NZMA GP COUNCIL
Mt Eden GP Jan White urges fellow GPs to respond to the interim Simpson report, to highlight the importance of the special GP–patient therapeutic relationship
Jan everything you say here about the inherent value of the doctor patient relationship is absolutely right, and is axiomatic to good General Practice. So it is profoundly depressing, indeed disturbing that there are signs that something that was so thoroughly understood when I started in practice in 1984, is in danger of being completely overlooked in a major review of Primary Care. Is that simply because it is not a measurable "KPI"? or that the money we save the health service can never be seen on a ledger? or is it because the review has the intent to de -emphasize the bits of Primary Care that it does not plan to invest in. An example of this thinking would be mental health. Major investment directed entirely to a new, yet to be trained workforce, who will have no connection with the patient or their family, with nothing to support the GPs for whom it accounts for 31% of every working day. I shall refrain from enlarging upon who pays for most of the extra time that involves.
Jan we simply should not have to present decades of research, evidence and publications that demonstrate the therapeutic nature of the doctor-patient relationship. It is not like the evidence does not exist or that it is hard to find. If the powers that be don't understand it and therefore won't fund it, the majority of our long-term patients do appreciate it (even if they do not understand it) - and then we will become a boutique service for those who can afford to pay and the well-being of the community will decline. Why do you think we do all the "mental health work" we do? It is because of the relationship that has been established and the trust that has been built up and because of the holistic model of care that General Practice embraces.
Trying to explain this to our so-called leadership and Ms Simpson is like trying to have a rational discussion with Donald Trump. They believe they are right and everything they do not believe in is fake news - evidence based or not. You cannot reason with a packet of frozen peas. Truth be told is that the packet of frozen peas is potentially more useful. You simply cannot help stupid. This is the embodiment of the Dunning-Kruger effect.
I am so pleased Jan articulated the value of continuity of care and the importance of the GP-patient relationship. We now seem to have strong voices in both the NZMA and the RNZCGP providing some evidence based feedback to the politicians from General Practice and how a re-emphasis on the value of the General Practitioner, particularly the traditional Family GP model, can not just improve health in NZ but also reduce overall health costs.
For too long we have sat back and allowed PHO (and even ex-PHO) and DHB managers' views to influence successive Governments resulting in the demotion of General Practice to a vague "Tier One" status and the GP to just another "Health Professional", of a similar standing to a pharmacist or midwife. Those managers are not our representatives, Kate and Jan (NZMA) and Sam (RNZCGP) are.
So how have politicians and DHBs responded to the management advice on the crisis in GP workforce? Initially it was with denial, then obfuscation to disguise the GP demise, then mitigation. Make GPs work harder for less remuneration, force fees down, push large clinic models, pay others more to do the "easy bits" and if something doesn't seem right, allow them to bypass the GP (despite good evidence GPs are the best "gatekeepers" and cost-effective health providers) to order expensive investigations and access services previously managed well in General Practice, yet deny or reduce GP access to those investigations or services.... I could go on about how illogical every decision has been. Essentially it means medical graduates are not choosing General Practice, and why should they as no one values the profession?
Yep, time to tell this Government (and the next) that we are not going to be ignored or lumped in as a "Health Professional" or even "just a GP". Firstly, we need to insist on full specialist recognition (if Vocationally Registered) with appropriate investigative rights, if just to provide a career path and goal to make General Practice attractive to medical graduates.
I personally would also push for major changes such as:
► every District Health Board and every Commission, Review, or investigation into primary care (or overall health) be required to have a practising Specialist GP member (not a PHO manager) with voting, if not veto rights;
► alternatives to PHOs be made available again, or at least reviewed, whether based on the South Canterbury model or perhaps Independent GPs with (DHB funded or subsidised) primary insurance;
► higher fees payable to Specialist GPs similar to QC lawyers (built in to capitation or insurance or private fees) - we are not "just a GP";
► inequity health reviews to be expanded to include the inequity of cost and care by practice (especially VLCA) and service (such as low income access to dental and optometry services).
I am sure other GPs would have excellent ideas to add, but by ourselves we get ignored, so we need the NZMA & RNZCGP to reflect our concerns.
Well put, could not agree more.
I have long thought that primary care funding should be taken away from DHB control. We seem to be the last cab off the rank, then end of the supply chain in their considerations.
Personally, Shree, it would be better to take the funding away from PHO's. Somebody has to hold and be accountable for the funding. Clearly PHO's aren't - and many seem to have a terrible tendency to dip their fingers ("top-slicing") into the funding allocated to reduce the cost of access i.e. "capitation". It is only right and proper that somebody be accountable for tax-payer derived funding, and that at the same time there is a mechanism to ensure equity. Again PHO's do neither of these things. What is required is better communication, understanding and mutual respect. PHO's do not promote this either. So what are the benefits of PHO's? What do they add to the provision of health care? Why does South Canterbury seem to be so out there both in the willingness to engage and the desire to do better?
New Zealand Doctor