Ru­ral health at risk of flat­line

The Southland Times - - Front Page -

Is there still a heart left in health care these days? With ser­vices chang­ing all the time, what are south­ern com­mu­ni­ties left with when it comes to mod­ern health care?

Ru­ral health­care in the south is be­ing eroded away, suf­fer­ing death by a thou­sand cuts.

In the past year, news broke of the down­grade of the Lums­den Ma­ter­nity Cen­tre, con­cern that Te Anau is look­ing to lose its res­cue he­li­copter ser­vice and in Tu­at­a­pere changes had to be made af­ter fail­ing to se­cure a full-time GP. The emer­gency depart­ment is of­ten un­der pres­sure in Invercargill be­cause peo­ple turn up to ED in­stead of opt­ing for the af­ter hours doc­tor ser­vice.

The dis­tinct im­pres­sion is that the sit­u­a­tion is get­ting worse, rather than im­prov­ing.

Ac­cord­ing the health board statis­tics, 40 per cent of gen­eral prac­ti­tion­ers in the south­ern health re­gion are likely to re­tire within the next 10 years, while the pres­sure ex­erted on the ex­ist­ing ser­vices by an age­ing pop­u­la­tion would re­quire more, not fewer, gen­eral prac­ti­tion­ers un­less some changes are made.

The po­ten­tial im­pact of this on the vi­tal­ity of ru­ral com­mu­ni­ties, and the wider im­pact this could have on at­tract­ing peo­ple to the re­gion, is a real con­cern for South­land Dis­trict mayor Gary Tong.

‘‘To at­tract peo­ple to ru­ral ar­eas to work, live and play re­quires ac­cess to ser­vices so of­ten taken for granted by many in big­ger com­mu­ni­ties. Health ser­vices are a ma­jor at­trac­tion to those with young fam­i­lies and those who are not so young. Many peo­ple look at health, ed­u­ca­tion and work as the de­ci­sion point when as­sess­ing a new way of life,’’ he said.

Ru­ral com­mu­ni­ties all over New Zealand were faced with the con­tin­ued threat of the loss of es­sen­tial ser­vices, and the re­gion’s fu­ture could not con­tinue to be threat­ened by the loss of ser­vices that help and pro­tect, Tong said.

Clutha-South­land MP Hamish Walker echoed con­cerns around the im­pact of health care on ru­ral com­mu­ni­ties.

‘‘Wa­ter­ing down or com­pletely re­mov­ing health ser­vices es­sen­tially rips the lifeblood out of ru­ral com­mu­ni­ties. If we want to at­tract and re­tain peo­ple in the CluthaSouth­land re­gion we must have em­ploy­ment op­por­tu­ni­ties, ed­u­ca­tional op­tions and high qual­ity, accessible health ser­vices. It’s al­ready very hard to source ru­ral GP’s as it stands, so it’s go­ing to get even harder if our ru­ral health ser­vices are down­graded,’’ he said.

Otago Univer­sity Dunedin School of Medicine As­so­ciate Dean Ru­ral, Divi­sion of Health Sciences Garry Nixon said the short­age of GPs and other health care work­ers was not just a ru­ral south­ern prob­lem, but a global one.

‘‘Just churn­ing out more and more GPs does not nec­es­sar­ily ad­dress the short­age in ru­ral ar­eas,’’ he said.

Although there was a na­tion wide short­age of med­i­cal pro­fes­sion­als, the greater is­sue was a mald­is­tri­bu­tion of that work­force.

Be­tween the med­i­cal schools in Otago and Auck­land, uni­ver­si­ties were work­ing to bring more doc­tors into ru­ral health with a fo­cus on re­cruit­ing med­i­cal stu­dents from ru­ral back­grounds, en­sur­ing pos­i­tive ru­ral ex­pe­ri­ences dur­ing un­der­grad­u­ate place­ments, and work­ing on a pro­gramme of vo­ca­tional train­ing or spe­cial­ist train­ing in ru­ral prac­tice.

One area where New Zealand was lag­ging be­hind other coun­tries like Aus­tralia and Canada was cre­at­ing ru­ral clin­i­cal schools, which pushes peo­ple and in­fra­struc­ture out into the ru­ral re­gions, thereby help­ing to bring qual­i­fy­ing doc­tors and health care work­ers into ru­ral set­tings, but also cre­at­ing career ad­vance­ment op­por­tu­ni­ties for doc­tors based in a ru­ral set­ting, thereby en­sur­ing that peo­ple con­tinue work­ing in those com­mu­ni­ties later in their ca­reers, Nixon said. ‘‘It gives them the same op­por­tu­ni­ties for career pro­gres­sion you would have had in the cities. It is a shift from re­cruit­ment to re­ten­tion,’’ he said.

A defin­ing fea­ture of ru­ral health care is that the bound­aries are more fluid be­tween dif­fer­ent pro­fes­sions, which makes for a far more sus­tain­able model, with many nurses now un­der­tak­ing roles that would tra­di­tion­ally have been ful­filled by GPs, Nixon said.

How­ever, the need for GPs in com­mu­ni­ties is still strong, as hav­ing good health care in a com­mu­nity made a town more at­trac­tive to other pro­fes­sion­als.

‘‘If we lose these sort of jobs out of small towns it has an effect on the other pro­fes­sional jobs in these towns, so these jobs are more im­por­tant to com­mu­ni­ties than just health out­comes,’’ Nixon said.

Tu­at­a­pere used to have a GP based in the town but in late 2017, af­ter try­ing and fail­ing to at­tract a GP, the Wa­iau Health Trust board and man­age­ment had a tough de­ci­sion to make.

Wa­iau Health Trust man­ager Jo San­ford said: ‘‘At the time, the board and man­age­ment were re­ally con­cerned about the in­con­sis­ten­cies our clients were get­ting from the high vol­ume of locum doc­tors we were hav­ing to re­cruit. It wasn’t fi­nan­cially sus­tain­able.’’

‘‘The ma­jor thing for us was be­cause there is such a huge GP short­age we were ex­tremely con­cerned about the pos­si­bil­ity that in the not too dis­tant fu­ture we would not be able to open the prac­tice be­cause we wouldn’t have a GP.’’

‘‘We looked at the model of be­ing led by a nurse prac­ti­tioner, and we were lucky enough to al­ready have the ideal per­son at the clinic, Amanda McCracken.

‘‘She has worked with the prac­tice since 2009, so has a very broad and deep knowl­edge of our peo­ple,’’ San­ford said.

The re­ac­tion from the com­mu­nity was mixed ini­tially, with some see­ing the move as a threat to their med­i­cal ser­vices.

‘‘Now 18 months down the track we have a very suc­cess­ful med­i­cal prac­tice, and the com­mu­nity is very happy with the ser­vice they’ve been pro­vided,’’ San­ford said.

The med­i­cal cen­tre has a doc­tor vis­it­ing from Te Anau once a week at present, help­ing to run the satel­lite clinic in Ohai, en­sur­ing that the re­gion’s med­i­cal needs are met.

‘‘I can’t say strongly enough how well it has worked for our com­mu­nity, pro­vid­ing the best pos­si­ble med­i­cal out­comes for our com­mu­nity in a ru­ral set­ting. We were quite ex­cited lead­ing the way with that kind of innovation,’’ San­ford said.

The cur­rent model has al­lowed the med­i­cal cen­tre to re­tain the same vis­it­ing doc­tor and same staff dur­ing the past two years, with pa­tients there­fore able to see the same per­son ev­ery time they visit the clinic, some­thing that is very rare in a ru­ral set­ting these days, San­ford said.

Gore Health chief ex­ec­u­tive Karl Met­zler said tech­nol­ogy could bring about big changes in ru­ral health care, but cau­tioned that the tech- nol­ogy needed to be fit for pur­pose, and not a so­lu­tion look­ing for a prob­lem.

‘‘It is not a panacea or a sil­ver bul­let,’’ he said.

One of the big­gest roles tech­nol­ogy could play was in spe­cial­ist care, where us­ing tele-health links could po­ten­tially re­duce or elim­i­nate the need for pa­tients to travel to big re­gional cen­tres for con­sul­ta­tions.

‘‘In 2018 I find it al­most crim­i­nal that peo­ple have to do a four hour round trip for a five to 10 minute re­vi­sion of their blood work. Our pa­tients ab­so­lutely have to put pres­sure on our clin­i­cal work­force and ask what the al­ter­na­tives are if they are told to go to Dunedin for a con­sul­ta­tion,’’ he said.

Al­ter­na­tive work­forces such as physi­cian as­sis­tants, which Gore Hos­pi­tal has been us­ing for a num­ber of years, are also key to the con­tin­ued health of ru­ral health care.

The reg­u­la­tory changes re­quired to make the best pos­si­ble use of these al­ter­na­tive work­forces needs to be a pri­or­ity.

‘‘It shouldn’t be a po­lit­i­cal football – we are on the precipice so it is time to put the lobby groups aside and look at how we work into the fu­ture,’’ Met­zler said.

South­ern Dis­trict Health Board ex­ec­u­tive di­rec­tor strat­egy, pri­mary and com­mu­nity di­rec­torate Lisa Ge­stro said the health board was aware of the chal­lenge com­mu­ni­ties faced.

‘‘We know we can do a bet­ter job of pro­vid­ing health care ser­vices across the South­ern dis­trict and make best use of our re­sources. Tra­di­tional mod­els of care won’t meet the fu­ture needs of our pop­u­la­tion


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