Despite changing her doctor to expedite medical appointments, Stephanie Opai takes her whānau to the Whangarei Hospital for urgent care as a lack of GPs in Northland is starting to bite.
She is among thousands of Northlanders who are being forced to wait for weeks to see their GPs and the situation is expected to get worse as population numbers go up.
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An aging workforce, high numbers of casual patients, and the usual spike of winter illnesses are exacerbating the situation.
According to Mahitahi Hauora, the organisation overseeing most primary healthcare in Northland, expected number of GP consultations in the region this year would be 502,350— 6254 more than last year.
Next year, the number is estimated to increase to 508,383 and on to 514,232 the following year.
Earlier this year, all three Kaitaia medical practices closed their books to new patients, saying a lack of doctors endangered staff and patients.
Pressures on Kaitaia GPs, apart from a shrinking workforce and high numbers of casual patients, forced Kaitaia Hospital to take over the town's overnight on-call doctor service.
Kaitaia's biggest practice, Te Hiku Hauora, has two clinics in Kaitaia and one in Coopers Beach with just 7.3 full-time equivalent GPs. That's three or four GPs fewer than required to serve 13,600 enrolled patients.
Opai, a Whangārei mum of four, said people needed to look after themselves better rather than rely on doctors and nurses given the pressure on medical services.
About 18 months ago, she changed her GP after being told there was no appointment for her daughter for the next two days.
"I normally wait for two to three weeks for a GP appointment so we go to the hospital for urgent care because it's free and they see us in a matter of hours as opposed to a matter of weeks.
"Plunkett says we need to take our kids to the doctors when they are sick, employers don't want staff who are sick at work so there's more expectation from our doctors."
Mahitahi Hauora spokeswoman Jenny Barrett said general practice has been changing over the past five years with an increase in the average size, the number wanting to buy decreasing, and more GPs opting to work as locums.
She said there has also been a significant increase in the number of people with one or more long-term conditions in Northland and that the increased demand for public health has resulted in a greater proportion of funding going to hospital-based care at the expense of community care, mental health and primary care.
Barrett said plans were afoot to set up Accountable Care Networks (ACNs) in three areas of Northland, with another two to three likely to be formed by July 2020.
The networks are a cluster that includes Mahitahi Hauora, general practice, Māori and secondary health, as well as education, housing, and social service providers working with communities to identify what their health needs.
Kerikeri GP Dr Grahame Jelley said replacing GPs who were getting to retirement age was a challenge.
He said medical students were increasingly pursuing training in fields other than general practice as they believed there may be greater social and financial opportunities, and exposure to larger hospitals in urban areas.
A joint proposal by the Royal New Zealand College of General Practitioners (RNZCGP), Rural General Practice Network and Universities of Auckland and Dunedin, to the previous Government, for the setting up of rural interdisciplinary teaching hubs was yet to be acted upon, he said.
Jelley said such initiatives were working well in Australia and could be used in New Zealand to help alleviate the shortage of GPs, especially in rural areas. Māori health outcomes were inequitable and a secure and stable interdisciplinary workforce in rural areas of high need was critical to address these inequities, he said.
"But that's just one part. The recruitment, financial and community support, and academic pathways all come into play."
He said a rapidly growing over 65 population in Northland, coupled with a large Māori and widely disbursed population, all put pressure on existing Northland GP services.
RNZCGP president Dr Sam Murton said if a patient needed to be seen urgently and couldn't get an appointment with a GP, they should call the health line service for advice in the first instance.
"They will be able to advise as to whether the patient should visit their normal GP practice, or the emergency department at the nearest hospital.
"If the patient visits their normal practice, we would advise they tell the practice manager or receptionist that the issue is urgent, so they can triage the request."
Murton said in an emergency, patients should go to the their nearest hospital or call 111.