General Practitioners are hoping for help to keep some high-needs practices in business and more subsidies for the most vulnerable patients, in the Government's first Budget. 

And a full review of the primary care funding envelope would address long-term funding issues by next year, Royal College of General Practitioners President Dr Tim Malloy said.

It follows hot debate over what will be in the Budget for primary health care, after the Government announced a delay to promised GP fees across the board - something it says it can't deliver by July 1.  

SUPPLIED

Royal New Zealand College of General Practice president Dr Tim Malloy says GPs want to see a very targeted version of the Government's policy, and a full review of funding in the long-term.

Health Minister David Clark has promised that policy would be phased in over a series of budgets, but Prime Minister Jacinda Ardern has hinted there will still be surprises in store on Thursday, in relation to GP access.

READ MORE:
* Jacinda Ardern says Budget will also help middle New Zealanders feeling the squeeze 
* Recap: Govt gears up for first Budget 
* Do we put enough money into the health system? 

GPs themselves, would not be concerned more time was being taken to roll out the Government's policy for a universal $10 cut to GP fees. 

Malloy said there were some significant cost access barriers preventing people from seeing their doctor in the first instance, but the policy had "some complexities" that were not immediately obvious. 

"When you dive down into it, it actually places some practices at risk of either being over-served - in other words utilisation of their services going up dramatically. 

"Which in some ways is of course what you're trying to achieve, but not to the point where they're unable to cope," he said.

123RF

GP access has been in the public eye after the Government announced it would not be delivering a key election promise this Budget. But the GPs aren't necessarily disappointed by that.

"Then the other risk is depending on which funding formula you use, you're exposing the practises to actually costing them money for us to be able to bring down the fee to the patients. 

"We feel they need to be addressed, but needs to be addressed across the whole system. If we're going to do that, then we actually feel we need to be looking at the whole of the funding envelope anyway, not just this top up that was currently being suggested." 

GPs were hoping the Government would be announcing a full review of the to primary care, tomorrow. Malloy admitted that was time consuming, so GPs had also been lobbying for a package targeted to patients at the greatest risk. 

Those included patients in certain Very Low Cost Access (VLCA) practices, which had access to significantly cheaper visits from Government subsidies.

However some of those practices, in the worst impoverished communities, were becoming unsustainable due to the level of Government subsidies they were receiving, compared to the size and demographics of the communities they were serving, Malloy said. 

"We are very concerned about that and we are looking to support them to ensure they stay in business and continue to provide their services. 

"Also, we are very worried about the patients who attend non-VLCA - or not highly subsidised practices - and yet they are still high-needs patients. We'd like to see an increased subsidy to them as well," he said. 

"These are mostly support packages as an interim measure, while the review process is undertaken."

There has also been speculation a package could include greater targeting of the cheaper GPs policy - perhaps around vulnerability or age of patients. 

Meanwhile, joint analysis released by the Council Of Trade Unions and the Association of Salaried Medical Specialists (ASMS) estimates the entire Vote Health budget must increase by at least five per cent, or another $805 million, to simply maintain current levels of service. 

That figure climbed to just over $1 billion - or 6.3 per cent - when the Government's election commitments and additional costs like pay equity for mental health and addiction workers was taken into account, said CTU economist Bill Rosenberg and ASMS analyst Lyndon Keene.

District Health Boards combined budget needs to rise from $12.6b to $13.2b, or an increase of $594 million (4.7 per cent), say the unions, to maintain the current level of DHB services and cover population and cost increases. Any new or expanded services or costs would be in addition to that. 

 - Stuff