Editorial: Holidaying doctors are not the solution

Picture / File

The GP crisis in Te Hiku has had a long gestation period. So too will a genuine, lasting solution. Perhaps that lends some validity to Mahitahi's plan to lure GPs with the offer of working holidays. That is the archetypal band aid solution, but, joke that it is, might be the best that can be hoped for.

Even if it works, and we're told that the signs are promising, it barely rates as any solution at all. As Kaitaia GP Cecil Williams, who walked away from his practice earlier this year when he could no longer ignore the toll that the pressure he was working under was taking on his own health, told the Northland Age in February, one of the keys to providing primary health services to an acceptable standard is continuity of care.

We're not going to get that with short-term imports who head north with plans to mix work with surfing. We're not getting it now. You don't have to be an expert to know that seeing a different doctor at every visit is sub-optimal, to coin a phrase. And you don't have to look far to find people in Kaitaia who have been badly served by GPs who have no knowledge of their history, or even access to their medical records.

Patients who are told in the course of a brief, routine consultation that the medication prescribed by a specialist isn't needed have every right to suspect they are not receiving the care they deserve.

The problem is that restoring Te Hiku's GP numbers to a proper level, thereby reducing the pressure that continues to build on those who are already here, is going to take time. It would be unreasonable to expect Mahitahi, the Northland DHB or even the government to come up with the "silver bullet" that Dr Williams could not begin to offer after he succumbed to burn-out. That said, this crisis has been building for years, and no one seems to have done much about it. Until now, when it might well be too late.

It is outrageous that new arrivals in Te Hiku are told that no general practice will enrol them, although the triage system that has been adopted is reasonable given the pressure practices are under, contrary to the impression given by the Sunday programme on TVNZ One on November 17. Those who are enrolled with a practice, it seems, can be assured of receiving the attention and treatment they need, but increasing numbers of people are not, because no one will take them.

Te Hiku is more fortunate than many small rural communities in that it has a hospital, which also provides access to GPs, albeit at a cost that might well be beyond the reach of some people. The situation is not quite as gloomy as Sunday painted it, but it is bad, and possibly destined to become worse. Northland's GPs are reportedly older than most in their profession, and burning out at a rate of knots, exceeded only by those in the Wairarapa and Wanganui.

The long-term solution, obviously, is to train more GPs, with a particular focus on working in rural/provincial communities. That is not a new idea though. It has been talked about by at least the last two governments. The relationship between the Northland DHB and Auckland University's Medical School is partly aimed at encouraging students to consider working in the region after graduation, and might well be having some effect, but much more needs to be done to address the GP shortage.

Earlier this year the DHB, having finally stirred from its torpor, in response to Dr Williams' revelations about the pressure Kaitaia's GPs were working under, decreed that medics at Kaitaia Hospital would be responsible for all health needs between the hours of 10pm and 8am, meaning GPs would no longer be on call 24/7. One practice told the Northland Age that that alone would effectively address the burn-out rate among GPs, but judging by those who were involved in the Sunday programme that was overly optimistic.

If Sunday faithfully described the current situation, nothing has changed, and Kaitaia's general practices are no closer to accepting new patients than they were when they closed their doors.

Whatever the situation, the decision to refer those needing primary care to the hospital at night hardly rated as an innovative solution to a serious problem. That arrangement had already been in place in the Mid North, and elsewhere, for some time, so it hardly qualifies as a stroke of administrative genius. Ask Cecil Williams, and he will tell you that it had not previously applied at Kaitaia Hospital simply because the doctors there refused to co-operate.

The problems, he said in February, included a lack of co-operation between GPs and Kaitaia Hospital doctors. With no proper triage system in place, those needing attention after hours (5pm to 8am, and weekends) had to see a GP first, at a cost that many couldn't afford, or were reluctant to pay, and often resulted in them being referred to the hospital anyway for treatment or procedures that a GP could not provide. Hospital doctors' refusal to take over after 10pm, he said, added to the GPs' workload, and delayed the provision of the required level of care.

He claimed that the hospital doctors had threatened to resign rather than adopt the after-hours system that worked well elsewhere, on the grounds that it would collapse the hospital system. Oddly enough, it does not seem to have done so.

And while the problem had been talked about for years, it had never been resolved, the ramifications of that including that Kaitaia was no longer seen as a desirable place for GPs to work. It was also having an effect on the hospital, which Dr Williams said had already lost many of its senior nurses.

Meanwhile television has once again done Te Hiku a major disservice by not emphasising that Kaitaia is far from alone in suffering a primary care crisis. The Sunday programme might has easily been made in Kerikeri, where general practices have also stopped enrolling new patients. The problem there might be even worse, given the investment there in providing aged care, and the requirement that every person who enters into such care must have a GP.

That is certainly proving to be a problem for Kaitaia's Switzer Residential Care.

Perhaps the programme will ease the situation though. According to last year's debacle of a census, Northland's population is growing faster than any other region's, which is obviously having an impact on all sorts of infrastructure, including health services. This latest dose of negative publicity might have helped put paid to that. Having no hope of enrolling at a general practice should be more than enough to put many people off the idea of immigrating here.

But if the best that anyone can do is to suggest offering doctors from around the country, and the world, working holidays in the Far North then we really are in trouble.

Any short-term fix would be welcome, but one might be forgiven for having the horrible feeling that that's the best we can hope for.

All the talk over umpteen years of training rural GPs to avert a looming crisis has seemingly come to nothing, and there is no reason to believe that the current Government's promises to do better will be any more effective.

Too many people have fiddled while Te Hiku's primary health service burned, and now it might well be too late to fix it.