Primary health care utilisation in Aotearoa New Zealand: a descriptive study of trends from 2008 to 2023
Mona Jeffreys



1
Abstract
The New Zealand Primary Health Care Strategy (2001) and subsequent government health policy have aimed to improve access to and expand the role of nurses in primary health care. Measuring primary healthcare utilisation is one way to assess the success of such policies.
This study aimed to describe trends from 2008 to 2023 in average annual general practitioner (GP) and nurse consultations, by gender, age, ethnicity, and area-level deprivation.
Primary health care service utilisation data were obtained from the Ministry of Health.
Average GP consultations per enrolled patient per year showed little change over the study period, with increases from 2.9 in 2008 to 3.1 in 2022, and a dip in 2020 and 2021 during the COVID-19 pandemic. In 2023, GP consultations were the lowest in the study period (2.8). Nurse consultations rose steadily from 0.4 in 2008 to 1.0 in 2023 and did not show a marked COVID-19-related dip. Māori had consistently lower rates of GP consultations and higher rates of nurse consultations than New Zealand Europeans. Utilisation of primary health care, particularly that provided by GPs, was low in 2023.
Possible reasons for Māori and older people consulting with nurses at higher rates should be investigated. These may be artefactual, due to our inability to age-standardise the data. Other possible reasons include nurse management of chronic conditions and barriers to accessing GP care. The fall in primary healthcare utilisation in 2023 will likely increase secondary care need.
Keywords: access, consultations, equity, general practitioner, nurse, nurse practitioner, primary health care, service utilisation.
References
1 Starfield B, Shi L, Macinko J. Contribution of Primary Care to health systems and health. Milbank Q 2005; 83(3): 457-502.
| Crossref | Google Scholar | PubMed |
2 World Health Organization. Declaration on Primary Health Care. Geneva, Switzerland: World Health Organization; 2018. Available at https://www.who.int/teams/primary-health-care/conference/declaration [accessed 1 December 2024].
4 Ministry of Health. Annual Data Explorer 2022/23: New Zealand Health Survey: Ministry of Health; 2024. Available at https://minhealthnz.shinyapps.io/nz-health-survey-2022-23-annual-data-explorer/ [accessed 13 June 2025].
5 Jeffreys M, Ellison-Loschmann L, Irurzun-Lopez M, et al. Financial barriers to primary health care in Aotearoa New Zealand. Fam Pract 2024; 41(6): 995-1001.
| Crossref | Google Scholar | PubMed |
6 Irurzun-Lopez M, Pledger M, Mohan N, et al. “Closed books”: restrictions to primary healthcare access in Aotearoa New Zealand-reporting results from a survey across general practices. N Z Med J 2024; 137(1591): 11-29.
| Crossref | Google Scholar | PubMed |
8 Grimmond D, Martin G, Tu D. GP Future Workforce Requirements Report: Allen+Clarke; October 2021. Available at https://www.rnzcgp.org.nz/documents/6/2021-GP-future-workforce-report-FINAL.pdf
10 Mohan N, Irurzun-Lopez M, Pledger M, et al. Addressing closed and limited enrolments in general practices in Aotearoa New Zealand: a mixed-methods study. N Z Med J 2024; 137(1599): 55-64.
| Crossref | Google Scholar | PubMed |
11 Holloway K. In a global nursing shortage, NZ’s reliance on overseas-trained staff is not sustainable. The Conversation, 20 November 2024. Available at https://theconversation.com/in-a-global-nursing-shortage-nzs-reliance-on-overseas-trained-staff-is-not-sustainable-240997 [accessed 27 February 2025].
12 Van Der Biezen M, Adang E, Van Der Burgt R, et al. The impact of substituting general practitioners with nurse practitioners on resource use, production and health-care costs during out-of-hours: a quasi-experimental study. BMC Fam Pract 2016; 17(1): 132.
| Crossref | Google Scholar | PubMed |
13 Jenkins-Clarke S, Carr-Hill R, Dixon P. Teams and seams: skill mix in primary care. J Adv Nurs 1998; 28(5): 1120-6.
| Google Scholar | PubMed |
15 Cumming J, Mays N, Gribben B. Reforming Primary Health Care: is New Zealand’s Primary Health Care strategy achieving its early goals? Aust N Zeal Health Policy 2008; 5: 24.
| Crossref | Google Scholar | PubMed |
20 Ministry of Health. Capitation rates; 2024. Available at https://www.tewhatuora.govt.nz/for-health-providers/primary-care-sector/capitation-rates [accessed 22 September 2024, updated 9 August 2024].
22 Forbes S. Overhaul of capitation languishing with Te Whatu Ora. NZ Doctor, 20 November 2024. Available at https://www.nzdoctor.co.nz/article/news/overhaul-capitation-languishing-te-whatu-ora
23 Crampton P, Dowell A, Woodward A, et al. Utilisation rates in capitated primary care centres serving low income populations. N Z Med J 2000; 113(1120): 436-8.
| Google Scholar | PubMed |
24 Health Utilisation Research Alliance.. Ethnicity, socioeconomic deprivation and consultation rates in New Zealand general practice. J Health Serv Res Policy 2006; 11(3): 141-9.
| Crossref | Google Scholar | PubMed |
25 Baldwin JN, Garrett N, Larmer PJ, et al. Primary care doctor and nurse utilisation rates for billed consultations across the Comprehensive Care Primary Health Organisation. N Z Med J 2019; 132(1498): 79-89.
| Google Scholar | PubMed |
26 Health New Zealand | Te Whatu Ora. PHO Services Agreement Reporting Requirements; 2014. Available at www.tewhatuora.govt.nz/assets/For-the-health-sector/Primary-care/Referenced-documents/PHO-Services-Agreement-Reporting-Requirements-Referenced-Document-11-June-2014.pdf [accessed 13 May 2025].
27 Boven N, Exeter DJ, Sporle A, et al. The implications of different ethnicity categorisation methods for understanding outcomes and developing policy in New Zealand. Kōtuitui: N Z J Soc Sci Online 2020; 15: 123-39.
| Crossref | Google Scholar |
29 Davis KM, Eckert MC, Hutchinson A, et al. Effectiveness of nurse–led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface: a quantitative systematic review. Int J Nurs Stud 2021; 121: 103986.
| Crossref | Google Scholar | PubMed |
30 Sheridan N, Hoare K, Carryer J, et al. Nurses’ work in relation to patient health outcomes: an observational study comparing models of primary care. Int J Equity Health 2024; 23: 198.
| Crossref | Google Scholar | PubMed |
31 Adams S, Boyd M, Carryer J, et al. A survey of the NP workforce in primary healthcare settings in New Zealand. N Z Med J 2020; 133(1523): 29-40.
| Google Scholar |
32 Irurzun-Lopez M, Jeffreys M, Cumming J. The enrolment gap: who is not enrolling with primary health organizations in Aotearoa New Zealand and what are the implications? An exploration of 2015–2019 administrative data. Int J Equity Health 2021; 20(1): 93.
| Crossref | Google Scholar | PubMed |
33 Talamaivao N, Harris R, Cormack D, et al. Racism and health in Aotearoa New Zealand: a systematic review of quantitative studies. N Z Med J 2020; 133(1521): 55-68.
| Google Scholar | PubMed |
37 Department of the Prime Minister and Cabinet. Proactive release: Timeline of Aotearoa New Zealand’s significant events and key All-of-Government activities. 10 October 2023. Available at https://www.dpmc.govt.nz/publications/proactive-release-timeline-aotearoa-new-zealands-significant-events-and-key-all-government-activities [accessed 11 December 2023].
38 Wilson G, Currie O, Bidwell S, et al. Empty waiting rooms: the New Zealand general practice experience with telehealth during the COVID-19 pandemic. N Z Med J 2021; 134(1538): 89-101.
| Google Scholar | PubMed |
39 Imlach F, McKinlay E, Middleton L, et al. Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences. BMC Fam Pract 2020; 21(1): 269.
| Crossref | Google Scholar | PubMed |
40 Imlach F, McKinlay E, Kennedy J, et al. Seeking healthcare during lockdown: challenges, opportunities and lessons for the future. Int J Health Policy Manag 2022; 11(8): 1316-24.
| Crossref | Google Scholar | PubMed |
41 Schäfer I, Hansen H, Menzel A, et al. The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study. BMC Fam Pract 2021; 22(1): 125.
| Crossref | Google Scholar | PubMed |
42 Xu Z, Fan J, Ding J, et al. The Impact of COVID-19 on Primary Care General Practice Consultations in a Teaching Hospital in Shanghai, China. Front Med 2021; 8: 642496.
| Crossref | Google Scholar | PubMed |
43 Foley KA, Maile EJ, Bottle A, et al. Impact of COVID-19 on primary care contacts with children and young people in England: longitudinal trends study 2015-2020. Br J Gen Pract 2022; 72(720): 464.
| Crossref | Google Scholar | PubMed |
44 O'loughlin C, Uia T, Grant C, et al. Consequences of COVID-19 protection measures on children’s respiratory health in Aotearoa New Zealand. N Z Med J 2025; 138(1610): 74-92.
| Crossref | Google Scholar | PubMed |
45 Ministry of Health. Annual Data Explorer 2023/24: New Zealand Health Survey; 2024. Available at https://minhealthnz.shinyapps.io/nz-health-survey-2023-24-annual-data-explorer/
46 Pledger M, Cumming J. Unmet need for primary health care and subsequent inpatient hospitalisation in Aotearoa New Zealand. A cohort study. J Prim Health Care 2024; 16(2): 128-34.
| Crossref | Google Scholar | PubMed |
47 Adams S, Komene E, Wensley C, et al. Integrating nurse practitioners into primary healthcare to advance health equity through a social justice lens: an integrative review. J Adv Nurs 2024; 80: 3899-914.
| Crossref | Google Scholar | PubMed |
48 Ministry of Health. Primary care announcements; 2025. Available at https://www.health.govt.nz/strategies-initiatives/programmes-and-initiatives/primary-and-community-health-care/primary-care-announcements [accessed 6 April 2025].
49 Nursing Council of New Zealand. Mātanga Tapuhi Nurse Practitioner. n.d. Available at https://nursingcouncil.org.nz/Public/NCNZ/nursing-section/Nurse_practitioner.aspx?hkey=1493d86e-e4a5-45a5-8104-64607cf103c6 [accessed 1 December 2024].
50 Harris DL, Holloway K. Nurse practitioners can ease NZ’s healthcare pressures – why is the role not better recognised or funded? The Conversation, 30 July 2024. Available at https://theconversation.com/nurse-practitioners-can-ease-nzs-healthcare-pressures-why-is-the-role-not-better-recognised-or-funded-235658 [accessed 1 December 2024].