“[In the past], you went to your family doctor, whom you not only knew well, but who likely delivered you and your mother and aunts and uncles,” Professor Ardagh says. “If you got unwell, you would see them.
“The relationship was very strong. Now, there is much more episodic, drop-in type care in general practice.”
Even if you have a good relationship with your general practice, as a consequence of episodic care, you are likely to not see your own doctor, he points out. Now it’s a case of people expecting to be able to buy dog food at 2am, so they expect to be able to see a doctor when they want to.
But a good relationship with your own GP reduces ED attendance, Professor Ardagh says. It is here where he and colleagues see hope for reducing demand.
In Canterbury, initiatives have been under way in the past decade that are helping keep people well in the community.
Nationally, on average, 250 people in every 1000 will go to an ED in any one year; in Canterbury, the figure is a lot lower at 180.
Christchurch’s after-hours primary healthcare facility, the long-established 24 Hour Surgery, has helped reduce demand, Professor Ardagh says.
It’s well known in the community that this is the place to go with minor illnesses and injuries, he says. Subsidised by the DHB, it is open 24/7 – a service not offered in many places throughout the country these days.
In some districts, GPs work right in the ED. At Thames Hospital, says Dr Hulme, a GP in the department looks after patients triaged level 4–5. This enables the more acute cases to be seen by emergency specialists.
In Taumarunui, Ms Dibble says the DHB is focusing on providing services to help keep people well so they do not turn up at the ED.
Digging into the reasons for ED attendances and repeat visits revealed some telling data. One child with respiratory issues was living in a house with 13 people. Their caregiver was very ill, and the house they were living in was damp.
The DHB is developing an integrated healthcare model, so various players in primary care work together on helping these children do better.
Dr Rodwell sees many patients who claim they cannot get an appointment to see their GP for a day or more. It would be helpful, as a hospital specialist, to be able to access a practice’s booking system and make the appointment with the person’s GP, he says.
The answers lie in practices making more time available for urgent appointments, he suggests. Large, multidoctor general practices, in particular, could be opening their doors on weekday evenings until at least 8pm and on Saturday mornings.
Ms Dibble says change won’t happen overnight, because habits are entrenched. Over time, a whole-of-system view will provide the answer, she says.
“The hospital ED is always there, it’s always available, it’s a constant in people’s lives.”