General practice system ‘is breaking’
End of overnight service indication of problems in North
Denise Piper
Patients now have no overnight doctor service between Whangārei and Auckland’s North Shore, as GPs struggle in a funding system they say compromises care and will result in patients dying if it is not urgently fixed.
Coast to Coast Health Care withdrew its overnight services on March 1 because of chronic underfunding, an ageing workforce and compromised doctor safety.
Chairman Dr Tim Malloy said the general practice system “is breaking” and he had been warning of the need to train more doctors and increase funding for 30 years.
“Northland is the canary in the coalmine because it’s the area falling over the most and the area with the greatest need,” he said.
“None of us GPs go to work to do a bad job, but the reality is that we are facing a serious set of circumstances under which care will be compromised and patients will die.”
However, Malloy said the Coast to Coast overnight service at its Wellsford centre was used only by minimal numbers.
“In our experience, the majority of things that happen at night are either able to be deferred until the next day or they are an emergency and need to go to hospital.”
The closure of the overnight service is another death knell for general practices in the north, where GPs say their clinics are on life support and have debt of “more than six figures”.
Malloy said the current state of the general practice service was very sad and patients would pay the price.
“There will be late diagnosis, more presentations to ED, longer waits in ED — it’s a domino effect. There will be people dying in ED waiting rooms.” Malloy said the overnight service was not cost-effective and the ageing workforce meant only a few doctors were available for overnight calls.
“Most of us found the pressure of being away from family night after night was tedious; at our age we feel like we’ve earned our keep.”
Three GPs’ cars were broken into while they were doing an overnight shift, along with the clinic’s vehicle.
The final straw was a woman GP being verbally then physically abused one night in February, Malloy said.
The change means there are no doctors available overnight between Shorecare at Smales Farm or the EDs at Whangārei, North Shore or Waitākere Hospitals.
While Malloy acknowledged there is a large distance between those health services, he said in an emergency, the best course of action was still to call an ambulance on 111.
Coast to Coast doctors were still available 8am to 8pm, with urgent care services expanding in Warkworth and Wellsford, despite the marginal viability, he said.
It also wants to expand in the fast-growing area of Mangawhai with hopes of a new centre.
“We know that what we can offer [in Mangawhai] is inadequate but it’s constrained by the facility.” Reti’s focus on recruitment, retention and remuneration Health Minister Dr Shane Reti, who was a Whangārei GP, acknowledged the problems general practice is facing nationwide.
His focus was on “recruitment, retention and remuneration” for GPs, including creating a third medical school with the University of Waikato.
Reti said he wanted to see more funding going to areas where it was needed most and he was looking closely at the Sapere Report.
The Sapere Report is an investigation into GP funding by an independent expert, which recommends an increase in funding for very high-needs practices of up to 230 per cent.
Despite Northland’s historic underfunding, Reti said the needs here are no greater than in any other part of New Zealand.
“Yes, Northland has had issues and will still have issues finding GPs, but other parts of the country do as well.”