Front-line role for senior doctors pays

Putting increased numbers of consultants and other senior doctors into hands-on work in hospitals can cut costs by lowering the numbers of patients who have to be admitted, a hospital board says.

Nelson Marlborough District Health Board chief medical adviser Andre Nel said the board had only a handful of resident medical officers and house surgeons at its hospitals in Nelson, Blenheim and Murchison, compared with many other district health boards.

"We see ourselves as a consultant-led service - consultants take a far bigger role in hands-on patient management at our hospitals," he told Parliament's select committee on health on Wednesday.

Not only did this approach lead to greater patient satisfaction, it tended to limit the impact of wage increases.

Asked whether the high level of involvement by consultants meant that they had to be paid more, Dr Nel said that the comparatively large amount of autonomy they had created greater job satisfaction.

"In terms of remuneration, there is some recognition of that, though we don't believe that it necessarily costs more to run the service in this particular way."

It seemed that patients were happier too, because those coming into the hospitals were more likely to see a consultant from the start. The board did also train hospital registrars.

Last last year, Nelson health authorities cancelled almost all scheduled surgery for five to six weeks to prepare for an influx of emergency and acute cases over the holiday period, and to save money.

The halt to elective surgery reduced the number of patients admitted to hospital and allowed medical staff to take annual leave.

Keith Rusholme, the board's general manager of hospital services, said some research had suggested that it was cheaper to have consultants as senior medical officers for smaller urban hospitals.

The system produced significant medical efficiencies, such as being able to provide just 30 medical beds for a population of 80,000 people in the Nelson area, he said.

This was quite different from other regions, because hospitals in other parts of the country, without senior medical officers dealing with the prospective patients arriving at the door, were likely to have a lower level of competence and higher levels of admissions.

Mr Rusholme also said the board was seeking a "one hospital-two campus" model for its two main base hospitals, Wairau, at Blenheim, and Nelson. When the board had first amalgamated it had combined support services, but clinical services were managed separately without a lot of contact between them.

The board's hospitals were pretty well staffed, though it had some difficulties recruiting psychologists, but its most difficult site to staff, Wairau, had a full workforce.

In nursing staff, it had a relatively low turnover, to the extent that most of the problems were caused by ageing workers retiring.

But the board said the one area where it provided general practitioners, Murchison, had to rely mostly on locums.

- NZPA