New health funding has been welcomed, but there are still concerns over the lack of a trained workforce. File photo. Photo: Photo /123RF
General practice doctors are grateful for the government's new funding for after-hours urgent health care, but there are major concerns about how it will be staffed.
The GPs say the funding acknowledges urgent care has been under pressure, but the funding is "reasonably light" for what the government is trying to achieve.
The government has committed to greater accessibility to urgent and after-hours healthcare in the regions, with several new 24-hour services planned around the country.
New funding of $164 million has been allocated over the next four years, with 24-hour urgent care clinics "identified" for Counties Manukau, Whangārei, Palmerston North, Tauranga and Dunedin.
The funding boost also covers "new and extended" daytime services for other centres, including Lower Hutt, Invercargill and Timaru.
In a pre-Budget announcement on Sunday, Health Minister Simeon Brown said the funding boost would mean 98 percent of New Zealanders would have access to in-person urgent care within an hour's drive.
"Strengthening urgent and after-hours care is an important part of our government's plan to ensure all New Zealanders have access to timely, quality healthcare," Brown said.
There are currently 48 urgent care clinics across New Zealand, most of which are jointly funded by Health New Zealand and ACC. On top of that are many other after-hours services that provide similar levels of care, but are not considered to be urgent care clinics.
Dr Angus Chambers is the chair of GenPro - an organisation that represents the people who own general practices and urgent care centres. He said it was "definitely positive" to have some investment in the after hour urgent care space.
"It's clearly a critical area for patient care and and it's under quite a lot of stress, so it's definitely good to see some thoughts into trying to support it."
His two main concerns were around the amount of funding and the lack of a trained workforce available to staff the clinics.
"The funding seems reasonably light for what they're trying to achieve."
He said when the allocated funding is divided between the hundreds of services across the country, the "money's not going to go very far".
Chambers also compared it to funding for telehealth services, saying the "complexity of providing an in person after hours service is so much greater".
After-hours involved doctors, nurses, a receptionist and facilities, he said.
"It's just a little bit hard to see how they've come up with a figure."
The other issue he said was going to be "staffing the services" because "the general practice workforce has never been weaker than it is at the moment".
He said some of the money will need to be used to make these roles more attractive and keep people working in New Zealand.
Chambers said there were a lot of GPs working around the country at "far lower than market rates" to keep those services going, "because they're part of a community".
"They see the need for some meaningful work, but we shouldn't have to expect GPs to work with altruism."
Overall, Chambers said the "fix" for decreasing demand on hospitals, emergency departments and the after-hours problem was "high functioning general practice care" so that people can get appointments in a timely manner.
"If we could manage chronic disease so it doesn't deteriorate, that is what will lead to far less demand."
Chambers said involving people who provide these services in decision-making would result in better outcomes.
"I think would get greater efficiency and greater effectiveness by trusting the people who actually deliver this work, rather than bureaucrats who are very well meaning, but have really very little idea how to deliver these kind of health services which are very complex and require a lot of experience to get right."
Existing investment will boost staffing - Brown
Brown told Morning Report the government's investments in primary care will ensure new urgent care clinics are adequately staffed with doctors.
"That's why we've announced another range of investments into primary care earlier this year."
Funding had been allocated to train 50 more GPs a year, 100 overseas doctors already in NZ, and for 120 nurse practitioners per year, he said.
"[The government] is putting a lot of effort not just into extending services or supporting services but also that workforce piece which we know is critically important."
He confirmed existing providers would be central to the new services.
"Generally they'll be working with current providers and looking to extend hours rather than building new clinics. For instance in Counties Manukau, where it's been identified the need for a new 24/7 provider, there's already a number of providers who provide after-hours care, Health NZ will go through a procurement process to identify a partner there to provide the overnight service in Counties Manukau," he said.
Financial viability, staffing key issues for GPs
Dr Luke Bradford is the medical director at the Royal New Zealand College of General Practitioners. The college looks after the education and standards, advocacy and policy work for the country's general practitioners, and has about 6500 members.
Bradford cautiously welcomed the announcement, saying it acknowledged urgent care had been under pressure and an unsustainable model.
"It's a vital part in the delivery of the healthcare system, so to acknowledge that it needs increased support was really important."
Bradford said the core issues for urgent care come from the financial viability of the model. He wants to make sure the funding supports the model.
Bradford said he understood the actual cost to see a patient was about $170 per person. Chambers added the cost to attend an after-hours clinic can range from $0-$260, which was highest he had heard. It varied based on age, ACC status and whether someone had a Community Services Card.
"Without funding going in, it's user pays," Bradford said, "there's no way the fees being charged were covering that."
Bradford said the other big issue was staff. Clinics are usually staffed - in large part - by GPs working "after hours and on top of their normal work," he said.
Rural "on-call hours" and those in the smaller centres often were not paid so you were getting "tired GPs, GPs being underpaid to do it, and therefore you were struggling to staff them."
He hoped that would level out due to this funding.
As to whether what the government has proposed was possible, Bradford said the "devil's in the detail".
He explained the 24/7 clinics were unlikely to be staffed by doctors overnight because there was not enough doctors.
"I suspect that it'll be a combination of nurses and paramedics with telehealth support."
But he did believe if conditions improved for clinicians working in urgent care, and if the clinics themselves were financially viable, "then a good service can be set up."
The majority of the funding would have to go toward staffing, because "you have to pay a premium to the staff who are going to be working overnight".
Staff safety was also a priority so people were not alone in buildings through the night, he said.
He was also unsure how extra nurses would be attracted to the roles, given the current pay disparity between primary care nurses and their hospital counterparts.
The New Zealand Nurses Organisation was also worried about staffing. Primary Health Care Nurses College chair Tracey Morgan said: "Our biggest concern is where will the staff come from.
"We welcome the focus on primary and community care but it ignores the main issue.
"The pressure on urgent care can't be fixed without solving the chronic under-staffing issues the sector faces."
She said until the government gave primary and community health care nurses pay parity with their Te Whatu Ora counterparts, "the sector will continue to lose nurses and health care workers to better paid jobs in hospitals and to better paid jobs overseas".
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