Little accuses GPs of making inaccurate claims on funding

Minister of health Andrew Little has written a terse letter to general practitioners, refuting claims of underfunding. 

In response, GPs told Little his information could “materially mislead the public”. 

Little’s letter, dated Dec 16, came in response to GP association GenPro’s ‘Save your family doctor’ campaign and “On the Brink” report launched in November. 

The group, which represents more than 400 general practices across the motu, called for the urgent addressing of fair pay for GP nurses, workforce numbers and funding. 

In his letter, Little acknowledged the important role of general practice and the pressures it is under, citing a ‘decade of structural underfunding of the health system’, exacerbated by the pandemic and last year’s winter respiratory illness spike. 

“However, there is a difference between listening and unquestioningly accepting claims made in furtherance of commercial interests,” Little wrote. 

Breakdown in trust 

A number of points raised in GenPro’s campaign were not supported by evidence, according to officials’ advice, he said. The seven-page letter details where Little agrees with officials and disagrees with GenPro. 

“Part of being an honest broker with you is making unambiguous that anyone receiving taxpayer funding needs to expect a high degree of scrutiny, firstly about the facts of that funding, and secondly to provide public assurance that taxpayers are getting value for their investments. 

"I do not consider that your On the Brink report accounted accurately to New Zealanders.” 

GenPro chief executive Philip Grant said such a breakdown in collaboration and trust between Little and GPs was disappointing and would be of concern to patients. 

“There is a very obvious difference of opinion as to the underlying funding and sustainability of those services and, particularly, the funding of nurses employed to provide them.” 

GP nurses’ pay 

GenPro said GP nurses were paid on average 10% less than hospital nurses, a claim supported by the NZ Nurses Organisation. It calculated it would cost $11.75 million a year to fund NZ's 1,000 or so general practices to match Te Whatu Ora/ Health NZ pay. 

Late last year, Little announced pay parity for a range of primary care nurses, excluding GP nurses because of a lack of evidence they were paid less. 

In his December letter, he said the government provided more than $106m (over two years) to general practices to support cost pressure increases. Te Whatu Ora estimated the cost of settling the issue at $7.7m, he said.  

Funding 

Little also talked about GPs’ repeated pleas for increased funding. In early 2022, the government commissioned the Sapere Research Group to review GP funding, as part of the health reforms.  

The review was completed in July but kept under wraps until it was released on Nov 16. It found that GPs were underfunded by 10 to 20% on average, and by up to 231% for very high-need practices. 

Government funding would need to increase by more than $600m each year for clinics to be able to properly address the unmet need in the community, particularly for Māori and Pasifika patients, the report found. 

In his letter, Little said the Sapere review was an important input for further advice on possible changes to funding settings.

“The review makes an important contribution to our understanding of the shortcomings of the current capitation formula for general practice, which is based on historical use patterns rather than population need,” he said. 

Budget 2022 includes $86m over four years to more equitably allocate primary care funding to general practices, he said.  

GenPro would be included in Te Whatu Ora’s work on new contracting and funding settings for GPs, Little wrote. 

Minister’s information ‘misleading’ 

In his letter, Little said it was disappointing that his office received media queries about the campaign before hearing about it from GenPro first.  

“While you owe me no obligation of reciprocity, and I will continue to seek to engage in good faith myself, you should expect that the public interest in that matter demands this letter should be publicly released,” he wrote. 

GenPro published Little’s letter on its website, as well as its response, dated Jan 9. 

Chair Tim Malloy fired back that information quoted in the minister’s letter and separate media statements could “materially mislead the public”.  

“I believe GenPro has been more than transparent and proactive in seeking collaboration, discussion and progress with regards to our analysis and data sharing associated with cost pressures, nursing pay disparity and, most recently, our proactive release of On the Brink with fully referenced data sources and substantiated recommendations,” Malloy wrote.