Health

Greetings from New Zealand... Dr Annabelle Mascott of Woolwell Medical Centre compares GP practice in New Zealand with ours in the UK

Iam currently taking a brief sabbatical and enjoying a working holiday in New Zealand. I thought it might be interesting to compare our own health service with that in New Zealand - how much it is the same, where it diff ers and what insights that gives us on our own position. GPs in New Zealand experience a very similar training to our own. Once qualifi ed, young doctors in both countries do a number of hospital posts to gain experience in diff erent specialities and then have a period of training in General Practice before taking exams and qualifying as GPs. Like in the UK, most GP practices are still owned by groups of partners, many of whom own the premises where they work as well. The partnerships then have a contract with the health service to provide medical services and get paid for the services they provide. Both countries pay a basic amount per patient (capitation payments) and then fees for diff erent targets and extra services. The GPs use this money to run the surgeries.

In contrast to the UK, the NZ health service is not free at the point of need. Patients in General Practice in NZ pay a contribution to the cost of a consultation when they attend, varying from about £10-20 per visit to the surgery. Consultations are free to most children and to some patients with a high number of medical conditions. There is a higher charge if you are not usually registered with the practice.

Home visits in New Zealand are very expensive and are rarely requested, although GPs there do visit nursing homes and patients with palliative and end of life needs. Like in the UK, there is a small charge for prescriptions but the number of medications available in New Zealand is much more limited and they have a very strict list of medications that can be issued on prescription. As they are a small country of only four million people, their government has limited funds to spend on medicines and therefore negotiates with drug companies to enable a preferred supply of one or two options for each sort of medication. GPs here are encouraged to stick to a list of regulated medicines but have a much wider choice and less restrictions.

When I am working in New Zealand, I work mostly in rural practice. Like in the UK, rural GPs tend to provide more care than in urban areas where other facilities are

easier to access. I am seeing lots of injuries and accidents that would usually be dealt with in minor injury units or A&E departments in the cities. There is little public transport between towns here and most people travel by car, so this can make journeys to hospital very prolonged and where possible patients prefer to be treated in their local practices.

Most practices in New Zealand have a mix of GPs and practice nurses as in the UK - and they are also experiencing a diffi culty in recruiting and training both doctors and nurses. In the UK this has been due to a combination of factors, including rising workloads, patients with complex conditions living longer and increased demand not being matched with adequate funding. This has resulted in General Practice not looking like an attractive career and therefore declining numbers of applicants. This, coinciding with retirements of many doctors who feel they cannot continue with the high workload, has led to a shortage of GPs in the UK which is going to take some years to reverse.

In New Zealand the problems are slightly diff erent, in that they do not train suffi cient numbers of the doctors that are needed and quite a number of younger doctors go to work in Australia, at least for some of their careers, as pay is better there and the cities can off er more opportunities.

Perhaps one of the most striking diff erences between us is that New Zealand society has two main cultural infl uences, Maori and Pakeha (European ancestry). Respecting both cultures is highly important in the

values and practices of the health service and is part of the guidelines laid down by the New Zealand Medical Council on how doctors need to behave. This translates into both mundane elements such as taking care of correct pronunciation of names, to how buildings are designed, decorated and blessed on opening. Learning about Maori culture and the history of New Zealand has been one of the most interesting things about working here.

I feel we have a lot to learn from one another about how to make General Practice both accessible to people from diff erent backgrounds but also a vibrant and effi cient workplace for the health practitioners of the future. n

Dr Annabelle Mascott is a doctor at Woolwell Medical Centre

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