New breed of doctor may solve West Coast's GP shortage

5:39 pm on 2 October 2020

The days of seeing a different GP every few months may be soon be over for Buller residents.

A doctor with a stethoscope writes up a medical record

File photo. Photo: 123RF

The West Coast District Health Board has four rural generalist doctors - two of them new recruits - set to start work in the coming months covering general practice in Westport and Reefton.

At present the DHB is forced to hire locums to work in both towns and patients can find themselves talking to a new GP at each appointment.

DHB general manager Phil Wheble said two of the four rural generalists would start work next month, one in November and another January. All would cover Westport and Reefton as part of their planned roster.

"This is very positive for the Coast; a lot of the training and recruitment work we've been doing on developing a rural generalist workforce is now starting to kick in and people are getting excited about it," Wheble said.

The doctors had a variety of experience and training, including general practice, obstetrics and emergency work, he said.

That enabled them to work across various areas in the DHB including primary and hospital level care, and in community clinics around the West Coast.

"We are actually in a unique situation now - Greymouth is almost fully-recruited for GPs and rural generalists and we are now looking to support those other localities."

South Westland would also in future be getting regular visits from the rural generalists, Wheble said.

DHB chairman Rick Barker said that would be welcome news for Reefton in particular, where there had been a high turnover of GPs for some time.

It was also welcome news on the financial front as locums were a major cost for the DHB, Barker said.

The DHB spent more than $1 million last year on locum cover for Buller. For the year to June 2020, the bill was $222,381 for locum doctors in Reefton alone. The cost of locum doctors covering Buller Heath in Westport was $839,696.

Wheble confirmed that sum included service fees of $670,564, agency fees of $90,167 and other expenses $78,965.

The rural generalist project was launched late last year to solve chronic shortages of doctors on the Coast and give people better continuity of care, and it was already proving its worth, he said.

"In gynaecology, for instance, we don't have the same problems as other parts of the country where women are waiting for appointments; our rural generalists are trained to handle acute obstetric cases, and that frees up our specialist to manage more gynaecology clinics."

Dr Brendan Marshall, who is managing the rural generalists initiative, said it was a model that was well-established in Australia and Canada.

"Primary care is the key to getting people working in rural areas and ... these are doctors who can deliver primary care. [But] they are also doctors who can work in hospital and inpatient settings ... with extended scopes of practice - traditionally these are in obstetrics and anaesthesia.

"Why? Because the delivery of procedural obstetrics defines the safety of the population."

Rural generalism was not just about doctors, but involved nurse specialists as well, Dr Marshall said.

"In this area the West Coast has led the way - a number of communities wouldn't have any health care if not for the rural nurse specialist as part of a multi-professional and multi-disciplinary team, both local and distant."

The current model [of trying to attract doctors to rural areas] was not sustainable, but a rural generalist workforce that was trained and credentialled, could deliver better care closer to home while reducing health care costs to both the hospital, Government and patients, Dr Marshall said.

It also gave doctors a variety of practice.

"I have gone from clinics in rural areas, to delivering babies one day, potentially in surgery the next, then seeing patients as a GP the next. It is an incredibly rewarding job for a young health professional, one you may not get in a main centre."

The DHB said the West Coast was at the forefront of the rural generalist model in New Zealand and it was being closely watched by other regions with similar problems.

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