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Speaker 1: Kyota. I'm Chelsea Daniels and this is the Front Page,

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Speaker 1: a daily podcast presented by the New Zealand Herald. Our

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Speaker 1: primary healthcare system stands at a critical juncture. At least,

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Speaker 1: that's the latest from the New Zealand Initiative. The think

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Speaker 1: tank has released a review this morning into the country's

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Speaker 1: primary care system. It argues that the current system faces

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Speaker 1: mounting pressures that threaten its sustainability and effectiveness. So, with

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Speaker 1: the vital role that gps play in our everyday healthcare,

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Speaker 1: what are the challenges facing our family doctors today? On

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Speaker 1: the front Page ends a research fellow doctor Prabani Wood

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Speaker 1: joins us to dive into another part of our health

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Speaker 1: system in crisis. Can we start with a bit of

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Speaker 1: your background, Brabani and how you came to become a GP.

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Speaker 2: So, yes, I did my medical school training in Oxford

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Speaker 2: and then moved to New Zealand twenty years ago now

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Speaker 2: with my husband who's also a doctor, and I've been

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Speaker 2: a GP in New Zealand now for just over.

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Speaker 3: Fifteen years now.

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Speaker 2: My path into general practice was convoluted, and I think

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Speaker 2: a lot of that is due to the fact that

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Speaker 2: general practice is still undervalued even.

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Speaker 3: Within our own medical profession.

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Speaker 2: We don't get much exposure to it as medical students,

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Speaker 2: and there's still a few people in hospital medicine that

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Speaker 2: probably looked down on it. So I did quite a

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Speaker 2: few years of work in hospital specialties before deciding to

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Speaker 2: make the move into and we care, and I'm glad

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Speaker 2: I did. It's the best career I really do think

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Speaker 2: going in medicine, but it's also probably the hardest.

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Speaker 1: What is the role at the moment of a specialist

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Speaker 1: GP in primary care?

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Speaker 2: So I think it's important and to use that term

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Speaker 2: specialist GP to begin with. You know, we are specialists

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Speaker 2: in that we undergo the same and rigorous postgraduate training

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Speaker 2: that all medical specialists do. We sit exams and we

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Speaker 2: are accredited by our college, the Royal New Zealand College

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Speaker 2: of GPS.

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Speaker 3: As specialist GPS.

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Speaker 2: We really need to know a lot about everything that

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Speaker 2: could possibly go wrong with a person, both in terms

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Speaker 2: of physical health and mental and emotional health. So we

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Speaker 2: are there to diagnose, investigate, treat and manage conditions. We're

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Speaker 2: also there to work out when we need to investigate

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Speaker 2: the further and refer on to our hospital colleagues. And

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Speaker 2: we're also there to prevent things from happening, you know,

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Speaker 2: picking up diseases early and preventing them from getting established.

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Speaker 2: So therefore you're trying to keep our patients healthy and

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Speaker 2: this overall saves the health system money. It makes sense,

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Speaker 2: right if you're picking up things early.

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Speaker 1: And I guess that's why it's so important to have

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Speaker 1: a regular GP that you have that relationship with, because

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Speaker 1: they can pick up on those tiny nuances.

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Speaker 2: I gets one hundred percent, and I think that's what

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Speaker 2: we're forgetting to talk about and acknowledge.

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Speaker 3: At the moment.

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Speaker 2: General practice isn't general practice without that continuity of care.

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Speaker 2: I don't think I can stress that enough. What we

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Speaker 2: do as specialist GPS is.

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Speaker 3: Very, very broad.

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Speaker 2: We've got to have a high level of expertise and

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Speaker 2: a very broad scope. You know, a study has shown

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Speaker 2: that general practice is the most complex specialty in medicine

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Speaker 2: based on how much you need to know and how

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Speaker 2: little time you have with each patient. It's it's very

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Speaker 2: broad and you have to keep applying your knowledge.

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Speaker 3: Keep up to date with new medicines and new treatments.

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Speaker 2: But you're always then applying that knowledge to the patient

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Speaker 2: in front of you, and you're following them through their

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Speaker 2: life course. So you're adapting your knowledge to each patient

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Speaker 2: that you see, and that's how you get those efficiencies.

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Speaker 2: Exactly as you said, you know, if you know you

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Speaker 2: as a GP, know your patient, and especially in the

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Speaker 2: context of a chronic health issue, every time you see them,

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Speaker 2: you don't have to start from scratch. Patients really appreciate

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Speaker 2: that it must be so frustrating to have to keep

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Speaker 2: telling your story over and over again each time, and

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Speaker 2: you can get right to the nitty gritty much more

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Speaker 2: quickly and pick up on things and subtle changes much

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Speaker 2: more readily.

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Speaker 1: What are the critical issues facing the sector at the moment.

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Speaker 2: It all comes down to a lack of funding and

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Speaker 2: recognition of the importance of the work do. The sector's

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Speaker 2: been under this funding pressure for many, many years, so

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Speaker 2: the critical ways that's manifesting are a major issue. With

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Speaker 2: workforce attrition, more and more gps are leaving. We've known

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Speaker 2: about a large section of our workforce being coming up

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Speaker 2: to retirement. We've known about that for a long time.

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Speaker 2: About forty five percent of gps had acknowledged that.

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Speaker 3: They would wish to retire within the next ten years.

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Speaker 2: But there are also mid career gps that are leaving

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Speaker 2: simply because the terms and conditions under which we are

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Speaker 2: working as gps are getting worse, and we're seeing more

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Speaker 2: fragmented roles as well, so as more roles in telehealth

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Speaker 2: come up, or roles in urgent care, for instance, so

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Speaker 2: people are leaving traditional GP roles for those instead.

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Speaker 4: Every single dollar must still have a bit outcomes for patients.

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Speaker 4: More money going in must mean more results coming out.

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Speaker 4: But under Labor we saw more money and worse outcomes,

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Speaker 4: longer wait lists and declining service levels, which is simply unacceptable.

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Speaker 4: Since being in office, this government has been taking action

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Speaker 4: and we're getting results. We've reinstated health targets because what

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Speaker 4: gets measured gets done. We're doing more operations. Last year,

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Speaker 4: the health system carried out of one hundred and forty

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Speaker 4: four thousand elected procedures, ten thousand more than the previous

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Speaker 4: twelve months. We're moving resources back to the front line,

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Speaker 4: cutting wasteful bureaucracy.

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Speaker 1: What needs to happen to the current funding model? What

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Speaker 1: should be done to kind of fix it to make

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Speaker 1: sure that those gps stay where they are in, stay put,

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Speaker 1: and encourage new gps to train into the specialist area.

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Speaker 2: There's quite a few things, but fundamentally, first of all,

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Speaker 2: in theory, the computation model makes sense, you know, having

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Speaker 2: some payment to have a patient enrolled under your practice,

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Speaker 2: but the model needs to reflect the needs of each

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Speaker 2: patient more readily, so to take into account chronic health issues,

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Speaker 2: for example, which aren't funded properly. So the funding needs

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Speaker 2: to reflect the needs of the patients that we're looking after.

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Speaker 2: That's first and foremost, so then we're able to actually

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Speaker 2: give the care to our patients that they need and deserve. Secondly,

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Speaker 2: in terms of what's happening with our workforce as GPS,

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Speaker 2: in general, your job is sized according to how much

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Speaker 2: time you're spending seeing patients. It doesn't really take into

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Speaker 2: account the amounts of time you spend doing vital, non

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Speaker 2: patient facing work.

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Speaker 3: And the amount of.

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Speaker 2: That work has really increased, I've noticed it over the

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Speaker 2: last few years. So in general, a recent survey by

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Speaker 2: our college showed that for every four and a half

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Speaker 2: hours and seeing patients, we generate around three and a

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Speaker 2: half hours of non patient for facing time, and that's

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Speaker 2: for following up on investigations you might have ordered, sending

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Speaker 2: referrals and following up on referrals. So it's all vital,

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Speaker 2: vital work, but in general that's not funded, and if

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Speaker 2: you're a GP owner, you would generally have to fund

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Speaker 2: your employees to carry out that work, but then the

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Speaker 2: practice loses money for it. So we've got to change that,

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Speaker 2: and we've got to acknowledge the vital non patient work

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Speaker 2: and pectation work that we do and also support gps

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Speaker 2: with their training costs, their ongoing professional development. Just as

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Speaker 2: the hospital specialists are funded, it would be nice to

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Speaker 2: have a similar setup for gps as well, so that

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Speaker 2: in itself would make the career more attractive for people

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Speaker 2: training to become doctors. And then finally, it's increasing exposure

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Speaker 2: for medical students into general practice. I mean, I know

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Speaker 2: when I was training, I probably spent less than ten

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Speaker 2: percent of my time in general practice, and I think

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Speaker 2: that's true for New Zealand trainees too. So getting medical

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Speaker 2: students exposed and spending a good amount of time working

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Speaker 2: in general practice would encourage more people to come into

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Speaker 2: the amazing profession.

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Speaker 1: Right So, at the moment, just the face to face

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Speaker 1: patient time is funded and all of that extra work

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Speaker 1: isn't funded. I mean, that doesn't seem to make sense.

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Speaker 1: And also you said training in hospitals is funded, but

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Speaker 1: extra training as GPS isn't funded.

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Speaker 3: No, we have to fund it ourselves.

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Speaker 2: Yeah, it's just the way it's the way it's been

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Speaker 2: in New Zealand for some time. I think because as

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Speaker 2: GPS and GP practice are their own small businesses, so

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Speaker 2: all your costs have to come out of your own pocket.

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Speaker 2: The hospital specialists are under a specific collective agreement through

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Speaker 2: the union.

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Speaker 3: Essentially that.

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Speaker 2: Allows them to have some funding for their own professional

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Speaker 2: development for instance, because.

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Speaker 3: Obviously it's important.

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Speaker 2: You know, you go to medical school, you do your

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Speaker 2: postgraduate training and get your qualifications, but it doesn't stop there.

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Speaker 2: You're always learning and we've always got to update ourselves

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Speaker 2: and that costs money.

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Speaker 1: I read in a report that in Northland alone, preventable

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Speaker 1: hospital visits cost over two point seven million dollars a year,

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Speaker 1: with more than five thousand emergency visits that could have

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Speaker 1: been avoided with early local doctor care. So should we

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Speaker 1: get better at saving and redistributing that funding. It seems

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Speaker 1: to me like that funding can then go towards GPS

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Speaker 1: and those non face to face contact hours.

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Speaker 2: Absolutely, I think, you know, I'd love to get stuck

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Speaker 2: in and look in more detail into alternative funding models.

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Speaker 2: I have to do that in the future, but it

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Speaker 2: makes logical sense to me that any money that's saved

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Speaker 2: by general practice from patients not having to attend the

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Speaker 2: emergency department, that saving could.

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Speaker 3: Then be fed back into a primary care.

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Speaker 2: So we're not asking for new money, but we're asking

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Speaker 2: for the money that we're saving to come.

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Speaker 3: Back back to us.

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Speaker 2: And that would absolutely make sense to look at things

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Speaker 2: like that in that way.

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Speaker 1: And the cost of going to see a GP is

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Speaker 1: out of reach for a lot of keyways. Some might

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Speaker 1: have thought that telehealth appointments might be cheaper alternative, but

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Speaker 1: it costs around the same regardless of how long your

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Speaker 1: appointment is or what form. What do you make of that?

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Speaker 3: Yes, the only way.

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Speaker 2: You can incentivize is by reducing the cost right for

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Speaker 2: the patient.

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Speaker 3: You know, when gps haven't been.

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Speaker 2: Funded well enough to be able to afford to give

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Speaker 2: the care to the patients that they need to provide,

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Speaker 2: they've had no alternative but to increase the fee that

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Speaker 2: they charge their patients.

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Speaker 3: And it's awful you're in that position.

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Speaker 2: And yes, it means many patients aren't able to afford

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Speaker 2: to go and see their GP. So it's only by

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Speaker 2: funding gps appropriately so they don't have to charge the

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Speaker 2: patients as much that you can incentivize the patients to

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Speaker 2: go and see their GP, and then you know, valuing

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Speaker 2: that continuity of care. So that could be a specific

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Speaker 2: target if we're looking at targets. So seeing how well

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Speaker 2: we established relationships with our patients is another way to

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Speaker 2: encourage people to go and see their GP.

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Speaker 5: GP's books are full in many parts of the country,

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Speaker 5: Waiting time to see a GP are unacceptably long in

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Speaker 5: many places, and the failure of primary health care to

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Speaker 5: meet the basic needs of people is one of the

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Speaker 5: if not the most important factors leading to pressure on EDS.

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Speaker 5: Because what do you or I do when we can't

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Speaker 5: get to see our doctor and we're worried about our health.

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Speaker 5: We go to the ED. That is all we can do.

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Speaker 1: And your report talks about the issues with aging it infrastructure.

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Speaker 1: Our inzed i've seen has reported this week that health

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Speaker 1: end Z is pausing one hundred and thirty six digital projects.

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Speaker 1: But do you want to see more investment being made

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Speaker 1: in modernizing our health sector?

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Speaker 3: Absolutely, it's long overdue.

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Speaker 2: I think there are moves to do this, but we

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Speaker 2: can't work in a system where we don't have access

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Speaker 2: in real time to vital information for our patients. You know,

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Speaker 2: as I mentioned in my report, as a patient, you'd

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Speaker 2: expect that if you moved to a different parts of

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Speaker 2: the country for work and you were lucky enough to

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Speaker 2: be able to enroll with a new GP, that your

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Speaker 2: notes would get through and come through easily to your

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Speaker 2: new but that's often not the case. If you went

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Speaker 2: to a physiotherapist for an injury and that was lodged

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Speaker 2: through ACC, you would expect that your GP would get

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Speaker 2: those that information and the ACC number, but that's not

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Speaker 2: the case. There's simple things that could be done whereby

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Speaker 2: information is more readily shared, both within primary care but

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Speaker 2: also between primary care and the hospital. Often hospital IT

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Speaker 2: systems don't talk to each other, so hospitals in different

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Speaker 2: regions their IT systems don't talk to each other, and

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Speaker 2: then also then don't talk to you primary care. We've

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Speaker 2: got some shared electronic records in different parts of the country,

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Speaker 2: but there's not one uniform record.

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Speaker 1: Yet and PRA Bannie, if you could talk directly to

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Speaker 1: Health Minister Simeon Brown, what is the one thing you'd

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Speaker 1: like to get him started on tomorrow.

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Speaker 2: First of all, his announcements of increasing some funding to

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Speaker 2: primary care is great. It's a great start, but I

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Speaker 2: would love for a real focus on reorientating our health

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Speaker 2: system around the foundation of good, well funded, well resourced

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Speaker 2: primary care. So build our health system around that and

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Speaker 2: a bottom up approach rather than the top down approach

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Speaker 2: which is hospital first and then primary care is kind

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Speaker 2: of as an after thought. We are the backbone of

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Speaker 2: the health system. So despite the issues that I've talked

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Speaker 2: about with our workforce and lack of funding, we're still

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Speaker 2: in primary care. In general practice are seeing twenty one million.

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Speaker 3: Plus patients a year. But the more and more stretched.

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Speaker 2: We are, the more pressure then gets put back into

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Speaker 2: the hospital system, and the only way to relieve the

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Speaker 2: hospitals is to improve the funding and resourcing of primary care.

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Speaker 1: Thanks for joining us, Probanni, thank.

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Speaker 3: You, thank you for having me.

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Speaker 1: That's it for this episode of The Front Page. You

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Speaker 1: can read more about today's stories and extensive news coverage

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Speaker 1: at enzedherld dot co dot nz. The Front Page is

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Speaker 1: produced by Ethan Sills and Richard Martin, who is also

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Speaker 1: a sound engineer.

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Speaker 3: I'm Chelsea Daniels.

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Speaker 1: Subscribe to the front page on iHeartRadio or wherever you

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Speaker 1: get your podcasts, and tune in tomorrow for another look

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Speaker 1: behind the headlines.