I overheard the receptionist telling someone via phone that the practice could not see them because they weren't registered there. She gave a number to ring where someone would tell them which Hutt Valley practices were taking on patients or the caller could go on the waiting list to be taken on at that particular practice.

Another incident was recently recounted to me about a young woman who turned up with shingles or chicken pox at a pharmacy. The virus was getting near her eyes and the pharmacist was very worried about her and tried ringing several practices in an effort to get her in front of a GP.

As I understand it, Labour poured an extra couple of billion into primary health. They changed GP funding. GPs are now paid per capita. That is they are paid for each enrolled patient whether they see them or not. I have heard that the DHBs are now becoming quite frustrated with some GPs because they are taking time off. And they are not enrolling new patients. Apparently GPs describe the problematic situation as an economic one. But it has been suggested to me it is an ethical one.

Not long ago we needed a plumber urgently. It was a Saturday morning and we had a burst main flooding the garden. I deal with a fantastic outfit, and a plumber was there within a couple of hours. He worked all day to fix the problem. He was able to go and get the supplies he needed because hardware stores open all weekend because they are staffed by people prepared to work all weekend.

But if you need to see your doctor urgently, even when he has been paid to see you, frequently it's an impossibility. GP practices work very limited hours. So the alternative is hospital emergency services or after hours - neither of whom has been paid to see you. (It could be argued that the hospital has, indirectly, but you will pay through the nose at the after hours.)

Outcome; Labour upped the spend on primary health substantially for no increase in productivity.

9 comments:

Amnion said...

Primary health funding is allocated to you via the practice you are enrolled with. There is no funding for you to be seen at other GP practices. If you are seen in the after hours clinic the money for your care is clawed back from the practice you are enrolled with.

The Hutt Valley is one of the areas in NZ that is underserved by GPs, there are not enough to service the population. There is a safe number of patients that any single GP can service - soemwhere from 1500-200 is usual, although 1500 is recommended by the College and if your population is high needs then 1200 is the recommended patient load. In the Hutt most practices are happy to see people on the waiting list. There is a new GP practice beginning in April which will easily mop up the 2,000 in the Hutt who aren't enrolled with a GP. Not being enrolled is unfortunately commonest amongst the transient poor and/or chaotic families who move a lot, so that is more disadvantage.

In Wellington area there are two walk in Accident and medical Clinics happy to see people who cannot get in to their own doctors on the day. The pharmacist should have recommended an A&M or the emergency department if their own GP couldn't see them. Most GPs would see their own patients urgently on the day.
If this is again a case of an unenrolled child then they have Ed or A&M to visit. A&M charges, ED doesn't.

The problem is too few GPs for the population. Rich NZ is oversupplied (nice houses and schools for doctors) and poor NZ is generally undersupplied with GPs. We need to train more GPs, its simple. Getting them to work where needed is not so simple...


Maybe the 24 hour A&M clinics are similar to your after hours plumber? No doubt the plumber charges far more than a GP at the after hours would...

Amnion said...

Rather than 'very limited hours' GPs actually provide a service 24 hours, but after hours they often group together to provide an after hours service. In Wellington there are 3 After Hours clinics, the Hutt, Kenepuru and Wellington.

Kenepuru and Wellington also run a day time urgent clinic, for people who cannot see a day time doctor.

Anonymous said...

no increase in productivity

Decrease, Lindsay, substantial decrease.

same everywhere else.


he problem is too few GPs for the population. Rich NZ is oversupplied (nice houses and schools for doctors) and poor NZ is generally undersupplied

Nope the problem is socialist provision of GP services. If the medical schools could accept anyone who paid full fees, and pass anyone who was capable after doing the course, and if GP could change what they linked and work when it was economic, we wouldn't be in this mess.

And if bludgers choose to spend $$$ on TVs, smokes, and drink rather than going to a GP - that's their problem. If they end up at a hospital clinic that's only our problem because they don't get charged full cost of the hospital fixing something later that a GP - or more likely changing their lifestyle - could easily have prevented. But instead of them paying - I pay.

wino said...

This is something I see becoming a huge problem round here too. I seldom see a GP (I've got enough speciallists chasing after me and I figure it is actually productive all round to ask the oncologist who is ordering a blood test if it is a good idea to check my cholestrol and a few other things at the same time - after all if it is all normal no further action is needed) but I have never ending dealings with the surgery I am enrolled with about whether or not they are my primary caregiver (and could you please sign the statement we sent out to confirm that...)

Also note that if you do ring the GP and try to make an appointment you'll have to wait a week unless you tell them on the phone that you'll have to go to A&E then as it is urgent (at which point they will see you in half an hour).

Something wrong with the system...

Anonymous said...

Plenty of millionaire Doctors out there and insufficient health care.
Compare GP health care with dental care. Dentists got shot of welfare years ago and who now gives the better service.Both have problems of insufficient numbers but dental care wins hands down.
When os Tony gpoing to revisit funding and allocate it to the person rather than the gp. After all its the person who uses the service and in many cases contributes to funds for the service.

MacDoctor said...

Bulk funding of GPs was a massively retrograde step. Consider. We know that the use of something increases as it's perceived cost increases (Moral Hazard, it is called). When Labour started bulk funding patients the perceived cost to patients dropped and patients therefore accessed GPs more often. Unfortunately, the GP's salaries hardly rose commensurate with this increased activity. GPs became busier, but not richer.

Most GPs reacted to this by restricting "walk ins" to appointments only. There ceased to be any incentive to see extra patients or urgent, time-consuming cases. The small amount of funding lost to after hours services was a small loss considering that GPs could be free of after hours work.

Net result: You can't get an appointment easily for your poorly wee girl and most GPs do not like to see un-enrolled patients because the paperwork for them is complex (for very little extra money.

The only fee-for-service (FFS) left is ACC which now gravitates to the A&Ms who deal with accidents far more efficiently than GPs and generally charge nothing for follow up visits (maximising use again via moral hazard).

The only true solution for this is not more doctors (though that is a real necessity for rural areas when the number is very low) - it is a return to a FFS model. If the government wishes to participate in this model, then it can subsidize the insurance companies, allowing the individual to purchase the GP portion of the insurance at a reduced price.

I am not holding my breath for this.

PS> FInd me a plumber who trained for six years and can take responsibility for life or death decisions and I will pay attention to your plumbing analogy :-)

Anonymous said...

Dentists got shot of welfare years ago and who now gives the better service.Both have problems of insufficient numbers but dental care wins hands down.
When os Tony gpoing to revisit funding and allocate it to the person rather than the gp.


Cretinous idiot: when is the government going to stop funding healthcare you mean!

because it doesn't fund dentistry - except through eg special welfare benefits - but that's another issue

Anonymous said...

it is a return to a FFS model.

absolutely. And - as the mess in the US proves - the government must be constitutionally prohibited from any involvement in healthcare (or education, or the "general welfare")

Anonymous said...

>>>"it is a return to a FFS model".
absolutely. And - as the mess in the US proves - the government must be constitutionally prohibited from any involvement in healthcare (or education, or the "general welfare")<<<
Excellent idea then we can have twenty percent of our population with only accident coverage if they are lucky enough to live near a hospital with an ED. jcuknz