DHB shoulders overnight on-call duty to relieve tired Kaitāia GPs


DHB shoulders overnight on-call duty to relieve tired Kaitāia GPs

Kaitaia, by Philip Capper
A GP shortage has stretched healthcare services in Kaitaia to breaking point. Photo: Phillip Capper
"At least removing the overnight and allowing GPs to sleep at night will make a huge difference and, hopefully, assist with recruitment" Northlan


 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.