General practice needs a complete funding overhaul, NZMA tells minister


General practice needs a complete funding overhaul, NZMA tells minister

Kate Baddock 2016
NZMA chair Kate Baddock
NZMA Briefing for the incoming Minister of Health
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General practice funding needs a complete overhaul, the NZMA has told the new health minister, David Clark.

The NZMA is also calling on the Government to commission an independent analysis of the health impacts of international trade agreements, such as the Trans Pacific Partnership which is currently being negotiated.

The demands are contained in a briefing for the incoming minister. The NZMA’s 11 key issues cover everything from workforce and training to euthanasia.

In the section on primary care funding and general practice sustainability, the briefing states the NZMA supports investment to reduce the barriers faced by vulnerable and high needs patients when trying to access care.

“The Very Low Cost Access (VLCA) model attempted to channel additional funding to those most in need but it has ultimately proved to be ineffective and inequitable,” it says. “Adjustments to the VLCA scheme alone will, however, not address affordability and access issues.”

Capitation formula ‘not fit for purpose’

In calling for a complete overhaul of general practice funding, the NZMA points to what it says is an increasing deficit in the relative value of capitation.

“The current capitation formula itself is no longer fit for purpose; it was developed over 15 years ago and does not reflect the nature of general practice today and the needs and expectations of patients.”

Dr Clark has pledged to review primary care funding within 18 months of taking office.

The briefing spells out positions which the NZMA has lobbied hard for in recent months and years, such as viewing health spending as an investment and tackling the social determinants of health. It describes health inequity as “a fiscal as well as a moral failure”.

It calls on the Government to strengthen investment in mental health and addiction services and commit to a target for suicide reduction.

It also repeats its call for a tax on sugar-sweetened beverages to tackle obesity, which previous health minister Jonathan Coleman rejected.

The association strongly supports the Medical Council’s intention for all prevocational doctors to spend a minimum of three months in a community-based attachment by the end of their second year of work and training, and calls for the Government to ensure adequate resourcing of these attachments across the country.

Training proposal ‘unworkable and naïve’

But while accepting the need to change the way vocational training is funded, the NZMA rejects the model proposed by Health Workforce New Zealand.

“We believe the proposal to use a Pharmac-like approach to training the health workforce is unworkable and naïve.”  

It says a contestable market model would lead to negative consequences.

The NZMA reiterates its opposition to euthanasia and doctor-assisted suicide, saying they are unethical. It has commissioned an independent report on the ethical issues of euthanasia which it offers to share with the minister.

The new government appears keen to sign a new version of the controversial TPP, despite the US stepping away from it after the election of Donald Trump last year. The NZMA has voiced its concerns about the “significant impact on health, health equity, and the social and environmental determinants of health” such deals can have.

“Government actions to protect and promote health should not be subject to challenge through an investor-state dispute settlement or similar mechanism. We therefore ask that, before committing to any international agreement on trade, the Government commission a formal, comprehensive, independent Health Impact Analysis.”


Before 1 August 2017 are stored in the Knowledge Basket

Contestable funding era approaches for postgrad training - 8 June 2017
Chorus of voices aims to burst bubble of sugary drinks consumption - 9 December 2016



Well NZMA, that's a start but Labour's promise to continue VLCA needs to be outright rejected by all of our organisations. It will liquidate many Access practices forced to unfairly compete against what will effectively be the free VLCA practices. Give it 18 months and it will be a disaster. Not that GPs with VLCA practices really care about it, think of all the newly unemployed ex Access funded GPs you can now employ as locums. Disgraceful.

The situation is so screwed tell me the wisdom of $8 GP visits? It will be cheaper to see the GP, waste 15 minutes of their precious time than to get a repeat script in every GP practice in New Zealand! Don't tell me it won't happen! Is this a wise use of an increasingly scarce resource?

Isn't it great the millionaire in the VLCA practice will get an $8 visit while the farm worker who just misses out on a Community Services Card in my Access practice has to pay $32! Where's the equity? Where's the universal proportionalism?

I agree about capitation needing a total overhaul but who would want to train in a specialty that has been so poorly represented, is so iniquitous and has no business case?!


This gives me hope for a move to equity. The NZMA and College's pre-election applauding of National's plan to preserve VLCA was incredible, as was the College making a case for VLCA preservation on National Radio this time last year.

Who in the College is advising on such a critical matter? How does the College ensure that the College's opinion and lobbying is representative of the sector? The Moodie report was representative of the sector. How does the College possibly correlate VLCA preservation with equity and proportional universalism? 

I have not met a GP with VLCA who wants to lose it. Willy Wonka didn't want to lose his golden ticket either.