Doctors at a West Auckland clinic say patients are facing increased wait times for appointments or being turned away altogether as the number of GPs in New Zealand stagnates.
The situation has not improved since RNZ reported on the issue in June, with up to half of the country's primary care practices now unable to take on any new patients, according to the Healthpoint website.
While New Zealand's regions had long been struggling with access to primary care, doctors said the problem was now spreading to metropolitan areas.
Hobsonville Family Doctors has not accepted new enrolments for two and a half years.
Reaching capacity with 7400 patients, they were among the 50 percent of primary care practices in West Auckland with closed books, according to the Healthpoint website.
Dr Torrance Merkle said it was a last resort.
"We would love to take more patients, but we can't do that when the patients we already have are waiting four to five days for an appointment."
Closing their books just before the pandemic, the practice reopened them at the end of 2020, but was inundated with 400 enrolments in the space of two months and had to close them again.
As the population of Hobsonville swelled, the practice set up a new wing that could accommodate 2000 new patients.
But they had been renting this space out as they could not find enough staff to work in it.
They had enough trouble just retaining staff.
"Over the last year, we had one GP retire and another GP move back home to Europe.
"This year, we lost a GP to Australia, and then another GP moved to Tauranga."
Dr Paul Nicholls joined the practice in 1988. He said much had changed since then.
"We used to be able to see people the same day or the day after, pretty much guaranteed, and be able to run extra clinics through winter for the surge in illnesses."
Now, he said people were living with medical issues for longer, meaning more complex issues needed addressing during their 15-minute appointments.
"We don't have a choice; we have to deal with it. You can't ignore it and ask them to go away for another week.
"The result of that is there's more in the way of staff burnout."
Dr Nicholls, who is nearing retirement age, said the only thing that could lighten the load was more GPs.
However, while the government said it was increasing the number of trainees from 200 to 300 per annum, the workforce had only seen an increase of 15 GPs in the last year.
The practice receives about 15 calls every week from people wanting to enrol.
"Some people will be totally affronted by a receptionist saying, 'I'm sorry, we're not taking on new patients'.
"They will interpret that as, 'Who are you to tell me I can't get medical care?'
"Really, it's just that we don't have the capacity."
According to the Healthpoint website, of New Zealand's 1215 primary care practices, just 610 were open for enrolments.
Te Whatu Ora Health New Zealand said the information on Healthpoint depended on each practice keeping its information up to date.
Access to primary care was unevenly spread across the country.
While West Auckland mirrored the national average, Wairarapa had just one of its 13 practices open to new enrolments.
A hiccup when it comes to referrals
Dr Nicholls said many people stayed with their city doctor, using video or phone consultations, after relocating to the regions.
He said this arrangement worked - until it came time to refer patients onwards.
"We don't have any knowledge of who is down in Hamilton or Timaru, what specialist to visit, or what hospital they go to.
"It creates a lot of problems and delays for them, which we're acutely aware of.
"But we do it because it's the right thing to do - they need care."
Even within West Auckland, some patients were travelling well outside their neighbourhood for a check-up.
One resident said although he had moved to Hobsonville, he still went to his old clinic in Ratanui.
"I can get in there when I need to - that's not a problem.
"[But] I've been trying to shift to the doctor upstairs [Hobsonville Family Doctors] for over a year and no luck."
Others had noticed their local doctors were under more pressure.
"I know at least two of the doctors have left the practice that I'm in," one resident said.
"One has gone north to live, and the other has gone on maternity leave. They're having difficulty filling the places that are left."
Another resident said she often had to wait up to two weeks to see a doctor.
"If it's anything urgent, you need to go see someone else, because you just can't get into your normal GP."
Bodies working hard to ease shortages
Health NZ's primary health care system improvement and innovation manager Adeline Cummings said she was working closely with the Ministry of Health and Māori Health Authority on solutions to workforce shortages.
She said the latest survey of general practices in May-June showed 34 percent had closed books, compared to 38 percent at the time of the previous survey in February 2021.
This did not include accident and urgent care or independent clinics which might also enrol patients.
Cummings said new investments would support the sector, including a salary increase for GP registrars in training, accommodation allowances for rural trainees, and funding for general practices that offered placements for postgraduate interns.
But in the short term, the workforce would rely on more international doctors and nurses coming in.
Health NZ kicked off its first major international recruitment campaign this week, targeting health professionals in the UK, Ireland, Canada, the US, and Singapore.
RNZ
