The government wants to reward better GP care. But what happens when targets take priority?

Getty Images Last month, Health Minister Simeon Brown announced new funding to reward GP clinics that meet a series of performance targets.

They include fully immunising 90% of enrolled infants at eight and 24 months, keeping 80% of enrolled women up to date with cervical screening, offering quitting support to 25% of smokers, and providing an approved online booking portal.

A total $40 million is tied to the scheme this year, with GP clinics eligible for payments when they hit the targets or make progress towards them.

Brown says the move is about recognising those clinics that get “results for their patients”.

But what if linking funding to performance-based targets comes with unintended consequences? As GPs practising in a range of care settings, we support efforts to improve immunisation, cancer screening and smoking cessation.

But clinics across New Zealand face very different challenges, raising questions about whether the same targets are appropriate for all.

International evidence also suggests performance-based funding can improve some aspects of care at the expense of others.

An uneven playing field There have already been concerns about whether changes to GP funding adequately reflect differences in patient needs around the country.

Research suggests performance targets can disadvantage practices serving communities with greater health, social and economic challenges, even when they deliver high-quality care.

Differences in patient circumstances can also make progress difficult to measure fairly.

Take the Calder Centre at Auckland’s City Mission, which serves a transient population with high and complex health needs.

Meeting the cervical screening target could require considerably more resources.

Similarly, practices in Northland, where the average immunisation rate is 64% , face barriers involving health-care access, workforce shortages, deprivation and trust.

By comparison, Canterbury’s average of 88% is already close to the 90% target .