30 Nov 2022

Urgent care clinics under strain

9:41 pm on 30 November 2022

Pressure is building at urgent care clinics with more patients coming through the doors, and not enough staff to keep up.

With both general practices and hospital emergency departments under strain, urgent care clinics are caught in the middle.

Dr Oruba Khalil could not remember a time in her long career that the health workforce had been under such strain.

She has worked at The Local Doctors Ōtara, an urgent care and GP clinic, for 24 years.

Now just a year shy of retirement age, she was considering an early exit from the profession.

Working long hours of overtime, Dr Khalil could not hold down a schedule outside of work and struggled to make time for exercise - or even a coffee break.

"When you see people waiting three, four hours, you can't afford to go and sit for your lunch.

"I know that if I go for my lunch, that's another half an hour on the wait time."

This year had been especially difficult, with waves of Omicron in March and July meaning more staff off sick, Dr Khalil said.

And with Christmas approaching, the burden on urgent care clinics could grow as general practices close for holidays.

"Our staff need to go for a break.

"Other GPs will close for some time, so usually we don't have a good time during Christmas, because we feel lots of pressure from other clinics, other GPs, casual patients... Accidents will increase during Christmas, so we have to deal with all these things."

Dr Khalil said earlier in her career, the clinic would never send patients home unseen, but now scheduling an appointment for the next day was sometimes the only option.

"The waiting time is long, people get frustrated, and sometimes we'll have some patients getting abusive. This happens because of the pressure.

"I understand how the patient feels, if he went to the hospital for four or five hours and was not seen, and then he comes here and he's not sure if we will see him or not."

Registered nurse Sonam Swastika Ram normally started work at 8am.

By this time, there was already a long queue of patients at the door.

Other than emergency cases, these people could still find themselves waiting hours for a doctor to see them.

When there were too many to cope with, nurses had to send some patients onwards.

"When there is a huge amount of patients in the queue, for example more than 90 or 100 patients waiting, and we have less doctors due to sick calls, then... We do a full triage, and if they can come the next day - for example, ACC follow-ups, and those who don't need to be seen soon - they can wait until the next day."

The nurses told patients that if their condition deteriorated, they should go to Middlemore Hospital or Ascot A&E.

People presenting with more minor conditions like a cough or cold were often told it was best to purchase cough mixture from the pharmacy and rest at home, with nurses checking up on them over the phone.

Swastika Ram said the job description of nurses had expanded in many areas to relieve some of the pressure on doctors.

But with the nursing workforce also experiencing shortages, this could place more stress on nurses.

"We have to do our normal triage, we have to do treatments, and we have to do immunisations, because we are doing everything in this clinic."

Tāmaki Healthcare regional director Bipin Thakkar said urgent care clinics had always taken on some overflow from general practices.

But that had increased drastically since the start of Covid, he said.

"People need more attention and more help during this time, and the doctors [around us] couldn't manage... We get a lot of patients coming from other doctors.

"They need help, and we provide that help."

Thakkar said the clinic took on referrals from all over Auckland, including from hospitals when they were at capacity.

The clinic's ability to cope with the large number of patients could vary from day to day, Thakkar said.

During the peaks of Covid, the urgent care clinic had dealt with up to 550 patients a day, up from an average of about 300 pre-Covid.

Since the pandemic began, the average number of patients had remained higher than pre-Covid levels, he said.

The number of staff working at the clinic also fluctuated daily; today there were six doctors in the morning, nine in the afternoon, and three for the evening shift, with five nurses on the day shift and three in the evening.

"During Covid, uncertainty is every day," Thakkar said.

"We don't know what is going to happen next, because someone could become positive and can't come to work.

Also, sometimes the staff is enough, but the rush is more, and then we can't cope."

The government was undertaking several initiatives to bolster the workforce, including support for internationally qualified nurses to gain registration in New Zealand, and covering international doctors' salaries during induction courses and internships.

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