Many of us working in general practice do not share the government’s optimism about the so-called “biggest shake-up in funding in 20 years.”
The reality on the ground is very different.
The new funding model does not address the current shortfalls, nor does it keep pace with CPI. It is not a solution, it is a delay tactic.
Funding that doesn’t meet the real cost of care
General practice is being asked to absorb more and more unfunded work under the assumption that we will do it anyway because we have a duty of care. But duty of care does not pay rent, staff, equipment or the cost of complex medical care.
• Hospital specialists are protected by collective awards.
• GP specialists must self-fund many of the provisions covered in the Association of Salaried Medical Specialists award.
• GP specialists deliver complex, technical, time-intensive care with the same level of training and ongoing education requirements yet are not remunerated accordingly.
The mismatch is stark. I recently calculated that caring for a GP-led palliative patient brought in $500 of government funding but cost me around $20,000 personally because I did not charge the patient.
This is not an outlier — it is the system.
Capitation creates perverse incentives
Under capitation, the less a GP sees a patient, the more capitation they keep, but high-needs patients don’t fit that model.
A high-needs patient seen 20 times a year can cost a GP around $2000 to care for. The harder we work, the more we lose until we reach the point where we are effectively paying out of pocket to provide care.
This is an inverse-value model. It rewards low-contact care and penalises the very patients who need us most.
The result: practices become non viable.
These losses get buried in practice-wide costings, but the impact is real:
• ongoing financial instability
• inability to recruit younger doctors
• burnout and attrition
• shrinking access for high needs communities
Young doctors with $120,000–$200,000 in student loans look at general practice and see a career where the more they care, the less they earn.
That is not a sustainable workforce pipeline.
The growing concern: political interference in clinical governance
Alongside financial strain, many of us are deeply alarmed by the increasing political interference in clinical decision-making. Minister of Health Simeon Brown has taken an unprecedented level of direct influence over the Medical Council of New Zealand.
Yes, the minister can endorse council appointments but directing professional standards, clinical expectations or regulatory priorities is not his role. He is a politician, not a clinician.
Recent policy pushes, framed as “patient-friendly reforms,” undermine safe practice:
• Twelve-month prescriptions promoted as if people with diabetes or cardiovascular disease need only annual review which is clinically unsafe.
• Telehealth and AI pushed as cost-cutting substitutes rather than properly resourced clinical tools.
• Funding increases that don’t meet CPI, while workload and acuity rise.
• Pressure on the Medical Council to step back from its longstanding commitment to addressing inequity in Māori and Pasifika health outcomes.
The Medical Council’s mandate is to uphold professional standards, ethics, training and public safety, including equity. Political ideology cannot override clinical evidence or ethical obligations.
There are also suggestions that doctors may be discouraged from speaking publicly. In a democratic society, that is unacceptable.
The offer was “half a loaf or crumbs”
The Minister of Health has stated that GPs “overwhelmingly back the funding deal,” citing that 86% of general practice clinics , not individual clinicians, voted in favour.
However, this statistic does not reflect unanimous support, nor does it capture the underlying concern about the long-term viability of the offer.
In reality, the choice presented to practices was not between a good option and a better one, but between ‘‘half a loaf‘‘ and ‘‘crumbs to a-quarter of a loaf’’, depending on the practice.
Faced with that, most practices chose the half loaf — the less damaging of two inadequate options. This decision should not be mistaken for genuine endorsement, but rather understood as a pragmatic response to very limited alternatives.”
While some practices may benefit from the funding adjustment, a significant proportion — potentially up to 40% — will continue to struggle, as this funding does not adequately account for CPI increases, both current and projected, and locks practices into a four-year period of minimal adjustment.
At the same time, costs are expected to rise, including nursing wages (such as MECA increases), operational expenses, and the uncertainty of inflationary pressures.
This creates a widening gap between funding and the real cost of delivering care. General practice is already under considerable strain, and for many providers, financial viability remains severely compromised.
Without meaningful adjustment, this agreement risks accelerating workforce burnout, service reduction, and potentially practice closures.
It is also important to recognise the broader system implications.
Managing patients in secondary care costs at least 10 times more than equivalent care delivered in primary care.
Underfunding general practice does not reduce system costs — it shifts and amplifies them. As general practice becomes less viable and less accessible, demand on hospital services will inevitably increase, placing further pressure on an already stretched health system and driving up overall healthcare expenditure.
The government must reconsider the funding formula for general practice. Sustainable investment in primary care is not only essential for maintaining access and quality at the front-line, but is also one of the most cost-effective strategies for protecting the long-term sustainability of the health system.
The bottom line
We have a duty of care not only to our patients, but to the integrity of the health system itself.
When political overreach threatens clinical safety, and when funding models make high quality care financially impossible, we must speak up.
This is not the profession we joined and it is not the system New Zealanders deserve.
• David McKay is a GP and palliative medicine doctor in Dunedin.
