One doctor a costly luxury?

Porirua’s after hours medical clinic could be replaced by a single paramedic covering an area from Kapiti to Tawa, in a cost-saving scheme planned to take effect as early as February 2013.

There was no plan to deploy more than one paramedic to cover both Porirua and Kapiti, Wellington Free Ambulance medical director Andrew Swain told KapiMana News.

Kenepuru Accident and Medical (A&M) clinic is staffed from 10pm to 8am by one doctor and two nurses. A proposal has been put forward by a group of doctors, Wellington Free Ambulance and Capital & Coast District Health Board staff to close the A&M overnight and extend Kapiti’s ‘‘Urgent Community Care’’ model.

The Kapiti paramedic attend an average 3.7 patients a night, and the A&M sees around 11 patients overnight.

A working group made up of 15 medical experts and community leaders is working out the details of the proposal.

Patients would call either 111 or the Healthline number to access the paramedic, who would be trained to a higher level than regular ambulance paramedics and be able to perform medical care in homes from dressing wounds to dispensing medicine, Dr Swain said.

If the paramedic was unsure how to care for a patient, or wanted to access patient records, they could call Wellington Hospital’s emergency department, he said.

The paramedic would be diverted to any 111 emergency occurring nearby, he said.

Paramedics have performed after-hours care in the UK for 10 years, and recently in Australia, Dr Swain said. ‘‘I think you can be confident in this system.’’

The paramedic would be overcautious when taking phone calls, to avoid underestimating the severity of a patient’s condition, said GP Larry Jordan, who was spearheading the proposal.

‘‘This kind of triage is increasingly being regarded as safe.’’

Challenges facing the Kenepuru A&M included cost, access and availability of doctors to staff the overnight shift, Dr Jordan said.

‘‘Provision of overnight care services has been particularly challenging in this region for a long time.’’

The aim of the paramedic proposal was to provide the best healthcare, but saving money was a strong consideration, he said.

‘‘Clearly we wouldn’t be proposing something more expensive.’’

After hours doctor Rob Kieboom said the proposal was unsafe and unsuitable, and deprived Porirua of a single after hours doctor.

‘‘Paramedics are very good for certain things, but they’re not qualified to see the range of patients we see,’’ he said.

‘‘It seems incredible that having just one doctor and two nurses onsite overnight at the Kenepuru A& M centre is regarded as a costly luxury.’’

The A&M was easily accessible by everybody in Porirua and Tawa, and had no problems finding doctors to staff it overnight, he said.

Waiting times would skyrocket under the scheme, and patients would no longer be observed by nurses while in a physical waiting room, Dr Kieboom said.

‘‘Overnight things can get nasty very quickly. How can they possibly provide a timely and safe service when people are waiting in line for three or four hours?’’