Primary care is a vital component of healthcare, acting as a preventive measure to avoid health problems from escalating in cost and severity. Yet, in New Zealand, the funding model for primary care is failing to recognize and adequately compensate for the critical work performed by pharmacists and general practitioners (GPs). This oversight has led to a system where the deepest and most necessary clinical work is actively penalized, resulting in a structural flaw that urgently needs addressing.
The issue lies in the "hidden subsidy" buried within dispensing fees and retail margins, which actively penalizes the most crucial clinical work. This model relies on high-volume, transactional care for healthy individuals to financially support complex, time-intensive care for the sickest patients. For instance, a pharmacist's time spent challenging a risky dosage through a phone call to a prescriber is not explicitly paid for, instead covered by the margin on dispensing routine scripts or the markup on vitamins and sunscreen.
This system fails to reward the absence of harm, as research consistently links primary care continuity to fewer hospital admissions. When budgets are tight, governments trim fees and margins, putting pressure on primary care and forcing it to move to more expensive solutions. This results in pharmacists having less time for important safety checks and GPs being forced to reduce consultation times or close their books, leaving complex needs unaddressed.
The solution lies in a shift from volume-based transactions to complexity-based funding. A pharmacist conducting a comprehensive medication reconciliation for an elderly patient on ten drugs should be compensated for the thinking involved, regardless of whether a physical product is dispensed. Similarly, a consultation that prevents a hospital admission requires far more time and skill than a routine script renewal. Funding models must recognize this variation and properly support practices serving high-need populations, enabling clinicians to spend more time with complex patients.
In conclusion, New Zealand's primary care sector cannot continue to rely on retail margins and the goodwill of overworked clinicians. Addressing the hidden subsidy and shifting to complexity-based funding is essential to ensure the safety net is not further strained and preventable harm is avoided. This requires a definitive change in the funding model to properly recognize and compensate for the critical work performed by primary care professionals.
