Rural health at risk of flatline
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