Three Rivers Medical managing partner Dr Hiria Nielsen. Photo: Three Rivers Medical
Tai Rāwhiti's largest GP clinic has been forced to cut its after-hours and weekend service because it cannot afford it.
Three Rivers Medical managing partner Dr Hiria Nielsen (Rongomaiwahine and Ngāti Porou), told Nine to Noon it would undoubtedly load more pressure onto Gisborne Hospital's emergency department, which was already struggling.
"It's been a really very difficult decision to make.
"We've previously prided ourselves on being open 365 days a year, because we're all about decreasing barriers, making sure that whānau who work during the week have time to come and get the healthcare we need."
However, due to financial strain and a staffing crisis, the clinic could no longer afford to keep the after-hours service going, and had defaulted to telehealth.
Telehealth could work "fabulously" for some things, but it could never fully replace "kanohi ki te kanohi" or face-to-face care, she said.
"We've held onto that [after-hours] for decades, but it's come at a massive cost, both financially - it's cost us hundreds of thousand of dollars a year negatively against our books, we've just swallowed that - but also in terms of cost to our staff."
It was not sustainable for staff to keep covering evenings and weekends after working long hours during the week, she said.
The clinic, which has 20,000 patients, has also been forced to close its books to new patients from this month.
Under-funded 200 percent
That too was due to "decades of underfunding - in the millions" and staff shortages, which meant they had to refuse new enrolments to ensure continued quality of care for the patients already enrolled.
As a 'very low cost access' clinic, Three Rivers does get higher funding to keep patient fees low - but it was still carrying "a 200 percent deficit" in terms of funding, she said.
It narrowly missed out on extra "equity" funding recently because that was earmarked for practices with at least 50 percent Māori patients enrolled.
Three Rivers has 9000 Māori, or 47 percent of its enrolled patients.
"Māori patients are missing out on that funding because of their choice of provider."
The funding would have been worth hundreds of thousands of dollars for a practice of their size.
"Sure it's a bandaid, but we're really needing bandaids, we are needing sticky tape or duct tape just to hold the seams together."
Three Rivers was having to consider raising fees from the current limit of $19.50.
The government has recently allowed 'very low cost access' practices to increase fees to $29 - but that would be "unattainable" for many of Three Rivers patients, Nielsen said.
"We are going to have to increase fees, haven't made the decision on where that's going to go - whānau will become more and more indebted to the practice, and we don't want that either."
The after-hours doctor usually saw about 20 patients a night, of whom one to three would have to be referred to ED because of their acuity.
Those patients would not all go to ED, or not get care at all.
In response to demand, the hospital had recently started employing GPs in the ED to help with the less acute patients, she said.
Unfortunately that could potentially make it harder for GP clinics, which could not afford to pay nurses what they get in hospitals.
Urgent reform was needed across the whole primary care sector, she said.
"Practices are going to dive, primary care is going to collapse.
"Tai Rāwhitii is already having the problem where our secondary services are on the brink of collapse, our hospital is on the brink of collapse, and we're not far behind."
Health NZ responds
Health NZ's regional system integration group manager Lisa Gestro said the agency recognised that primary care was facing "capacity and resource constraints".
"We have a national primary care development programme underway which includes the review of the funding approach for general practice.
"We understand that general practices in Tai Rāwhiti under the Pinnacle PHO network all have virtual services and a free nurse triage available. All practices have virtual GPs available until 10pm."
Meanwhile, the community could also access the health advice website Healthify, pharmacies and continue to call their own general practices.
Healthline was available to give free health advice at any time, and for emergency situations, people should call 111 or go to the ED.
