Rural general practice needs more than another working group - Dr Angus Chambers
Pahīatua’s healthcare struggles are not an isolated problem. They’re a symptom of a rural primary care system at breaking point, writes General Practice Owners Association chairman Dr Angus Chambers.
Rural New Zealand deserves the same access to quality, face-to-face healthcare as people living in our cities.
But that access is increasingly at risk.
Across the country, rural practices are struggling to recruit and retain doctors, nurses and other health professionals.
Six staff at the Pahīatua Medical Centre resigned on the same day last month, amid growing concern around extreme workloads and patient safety. Over the past two years, 81 staff have resigned from the Tararua Health Group.
In some communities, telehealth is becoming the only option because there simply are not enough clinicians available to provide face-to-face care.
Telehealth has an important role in modern healthcare. But it cannot become the default because we have failed to make rural face-to-face general practice sustainable.
Providing care in rural New Zealand is harder and more expensive. Practices serve smaller, dispersed populations.
Patients often travel further. Vacancies can remain open for months, and smaller teams have less capacity to absorb staff shortages or unexpected increases in demand.
Yet our funding model does not adequately recognise those realities.
In some cases, rural practices are effectively paid less for delivering a model of healthcare that costs more to provide.
It should be no surprise that we struggle to attract doctors and other health professionals to rural communities when the practices employing them are financially constrained and the work can involve greater professional, personal and practical costs.
The Government has recognised some of these pressures.
This year, following negotiation, rural practices received an additional $3.1 million and a 3.16% increase in rural funding.
That was welcome, but it does not address the fundamental problem.
The Government has also established a rural working group to examine workforce and other challenges.
We welcome genuine efforts to improve rural healthcare. But we should be realistic about what another working group can achieve.
Rural working groups have examined these challenges for years. Too often, they reach the same sticking point: funding.
We do not need another diagnosis of a problem that is already well understood. We need action.
The situation at Pahīatua Medical Centre shows what can happen when persistent workforce shortages and financial pressures converge.
Staff have publicly warned of significant delays in preventive screening programmes, months-long waits for appointments and growing concerns about patient safety.
Frontline clinicians have described a situation where demand continues to grow while staffing levels struggle to keep pace.
It is important not to pretend that every factor behind the situation is precisely understood, but what is clear is that Pahīatua is not simply a local issue.
It is a warning sign for rural healthcare across New Zealand.
What is happening there reflects challenges that many rural practices know all too well: difficulty recruiting clinicians, increasing pressure on remaining staff, and a constant struggle to provide the timely, face-to-face care that communities deserve.
Australia offers some useful lessons.
After facing significant rural general practice workforce challenges, it introduced financial incentives, including rural loadings and payments for doctors choosing rural pathways.
It has also used creative initiatives such as online “speed-dating” sessions and tours connecting trainees with regional communities.
The lesson is not that New Zealand should copy Australia. It is that incentives matter.
Attracting people is only part of the answer.
Retaining them requires sustainable practices, professional development, housing, childcare and career opportunities.
That starts with making rural general practice financially viable.
Pahīatua again illustrates why retention matters just as much as recruitment.
Rural practices cannot function when there is difficulty filling vacancies as quickly as they arise.
Every departure places further pressure on those who remain, increasing workload, burnout and the risk of a downward spiral that becomes increasingly difficult to reverse.
In the General Practice Owners Association’s (GenPro’s) Seven Steps to Restore General Practice election briefing, we called for a minimum 30% cumulative increase in general practice funding over three years, with funding that keeps pace with the cost of providing care.
For rural practices, there should also be a premium reflecting factors such as remoteness, population size, distance and workforce availability.
A properly designed rural premium would help make rural practices more attractive places to work, support investment in facilities and technology, and give doctors greater certainty when considering a rural career.
Rural general practice should be treated as essential health infrastructure.
When a practice loses capacity, patients may have to travel further, preventive care can be delayed, and hospitals face additional pressure.
Increasingly, patients may simply be offered telehealth because there is no clinician available to see them in person.
That is not a sustainable workforce strategy.
The rural working group may produce useful ideas. But we should not confuse activity with progress.
If the Government wants to address the rural workforce crisis, it must ensure the practices employing that workforce are financially viable.
Rural communities do not need another conversation about why their healthcare services are struggling.
Communities such as Pahīatua are already experiencing the consequences of workforce shortages and years of under-investment in primary care.
The warning signs are visible today. The question is whether policymakers are prepared to act before more rural practices reach breaking point.
New Zealand’s rural communities deserve better than a system that continually acknowledges the problem while failing to address its root causes.
They need a funding model that makes rural healthcare sustainable and a workforce strategy that gives health professionals a genuine reason to choose, and stay in, rural New Zealand.
Because where someone lives should never determine whether they can see a healthcare professional face-to-face.
Dr Angus Chambers is chair of the General Practice Owners Association.