The man's GP believed he was getting counselling for his depression. Photo: 123RF
A struggling GP practice was allegedly told by a Te Whatu Ora / Health NZ committee to set up a café inside the clinic to bring in extra cash.
And others are hosting sausage sizzles and asking patients to "pay one forward" to help patients who could not afford rising fees, a primary health organisation (PHO) chief executive says.
In September, General Practice New Zealand surveyed PHOs that deliver GP services, with about 76 percent of them responding. The results made for stark reading. More than 60 percent of PHOs had clinics in their network facing closures, 61 percent were reducing services, and 100 percent were restricting patient access in some way.
Among the reasons given were financial pressures and issues of burnout and retention with GPs.
In the survey, one practice revealed Te Whatu Ora's fees review committee - which made independent recommendations about increases to GP fees - suggested a medical centre set up a café to ease financial pressures.
Andrew Swanson-Dobbs, chief executive of WellSouth - the PHO for the clinic which got the café advice, told Checkpoint on Tuesday it was "silly advice".
"We shouldn't be advising practices to do things such as open a café."
He said it was a "real struggle" at the moment, with practices having sausage sizzles and asking patients to "pay one forward".
"In my patch, we've got a number of community trusts that own those services because they want health services to remain in their village, and they need to raise money in order to be able to afford doctors and nurses working in those practices so those communities can maintain care."
Swanson-Dobbs said GPs were the "foundation of primary care" in New Zealand, hosting 20 million consults a year.
"We've come to the stage where recommendations are 'open a café' or 'raise money elsewhere' because patients can't pay any more," he said, despite the fee increases allowed by the government not covering increases in costs and inflation.
"It's not what a lot of practices signed up for… that's not why doctors went to medical school. That's not why the nurses went and trained to help patients. That's not what they want to do in order to be able to deliver care.
"But don't forget, we've got an issue where nurses in primary care get paid less than their hospital colleagues, GPs don't get paid as much as the secondary care colleagues. That pay disparity still exists, and we've got to try and find ways to keep the workforce in primary care."
He said health funding had mostly focused on hospitals, not prevention.
"What we really do need to do is reorientate to keeping people well in primary care. You're talking to a PHO CEO, a person who's passionate about primary care in general practise.
"We really need to pivot the whole health system to prevention, early intervention and services closer to home. Basically, if we want general practice to be here into the future, we need to value it, and we need to fund it so that people want to work in it."
Te Whatu ora said the fees committee which made the alleged recommendation was independent, so essentially the suggestion was not from them.
"Fees reviews committees are external to Health New Zealand," director of living well Martin Hefford said.
"General practices are referred to a committee for a fee review where fee increases are above the level set within the Annual Statement of Fee Increases completed by Sapere for Health NZ each year.
"Health NZ would not suggest that general practitioners would use rental from a café to subsidise patient services."
Swanson-Dobbs said the primary care sector would "keep bleating on about this issue".
"If you want general practice services to continue, you need to value and we need to fund it appropriately so we don't need to do these sausage sizzles, pay-it-forward, cafés in general practice - it's not what we should be doing with our health system."
