Post Code Health Lottery

Statement from WellSouth Primary Health Network CEO Andrew Swanson-Dobbs

Dear Colleagues,

Much has been said about the postcode lottery within the hospital setting, but little is mentioned about access to primary care.

WellSouth Primary Health Network sits at the bottom of Te Waipounamu, supporting the 77 general practices that do an amazing job looking after the 330,000 people enrolled in your practices.

At last count, there was about $1.6 billion a year going into capitation for the over 1,000 general practices nationally - which should provide 24/7 access to care. However, we have long disputed that capitation covers 24/7 and that it is insufficient to cover the cost of care.

We know many areas in NZ where general practice has ceased to deliver after-hours access, and instead, patients are accessing urgent care facilities and/or ED.

However, many areas continue to provide care after hours, particularly rural, as there are often no other options.

For those practices classified as ‘rural,’ there is an additional $27 million a year to support them.

This is about 1.7% more funding over the $1.6B, and it is simply insufficient.

For the 77 practices we support, 37 are classified as rural. 47% of the 330,000 patients in our patch are enrolled in those 33 practices.

Our proportion of the $27 million is $5.4 million. While a good chunk of change, however when you understand the costs it’s trying to cover, it’s pathetic.

This is not the only inequality. Another example would be palliative care funding. We have $144,000 to spread across our 330,000 patients.

There is no consistency across the country. We are aware of a PHO with about 170,000 patients enrolled, and they have a $736,000 contract. Another PHO with 400,000 patients has a $750,000 contract.

While on the topic of palliative care, one GP pointed out that recently they get paid far more with ‘assisted dying’ than quality palliative care – why is that?

While I am on a roll, can I point out another huge discrepancy – Primary Options for Acute Care.

It’s a fancy name for a bucket of money for our practices to claim from with the explicit instruction “if you can provide intervention that keeps them out of hospital, do so and we will pay you.” When we compared revenue across the South Island a few years ago, we discovered that the Canterbury practices had over $11 a patient while we had 70 cents.

To the credit of Health NZ, last year that went up to $5 per person in our patch. I had hoped it would have increased to match Canterbury this year, but alas, I was wrong.

Best not start me again on Telehealth. While it should be a wonderful ‘addition’ to the sector, it has been implemented as a substitution.

Given the complete underfunding of rural general practice, a doctor recently pointed out to me that the government would rather pay a GP more to talk to a patient in the rural community on the phone instead of seeing the person face to face in the community they live with all the history and understanding that exists.

I have said it before and will say it again – as a country, we need to have a debate and agree on what we value, and if it is general practice, then fund it.

If we want rural general practice to exist into the future, we need to do more than spend months trying to figure out how we divide up the embarrassing $27 million that gets spread across rural practices.

I will continue to advocate for general practice, particularly the ones in the Southern network that have been underfunded for years. We are slowing turning this around but there is more work to do.