Comment: Think of the last time you visited a primary health clinic. Did you see the same doctor you have seen for the past five, 10 or 20 years? Many readers will answer in the negative. Your regular general practitioner may have retired and/or sold their practice, and the new owners might not be another GP, but a listed private company. This reflects some big changes transforming our primary care landscape.
According to NZ Doctor an estimated quarter of general practices are now owned by large corporates such as Tāmaki Health and Tend Health. The trend is likely to continue.
The shift is not entirely surprising. Many of the doctors who established or bought small community practices in the 1980s and 1990s are now retiring. Fewer younger doctors are interested in buying into a practice and taking on the responsibilities of running a business.
That’s partly about economics; buying a practice requires significant financial investment. It’s also about changing expectations. Today’s GP workforce is more diverse, more female and often looking for flexible working arrangements that fit around family life. Others want to work within Māori, Pacific or community-based providers rather than owning a private business.
Ten years ago, most GPs worked within the traditional owner-operated model. Today, that share is shrinking as larger organisations acquire practices and consolidate services.
Some of these changes bring genuine benefits.
A larger organisation can invest in better IT systems, administrative support and modern facilities. It may be easier to recruit staff. It may mean patients can get appointments more quickly, which can only be a good thing in a country where many people struggle to enrol with a GP or wait weeks for routine appointments.
For someone with a relatively minor health issue, seeing any clinician promptly may be more important than seeing a particular one.
But something is often lost in the process.
Research consistently shows that continuity of care, seeing the same doctor over time, leads to better health outcomes. Patients are more likely to get appropriate preventive care, less likely to be hospitalised, and more likely to receive treatment that reflects their full medical history.
This becomes especially obvious for people living with chronic health conditions.
Imagine someone managing diabetes, heart disease, asthma, depression, or several conditions at once. A doctor who has known that patient for years can often spot subtle changes, understand how different health issues interact, and help navigate difficult decisions.
That relationship can quite literally keep people happier, healthier and out of hospital.
The challenge facing primary care is that continuity and access are increasingly pulling in opposite directions.
New Zealand’s population is ageing. More people are living longer with chronic illnesses that require ongoing support. At the same time, workforce shortages make it harder to provide everyone with a regular doctor.
Under the traditional model, patients sometimes struggled to access care because local practices were not taking new patients. Corporate providers may improve availability by employing larger teams and spreading patients across multiple clinicians.
In other words, you may find it easier to see a doctor, but harder to see your doctor.
Whether that is a reasonable trade-off depends largely on who you are and what healthcare you need.
My bigger concern is that healthcare businesses answer to different incentives depending on who owns them. Independent GPs are certainly businesses too, but many have been deeply embedded in their communities, often developing long-term relationships with patients that span generations.
Corporate owners have obligations to investors and shareholders as well.
That doesn’t automatically mean poorer care. Some corporate providers are doing important work in communities with significant health needs. But there is a risk that organisations seeking returns will focus on patients who are simpler and less expensive to treat while under-serving more complex populations whose care costs more.
That concern extends beyond individual practices.
Primary Health Organisations receive public funding to help ensure New Zealanders can access affordable primary care. They play an important role in improving health outcomes, particularly for communities that have historically been underserved.
As corporate ownership expands, large commercial interests may exert greater influence over the policy settings that shape primary care.
Government sets the formulae by which our PHOs and primary care practices are paid. The danger is that public funding intended to improve population health could increasingly be leveraged towards generating returns for investors.
Independent practices will continue to exist. Community-led providers will remain important. Corporate operators will become a larger part of the mix.
But the transformation underway raises an important question: do we see primary care primarily as a community service, or as a healthcare market?
The answer will shape not only who owns your local medical centre, but also the kind of care future generations can expect when they walk through its doors.
