Why the distinction matters: Recognising the value of specialist GPs

As pressure on the primary care system increases, we continue to hear general practice described in terms of access, workforce supply and cost.

What is often missing from workforce discussions is the distinction between vocationally trained specialist GPs and non-vocationally trained clinicians working in primary care settings. Recognising this is not about hierarchy or protectionism; it is about ensuring patients, practices and the wider health sector understand the full value of general practice as a medical speciality.

Vocationally trained specialist GPs are specialist doctors who have either completed the General Practice Education Programme through RNZCGP, gaining Fellowship after approximately 11–14 years of training, or completed equivalent vocational training overseas that has been assessed and recognised by the college.

This training equips Fellows to deliver complex, comprehensive, patient, whānau and community-centred care, grounded in long-term relationships and confident management of uncertainty. The scope of general practice is defined as, “...a clinical speciality orientated to primary care. It is personal, family and community-orientated comprehensive primary care that includes diagnosis, continues over time and is anticipatory as well as responsive.”

Specialty brings breadth and depth

Non-vocationally trained doctors working as GPs, while bringing valuable experiences and access, do not have the same breadth and depth of speciality training in general practice medicine. NPs also are highly skilled health professionals practising within a nursing scope of practice and endorsed by the Nursing Council of New Zealand. NPs play an important role within primary healthcare teams but they are not intended as substitutes for specialist GPs.

GPs are the entry point to the health system for most people, with general practice managing about 24 million patient contacts each year. As more patients present with complex health needs and multimorbidity, there is growing urgency to ensure the workforce is well trained and properly resourced to meet that demand.

There is strong evidence that general practice is the most complex of the medical disciplines.1 Greater recognition of this by policymakers and health system leaders would help support the training, funding and workforce planning needed to sustain high-quality general practice care.

Vocationally trained specialist GPs bring distinct value. Their training is designed to support breadth and depth of practice, person-focused care, sound prioritisation, and skilled management of risk and uncertainty - contributions that are often overlooked in models that commodify clinical care.

National and international evidence over decades shows that strong general practice reduces hospital admissions, improves equity, increases life expectancy, improves patient wellbeing, and delivers better value for money. New Zealand has, however, for many years, underinvested in primary care/general practice allocating only approximately 6 per cent of the overall Vote Health, while on average, many other OECD countries invest about 14 per cent in primary care and general practice.

Failure to invest shifts risk

Failure to invest in the specialist GP workforce shifts the cost and the risk elsewhere in the system instead of allowing issues to be addressed early and managed in the community and close to home. It triggers pressure to implement poor substitutes based on commodification of care. In other countries such measures designed to increase efficiency have introduced new forms of inefficiency and underpinned the evidence-based functions of general practice.

As workforce pressure grows, many vocationally trained specialist GPs are working differently within multidisciplinary teams. Nurses, NPs, pharmacists and other allied health professionals are vital to meeting community need, particularly in rural and underserved areas. In the strongest model, specialist GPs add value by providing continuity, managing complexity and offering clinical oversight that enables other team members to work at the top of their own scopes while patients receive coordinated care.

Continuity is where it counts

Continuity of care is where the value of vocationally trained specialist GPs is most clearly realised. Approaches that commodify primary care assume it does not matter who provides care as long as it is delivered, yet the evidence shows otherwise.2 Long-term, trusted relationships enable earlier diagnosis, safer prescribing, better management of chronic and complex conditions, lower mortality, less pressure on secondary care, and lower system costs per patient. The college’s workforce surveys also show that this continuity and the ‘cradle-to-grave’ care it enables are among the factors that keep doctors in general practice, alongside professional autonomy and meaningful work.

Vocational training, continuity and consultant-level generalist expertise are not luxuries; they are foundational to a sustainable and equitable primary care system. If we want primary care that can meet growing patient need, we must explicitly recognise and design for the specialist value of vocationally registered GPs.

If primary care relative funding levels within the health system were based on value for money effects on population health, or cognitive complexity of the job then general practice would be the highest paid of the medical specialities. This would address the current inequity along with the recruitment and retention issues we are currently facing.

This column was published on NZ Doctor on 12 June.