Workforce limitations not just funding are behind the Government delaying boosting primary care services including staggering the introduction of cheaper GP fees for all, says Health Minister David Clark.
Clark was addressing an audience of predominantly GPs on Friday during the weekend’s South General Practice Conference in Christchurch. He was responding to questions on delays to primary health changes promised or indicated pre-election – including reducing the cost of all general practice adult visits – not just expanding cheaper fees to all people with community services cards.
“I would like for primary care to be scaling up faster than is possible,” said Clark. He said while it was “absolutely true” that there were fiscal constraints causing some delays but said the sector had also told him workforce changes were needed before primary care could meet the expected increased demand of making visits cheaper.
“So that’s why we chose to do the Community Services Card first,” said Clark. He said the sector had told him to take one step at a time and to first ‘scale-up’ the workforce, because lowering the cost of access would lead to increased demand from people who hadn’t had access so readily up to now.
Labour had promised pre-election to cut the cost of visiting a general practice for all adults by $10 from July 1 this year. But this was rolled-back in the Budget to extending access to very low-cost GP visits from December this year to the expanded number of people now eligible for a Community Services Card – an estimated additional 500,000 plus people.
“With the Community Services Card broadening access, we think, for people – those 500,000 most financially stressed New Zealanders… that’s going to mean increased demand.”
In his address to the conference he said increasing capacity for the general practice workforce could not solely rely on funding additional training places and improving retention “could make a significant difference in the supply of vocationally-trained GPs.” “HWNZ intends to establish a taskforce to help us to understand the wider medical workforce pipeline and how we can do more to retain skills and investment in all stages of training and practice,” said Clark.
He said the pressure on GPs meant the sector also needed to promote career opportunities for all members of the multidisciplinary team – including nurse practitioners (NPs), clinical pharmacists and others. Along with supporting different models of care that promote virtual access and free-up clinical time like patient portals, telephone triage and online consultations.
Later in the session – in response to comments from a nurse practitioner about the need for better utilisation of the NP workforce – Clark said he was personally convinced of the value of the NP workforce.
Minister quizzed on GP training places, scrapping VLCA & nurses’ pay
Clark was quizzed after his speech on whether he had followed through and funded additional GP training places for the 16 potential GPs that it was understood had missed out places in the 2018-19 intake of 190 places.
He told the conference that it had been the Government’s intention to find funding for more but found that a number of potential trainees had turned down or chosen not to take up a place. He said sadly the result was that it wasn’t able to get more than 190 trainees this year and was funding every GP trainee who was eligible.
“We will look to fund more in the future. Obviously I can’t announce the budget today. But we are looking at how we can increase those funded places.”
Another GP in the audience asked Clark whether he was proposing to scrap the current differential funding for Very Low Cost Access (VLCA) general practices which allows them to offer very low fees to patients.
Clark said “at this stage the short answer is no”. He said the Government’s priority was to increase accessibility and see a growth in universal provision of services and the first step was extend VLCA fee levels to people with Community Services Card at all practices.
But he added that that he had also been made aware of the challenges to neighbouring non-VLCA practices,, that also had high needs patients and he had asked Ministry officials to keep this ‘front in mind’ during current negotiations looking at the sustainability of difference practise settings.
The impact of the pay rise recently settled for district health board nurses was also raised during the question session with concerns raised that having to match the DHB pay increase would impose a ‘significant cost’ on primary care.
Clark said he accepted that workforce costs were going up for the sector and the challenge was real.
He added that he had received Ministry of Health advice that the Labour Cost Index (which reflects movements in salary and wage rates and is used to fee into the funding formula for primary health care) had ‘jumped significantly’ because of the pay equity settlement so primary care “has been getting the funding in advance of the cost increases coming”. He told the gathering that he was “not intending to stop that …you guys face plenty of pressures”.