About half of all GP clinics are picking and choosing or "cream-skimming" which patients to enrol, new research has found.
A paper published in The New Zealand Medical Journal today has found more than three-quarters of practices surveyed have had closed their books to new patients or limited enrolments in the last four years.
Of the 227 practices surveyed, fewer than one in three were freely enrolling patients in 2022.
Victoria University epidemiologist associate professor Mona Jeffreys, who co-authored the paper, said unlike previous studies, they did not simply look at whether practices were enrolling patients or not, but also asked them about "limited enrolments" over a four-year period.
"So some practices are not in general open to new patients but will accept for example people who have just moved to the area, or family members of existing patients," she said.
"But there's also some evidence of selection of people who can enrol according to their health.
"Some practices are choosing the healthier patients and some practices are choosing patients with significant need because they are there clearly to provide care.
"So it's a really mixed picture but the bottom line is that in 2022, only 28 percent of practices were fully open - would take any patient that crossed their doors."
That was down from 57 percent of practices being "fully open" in 2019.
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The situation had "clearly worsened" over the last three years due to the multiple impacts of the Covid-19 pandemic: higher demand for health care, high rates of staff illness and border restrictions adding to workforce shortages, the paper found.
Restricted enrolment posed "a widespread barrier to health access and equity", and it was likely that a selection process for enrolments would "affected those who are already most discriminated against", including Māori and Pacific people.
"Patient selection, also termed 'cream skimming' of patients, is often found in primary care for multiple reasons, sometimes even as unintended consequences of well-meaning incentives."
Some general practices were rejecting patients with more complex needs because the funding did not "sufficiently compensate the higher costs associated with higher-needs enrolees", researchers wrote.
This breaches national enrolment policy, which states "No individual is to be refused enrolment on the basis of health status, anticipated need for health service or any form of discrimination".
"This experience is echoed internationally. We recommend investigating fairer patient intake methods."
Jeffreys said most people who were unable to enrol with a GP either did not get healthcare, or ended up in emergency departments.
Very few could afford to pay the significantly higher unenrolled patient rates - if clinics would see them at all.
"The capitation fees that practices get are not really enough, in fact they are not enough for practices to continue working," she said.
"What this is really underlining is the underinvestment in primary care, which we know is having a knock-on effect on hospital-level care."