GP Philip Harrison asks whether farewelling the ‘wicked Minister of Health’ and welcoming Princess Jacinda and her new minister will be a fairy tale for primary health or a second ‘kiss of death’.

So the fairy Princess Jacinda has arrived at the palace and anointed everyone with a wish.

The Ministry of Health awaits its golden nuggets (hoping they are not actually brass). And out goes the wicked Minister of Health – like most GPs, he didn’t listen to us – and in comes the Labour champion Mr Clark who we may hope will start to treat us like human beings.

Stories loom everywhere about GP burnout (now even addressed in the Declaration of Geneva thanks to Kiwi Dr Sam Hazeldine), early retirement (40 per cent of GPs in the next 10 years is oft quoted), and crises with the VLCA (Very Low Cost Access) scheme funding (with most high needs patients not having have the luxury of low cost fees).

But, lets face it, with Winston holding the balance, either way, we in primary care have much to be cheerful about. Free over-65 checks, free under-14s, teenage health checks, reduced fees to community card holders, mental health funding for the under-25s. Almost no-one pays. Bliss!

A sting in the ‘tale’

Like all fairy tales however, there is often a little sting in the ‘tale’ and so we might see for primary care funding.

As the question remains: is free health care all that is needed?

Well no, because did not the NHS in the United Kingdom find that free care for all doesn’t fix the problem either? Health literacy and denial are everywhere. Similarly, UK emergency departments are equally clogged by the high needs populations although they do have far more high needs than we have across many ethnic groups. GP appointments are equally hard to come by there, even in 10 minute slots, and out-of-hours care difficult to staff.

Health care demand is high everywhere, in fact in most countries health care need is almost unquenchable.

But let’s not get gloomy, this is New Zealand and Jacinda is here with her army of froglets carrying magic spells, optimism, compassion and intent to change everything through direct government funding and a promise of no tax changes till the next parliament.

That government ’surplus’ will have to go a long way one suspects. A fiscal hole, one hears Mr Joyce mumbling to himself rather unconvincingly. I suppose it all depends on whether there is world recession or national disaster…

No such thing as a ‘free lunch’

Meanwhile our previous National government’s free under-6s and under-13 initiatives remind us that there are no free lunches in primary care.

‘Free’ anything does at least three things:

  1. It initially leads to an increase in demand not previously envisaged (and that we cannot cope with without more resources).
  2. It then leads on a disproportionate increase in demand at after-hours clinics (as people need to work) – leading to more GPs doing after-hours duties, (thus further contributing to long hours and aggravating the much talked about burnout of GPs).
  3. It increases overheads (costs) in primary care.

So, if GPs are already doing excessive hours, can they proportionally reduce their standard hours to address this imbalance? But what if this further increases demand? With that demand inevitably passed on to after-hours clinics or accident & medical centres.

So will free annual checks for over-65s, free under-14s, and $8 community card GP visits now follow the trend of the under-13s? This is a potentially huge issue with respect to the increasing retired population. What if this already ‘frequent attender’ group attends even more frequently?

Ultimately, direct funding to after-hours services will increase (yes many charge their local primary care facilities an annual fee – many thousands of dollars), surgery/health centre claw backs will grow, and additional commitments of staff to after-hours facilities will increase (with low levels of compensation).

So, who will fund the shortfall? The Government? By all accounts unlikely. In fact, it will inevitably fall on primary care. Moreover, this will affect all staff not just GPs. Possibly a second, if inadvertent, ‘kiss of death’?

Without more doctors, nurse practitioners (rare as hens teeth) and resources this keeps going around in circles. Money does not fix this. And in the next 10 years 40% of our current baby boomer GPs will retire.

Can we have faith in our government’s promises? Personalities apart, the funds will have to come from somewhere, taxation we understand will be deferred till the next parliamentary term, and one just has a sneaky feeling that, with so many promises, the money will run out.

For now, as I am over 65, I am happy to wait and see. But I will continue to see only my own GP. I think it’s more important that she knows me, as I get even older. And lucky me, yes need it or not, I am free.

Philip Harrison is, luckily, now a semi-retired, former Lower Hutt practice-owning GP.

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