Who owns NZ GPs: The private equity giants, Kiwi corporates and the doctors
On the surface, both deals confirm corporate buyers’ interest in owning general practice medicine as well as the urgent care treatment and other specialty areas sometimes associated with or otherwise bolted on to practices, including mental health care, dermatology and even cosmetic medicine. It’s an uncomfortable fact that cuts across the often repeated concern that New Zealand GPs are underfunded by government. Tamaki Health has 51 general practice and urgent care clinics, including the White Cross banner, while Green Cross has 65 clinics, many of which operate under the brand The Doctors. Photo / NZMECentral government funding for primary care, community, public and population health, a large chunk of which is shared by general practices, albeit unevenly, is budgeted at $10.348 billion in fiscal 2026/27, up $2.1b over the past five years, or an annualised increase of more than 5%. Recent changes, across capitation, the fixed annual fee paid to practices per enrolled patient (including performance-based capitation), vaccination, rural funding and other money for enrolled patients, will take general practice-specific funding from $1.795b in the current year to $1.912b budgeted for 2026/27, an increase of more than 6%. They’re not exceptional increases; the 22/23 rise was outflanked by very high price inflation that year and wage inflation across the wider health sector has run hot throughout the period. The overall totals also mask instances where increases in some areas marry reductions in others. However, they do skew higher against fading inflation in the past couple of years. Several industry participants with knowledge of large corporate owners said the increases in public funding have played a role in plumping the appeal of general practice as a business. It’s worth noting that Green Cross’ most recent annual report cited an 8% increase in revenue in the year to March, driven by public “funding uplift and incentive payments linked to national immunisation targets”. Valuations The high valuations of both Tamaki and the Green Cross medical business have certainly raised eyebrows. Tend is paying $270m, subject to adjustments including for net debt and net working capital, for a business for which earnings before interest and taxes (ebit) were $26m in the last financial year. Tend Health chief executive Cecilia Robinson is set on expanding her brand of technology-enabled primary care.This price tag of more than 10 times ebit eclipses the general industry rule of thumb, which values general practice at between three and five times ebit. Sources told the Herald other interested parties included Sydney-based private equity firm Adamantem Capital, Sydney-based Genesis Capital and even TPG. The price paid by TPG for Tamaki has never been publicly disclosed. TPG declined to provide comment for this story or answer questions but the Herald understands the price was $450m, a huge increase from the $154m company valuation in 2022, when Australian private equity firm Mercury Medical Holdings was approved by the Overseas Investment Office to buy the 50% of Tamaki that it didn’t already own. Mark Forman, a partner at MinterEllisonRuddWatts who specialises in mergers and acquisitions and private equity transactions, suggested that the number of interested buyers in Green Cross was one reason the price went so high. Heavy in the cost of specialised staff, who are frequently in short supply, general practice isn’t a classic private equity target, Forman said. But the recession-proof reliability of healthcare demand coupled with dependable public funds (although these come with heavy regulation and caps on co-payment by patients), as well as the opportunity to streamline and centralise costs in a sector that has been slow to modernise, are all attractive. “Roll-ups” into larger corporate structures provide considerable business advantages and efficiencies, including deep pockets for capital investments – especially in IT, and digital platforms and systems. But the bigger targets in New Zealand general practice are now sold and Forman thought that other sizeable deals, especially for private equity, are unlikely, at least in the short to medium term. A handful of medium-sized players (outside charity and non-profit structures) do present some opportunity, he said. Forman didn’t name any businesses, but some sources cited examples such as the doctor-owned network Tui Medical in Waikato, and Silverdale Medical and the Greenwood Medical Centre, both in Auckland, as possible targets for further corporate ownership. Forman suggested that Tamaki and Tend are also likely to continue to add to their businesses, buying individual practices incrementally. A flu vaccination being given at Hastings Health Centre. The widely-held centre provides an umbrella for a range of sub-practices in Hawke's Bay. Photo / Warren BucklandA contrast in ownership TPG is a giant, private equity-funded asset manager that invests hundreds of billions of dollars. A spokeswoman declined the Herald’s request for an interview about the rationale for the Tamaki deal and the company’s plans. Many in and around New Zealand healthcare are profoundly wary of the profit motives of corporations, and especially of private equity. Commentator and former executive director of the Association of Salaried Medical Specialists, Ian Powell, holds that the profit motive for private equity players is sharper and more detached from patient wellbeing than it is for local businesses, especially those that are owned by their operator doctors. The view has also been taken up by the Labour Party, whose health policies announced late last year included a plan to offer low-cost loans to help GPs and nurse practitioners buy owner-operator practices. But while the TPG deal, with its scant detail, provides plenty of room for those sceptical about remote and foreign owners’ intentions, the Green Cross sale to Tend defies easy caricature. Auckland-based Pencarrow Private Equity’s VI Investment Fund is currently a 24% owner of Tend and Pencarrow representatives have two seats of the company’s six-person board. However, Ngāi Tahu Investments holds a stake worth several million dollars in the Pencarrow fund and the iwi also holds a very small direct stake in Tend (0.79%), as does its savings scheme Whai Rawa (0.89%). Ahuahu Group, owned by Maniopoto iwi, is also a shareholder (0.88%). And earlier this year, Tend went into partnership with Ngāti Whātua Ōrākei, to run its Ōrākei Health clinic. Currently, the iwi shareholdings are eclipsed by others, chief among them Cecilia and James Robinson, the company’s founders and co-chief executives. However, the Green Cross deal is about to change that. Ngāi Tahu Holdings, Ngāti Whātua Ōrākei and the Ahuahu Group are all participating and they are also joined by newcomer investors Nāti Growth, the investment vehicle of Ngāti Porou, and other as yet unnamed iwi. Ngāi Tahu will clearly become a major shareholder and Cecilia Robinson confirmed that the iwi is set to gain at least one board seat. Labour leader Chris Hipkins flanked by health spokeswoman Ayesha Verrall (left) and finance and economy spokeswoman Barbara Edmonds last October, making a health policy and funding announcement. The policy included a loan scheme to boost GP practice ownership. Photo / Mark MitchellIn response to written questions, she declined to provide any further breakdown on the source of funds. She emphasised that shareholders’ aim is to build Tend into a “100-year Kiwi-owned healthcare business” and that the company will continue to “consider acquisitions where they support our purpose and improve access, quality, patient experience and a healthier population”. The aim appears to marry well with the often long-term, social focus of iwi.Ngāi Tahu spokeswoman Deborah McPherson said Ngāi Tahu Holdings chief executive Todd Moyle was not available for an interview. In a written statement he said that Ngāi Tahu is excited to support Tend as a New Zealand-owned business and that its focus on technology is improving patient health and access to care. GP ownership in retreat Health New Zealand records that 951 general practices receive capitation funding across the country as of June 1. An estimated 68% are owner-operated by their GPs and to a lesser extent by other clinicians, including nurses and nurse practitioners. Ownership by GPs has been in slow retreat for decades and demographics suggest this will continue. The Royal New Zealand College of GPs’ most recent survey found that their median age is 51, 70% rated themselves moderately or highly burned-out and 35% intend to retire by 2030. Alongside corporates, charities, non-profits and trusts also consolidate practice ownership and otherwise step into the gap as general practitioners retreat from ownership (which, to be clear, they still dominate). Examples include the South Link Health Group, which encompasses 23 general practices and provides centralised IT, software, business management and administration; it’s owned by the South Link Education Trust Board, a registered charity. Māori Trusts are also common. Ngāti Porou Hauora Charitable Trust operates six clinics on the heavily rural North Island East Coast. Charity-owned Primary Health Organisations also play a big role; in its last annual report ProCare cited ownership of six general practices, the largest of which is Health New Lynn, which has some 20,000 enrolled patients. As much as any other trend, higher capital costs for technology upgrades, innovation and the digital systems required to drive business efficiency – booking platforms, patient data management, cyber security and AI to name a few – mean consolidation in general practice is likely to accelerate. Tend, which has a mixed digital-physical care and business model, started up with shareholder equity of $50m six years ago. Its first order of business was to build a patient app. The company has poured tens of millions of dollars into technology systems. That app now tells patients where and when the most immediate physical and video appointments can be booked in the network; it makes bookings and cancellations; facilitates the purchase of medical certificates (typically involving a quick nurse phone call) and prescription renewals; it provides prices and adjusts for concessions; it takes payment. Expensive digital systems, especially those that are custom-made, only make financial sense when they are deployed to drive services and efficiency on a large scale; this suggests there is more deal-making to come. Green Cross 413,000 enrolled patients 65 clinics Owners: publicly listed, a shareholder vote on the sale of the medical division to Tend is scheduled for July. The majority of Green Cross medical clinics are controlled entities, owned entirely or substantively by Green Cross. In many instances, ownership stakes are retained by others, typically clinic doctors and/or other clinicians. Eleven clinics are classified as “associate entities” in Green Cross disclosures; the company holds an ownership stake in these instances and significant influence, not control. Tamaki Health 230,000 enrolled patients 51 clinics Owners: US-headquartered private equity and asset management giant TPG (Texas Pacific Group), publicly listed on the Nasdaq. Tend Health 148,000 enrolled patients 25 clinics Owners: Cecilia and James Robinson (34%), Pencrow VI Investment Fund, private equity (23.8%), Philippa Greenwood and Theresa Gattung (17.68%), Marko Bogoievski (17.68%). Omnihealth 85,000 enrolled patients 17 clinics Owners: Gavin Brian Pitt (28.56%), Gordana Stojadinovic (28.56%), Mark Wills (12.38%), Virginia Christie Wanaka (15.55%), Sanford World Clinic, owned by US-based non-profit Sanford Health (14.65%). Tui Medical, Waikato 50,000 enrolled patients 9 clinics Owners: more than a dozen Tui clinicians have company shareholdings, but the majority 71% stake is held through Ram Health Ltd by Dr Seema Menon, Dr Navin Najan, Dr Stanley Koshy and Dr Fiona Koshy. Hastings Health Centre 34,000 enrolled patients, across a group of “sub-practices” beneath the umbrella banner 3 clinics Owners: both Hastings Health Centre (2001) and the Hastings Health Centre Ltd are very widely held by centre doctors and other clinicians, the single largest stake in both entities (26.25%) is held by Malcolm Taylor, Josephine Messerschmidt, Paul Messerschmidt and Michael Lawrence Jackson. Silverdale Medical, Northern Auckland 25,000 enrolled patients Owners: skin cancer Dr Martin Denby and cosmetic medicine Dr Sara Hart (9.52%); GP Dr David Hassan (9.52%); Dr Meng Hui (Marcus) Ang (9.52%); Dr Sarah Wiseman (9.52%); Dr Gi Hoon (Andrew) Han (9.52%); Dr Hsang Yu (Peter) Chai (9.52); Dr Isabelle Duck and Christopher Sibley (9.52%); Dr Oliver Walton (9.52%); Dr Christopher Whittington (9.52%). Includes urgent care doctors, cosmetic medicine doctor and skin cancer doctor. Third Age 26,520 enrolled patients 5 clinics Owners: publicly traded, largest stakes held by founder and director Bevan Walsh (25%) and his former partner Lenore Bauer (19%). Greenwood Medical Centre, Epsom Estimated to have more than 25,000 enrolled patients Owners: Dr Russell Eggleton and Dr Hannah Eggleton (14.29%); Dr Catherine Cearns and Dr John Carter (14.29%); Dr Scott McLaren and Ruth McLaren (14.29%); Dr Tony Chiu and Lucy Cheng (14.29%).WeCare Health An estimated 24,000 enrolled patients 4 clinics Owner: Jamie Schwass, chiropractor Ownership stakes are often held through companies and are sometimes held jointly with family members not named here.Not all minority shareholders are listed.Clinics include both general practice and urgent care clinics. In addition, some general practices include urgent care and other specialties and services such as mental health and addictions care, dermoscopy and cosmetic procedures. Kate MacNamara is a South Island-based journalist with a focus on policy, public spending and investigations. She spent a decade at the Canadian Broadcasting Corporation before moving to NZ. She joined the Herald in 2020.Stay ahead with the latest market moves, corporate updates, and economic insights by subscribing to our Business newsletter – your essential weekly round-up of all the business news you need.
