Whangārei is stuck in a "vicious" healthcare circle as overworked general practices grapple with more patients re-routed from a swamped emergency department.
But the city is only a microcosm of a regional and national healthcare system in distress, Northland GPs say.
Their comments come in the wake of national concern about the state of New Zealand's overrun emergency departments after both Whangārei and Dunedin hospitals hit capacity last week. Capacity levels of other EDs nationwide were labelled as "dangerous".
On March 25 the Northland District Health Board (NDHB) asked the public on four consecutive days to keep the 31 available beds in Whangārei Hospital's ED for emergencies only to alleviate high numbers of patients.
People were asked to visit a GP, Māori health provider or pharmacist for routine care. Under urgent care, the post advised people to head to an urgent-care (after hours) medical centre – with White Cross the city's only available option other than ED.
Last Tuesday and Wednesday, 246 patients turned up to ED but NDHB general manager – medical and elder services, Tracey Schiebli, said this was within the department's normal range as the hospital had become busy year round.
"The traditional winter peaks no longer exist and we experience surges of demand on a daily and weekly basis."
She said as a medium sized hospital – with 246 inpatient beds that include maternity but exclude mental health – the biggest challenge was the lack of consistency in patient numbers over a 24-hour period.
"We have daily planning meetings to make sure we don't exceed available beds across the hospital. This means that we have to be flexible about where we place patients at times."
Flexibility that has led to an increase of cancelled planned surgeries and potentially longer waits in ED.
"One of the strategies we employ is to transfer patients to our rural hospitals when they have capacity and transport is available, ideally for patients who live closer to those areas," Schiebli said.
At an August 2020 NDHB meeting, chief executive Dr Nick Chamberlain said they could not meet the target of 95 per cent of patients leaving the region's hospitals' emergency departments within six hours.
The percentage of patients been seen and treated in ED within six hours was 85 per cent.
Annually, Whangārei ED dealt with about 43,000 people, which meant more than 160 patients on some days. Wait times ranged from one hour to 14-plus hours.
Information Schiebli said would ring true until a new hospital was built.
"Our facilities are a major issue and the Australasian Health Facility Guidelines and National Asset Management Plan demonstrate our emergency department is half the size it should be."
Designs are currently being drawn up for a new Whangārei Hospital but the wait could still be up to a decade.
Overcrowding in Whangārei's ED will be temporarily reduced by the creation of an assessment unit, Schiebli said.
But people needing non-urgent care would continue to be encouraged to see their GP or other primary care provider.
Primary care is the professional health care provided in the community – usually from a GP, practice nurse, nurse practitioner, pharmacist or other health professional working within a general practice.
"However we acknowledge that our primary care services are also under pressure with growing demand," Schiebli said.
Whangārei GPs were frustrated as they agreed people should have been able to access primary care services in the first place but the system was plagued by inadequate Government funding causing burn out, poor staff retention, and financial barriers.
Health Minister Andrew Little addressed Parliament about reforms to the health system in March where he acknowledged without change the system, already under stress, was going to worsen as 20 per cent of Kiwis became 65 and older.
"With an ageing population and growing burden of chronic disease we know that demand for health services is going to grow substantially over the next decade."
Dr Andrew Miller, from Bush Road Medical Centre in Kamo, said around 10 per cent of people did not have the money to afford primary care and GPs did not have the funding to be able to provide cheaper visits.
Government funding for District Health Boards is heavily influenced by the average age of the population, how unwell people are, and how quickly the population grows.
However the cap on the NDHB's funding from the Government is deemed to fall very short of the realistic funding required to cater for Northland's population growth.
A situation being confounded by more elderly people moving to the region who are not funded by NDHB as they have not filled Census forms.
"We've got a quicker than average growth in Northland and they're not providing us with accurate funding," Miller said. "It's strange since we are one of the most deprived areas in New Zealand. We're expected to deliver the same as every other DHB but they're not going to fund us for it."
Northland's population is also significantly older than the national average. The elderly population, aged 65 years or older, has the highest population growth in the region which puts a higher demand on the health care system as this age group has comparatively higher health need.
Frustrated feelings from GPs were further fuelled by Prime Minister Jacinda Ardern's comments on The AM Show on Monday.
Ardern, in response to the country's overrun emergency departments, said she would "like to see us really focus on preventing people from ending up in ED in the first place."
Miller said this was everyone's goal and their clinics were becoming grounds of innovation as they did their best to cope with a high demand.
"We're stuck in a muddle and it's being like this for 30 years, so we need be more innovative. One of the things we are doing – which you will see around New Zealand – is the Health Care Home model."
When patients phone the Bush Road Medical Centre to make an appointment, a clinical staff member will return the call and find out what is going on and create a plan action – to avoid unnecessary or difficult visits to the centre.
"The resolution rate averages around 30 to 40 per cent of patients who are able to be sorted out over the phone," Miller said.
More than 175 practices across the country have implemented the Heath Care Home model.
Miller said the model meant time was better utilised when people did attend the centre as GPs already had the information and a plan of action had been created.
But it was not going to solve a "whole system at capacity", Miller said.
"People are sent from one place to another because there is no supply to meet the high demand. White Cross can see people but then they are just delayed there rather than at ED."
The General Practice Owners Association (GenPro) chairman, Dr Tim Malloy, said the pressures on ED was a consequence of poor whole-of-system planning and a lack of appropriate resourcing to manage growing demand from an increasing and ageing population.
He said if the vicious circle of health care continues in the form of ongoing chronic underfunding of GPs the health outcomes for Northlanders will be impacted, and the sustainability of GPs and urgent care providers will be undermined along with continued and increased pressures on hospitals and ED departments.