DHB lightens workload
Non-acute patients being told to go to the White Cross
Whanga¯ rei Hospital’s emergency department is giving free vouchers to non-urgent patients to seek treatment at White Cross under a partnership aimed at better prioritising medical care.
About eight patients are referred to the White Cross daily to help ED doctors manage their workloads and to focus on treating people needing urgent care.
The Northland District
Health Board has introduced an app called Emergency Q that patients can download to look at the wait time in the ED and whether they should seek treatment elsewhere.
Patients attending the ED are first screened and the decision to send them to White Cross is based on their individual needs.
In Northland, the initiative is in place only at Whanga¯rei Hospital’s emergency department.
“Clear information about who can safely choose to go to White Cross, the comparable treatment times, payment support for those who need it, and text reminders if they do not present quickly creates a safe package of appropriate support,” NDHB chief operating officer Paul Welford said.
The voucher value varied depending on the patient’s circumstances but was designed to cover all out-ofpocket costs, he said.
Examples of non-emergency cases listed on the Emergency Q app include: colds and flu, sore throat, diarrhoea, vomiting, headaches (like ones you’ve had before), bruising, swelling, sprains, cuts that aren’t very big, rashes that won’t go away after days, bladder infection, constipation, and problems that haven’t gone away after weeks.
Mahitahi Hauora chief executive Phillip Balmer said Northland DHB was following the lead of other DHBs that referred patients when the demand was high to alternative sites for subsidised care.
Balmer introduced Emergency Q at Counties Manukau DHB two years ago following a similar initiative at the Waitemata DHB.
He said NDHB was doing it proactively and patients were then being seen more quickly, albeit in a different location.
“While we know wait times to see a GP are high, we are not seeing a large growth in triage 4 and 5 patients who could be seen by their GPs coming to the ED. In fact they are lower.”
The pressure on hospital emergency departments, coupled with a chronic shortage of GPs around Northland, has prompted the Association of Salaried Medical Specialists (ASMS) to call on NDHB to consider employing GPs directly.
ASMS executive director Sarah Dalton said there were clear flaws in the current model of primary healthcare and having non-urgent patients being turned away in hospital emergency departments was not unusual.
She said in areas where access to GPs was difficult and there was a reliance on locums, district health boards should consider employing a number of GPs directly.
“Best care for patients is not locumbased. If we want GPs to settle in smaller provincial communities, we need to offer income
certainty and terms and conditions of employment which attract them and enable them to stay.”
Dalton said the West Coast DHB, Waikato, and DHBs across Auckland have hired GPs that worked in community-based emergency clinics.
A shortage of GPs in Northland was mirrored by a serious shortage of medical specialists, she said. Welford said NDHB already employed GPs for specific demand management initiatives but was not actively trying to provide routine primary or urgent care.
An ASMS staffing survey carried out last year found the NDHB had a 36 per cent shortfall of hospital specialists — the largest of any other DHBs.
Clinical leaders estimated they needed 60 more full-time equivalent senior doctor positions to provide safe and appropriate care to patients and the community. But NDHB disputes this, saying it has the largest number of senior medical officers per head of population for a secondary care provider. It claims to have 110 per 100,000 people, compared to the 93.4 national average.