New Zealand GP Funding Tied to Performance Targets Raises Equity Concerns

New Targets and Funding

New Zealand Health Minister Simeon Brown recently announced a $40 million funding scheme to reward general practice clinics that meet specific performance targets. These goals include fully immunising 90% of enrolled infants at eight and 24 months, keeping 80% of enrolled women up to date with cervical screening, offering quitting support to 25% of smokers, and providing an approved online booking portal. Clinics are eligible for payments when they hit these targets or show progress toward them, with the government stating the move recognises clinics that deliver results for patients.

Challenges and Inequality

However, critics and practitioners argue that uniform targets may disadvantage clinics serving communities with greater health, social, and economic challenges. Practices in regions like Northland face barriers such as workforce shortages, deprivation, and trust, with an average immunisation rate of 64%, compared to Canterbury's 88%. Similarly, smoking cessation targets may be easier to reach in wealthier areas with fewer smokers. Online booking portals also present practical difficulties for understaffed clinics that rely on triaging urgent cases, as well as for rural areas with unreliable internet and mobile coverage.

International Lessons

Researchers point to similar schemes overseas, such as the United Kingdom's Quality and Outcomes Framework introduced in 2004, which rewarded practices for meeting quality indicators. That framework was criticised for encouraging tick-box medicine, where GPs focused on measurable tasks rather than individual patient needs or multiple chronic conditions. Studies found that after its introduction, patients were less likely to see the same general practitioner over time, a factor linked to better health outcomes.

Context

Performance-based funding systems often focus on easily measurable tasks, which can lead to the neglect of harder-to-quantify elements of care like trust, communication, and managing multiple conditions. While the New Zealand government has stated it will monitor continuity of care and patient experience, these measures are not tied to funding in the current year. How equitably the scheme performs will depend on whether it accounts for the varying challenges different practices face.