By the late 20th century doctors had a much greater capacity to cure than at any stage in the past. Immunisation, antibiotics and new pharmaceuticals dramatically increased doctors’ ability to relieve pain and reduce suffering. Infectious diseases as a cause of death and illness had declined, as had infant and maternal mortality in childbirth.
However, as the threat of epidemics receded, doctors seemed less necessary to ensuring longevity. GPs’ dominance of primary health care came under threat – from patients, other health professionals and alternative practitioners.
Fertility Action (FA), later called Women’s Health Action, was founded in 1984 and is probably New Zealand’s best-known women’s health activism group. In its early days the group campaigned for safer contraceptive devices. In 1987 FA brought the treatment of cervical-cancer patients at National Women’s Hospital to public attention.
Until the late 1970s doctors were accustomed to caring for patients and prescribing treatments without much consultation with those patients – the ‘doctor knows best’ approach. Women’s groups in particular challenged this approach, as feminism contested male doctors’ control of women’s bodies and health. Māori questioned the ability of Pākehā doctors, many of whom had little understanding of Māori society and practices, to adequately treat Māori patients. The medical profession was slow to respond to these challenges, and doctors were often unwilling to acknowledge failings in their practice.
A 1987–88 inquiry into the treatment of cervical-cancer patients at National Women’s Hospital during the 1960s and 1970s led to the establishment of a Health and Disability Commissioner in 1994. The commissioner investigated patient complaints about GPs and other medical professionals. How GPs worked was made public to a much greater extent than before, and they were encouraged to share information more freely with their patients.
The New Zealand Bill of Rights Act 1990 contains two sections relevant to health. Section 10 states that ‘every person has the right not to be subjected to medical or scientific experimentation without that person's consent’, and section 11 that ‘everyone has the right to refuse to undergo any medical treatment’.
In the early 1970s midwives began to re-establish their independence from doctors, supported by women who argued that childbirth should be treated as a natural process rather than a medical event. At the same time, GPs’ control of birth was increased – from 1971 midwives could not legally deliver babies unless a doctor was present.
However, the dramatic reduction in the risk to women’s and children’s lives in childbirth undermined GPs’ attempts to justify their dominance of midwifery. This argument had been used effectively (if inaccurately) to suppress independent midwifery in the 1920s and 1930s, and to shift almost all New Zealand deliveries into hospitals under the control of doctors. From 1990 midwives could deliver babies independently, without a doctor present. From 1996 they were required at all births, and GPs who delivered babies had to pay a midwife out of the lump-sum maternity payment they received from the government. Offering maternity care was no longer financially viable for GPs and they gradually stopped providing it. They continued to care for children and mothers after birth.
From the 1970s nurses were trained independently of doctors, at polytechnics (and later universities) instead of hospitals. However, they were unable to establish themselves as autonomous primary health care practitioners to the same extent as midwives.
The government first funded practice nurses within rural general practices in 1969 to relieve overworked GPs. This scheme was extended to urban practices in 1970.
Practice nurses were doctors’ employed assistants, but were unable to extend their scope beyond routine medical and administrative tasks. When government funding was cut in the 1980s and 1990s, some practice nurses were made redundant or had their hours reduced. Despite this lack of independence, practice nurses were an important part of the primary health sector and delivered crucial services such as immunisation.
Chiropractors and osteopaths gained ground after the Second World War. Chiropractors were regulated from 1960 and osteopaths from 1978. These practices, along with acupuncture, were later subsidised for accident-related treatments by the Accident Compensation Corporation (ACC). This went against the advice of doctors. From 1999 consumers could go straight to these practitioners for ACC-subsidised treatment – previously, referral from a GP was required. In the late 20th century alternative therapies in general became more popular, which constituted a challenge to GP care.