One doc­tor a costly lux­ury?

Kapi-Mana News - - FRONT PAGE - By AN­DREA O’NEIL

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?’’

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