Patients referred to hospital with cancer and other potentially urgent conditions are being sent back to their GPs because of the Covid-19 pandemic.
The alarming situation could cost patient lives and has been raised by the Health and Disability Commissioner Anthony Hill in a rare letter to Health Minister David Clark.
It comes as NZ Medical Association chairwoman Kate Baddock, a GP in Warkworth, told the Epidemic Response Committee this morning that patients who need colonoscopies and other investigative treatment were being declined by hospitals.
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In the letter to the minister, seen by the Herald, Hill said the consequences would be particularly serious for patients where early diagnosis and treatment was key to survival, including cancer and coronary disease.
"Deferring or declining patient referrals which would be accepted under normal circumstances and have followed appropriate health pathways carries potentially serious consequences for patient safety," Hill wrote.
He said a solution was imperative so that resulting health risk stayed visible to the system.
"Referring patients back to primary care, who were accepted for surgery that has subsequently been cancelled, is not appropriate."
Some district health boards had been doing that.
"These patients should be retained on DHB waiting lists/booking systems and be re-prioritised as elective surgery comes increasingly back on line."
Hill said patients inadequately prioritised according to clinical risk, and poor communication with consumers, were a common feature of investigations by his office into treatment delays.
He said it was vital that all services, particularly those deferring non-urgent procedures and referrals, were regularly reviewing waiting lists to ensure patients were being appropriately prioritised.
"These reductions in health care service activity signal a building unmet need in the community and raise clear equity issues," Hill wrote.
"Action needs to happen now to plan for the surge in activity that will occur as restrictions ease."
Hill told the minister he was concerned with inconsistencies across the country in the way DHBs were applying the National Hospital Response Framework, particularly in respect of acceptance of GP referrals.
"While I know that there is currently work under way to address this, I am concerned that these issues have serious repercussions for equity and patient safety."
Hill said it was appropriate that some hospitals were freeing up resource and deferring non-urgent care during the response to the coronavirus.
However, he had received reports pointing to a lack of consistency in how DHBs were interpreting and applying the response framework.
This was evidenced by:
• Unwarranted inconsistencies between DHBs in accepting GP referrals;
• Reduced or withdrawn specialist hospital services;
• Inconsistent elective surgery cancellations across the country.
"I am concerned by reports of unwarranted rejections of referrals and a lack of
clarity and consistency across the country in regards to what is accepted and what is not."
He warned the system needed to operate in a nationally consistent and coherent way.
"Geographical inequities in services is already an issue I see across complaints to my office, and I am concerned that this will be exacerbated by current sector behaviour."
Baddock told the Epidemic Response Committee this morning that GPs were also concerned over patient referrals.
"The longer we defer them with anything that could be cancer then their health outcomes are going to be significantly worse."
She read an extract of a DHB response on patient referral to the committee.
"Due to the recent Covid-19 outbreak, we are unable to continue providing outpatient appointments for non-urgent patients.
"As a result of this, we have had to cancel our outpatient appointment and we are returning your patient to your care," she read.
"This is happening over and over again," Baddock said. "Just being stopped by the hospitals from being seen at all and as a consequence, the outpatient clinics are empty.
"The patients are just not there and although there has been an excellent preparedness for a Covid-19 rush, an inundation to the hospitals but because of the way it has been managed, that has not occurred."
Health Minister David Clark noted the Health and Disability Commissioner's concerns and said he would respond to Hill directly in due course.
"As he acknowledges in his letter, there is work underway by the Ministry and DHBs to address the issues he's raised and I expect to have more to say on this very soon."