Access to primary healthcare is as critical to a government's survival as keeping the lights on. Yet a quarter of a million Kiwis cannot even register with a local GP.

This isn't a mere statistic – it's a daily reality for thousands of families.

It means parents unable to get timely care for their sick children, elderly patients struggling to manage chronic conditions without regular check-ups, and working adults delaying treatment for health issues that, left unchecked, could become serious or even life-threatening.

This GP shortage ripples through communities. It means longer wait times for those who do have a GP, overcrowded emergency departments dealing with issues that should be handled in primary care, and increased stress on an already strained health workforce. In rural areas, the situation is often more dire, with some communities left without any local GP services at all.

While Australia boasts 3.8 GPs per 1,000 people, New Zealand limps along with just 3.0. This is not just a numbers game – it translates to real differences in care. Australian patients generally find it easier to get appointments, receive more time with their doctors, and benefit from a more robust primary care system that can nip health issues in the bud before they become serious.

The economic toll of this disparity is equally stark. A recent study estimates the GP shortage costs the country over $1 billion annually in lost productivity and unnecessary hospital admissions. But even this figure fails to capture the full human cost – the anxiety, discomfort, and potentially life-altering consequences of delayed or absent primary care.

The problem is not merely a policy challenge – it is a ticking time bomb for public health and political stability. As more New Zealanders struggle to access basic healthcare, trust in the system erodes, and the social contract between government and citizens comes under strain.

As Dr Bryan Betty, newly appointed to the Ministerial Advisory Committee on workforce, bluntly stated last month, "We're facing a perfect storm in general practice."

The recent appointment of a commissioner to replace the Health New Zealand board is merely the latest warning sign of a system on the brink of failure. As the new administration grapples with runaway costs and bureaucratic bloat, this GP crisis threatens the very circuitry of our healthcare system.

The New Zealand Initiative's 2023 report, Lifeline for Health: Meeting New Zealand’s need for General Practitioners, paints a stark picture. Co-authored by Emeritus Professor Des Gorman and former Treasury Secretary Dr Murray Horne, the report demonstrates that a declining GP-to-population ratio and looming capacity crisis are not abstract concerns. They translate into real and growing threats to public health.

International comparisons throw New Zealand's GP crisis into sharp relief. While precise figures are elusive, it's clear that countries like Singapore have managed to maintain higher ratios of GPs per capita. New Zealand's position relative to the OECD average is equally concerning. These comparisons are stark reminders of the ground New Zealand must make up.

The new coalition government’s commitment to training more doctors is a promising sign it recognises this crisis. The appointment of Dr Bryan Betty to the Ministerial Advisory Committee on workforce suggests a willingness to incorporate expert input into policy decisions.

However, these initiatives, while welcome, represent only the initial steps in what must be a comprehensive overhaul. The government's focus on building a "home-grown, culturally competent workforce" is commendable, but it must be paired with immediate action to stem the tide of GPs leaving the profession or reducing their hours.

A three-pronged approach is necessary: retention of existing GPs, increased training and recruitment, and innovation in primary care models. The government's current plans touch on recruitment and training but fall short on retention and innovation.

Addressing this crisis requires a deeper examination of why GPs are leaving the profession or cutting back their hours. It's not merely about numbers; it's about making general practice an attractive, sustainable career choice. This means tackling overwhelming administrative burdens, inadequate remuneration, and lack of work-life balance that plague the profession.

The government's efforts to attract overseas-trained doctors are necessary in the short term, but they are akin to applying a plaster to a gaping wound. Systemic changes are required to make New Zealand an attractive destination for medical professionals in the long term.

One area where the government's approach is lacking is innovation. New models of primary care, including team-based approaches that leverage the skills of nurse practitioners and other allied health professionals, must be explored. Digital health solutions and community-based health hubs that integrate primary care with other health and social services could revolutionise primary care delivery, making it more efficient and accessible.

Funding is the elephant in the room. The government faces significant fiscal challenges, but investment in the GP workforce must be viewed as exactly that – an investment, not merely an expense. Strengthening primary care can reduce pressure on hospitals and emergency services, ultimately leading to more efficient use of healthcare resources.

A comprehensive strategy that goes beyond increasing GP numbers is essential. The role of GPs in the healthcare system must be reimagined, the status of general practice elevated, and an environment created where GPs can thrive professionally while delivering the best possible care to their patients.

The government's initial steps are promising, but they are just the beginning. Sustained effort, innovative thinking, and a willingness to challenge the status quo are required. A vision of New Zealand with accessible, preventative, community-based healthcare is achievable, but it demands more than incremental change. It requires a fundamental shift in how GPs are valued and supported.

The health of the nation depends on the health of its primary care system. It deserves the attention – and the resources – commensurate with its critical importance. Only then can New Zealand claim a healthcare system that truly serves all its citizens, from Auckland's urban centres to the remote corners of Southland.

Solving the GP crisis is not just about healthcare – it's about maintaining the social contract between government and citizens. Just as a government that can't keep the lights on will quickly find itself in the dark, one that fails to provide basic healthcare access may soon find itself out of power.

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