The GP telling medical students to consider another career

A Canterbury-based GP says he no longer recommends the speciality to trainee doctors.

Dr Dermot Coffey is one of many GPs who have been in touch with Morning Report this week to talk about the state of primary health care.

On Thursday, a Whangārei doctor said the funding model in general practice was "beyond broken", with many quitting to take up higher-paid jobs with less paperwork and stress. And a survey completed last year showed GPs were doing about 46 percent of their work unpaid - often after hours and on weekends.

Just 14 percent of medical students in a recent poll reported by NZ Doctor said they were considering becoming GPs.

Coffey, a GP of nearly two decades after moving to New Zealand in the 2000s, told Morning Report on Friday he had always recommended to students and colleagues back in Ireland that "general practice in New Zealand always had been a good option".

"Now I would, particularly for medical students, I unfortunately would do the opposite… It's not an attractive job and they have choices. And if we're asked, is it something that we would recommend to them? I think we have to say that at the moment it is not."

He said listening to politicians on both sides gave him "a sense of hopelessness that nothing is going to change".

"They're tinkering at the edges. Some of the policies will make the working conditions worse, potentially," singling out Labour's promise of three annual free GP consults, if it came without "other changes".

The government has talked up the establishment of a new medical school in Waikato as helping with the workforce shortage, as well as leaning more on pharmacists and nurses.

"I'm a simple GP, I don't have the answers, but I can't sort of point out things that are not going to work," Coffey said.

"What they're trying to do is to squeeze us more and more. without putting the supports in place. And ultimately, that all comes back not to funding, but to the system, the capitation system as it stands. The problems we're having now are inherent to that system. It's been there from the start. It was always going to happen. It just has been accelerated by things like Covd and things like this.

"But it is predicated on a 10- to 15-minute appointment system, which is just incompatible with the way people live and with the realities of healthcare."

GP practices are funded based on the number of people enrolled and various demographic markers, such as age, gender and ethnicity.

"The minister will probably talk about today bringing in new capitation funding… which would not be predicated on things like ethnicity, which is another problem that we have with the government at the moment.

He said tinkering with the system - his view of both major parties' proposals so far - was "just going to perpetuate and exacerbate the problem as it stands".

Health Minister Simeon Brown told Morning Report the problem did not emerge overnight, and there was no "single simple solution" that would solve it.

He said the new Waikato Medical School would focus on would-be doctors who actually wanted to be GPs, particularly in rural areas.

"So that's about the long-term. In the short-term, last year we announced as part of the Budget a number of workforce measures for primary care - including funding 100 placements for overseas trained doctors to be able to start their careers here in New Zealand in primary care, 120 places for nurses to become nurse practitioners each year for the next five years in primary care, 120 nurses to become nurse prescribers in primary care - that actually was oversubscribed. We've got 235 doing that training this year…

"And this year, we're currently working with primary care sector leadership around changing the funding model for primary care to include rurality, comorbidity, and also other factors which impact on patients, which haven't been recognised for a very long time."

He said the new Waikato school would be based on a successful initiative in Wollongong, Australia, and rejected criticism it would just end up training new doctors who end up moving across the ditch for better pay and conditions.

"What you've done is you've just put to me a line from the University of Auckland and the University of Otago, rather than talking to the University of Waikato," Brown told Morning Report co-host John Campbell.

"I'm not sure if you've had them on your show this week, but I would've suggested if you're having a whole week focused on rural medicine, you might've wanted to talk to the actual new medical school with a focus on rural medicine and actually put those challenges to them and listen to all of the work that they're doing up and down the country right now, engaging with rural primary care practices, to establish clinical placements.

"They'll be making further announcements soon around that.

"There's no single simple solution to this problem. There are many solutions that are needed. That's what we as a government are focused on because we believe that primary care must be at the heart of our health care system. It is an area which I'm incredibly focused on as a minister, and we will continue to be focused on as a government."

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