‘We’re not taking on any new patients’: the reality of the funding and workforce crisis in primary care

General practitioner (GP) workforce shortages in Aotearoa New Zealand (NZ) have led to practices capping their patient enrolments in recent years. Practices closing their books means that people without a current GP or those relocating to another area may have difficulty accessing care, with lower-income and rural patients disproportionately affected. Lack of access to a GP means patients may attend emergency departments for non-urgent issues or delay seeking help, leading to poorer health outcomes. Pledger and colleagues published a study of practices in NZ with closed books in 2023,¹ and have now produced an update for 2025.² They have found that about a quarter of practices had changed their status from open to closed or vice versa, but overall the percentage of general practices with closed books has not improved. While felt across the country, the impact is greater in Northland, the middle-lower North Island, and the lower South Island.

In a companion paper, these researchers have looked at the patient characteristics of practices with closed books.³ Practices are more likely to have closed books when their practice population has a higher proportion of people born in NZ, had lower health status, are Māori or European, female or living in large or medium urban areas, and less likely where there is a higher proportion of males or Asian peoples. Being born in NZ is location-dependent and may relate to the patterns of migrant settlement.

A major contributor to GP workforce shortage is due to general practice funding having stagnated over the past two decades. Irurzun-Lopez and colleagues have analysed the funding the Ministry of Health transfers to Primary Health Organisations over time.⁴ They find that only 5.4% of the country’s health budget goes to primary health care, and this has not changed since 2009. Despite successive governments having strategic primary health care goals, they never prioritise funding to achieve this.

Sexual health is another theme in this issue. Harris and colleagues conducted two qualitative studies into Māori women’s experiences of sexual and reproductive healthcare. Having contraceptive options clearly explained and informed consent were found to be important and empowering, but better communication with their healthcare providers and improved dissemination of sexual and reproductive health knowledge was needed.⁵ A further study exploring experiences when accessing sexual healthcare found that comfortable spaces and caring and respectful staff were important. Patients need to be treated with dignity, and as people not numbers.⁶

The national Cervical Screening Programme has shifted from PAP smears to human papillomavirus (HPV) screening, which can be either self-collected or clinical-collected. Rose and colleagues present results from 921 surveyed women about their HPV testing experiences. Most chose to self-test for comfort, convenience and privacy reasons.⁷ In a thematic analysis of their free text responses, the majority shared positive comments, but a minority described unfavourable aspects such as being inadequately informed, issues around self-testing and inappropriate physical space.⁸

Many different types of screening can take place in primary care. YouthCHAT (Youth electronic Case-Finding and Help Assessment Tool) is used to assess a number of lifestyle and mental health issues in young people in primary care settings,⁹ This includes smoking and vaping. Zhou and colleagues analysed 3462 completed YouthCHAT screens of adolescents aged 14 years or younger, and found 22% reported ever having vaped and 12% ever having smoked. Ninety-three percent of those who vaped have never previously smoked, hence they are not using vaping as a smoking cessation strategy.¹⁰ All the current smokers also vaped. It is concerning that these 13 and 14 year olds appear to have easy access to vaping products, despite it being illegal to purchase these under age 18. The authors conclude that much tighter controls of sales and marketing of vaping merchandise is needed to prevent early teens taking up vaping.

Primary care professionals are often also expected to screen for alcohol use. A screening programme of adults aged 50 and over for alcohol-related harm was introduced in parallel with professional training. Towers and colleagues found that screening rates increased initially but then fell with the onset of the COVID-19 lockdown.¹¹ However, many of the health professionals reported that the intervention helped them change their practice and increased their comfort in screening.

Infectious disease surveillance is another form of screening, and sentinel primary care practices have been involved in respiratory virus surveillance programmes, especially for influenza, for decades. There have been recent improvements in multi-viral point-of-care testing (POCT) via a rapid antigen test (RAT). A study by Dowell and colleagues found that using POCT swabbing for immediate RAT, followed by polymerase chain reaction (PCR) testing for SARS-CoV-2 (COVID-19), influenza, respiratory syncytial (RSV) and other respiratory viruses in primary care settings during a viral pandemic was feasible and useful.¹² While providing individual patient care, this approach is also helpful for providing multi-viral population surveillance.

The final two papers in this issue address dental health in children. Zhang and colleagues have conducted a scoping review on the use of silver diamine fluoride in dental services for preventing dental caries.¹³ They find that this is a minimally invasive and cost-effective treatment for arresting dental caries in children aged up to 14 years, and advocate integrating silver diamine fluoride into national oral health strategies for children. Lastly, Ram and Han have studied the oral health status of children with disabilities in Auckland, finding high caries rates and significant unmet dental care.¹⁴ They conclude that there is an urgent need for tailored dental services for these children.

This issue finishes with our usual Charms and Harms column addressing globe artichoke,¹⁵ and a Cohchrane Corner on quitting smokeless tobacco use.¹⁶