\u201cYou haven\u2019t got that personal relationship; I think that\u2019s a big loss for general practice,\u201d Budelmann says.<\/p>\n
Dr Hilmer Budelmann worries about the direction the general practice sector is heading in with the reduction of long-term patient relationships. Photo \/ Anna Heath<\/p>\n
The option to see a doctor online through a Zoom appointment has become increasingly available following the Government\u2019s $165 million investment in Telehealth, a 24\/7 digital health service, in mid-2025.<\/p>\n
Chairman of the General Practice Owners\u2019 Association (GenPro) Dr Angus Chambers has criticised the Government\u2019s investment in Telehealth and says it failed to deliver on its promise to reduce admissions to emergency departments.<\/p>\n
\u201cThere\u2019s a huge commercial imperative to do it this way because it\u2019s far cheaper to provide a telehealth consultation than an in-person one. You don\u2019t have to have the same room rentals, cleaners coming in, or nurses,\u201d Chambers says.<\/p>\n
\u201cPhysical examination is one of the critical safe operating procedures. You know, when a doctor sees someone walk into the room sometimes you can tell their medical condition just from their gait.\u201d<\/p>\n
Doctors spoken to by the Weekend Herald say there is a continuing preference for in-person care despite increased access to online appointments.<\/p>\n
Freemans Bay Medical Centre GP Dr Jamie Shepherd says during the Covid-19 pandemic his practice rose to doing nearly 100% of appointments online, but once everything opened back up again the amount dropped back down to about 2-5% – the same percentage it had been pre-Covid.<\/p>\n
Shepherd considers himself a strong proponent of online care but says it has been interesting to observe how patients still prefer face-to-face appointments and that probably comes down to the sense of trust they feel when dealing with a GP they see regularly.<\/p>\n
\u201cHumans are social beings. I actually think they prefer most of the time to actually have that relationship and one-on-one conversation,\u201d he says.<\/p>\n
A 2021 nationwide study of the Norwegian population, found that patients who had appointments with the same GP for 15 years or more had a 25-30% lower risk of acute hospital admissions or premature death.<\/p>\n
Shepherd says sustainable general practice should focus on achieving that continuity of care and determining what patients\u2019 individual needs are, rather than looking at patients through an income or corporate lens.<\/p>\n
He says losing the in-person touch of consultations could be detrimental to delivering the best care.<\/p>\n
\u201cPeople come and tell us some of the most personal, often distressing, really hard conversations, and they\u2019re not going to deliver those to someone they don\u2019t have a relationship with,\u201d he says.<\/p>\n
Dr Karl Cole has been a GP for over 30 years and previously served as a doctor for the NZ Special Air Service (SAS) before purchasing Papatoetoe Family Doctors in South Auckland.<\/p>\n
He has worked at the practice for 18 years and has also held a range of health leadership and ICT roles specialising in health technology.<\/p>\n
Talking to GPs in central Auckland compared to his area, Cole says it is like \u201ctwo different worlds\u201d and the access to healthcare is totally different with patients often being more dependent on the public hospital.<\/p>\n
\u201cA large part of the population are high needs, and they\u2019ve got learned helplessness from the system pushing them down all the time, so you need to listen to them, and they prefer doctors who take the time to listen,\u201d Cole says.<\/p>\n
At times the role of a doctor, he says, is also to provide human contact and people will come to see GPs really needing to talk to someone and when they are feeling extremely distressed about life and suicidal.<\/p>\n
He says it\u2019s been surprising to see how well AI large language models can provide comforting advice through chats, but he questions whether the technology will ever develop to be good enough to take over the role of a person or doctor with lived experience.<\/p>\n
\u201cThat\u2019s going to be the real interesting question for all of humanity right now, is how much this artificial intelligence is good enough to actually replace a person.\u201d<\/p>\n
The practice is embracing online care and Cole says online appointments can offer seamless care for people in the right circumstances, however there are still things that can\u2019t be achieved virtually.<\/p>\n
\u201cThere are all sort of funny things that happen on screen. It can make you look overweight, or flatten you and it depends how people hold the camera,\u201d he says.<\/p>\n
At Hobsonville Family Doctors, Dr Kate Richardson has observed many patients are still seeking out in-person appointments. Photo \/ Michael Craig.<\/p>\n
Dr Kate Richardson, who works as a GP at Hobsonville Family Doctors, says an important part of the art of medicine is physical examination and there are things doctors can pick up on when sitting inside a room with a patient.<\/p>\n
\u201cYou are often picking up on subtle things in person such as body language, the way people are talking, how they appear physically \u2014 that could be missed online and that people may not offer to you online as well,” Richardson says.<\/p>\n
She says general practice has been underfunded by the Government for a long time and sole business owners have less financial flexibility and capital which is causing them to sell to larger corporates. She doesn\u2019t see corporates as being something inherently \u201cbad\u201d but says this is the reality of the funding system.<\/p>\n
However, some practices see online care as a way to improve access for patients.<\/p>\n
Tend Health is a growing healthcare provider in New Zealand that has taken a digital-first approach, including the use of an app to book appointments or request repeat prescriptions, and allowing patients to do 15-minute online consultations for medical certificates.<\/p>\n
Tend Health chief executive Cecilia Robinson says GPs are already overwhelmed and opportunistic screening such as spotting a potentially cancerous mole on a patient is often not happening in appointments. <\/p>\n
She says online care offers a way for people to be seen who otherwise might not engage with health services.<\/p>\n
\u201cWe particularly see M\u0101ori and Pacific users, and if you\u2019re having to take time off work and put three kids on a bus and get to your local medical centre that might not be practical for you,\u201c Robinson says.<\/p>\n
\u201cThe right thing to do is to be able to be seen, whether that\u2019s a person or online in that instance.\u201d<\/p>\n
Tend has observed a lifting in workforce participation, Robinson says, because clinicians are able to extend their hours and have more flexible working arrangements when conducting online appointments.<\/p>\n
\u201cWe had one clinician that recently went to Canada for three or four months and he worked Canadian nights and evenings,\u201d she says.<\/p>\n
\u201cIt\u2019s actually really hard to get clinicians into rural areas, and in some instances, we\u2019ve seen Health NZ spend hundreds of thousands of dollars trying to recruit people but it hasn\u2019t worked.\u201d<\/p>\n
Robinson says when Tend took over an Ashburton practice operating with just one GP and over 4500 patients that was on the brink of shutting down, the waiting times reduced from 28 days to six days.<\/p>\n
To achieve that, a mix of GPs and nurse practitioners working both in New Zealand and remotely from Australia would assess patients, using Zoom as well as an in-person nurse to carry out physical check-ups.<\/p>\n
Tend Health CEO Cecilia Robinson says the approach of their primary health organisation is data-driven and focused on achieving the best possible health outcomes.<\/p>\n
Across the Tend network, clinicians from other parts of the country can fill in for a doctor if they are unwell or away, which Robinson says is a way Tend has cut down on smaller, rural clinics building up a backlog of appointments.<\/p>\n
Shepherd is also the owner of Remuera Doctors and Mission Bay Doctors and says in his view GPs need to embrace new technology such as the use of AI to cut down on administrative tasks that can weigh down a practice.<\/p>\n
\u201cThe time spent with a patient for me is about creating value. We\u2019re actually not time constrained but we have some efficiency issues,\u201d he says.<\/p>\n
For patients, being able to do doctor appointments from a work office or home could be appealing to save time, but Hobsonville Family Doctors GP Dr Torrance Merkle says many patients still want to build a relationship with their doctor and will often cancel or reschedule an appointment if they can\u2019t see their preferred GP in-person.<\/p>\n
Telephone and online consultations are another way to minimise cost for the Government, according to Budelmann, but patients are booking Telehealth appointments for their routine, straightforward prescriptions which leaves GPs with their books filled with more complex appointments and conditions.<\/p>\n
He believes the decline of GP-owned practices has been steady over the past few decades, but the Government\u2019s recent investment has accelerated the trend.<\/p>\n
Chambers says there is a place for Telehealth, and it can provide greater convenience for patients for follow-up appointments, but he is concerned the level of investment is pushing New Zealand towards a situation where patients are seeing different doctors constantly and no one face-to-face.<\/p>\n
\u201cIt\u2019s probably very hard for a telehealth doctor not to prescribe because someone\u2019s rung up and paid a reasonable amount of money, and they expect something,\u201d he says.<\/p>\n
\u201cIf we got rid of safe operating procedures in the airline industry, you can probably predict there\u2019d be a greater increased chance of people dying.<\/p>\n
\u201cWe\u2019ve got people\u2019s lives in our hands too … we think it exposes people to risk significantly.\u201d<\/p>\n
Robinson says it shouldn\u2019t be a question of online versus in-person care but rather what is easily accessible for the patient and the best fit for clinicians.<\/p>\n
\u201cI think that it\u2019s really important that we\u2019ve got people who are prepared to disrupt across any sector, whether that\u2019s education or health, in terms of actually trying to improve healthcare outcomes.\u201d<\/p>\n
She says her personal view is that New Zealand as a country funds healthcare well but the distribution of funding is what is important and that providers become more responsible for driving and achieving health outcomes within the population.<\/p>\n
The use of AI for patient notetaking<\/p>\n
Doctors across the country are now using artificial intelligence (AI) scribe tools to listen to patients and take notes during appointments, with many GPS saying there are benefits to the new technology, but it is still prone to errors.<\/p>\n
In 2025, the Government rolled out Heidi AI – an AI scribe designed by a private, Melbourne-based technology company – to 1000 doctors and frontline staff working in emergency departments.<\/p>\n
Merkle says an AI scribe is a useful tool and he uses it for longer consultations, but he has noticed it will often have omissions and won\u2019t always catch the most relevant points of a consultation.<\/p>\n
Merkle noticed in a recent consult, the notes made by Heidi AI did not pick up on a patient\u2019s elevated work stress and loneliness as being a significant point, but in Merkle\u2019s eyes this was the root cause of many of the patient\u2019s symptoms.<\/p>\n
\u201cIt gets about 80% of the gist of it,\u201d he says.<\/p>\n
\u201cIn general practice you\u2019re very rarely seeing people for one thing it\u2019s often like four, and AI is not that good at guessing.\u201d<\/p>\n
He says many doctors also process through written note-taking and it can help to commit things to memory, and this is why he doesn\u2019t solely rely on AI to take notes.<\/p>\n
Chambers says he thinks AI will carry out a lot of the meaningless, repetitive tasks that burden GPs, such as routine blood work for medications, but individual clinics will have to work hard to ensure there are no privacy breaches for patients.<\/p>\n
Budelmann says using an AI scribe has cut down on waiting times at his clinic because he spends less time writing down notes between consultations.<\/p>\n
\u201cIt can go wrong sometimes. Heidi fills in gaps and perceived gaps or says something that is totally out of context, so you\u2019ve got to check it,\u201d Budelmann says.<\/p>\n
Robinson says that at Tend Health doctors are using a self-developed AI scribe tool that is different to Heidi.<\/p>\n
She says they chose to build their own AI scribing tool because of concerns for the privacy of patients and to embed information that was context-specific to the healthcare environment in New Zealand like the use of Te reo M\u0101ori.<\/p>\n
She says Tend Scribe AI collects data from previous appointments with patients, such as their age and current medication, and it will have this information stored before it begins listening to a consultation.<\/p>\n
It also could provide support with making a diagnosis for clinicians and so far had recorded a low error rate, she says.<\/p>\n
\u201cI\u2019ve got full confidence that it will improve healthcare diagnoses and make them more consistent.\u201d<\/p>\n
Shepherd has been using Heidi for over two years and says he likes how it allows him to give his full attention to the patient during a consultation rather than having to constantly type notes.<\/p>\n
It has also reduced waiting times at Freemans Bay Medical Centre from 12 minutes down to about seven minutes.<\/p>\n
\u201cI remember early on a patient reflecting that they found it unusual because I could look at them for the entire consult,\u201d he says.<\/p>\n
Richardson says she also finds this particularly useful for consultations where patients are distressed, such as appointments about mental health, as it could appear unempathetic to be distracted and typing during the appointment.<\/p>\n
Shepherd says Heidi AI will not store the patient\u2019s name and personal data whereas with opensource AI such as ChatGPT personal data can be used for training and be reviewed by humans who work for the companies.<\/p>\n
\u201cWe are the custodians of our patients and that includes their privacy, I think most GPs would be really conscious of that,\u201d Shepherd says.<\/p>\n