Can you give a run down of after hours on call requirements/ expectations around the country ? It seems in large centres there is no after hours component . Somebody else does the 8 or 9 or 10 pm to 8 am cover whether ED s or / hospital services or very few 24 hr Urgent care Centres > Differentially remunerated by ACC or via ? a visiting service in Auckland .
What are the current payment arrangements around the country ?
There has recently been some discussion in the trenches about GPEP 2 remuneration packages and expectations from the RDA with many comments that the income paid to GPEP 2 s seem to exceed the income of many practice owners . around the country .
In Whanganui the Whanganui PHO owns the after hours clinic and payed $100.00 for an after hours visit to a rest home to reduce over use and admissions through ED . Does this still occur . Are GPs paid to do overnight call now by the PHO ? Have there been any home visits between 7pm and 8 am in Whanganui over the last 3 years ?
Is $100 a home visit , no mileage ,no on call rates , no expenses , no holiday no long service pay, no sabbatical sick pay . etc a universal payment arrangement around the country ? If not what are the going rates ? A few years ago Prime nurses were getting on call rates of $2,000 a weekend in some areas. Hospice and a number of Trust ASMS MECAs have on call rates of several hundreds of dollars for being available on call .
The WRHN practices in Taihape and Raetihi do not have on call medical staff after hours and weekends according to the phone triage service .
Kaitaia is just one tip of the country where it seems logical to have after hours covered by the hospital ED what about the other tips East Cape , Cap Egmont , Cape Farewell , Akaroa, Blenheim , Nelson Westland Pencarrow heads Christchurch , Dunedin , Oamaru Queenstown Dunstan Gore and Invercargill ?
Is this the canary in the coal mine for things to come across Aotearoa and primary care? Can we expect more of this in other hard to staff areas? I tend to think so. Why the shortage in the first place? We should start asking this question and dealing with the cause of the haemorrhage because no amount of “patching and hoping” will fix a problem that is not addressing the core issue.
General Practice has been hanging on for as long as it can between the downward pressure of DHBs to deliver more complex care to the community, and the upward pressure from patients to get more done in the shortest duration of time possible because patients don’t want to have to come back for multiple appointments, or pay for longer appointments necessarily.
Between trying to balance the needs of the patient in a patient-centric model, while understanding and respecting the constraints of the health system we work in, being the meat in the proverbial sandwich is not an easy task!
In the same breath, we have watched the funding model become poorly reflective of the level of work involved. In order to maintain business viability with rising costs, we are often expected to see more patients, in shorter time frames, agonise over health targets to reach pho prize payments, all while meeting our own high level of performance expectation that we inevitably put on ourselves. It’s exhausting, it leads to rapid fire consults yielding potentially unsatisfactory medicine, and it’s unsustainable. It’s hardly the kind of work environment that will have doctors clambering over themselves to become GPs, let alone become GP owners.
And to be very clear here, we NEED GP owners. No other model will do better than to have a doctor who has “skin in the game”. Much like the contemplative patient ready for change, once they have bought into the approach, become invested in the outcomes, they stick around. Sometimes for decades. And for continuity of care, and all the benefits that come with that, this is exactly what we need. We don’t just want more GPs, we want them invested in their practices and their communities. This is how you you achieve tenure.
I am worried that we are not creating an attractive environment to support this model anymore. The corporatisation of general practice is leading to a generation of uninvested doctors. This in turn is leading to a level of churn that limits how effectively we deliver on continuity of care. If we don’t do enough to attract GPs into an ownership model, then we can expect the canary to start looking moribund in fairly short order, and not just in the winterless north. Winter is well and truly here!
100% correct Marcia! The issue is we've had no representation for years and the business case has been lost. Inequities have created GP ghettos. It's not just the after hours, an increasing number of GPs where I work have closed their books and we currently have a Minister with a mindset to "disrupt" us! Just what a teetering sector needs when we're already ~50% behind in our funding compared to when capitation started. Genius.
This model is a long way from being either new or unique - nor does it go as far - and yet I can state with authority that while it helps to a degree with the sustainability of the current workforce it does little to address the issues we face as a profession going forward. Succession planning is a real headache that is not helped by a disconnected Minister, Ministry and Government. Fortunately the same cannot be said of our DHB. Now while we are working hard at looking at solutions we are constrained by a lack of resources. I am staggered to think that all our leaders seem to be doing is wringing their hands and muttering quietly to themselves. I would have thought this would have been a core issue in any Primary Health Care Strategy but given there was no actual strategy I guess I should not be even vaguely surprised.
New Zealand Doctor