Shane Reti: Declined GP referrals the tip of the iceberg

Easing pressures on the health system will be challenging but there are things that could be done today that don't involve declining referrals and cancelling follow-ups, says Shane Reti. Photo / File

OPINION:

Hospital waiting lists continue to break records as more and more New Zealanders wait longer and longer.

Between those waiting to see a specialist and those already on the surgical list waiting for surgery, there are now more than 200,000 people on waiting lists.

More than 5000 have waited 12 months for their surgery, well beyond the four-month target.

Tragically, 81 of these became so unwell that they have been removed from the list after being categorised "exit code 15 medically unfit". A cold term giving cold comfort to those who may never get their surgery.

The real size of the wait list may be significantly larger than the official numbers suggest. Many people never even get on the wait list because their referral is either declined or GPs don't bother to refer because they know their referrals will be declined. In Christchurch, GP referrals have been declined for months. The plan seems to be to simply shut the front door.

The following table gives a regional breakdown of declined referrals to hospitals in the past year, showing a total of 130,000.

The total should be seen in context. Most of these referrals are from GPs and at least some will be declined because the patient doesn't meet a reasonable minimum entry bar to make the waiting list.

However, a GP referral is generally only done when there is real and genuine need.

Waikato Hospital recently sent 2224 patient referrals back to their GP for reassessment. Only 200 were subsequently deemed no longer necessary.

Care and collaboration with primary care should set the entry bar rather than simply shutting the front door as Christchurch has done. Restricting the gateway sits alongside several announced wait list initiatives including cancelling follow-up appointments and only operating on those waiting more than 12 months instead of the promised four months.

This data throws a light on possible unmet needs in the community at a time when the health system is already in crisis, waiting lists are at record levels, with many of the 130,000 who were declined unable to see a specialist, despite needing to.

The data also needs to be looked at through a geographic and demographic lens. How do we explain that MidCentral (7797) has nearly double the number of GP referrals being declined as Northland (3436) despite having a similar population?

Easing pressures on the health system will be challenging but there are things that could be done today that don't involve declining referrals and cancelling follow-ups.

Firstly, we should acknowledge the crisis and show the sector that Government is not out of touch. Secondly, we could give international nurses a pathway to residency from the time they arrive. Third, we should re-establish wait-time targets with public reporting and accountability.