Te Whatu Ora projected New Zealand will be 1000 GPs short by 2033. Photo: Petr Macháček / Unsplash
Leaked documents show West Coast Health has proposed closing its weekend and after-hours GP clinics and using a telehealth service instead.
The proposal - marked as confidential and for Te Whatu Ora staff only - states high workloads and recruitment issues in the region have put pressure on primary care practices and their staff.
"Increasing patient demand, unmet need from secondary care, an ageing population, and an increase in chronic conditions are some of the pressures faced by primary care practitioners," the document reads.
"The expectation that clinicians will work a full daytime shift and be on call on weekends and after-hours or operate a walk in service on weekends or after-hours is no longer sustainable."
It notes the GP workforce was also ageing, and that Te Whatu Ora projected that New Zealand will be 1000 GPs short by 2033.
In the document, West Coast Health said an alternative model was needed.
It proposed all West Coast practices adopt a telehealth service provided by Ka Ora Telecare National Rural Telehealth Service as the main after-hours and urgent care provider.
Patients would be directed to call or visit Ka Ora online when they called or turned up at their GPs after-hours, where they would then be triaged by a call taker.
Any consults with a nurse would be free, but patients 14 and older put through to a GP would be charged up to $50.
Anyone requiring in-person care would be referred to the closest emergency department or rural nurse specialist.
West Coast Health said the telehealth service would increase capacity in the after-hours system and improve access by replacing short weekend clinics with 24/7 care on weekends, weeknights and public holidays.
Patient Voice Aotearoa chair Malcolm Mulholland. Photo: LDR / Stuff / David Unwin
Patient Voice Aotearoa chair Malcolm Mulholland described the proposal as a recipe for disaster.
"The closing of urgent primary care and after-hours health services on the West Coast will have dire consequences for the people of the West Coast. The isolated region has an older population with higher health needs with less access to cellphone and the internet."
Mulholland worried people who in urgent need of emergency care would struggle to receive it in a timely manner, and those with poor phone access and intermittent internet access would struggle to use a telehealth service at a time when they urgently needed it.
"I am not being critical of the stressed health workforce of the West Coast. Clearly, they are overworked and underpaid by a health system that has failed to appreciate the challenges they face."
Mulholland said while telehealth did have its place in healthcare, he could not see it working as it needed to in this instance.
"It is not the silver bullet being promoted by the West Coast Health proposal and is only one tool that can be utilised in certain circumstances."
He said other options could include keeping some clinics open after-hours in more isolated communities, or having two more emergency care helicopters based in Westport and Fox Glacier to transport patients.
'No decisions have yet been made'
Te Whatu Ora spokesperson Philip Wheble, West Coast associate group director operations, said the region was "very unique when it comes to the delivery of healthcare services, particularly primary care".
"There are only three private general practices on the West Coast - one located in Greymouth, one in Hokitika and one in Westport - with the remainder of primary care services delivered by Health NZ. However the funding model remains the same as the rest of the country, with the local primary health organisation West Coast Health the funder of primary care, including after-hours services."
He said Ka Ora was "already available", and the impact of using it after-hours in place of GP practices was being discussed.
"No decisions have yet been made," Wheble said, and insisted any changes would not impact provision emergency services.
"For clarification, the PRIME (Primary Response in Medical Emergencies) service is part of Hato Hone St John's response to emergency 111 calls. PRIME responders are on-call and support Hato Hone St John in response to emergencies when resources are available to do so. This is not proposed to be changed as this proposal is about after-hours care, not emergency care."
