The New Zealand Medical Association has issued a dire warning around the survival of GP clinics, and raised concern about a "deluge" of patients needing to be seen as the Covid-19 Alert Levels lift.
Chair Kate Baddock told Parliament's epidemic select committee today that GPs are concerned for their patients who are not seeking medical support during lockdown.
It comes after emergency departments and GP clinics across the country saw a dramatic decline in patient numbers during the lockdown - with many patients in worse condition by the time they seek medical help.
Dr Baddock said they are anticipating a "deluge" of patients as the Alert Levels lift.
However, due to the drop in patient numbers and issues surrounding late payments or no payment at all from virtual consultations, Dr Baddock said there were questions over the survival of many practices.
"We are very much hand to mouth in terms of cash flow, so when that cash flow is turned off... the ability for general practice to stay afloat in this kind of environment is very, very unlikely in lots of cases."
She said a solution was needed by the end of the week as the cashflow was "literally not there".
When asked at her daily media conference about financial issues for GPs, Prime Minister Jacinda Ardern said $45m "to date has gone into general practice, that’s everything from supporting virtual consults, additional costs as part of testing and also they are eligible for the wage subsidy".
"We have recognised the costs they’ve faced and we have worked hard to support them as well."
GPs were given a $15 million boost by Government on April 2, and had the expectation of $11 million a week for four weeks.
Dr Baddock said an additional $22m "has not happened", saying that Government "reneged on that expectation and the final tranche has not been forwarded to General Practices".
Health Minister David Clark said in a statement that the Government recognised the impact the lockdown has had on GPs "and the vital work they do".
"That’s why we’ve provided $45m to date in recognition of the costs they face. In addition they are able in many cases to access our wage subsidy scheme. The Minister of Health and officials are currently discussing with GPs’ leadership what further funding may be required.
"We’ll provide further detail when those discussions have progressed."
A Ministry of Health spokesperson said GPs had recieved the initial $15m for Covid-19 response support and $7.8m to DHBs to reimburse practices for testing.
"A further $22.4m was paid to general practices in the last ten days, including a weighting for rural practices, to support general practice during Levels 3 and 4."
Dr Baddock said clinics were grappling with mental health issues associated with job losses and loss of income, which could increase in the next six to 12 months.
"We need to be in a position to deal with that because we are the ones that our patients know and we are the ones that they are going to come to for health - we don't want to be turning them away."
It is not the only health sector concerned during the Covid-19 lockdown.
NZ Dental Association president Dr Katie Ayers estimated 20,000 New Zealanders are delaying seeing a dentist, giving the example of a person who was in intensive care due to life-threatening dental infections.
She said there was a lack of support and "virtually no available PPE".
"The dental profession has been telling Government and the public for weeks about continued access issues around the mandatory requirements and quantities of PPE.
"There is currently no indication when dental practices will be able to reopen and a workforce of over 10,000 is essentially sitting without work.
"One out of eight practices already having laid off staff and up to 45 percent currently being forced to consider doing the same."
Last week, Mr Clark announced a $200 million boost for personal protective equipment (PPE) to include 20 million face masks, 9.4 million pairs of gloves and 1.2 million aprons.
He added that $140 million worth of orders of PPE had already been placed, meaning over the next eight weeks an additional 75 million items will arrive in New Zealand.
Dr Baddock also told the committee that the issues around flu vaccination distribution a "complete debacle".
The confusion around the extension of high risk groups only being able to be vaccinated saw some organisations that "couldn’t deliver their vaccinations but didn’t relinquish their vaccines to where they might be more needed", she said.
"It meant that we in general practice just could not get vaccines, we in our practice could not get vaccines for 10 days and we have over 4000 patients who needed vaccinations in those vulnerable groups."
"I don’t want to see what happens with flu to be happening when we get a Covid-19 vaccine."
When asked about this today, Prime Minister Jacinda Ardern said she disagreed that it was a "debacle", saying the campaign began earlier, there were more vaccines and during a pandemic there would be more people coming forward to get the vaccine.
"We wanted to be prepared and we have more flu vaccine than we would usually offer as well. We want to protect New Zealanders."
The Government kicked off its annual influenza vaccine campaign earlier than usual, with hope that by preparing for the flu, it would help manage the damage for hospitals during the Covid-19 outbreak.
As part of the push, 400,000 more flu vaccines would be available this year, compared to last year.
On personal protective equipment, Dr Baddock there had been a heightened anxiety amongst people about wanting to be adequately protected. However, it had been available and there was a steady supply for those in the medical profession.