WellSouth, the primary health body for the region’s hard-pressed and cash-strapped rural medical practices, is hopeful the new Health Minister will do more to support primary care – particularly in remote areas.

WellSouth chief executive Andrew Swanson-Dobbs said he hoped Minister Simeon Brown would adopt the recommendations of last year’s hard-hitting review, and approve a much-needed injection of funds.

The official review identified issues such as inequities in service provision, workforce pressures, high clinical risk, and barriers to accessing care. Ongoing staff shortages were also a significant concern.

Swanson-Dobbs, who spent much of 2024 advocating for better funding, noted that last year’s government offer of a 4% increase “was not enough for general practices to remain financially sustainable.”

The offer fell well short of the 14% increase recommended by Health NZ.

Instead of increasing funding to a sustainable level, the government allowed regional practices to hike consultation fees, which many reluctantly did.

An example of the strain is Fiordland Medical Practice, where in an email spent to patients, it explained that capitation funding has failed to meet inflation for 19 out of the past 20 years, creating increasing pressure on services.

In particular, the PRIME (Primary Response in Medical Emergencies) service, which provides coordinated emergency responses in rural areas, is under strain. In Te Anau, the average number of responses is 37 per month, with peaks during busy periods. This places significant strain on both ambulance and medical staff.

The review found that rural areas like Te Anau and Central Otago, which lack direct access to emergency departments, are particularly vulnerable.

“Access to unplanned and urgent care in the Southern region is in crisis, with a lack of resources, inconsistent delivery, growing populations, and geographic challenges,” the review says.

Capitation, the system through which Health New Zealand allocates funds to Wellsouth, is a central issue.

The fixed per-patient subsidies are insufficient given rising patient numbers, which have increased by 7.4% in rural areas to over 144,000.

The average ratio of patients to general practitioners in these regions is 1654, far exceeding the recommended ratio of 1300 to 1400.

Moreover, PRIME funding is inadequate to cover the demands of rural practices. The Fiordland Medical Practice reportedly receives just $2.16 per hour for PRIME services, which must cover the cost of on-call clinicians, staff training, a practice vehicle, and medical supplies.

“We provide the majority of crewing for air rescue,” the email said, pointing to the additional pressure of air rescue missions on staff and training.

PRIME regional manager Andrew Goodger said there were other funds designed to help rural practices with workforce retention, remote operational costs, and after-hours services.

However, “once again, they came nowhere near meeting the financial burden” of running a rural practice, especially in high-demand areas like Fiordland.

WellSouth surveys have shown that the strain on staff in rural practices is taking its toll.

A recent survey of 78 general practices in the Wellsouth network found more than three-quarters of respondents felt “mild to moderately burnt-out,” with an additional 11% reporting “highly burnt-out” levels.

Swanson-Dobbs called the results alarming but not surprising, “given the persistent challenges including the under-funding of primary care and workforce constraints.”

Fiordland Medical Centre, located in a popular tourism hotspot, experiences a particularly intense workload during the summer, which is the busiest time of year.

Swanson-Dobbs emphasised the need for a system that prioritises primary care.

“We need to reorientate the health system to focus on care at the top of the cliff, not just the bottom,” he said, highlighting how many western countries allocate far more of their healthcare budget to primary care than New Zealand.

Looking ahead, Swanson-Dobbs hopes Wellsouth will have a greater role in shaping the funding model for primary care in the region.

However, he stressed that this will require a shift in priorities from the new Health Minister.

“Capitation funding is no longer fit for purpose and is compounding the pressures felt across our Southland and Otago general practice networks,” he said.