General Practice New Zealand chair Dr Bryan Betty Photo: Supplied
"We're reaching a crisis point now, I can see a lot of harm coming."
That is the message from some GP clinics desperately trying to avoid closing their doors or putting up prices for patients.
GPs had their funding increased by four percent in July and were given the greenlight to lift their fees by more than seven percent.
But some clinics - whose margins are already thin - say putting the cost on the patient will simply turn them away.
In the latest installment of our Crunching the Numbers series, Checkpoint looked at how much it can cost to see the GP and the difficult choices both patients and clinics are having to make.
From $19 to $90, the price of a trip to the doctors varies throughout the motu.
Over the last two years data shows the cost of seeing a GP has jumped 23 percent on average.
Some people RNZ spoke to in Auckland's Ōtahuhu said the price of a doctor's visit could determine whether or not they went.
Putting costs on paitents will turn them away - GP clinics
One man said he paid $19 and avoided going to the doctor sometimes. "If there is not enough money I don't go but I need to go to see the doctor."
Another woman said she paid the same and if prices went up she would not go at all. "There have been a lot of times I've put off going to the doctors to be honest, because I'm like, I just don't have the money for this right now.
"You know, I'm not rich, but I've got family who pay like fifty bucks just to go to the doctor and they're like they haven't gone for a couple of years."
According to data collected from clinics - the cost of a GP visit can vary wildly.
The most expensive was in Auckland for $88 while the cheapest was $9 in Gisborne.
In a survey by the General Practice Owners Association nine out of ten clinics indicated they would be putting up their prices if they had not already done so.
But the chair of General Practice New Zealand Bryan Betty said it is not a position they wanted to be in.
"There is concerns that patients may not be able to afford to visit their general practitioner or see their doctor or nurse, which could put more pressure on emergency departments and hospitals.
"However, if this isn't done there are real real concerns of the viability of some clinics around the country."
Dr Betty works at a low cost clinic in East Porirua which closed their books to new patients six months ago.
He said about 50 percent of clinics have had to do the same or cut back their hours because they do not have enough staff.
That is a familiar situation for Dr Hiria Nielson who runs Three Rivers Medical in Gisborne.
For the first time in 30 years the clinic has closed their books to new patients, and is using telehealth for weekends and afterhours.
When asked if she ever imagined she would be in this position, "no we're very disheratened to have to make this decision,"Nielsen replied.
Dr Nielsen said telehealth is not suitable for a lot of their patients who only reach out when they are in crisis.
Their clinic is low cost which means the most a patient pays without a community services card is $19.50, the government has given low cost clinics the option to put their prices up to $29.50.
But Nielson said that is simply not an option.
"That's never going to work in Tairāwhiti that's the difference between a whole meal or feeding your whanau for that night."
Equity funding for GP clinics was made available last year - if at least 50 percent of enrolled patients were Māori.
At Three Rivers Medical 46 percent of their patients are Māori - because they are four percent short - Nielsen said they miss out on $800,000 in funding.
"People's health doesn't change depending on how many māori patients are in the certain practice, they are still gonna have the same amount of diabetes the same. amount of heart attacks same amount of strokes."
In July, the government increased funding for GPs by four percent and confirmed they could raise their fees by 7.76 percent.
That was despite warnings from the primary care sector that a double digit increase was needed.
"A report commissioned by the Government three or four years ago called the Sapere Report estimated about a $200 million deficit across the country in terms of the underlying funding so this has built up over the last ten years."
Dr Bryan Betty said the funding model for GP clinics was created 20 years ago and needed an urgent overhaul.