Roughly a million New Zealanders are missing out on seeing their GP, a survey has found, with the most commonly reported barrier being it taking too long to get an appointment.

That’s according to the latest New Zealand Health Survey, published in December.

It found 1 in 5 adults (21.2%)​ and 1 in 7 children (14.8%)​ found that the time taken to get a GP appointment was a barrier to visiting the GP in the 12 months prior to the 2022/23 survey.

This was up from 11.6%​ of adults in the previous year.

Cost was another commonly reported barrier.

One in 8 adults (12.9%)​ reported not visiting a GP due to cost in the 12 months prior to the survey – higher than the previous two years.​

This was worse for disabled adults: 1 in 4​ (24.3%) reported the time taken to get an appointment as a barrier to seeing the GP, and 1 in 5​ reporting cost as a barrier.

Disabled children were more likely to experience time taken to get an appointment as a barrier than non-disabled children, it found.

Porirua-based specialist GP, and chair of General Practice New Zealand, Dr Bryan Betty​, said general practices are dealing with more complex medical needs, increased pressure from patients, workforce shortages and a funding system that has “not kept pace with demand”.

Betty said international evidence points to access to general practice leading to fewer hospital admissions, fewer emergency department presentations and longer life expectancy.

When people can’t get general practice care in a timely way, their condition can worsen over time, Betty said.

“The effect of that we see in overflowing EDs, and hospitals full of patients who many could have been avoidable if they had good primary care.”

Capacity is an issue: about a third of general practices are not taking on patients as there are not enough doctors and nurses, he said.

“We just don’t have enough GPs, [that’s] really having an effect.”

Aotearoa has fewer GPs per capita than other countries, and about 50% of the GP workforce are due to retire by 2030, he said.

“These issues are quite immediate”.

The second issue is the way general practice is funded (capitation), which is a per-patient payment.

A report published last year pointed to “significant under-investment”, as well as issues with the way GP funding is structured, he said.

Betty said this is based on each patient visiting 2.5 times per year. Their latest data, on the other hand, suggests it’s more like four visits per patient, per year.

“Demand has increased dramatically, but hasn’t been matched by investment.”

Betty said investment in primary care, and a redesign of the capitation funding system is “key to a functioning, healthy, health service”.

“We need to rebalance the health system with investment in primary care now before the situation worsens,” Betty said.

President of the Royal New Zealand College of GPs, and Wellington GP Dr Samantha Murton​ said the Health Survey statistics “will only worsen” if solutions to retain the current workforce, support them to train, and grow the next generation of specialist GPs are not implemented.

“General practice teams all over Aotearoa are losing GPs, nurses and other valuable healthcare workers due to the increased workload pressures, lack of pay parity and lack of investment in our services.”

Murton said general practice needs to be funded correctly “to meet the needs of the one million people who cannot access our services. Visiting the GP is a right that everyone should have access to”.

With an ageing and growing population, with more complex health conditions, it’s “imperative” the workforce is well-resourced and supported to meet people’s needs now and in the future, she said.

Health Minister Dr Shane Reti said he is expecting advice from officials on priorities for the primary sector, including funding and access issues.

“I acknowledge there are some significant issues impacting on the primary care sector in New Zealand, particularly the ageing workforce. And given New Zealanders receive most of their healthcare from the primary care sector, it’s important these are addressed with some urgency.”

Reti said it’s an “absolute priority for this Government, and for me, to develop the homegrown culturally competent doctors New Zealand desperately needs”.

“The principle that I’m looking to have reflected is that where the work is done, that’s where the funding should go – particularly those practices with high needs and a high morbidity focus.”