Hāwera GP Keith Blayney, 71, and his practice manager wife Shirley spend both their pensions keeping their clinic open, but say that's better than accepting government funding. Photo: Supplied
Correction: This story has been amended to correct a reference to the percentage of the workforce that GPs represent.
Hāwera GP Keith Blayney earns less than his receptionist these days - but claims it is better than relying on the government's "flawed" capitation funding system.
Under capitation, practices are paid an annual fee by the government for every enrolled patient - no matter how many times they visit the doctor - and patient fees are capped.
When the system was introduced back in 2001, he and his wife Shirley - the practice manager - decided against joining. He said this was because they could see it was "doomed to failure", due to the ageing population with ever-growing health needs.
"The determinants of health are outside a lot of what we do, so predictably it blew out the number of people [needing care]. I don't want to blame anybody, but some practices took on a lot of patients they weren't able to manage."
Dr Blayney is free to charge patients whatever he likes.
"Some left because of that, because the fees went up. But it was quite a small number because most wanted to keep the GP they had seen for ages and have that continuity of care."
He did not want to say what his standard consultation fee is - that is commercially sensitive - but confirmed it was cheaper than a cut and colour at his wife's hair salon.
"Try going to your dentist, or your lawyer or your accountant or your hairdresser or your vet, I mean look at some of those vet bills!"
Even so, after 44 years in practice, Dr Blayney, 71, is not getting rich off it.
"For quite a while, I've been earning less than the living wage, and now I'm earning less than the minimum wage.
"We've had to constantly re-invest in the practice to keep it viable, so that means my superannuation and my wife's superannuation both go to support the practice.
"If it was a commercial enterprise, it would have closed years ago - but what do you do when you retire? 'Oh, might go and volunteer for something. What shall I volunteer for? What am I good at? I might as well volunteer for my own charity, called a general practice'."
Chronic underfunding killing general practice
It is generally accepted that funding for general practice is woefully inadequate, with National, ACT and New Zealand First all pledging - before the election - to boost funding.
A briefing by Te Whatu Ora to the previous health minister Dr Shane Reti just over a year ago found primary care needed between $353m and $1.36b to treat unmet need.
Nationwide, the country is short about 600 GPs.
Almost 40 percent of doctors were GPs between 1980 and 2000. Since that time, that proportion has dropped to below 25 percent.
In an interview with RNZ last year - the National Clinical Director Primary and Community Care, Dr Sarah Clarke, said Health NZ was re-weighting capitation funding to better match the actual cost of treating patients, like those with chronic health conditions.
"At the moment, the weighting doesn't really push the money where the need is, so we need to make sure all the money is going to the right places."
However, Royal NZ College of General Practitioners medical advisor Dr Luke Bradford, said Health NZ was trying to make those "adjustments" without increasing total funding.
"Everyone is already underfunded, so if you then take away some money from some of those practices because they have fewer elderly patients or similar then they will be even more underfunded.
"What we need is to bring everyone up to a level that's sustainable."
No promise of funding boost from minister
RNZ asked the new Health Minister Simeon Brown whether he planned to increase funding to GPs, as promised by all three parties in the coalition Government.
In a written response, he said he was "aware of the significant challenges patients are having trying to access GPs".
"This is a key priority for me as Minister of Health. I am focussed on ensuring all New Zealanders can access timely and quality primary healthcare, which will also take pressure off emergency departments."
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