Lucy Ratcliffe

Under graduate and post graduate medical training received a boost of more than $42 million in today's Budget.

Health minister Tony Ryall has announced 25 extra state-funded GP training places in the 2009/10 financial year with another 50 places by 2010 at a cost of $17.5 million over four years.

That brings the total of state-funded GP places to 154, with those extra 25 students starting in the 2010 academic year, RNZCGP chief executive Karen Thomas says.

"The extra 25 were promised and we're delighted that the promise has been fulfilled," Ms Thomas says.

"The increase to 50 was alluded to in the National Party's health policy and in the economic climate I'm absolutely delighted they've been able to follow through."

Sixty new places for medical students

Sixty new state-funded places for medical students announced in the Budget today will cost $25 million, with money coming from Vote Education and Vote Social Development.

The Government intends to increase this to 200 new places each year over the next five years, Mr Ryall says in a media statement.

"New Zealand has the highest percentage of foreign trained doctors of any OECD country (36 per cent) and is also the biggest exporter of doctors (29 per cent)," Mr Ryall says.

"The increase in medical undergraduate places, combined with the voluntary bonding scheme, will help build our own capacity at home."

Auckland professor delighted

Auckland University's medical and health sciences faculty dean Iain Martin is delighted at the Budget announcement of 60 new medical student places.

"Not only with the 60 places, but the clear understanding there needs to be a five year plan. I think that's good news," Professor Martin says.

The announcement is especially good given the pressure on the budget, he says.

The university has already invested in building the faculty's capacity to take more students with a $240 million refurbishment and extension of the Grafton Rd campus over the next four years.

Investment in infrastructure needed

While Auckland University's medical school head Des Gorman believes the numbers of funded medical student and GP places will go a long way towards self-sufficiency, there needs to be investment in infrastructure too.

When the GP training numbers are boosted, the practices generally have to kick out the medical students to make room for the registrars, Professor Gorman says.

Ms Thomas says the college is aware of this and is working closely with Auckland and Otago universities on making sure medical student experience in general practice is not compromised by the GP registrar places.

Unfortunately no part of the Budget's $245 million over four years for capital infrastructure in health has been allocated to primary care.



Feedback

Comment from Temuka GP Bryan Moore

While I must applaud the Government for its commitment to improving the workforce situation, particularly with regard to general practice, it is still far too short of the mark.

Let us consider the facts:
• There are currently 325 "new" positions per year for students wishing to study medicine (I do not use the term "first year" as this is no longer applicable. We have a lot more entrants for health sciences and from this group 325 are selected).
• The Government is providing funding for an additional 200 over five years - that's 40 new places a year. Good job. 365 places a year from next year.
• In 1988 over 30 per cent of final year students indicated a preference for general practice.
• In 2003 that number had fallen to less than 6 per cent (in the US it is less than 1 per cent!)
• 30 per cent of medical graduates leave New Zealand within three years of graduation. Assuming this remains unchanged - and the signs are it is increasing - then 110 of the 365 Graduates will leave.
• If 6 per cent of the remaining students choose to enter general practice, this is 15 a year.
• The first of these will only enter the training programme in nine years' time.
• The current uptake of registrar positions in general practice is "high" because of RNZCGP requirements for vocational registration. All GPs not currently vocationally registered will eventually be required to become so. This can only be completed via the registrar pathway in the future, so there are currently existing GPs holding registrar positions. These are not all "new recruits".
• There are about 3300 GPs in New Zealand at present. The average age for male GPs is over 49, for females it is over 45. This means that within the next 20 years we WILL lose half the current workforce. This is a requirement for at least 1650 NEW GPs. At the current rate of training, and with the additional university places, we will train 291.
• Over 50 per cent of GPs now only work part-time. This is an increasing trend. It is recognised that it is the older GP who works full-time and who is the practice owner. This would mean that better than a one-for-one replacement is needed. Optimistically this would need a 1.5 to one replacement rate, or 2475 new GPs over 20 years. This assumes no attrition. That's 125 new GPs a year from today.
• There is already a shortage of GPs. Many GPs have declined to take on new patients - this is obviously due to current workload. The population is ageing and there is an increased demand for services. This budget proposes to move services from hospitals into general practice. It also proposes that the GPs are going to do (more) teaching. When? How? Where?
• There is NOTHING in this budget designed to retain the current workforce. It only serves to increase the pressure on existing GPs. This will only prompt more to leave. The fewer GPs there are, the less attractive general practice becomes, the less attractive it becomes, the harder it will be to recruit and retain new GPs. Australia has built 11 new medical schools! They acknowledge this is not enough. We get offered a Band Aid.
• Government has claimed that capitation provides at least $27.50 per consultation. Since then we have had a 2.879 per cent increase in funding. Does this mean we now get $28.50? We all know this is not so. General practice delivers services to patients, services Government has claimed that it funds but clearly doesn't. Calculations suggest this amounts to $354 million a year in unpaid-for services. General practice is not asking for this money. It shouldn't have to. For my part I wouldn't even mind if this was spent on services for patients - actually I would prefer it was but I know that it won't be.

Where does the funding go? It goes to DHBs. What do we get from DHBs? We get more overpaid bureaucrats and fewer services for our patients. The health services in this country do not require a Band Aid, they require major surgery - including several amputations.

I guess given the propensity for giving the various budgets appellations, this one should be called "Bill's Band-Aid Budget".