New Zealand GPs divide over contracts

BMJ 1995; 311 doi: (Published 25 November 1995) Cite this as: BMJ 1995;311:1387
  1. New Zealand

    The New Zealand Medical Association is facing desertion by up to 1000 of its general practitioner members. The situation is the result of deep division among doctors over the introduction of general practice contracts. The association is now considering allowing a second group of general practitioners to form under its umbrella to represent members who choose not to work under general practice contracts. The fear is that, if the association does not accommodate these doctors, they could leave the General Practitioners Association, which is linked to the New Zealand Medical Association.

    “Britain had all these problems when contracting and non-contracting doctors couldn't get on,” said the medical association's chairman, Dr Dennis Pezaro. “We need to know if New Zealand can be big enough to get past what are basically fairly petty arguments.”

    General practice contracts have caused division within the profession since their introduction as part of market driven health reforms three years ago. GP Action, a group set up to lobby against the contract, effectively overthrew a pro-contract administration at the General Practitioners Association two years ago, at a time when the association and the New Zealand Medical Association were at loggerheads over health reforms.

    Since then about half of the country's 2500 general practitioners have moved on to contracts and the General Practitioners Association is now chaired by a general practitioner in Auckland, Dr Clive Stone, who is himself in a contracting group. Dr Stone is facing criticism for conducting what are seen as feeble negotiations with the funding bodies (regional health authorities), which wish to tighten the conditions under which non-contracting general practitioners can work.

    The most contentious issues in the negotiations have been a stipulation by regional health authorities that all general practitioners have a duty to provide 24 hour care (or to have appropriate cover arrangements in place) and a broadening of the definition of a general practitioner. The revised definition states that a general practitioner must provide comprehensive care to a practice population. This in effect precludes doctors who work in accident and medical clinics--which offer only urgent services--from claiming general practice subsidies.

    Dr Stone supports the regional health authorities' call for these changes, saying that the profession has a duty to “promote the conditions of general practice.” His critics argue that the subsidies belong to patients, who should be able to choose where they obtain their medical care.

    Now both the New Zealand Medical Association and the General Practitioners Association have called urgent meetings to discuss ways of accommodating the factions.

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