Forecasts that Palmerston North’s GPs are retiring are coming true. New Zealand’s GP workforce is ageing, with not enough new recruits coming on, and in Palmerston North the situation is as bad as anywhere. The MidCentral Health district has about 52.4 GPs for every 100,000 people, just over 100 of them still working at the end of 2019.Now there is one less, with Cook St Health Centre GP John Drake giving up practice just before the Covid-19 crisis sent health services into an era of even more rapid change.
Coming up 70 this year, Drake said it was time to ask whether he was still up to doing “the hardest job” in health. His decision was to pull out, leaving a practice fully staffed with four other doctors, a nurse practitioner, and four practice nurses on the team.
Drake has seen huge changes in his 45-year career and has done more than most to encourage the transformation of primary care to deal with the looming shortage of family doctors. He has been a staunch advocate for spending money in primary care and preventive medicine, where the biggest health gains can be made, and has bemoaned the fact doctors and nurses in hospitals earned more than their community cousins. He was heartened by the recommendations of the recently released Simpson report that put a strong emphasis on primary care.
Graduating in Auckland in 1975, Drake spent more than a decade broadening his experience before setting up at Cook St. He trained in anaesthetics in the United Kingdom. He did his training in obstetrics at the National Women’s Hospital in Auckland. His first job as a GP was in rural New South Wales, Australia. He worked as a locum in Dannevirke, back when the town had a full hospital, with GP surgeons and anaesthetists.
He remembers the days of hand-written prescriptions, “which were given to the patient, who took them to the pharmacist who tried to decipher. And occasionally mistakes were made.”It was the 1990s when Cook St became one of the early practices to adopt computers, “and then we had to learn to type”. He has embraced improved software and technology, which left the practice in good stead when the Covid-19 lockdown accelerated the switch to virtual consultations.
Drake has been a “cradle to grave” sort of GP, active in maternity care until midwifery took over, involved in planning for setting up Arohanui Hospice, and continuing to care for palliative patients. Drake was acutely aware of the pressure on general practice with declining numbers of medical graduates interested in buying into a business in a regional city. He has done his bit to train and encourage young doctors to consider work in primary care and in Palmerston North, and to develop the education and skills of nurses. Between 1986 and 1997 he was a teacher in the GP training programme, pulling out when post-graduate education became self funded and younger doctors chose the better dollars available in hospitals. He helped train two young doctors each year for 10 years and more recently has hosted sixth-year medical students.
“We do our best to show them why being a GP is a great job.”
Drake was also part of the group that set up City Doctors in the 1990s, a roster designed to help ease the pressure on GPs working after hours. But still, demand overwhelmed the number of doctors available.
The Cook St practice was one of the early health centres to recognise how much more nurses could do to provide primary health care. Drake’s former practice nurse, Karen Lowe, is now a nurse practitioner, who acknowledged the way he had accepted change and recognised the potential of everyone in the team. “He has been particularly supportive of advancing the nursing role in general practice, especially the nurse practitioner role in our region, having at times to defend his decisions to his medical colleagues.”