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Date: 14/05/2025
Primary care physicians are leaving the profession in alarming numbers, and one of the driving factors is the relentless burden of uncompensated work. The health network—including specialists, hospitals, and even patients—expects general practitioners (GPs) to perform hours of unpaid labour, a demand that is neither fair nor sustainable. This silent expectation places additional stress on GPs, diminishing their professional satisfaction and leading many to abandon primary care altogether.
The Crisis of GP Departures
New Zealand's general practice workforce is in crisis.
In 2020, GP burnout reached its highest recorded level, with increasing workloads and administrative burdens being key drivers.
These statistics paint a stark picture: primary care is under immense pressure, and unless the burden of uncompensated work is addressed, the crisis will only worsen.
The Problem with Automatic Forwarding of Notes
The Royal New Zealand College of Urgent Care (RNZCUC) mandates that Urgent Care doctors ask patients whether they have a GP and if they want their notes sent to them. While this may seem like a reasonable way to maintain continuity of care, in practice, it overburdens GPs with work they are neither responsible for nor compensated to handle.
The Urgent Care physician who examined the patient is legally responsible for the completeness of that care. Forwarding the consultation notes to the GP does not absolve the initial physician of their duty. The college argues that this practice "safety nets" the patient, but true safety comes from clarity of responsibility, not from shifting work to another doctor who was not involved in the initial consultation.
A far more clinically effective approach would be to engage the GP through a referral letter when necessary. For instance, if a patient presents to Urgent Care with an undiagnosed diabetic crisis, it makes sense to send a referral letter stating:
"I saw your patient today in Urgent Care. He presented with a blood sugar of XX and was newly diagnosed with diabetes. He will need ongoing primary care follow-up and management of his condition. I have advised him to see you next week."
Such targeted communication is respectful and ensures continuity of care where necessary. Dumping every assessment completed into the GP’s inbox without context does not serve the patient or the GP.
The False Belief in the "Custodian of the Patient Record"
There is a widespread but incorrect assumption that the GP is the "custodian of the patient’s record." A GP keeps records to fulfil their legal obligation to document interactions with patients. However, the system does not compensate them to serve as a universal data repository for every interaction a patient has within the healthcare system.
The Overuse of CC'ing GPs on Diagnostic Results
GPs are frequently copied on every diagnostic result a patient undergoes, despite the fact that they did not order the test and are not responsible for acting on the result. The legal obligation to follow up on a test lies with the ordering physician. If a GP needs access to a patient’s diagnostic history, they can retrieve it from TestSafe or another shared system. Unnecessary cc’ing of test results clogs GP inboxes, forcing them to spend personal time sorting through results they did not request and are not expected to act upon.
Specialists often send results to the GP partially so that the patient can access it in the GP’s patient portal. This is not fair to burden this purpose on the GP. Either the specialist should provide their own portal to the patient, or they should cc the result directly to the patient instead of the GP.
Hospitals and the Flood of Unnecessary Information
Hospitals routinely send every single message, diagnostic result, and clinical note to GPs, contributing to the information overload. Instead, the system should focus on delivering a well-documented discharge summary at the time of discharge. This summary should contain only the pertinent details needed for ongoing management, rather than an exhaustive record of every test and note compiled during the patient’s hospital stay.
The Burden of Healthline Summaries
Healthline, a government-run health advice service, sends GPs a summary of every single call made by their patients. These messages flood GP records, despite the fact that most GPs have no intention—or obligation—to act on them. This practice adds unnecessary workload without contributing to meaningful patient care.
The Burden of Duplicates and Triplicates
To add insult to injury often documents are sent multiple times. This data from our practice over six months show the extent of the problem. These includes items like referral acknowledgements, hard copy notes, radiology reports, renal function tests, referrals, special authority response, liver function tests, Urine cultures, CRP. Some are sent 4-5 times in the same day.
Think before send
GPs, UCs, specialists and hospital records departments must all take a pause and think before they send. Is it really necessary? Is it professionally curated and edited? Is it only what is necessary. Too often technology has created a data burden that is not improving health care but making the GP's job an admin job instead of a clinical assessment one.
The Fundamental Issue: GPs Are Not Paid for This Work
Unlike hospitalists, who work within publicly funded hospital systems with access to facilities, equipment, and administrative support, and salaries, the GPs must cover the costs of running their own practices from the compensation they earn. This includes renting clinic space, purchasing medical equipment, employing staff such as nurses and receptionists, and covering operational expenses like utilities and technology systems. Every uncompensated task added to a GP’s workload further strains these limited resources, making general practice increasingly unsustainable.
GPs provide care through booked consultations, where patients pay for their time and expertise. The healthcare system must stop inundating GPs with information and responsibilities that they are not compensated to manage. Capitation payments, which were originally designed to cover primary care costs, now represent an ever-decreasing fraction of actual earnings. As a result, GPs are asked to do more and more unpaid work, eroding their job satisfaction and leading many to exit the profession. Beyond the retirements – young doctors are leaving the profession disgruntled with the expectation that they spend the time they should be tucking their children into bed with a book doing their inbox as uncompensated work.
A Call for Change
We will begin rebounding messages that we determine to be inappropriately sent to primary care. These messages will be returned to the sender’s inbox with the expectation that they take responsibility for the information they generated. Primary care cannot continue to function as the default repository for every clinical interaction and diagnostic result within the healthcare system.
If we want to retain primary care physicians and ensure the sustainability of general practice, we must address these inefficiencies. The solution is simple: stop sending GPs unnecessary work.
By respecting the time and expertise of primary care doctors, we can create a more efficient, fair, and sustainable healthcare system—one where GPs choose to stay rather than being driven away.