GPs say specialist shortages at Whanganui Hospital adding to strain

Health New Zealand says there are “capacity constraints” in orthopaedics. Photo / NZME

A shortage of some specialists at Whanganui Hospital is putting extra pressure on GPs already under strain, local doctors say.

Health New Zealand Te Whatu Ora has written to Whanganui GPs asking them to consider “all options of care” before referring those who need it to specialist orthopaedic care.

A statement from Health New Zealand said there were “capacity constraints” in orthopaedics but it was currently recruiting an additional surgeon.

“We also don’t have a full complement of permanent sonographers so we are partially reliant on locums. We are currently seeing all accepted referrals while we recruit for more permanent staff.”

Whanganui Regional Health Network (WRHN) chief executive Judith MacDonald said when a specialist workforce was stretched the threshold for referral could go up.

“Therefore general practice then has to manage that patient who they know needs to see a specialist but can’t get in because there’s a waiting time or triaging period.

“If you don’t have health insurance and can’t circumnavigate the public system then you are on a waiting list for a long time.

“Someone has to manage your care because you’ve got pain, disability and it makes you depressed, and therefore general practice has to manage that.”

Whanganui Regional Health Network (WRHN) chief executive Judith MacDonald.

Health New Zealand Whanganui chief medical officer Dr Nathalie de Vries said a letter on orthopaedics services had been shared with general practices via the primary health organisations networks.

“We have written to our primary care colleagues to provide process guidance to ensure that all clinical pathways are considered and that these options have been considered in the referral process.”

Whanganui GP Dr John McMenamin said it could end up meaning a patient with chronic joint pain awaiting orthopaedic surgery, for example, could find themselves relying on their GP to manage their pain and monitor their condition for months longer than expected.

“This means that GPs are not only handling routine care but also overseeing conditions that would typically be managed by a hospital specialist,” he said.

“These added responsibilities are leading to longer waiting times for GP appointments, which can understandably be frustrating for patients.”

MacDonald said any time a referral was sent back to general practice, doctors had to continue managing the patient despite their requirement for surgery or a specialist appointment.

“What the practices are saying is there’s a lot of workforce issues in hospitals and waiting lists that are blowing out because our baby boomers are now entering into the system.

“The volume was always going to be more than the system could cope with – that’s real now.”

McMenamin said at the core of the issue was patient wellbeing.

“We deeply respect and support our specialist colleagues, who are working under significant pressures in areas such as orthopaedics, rheumatology, and ultrasound services.

“However, these shortages are having a tangible impact on patient care, and it’s important the public understands the challenges we face in primary care.”

Health New Zealand said there weren’t any rheumatologist vacancies and they were providing services for the community.

De Vries said they had been working closely with local primary health organisations, National Hauora Coalition and Whanganui Regional Health Network, on improving referral quality and ensuring they meet guidelines for specialist services.

“We are undertaking this project to promote all options of care available to our community and to reduce time spent triaging referrals so that more patients can be seen in a timely manner.”

The Royal New Zealand College of General Practitioners’ medical director Dr Luke Bradford said shortages were being felt particularly in orthopaedics due to the ageing population and a requirement for a hospital bed post-surgery.

He said across New Zealand there were large waiting lists for ear, nose and throat (ENT) surgery, gynaecology and orthopaedics, and patients who were waiting for operations had to be managed by general practices.

“Each of those patients gets seen much more frequently than your average patient, and it leads to much less satisfactory outcomes, and it makes it harder for everyone else to get in and get seen.

“It’s a classic example of the fact we are one system, and if you break one part of a system the other parts become stressed.”

On April 12, Health Minister Dr Shane Reti provided further detail about how the Government is planning to achieve the health targets it set in March.

The five targets the Government hopes to achieve within six years include reducing the wait times for a first specialist appointment and elective treatment to less than four months for 95% of patients.

McMenamin said it was important to highlight that these challenges were not unique to Whanganui.

“While the situation is difficult, we are working closely with our specialist colleagues to ensure the best possible outcomes for our patients.

“This collaboration is essential, but we also need systemic solutions, including investment in healthcare recruitment and infrastructure, to address these growing challenges.”

WRHN clinical director Dr Emma Davey said it was intended that WRHN leaders would be discussing in detail with clinical leaders at the hospital how they could work together to manage risk for general practice.

“But also to reduce risk for patients that are caught up in a chaotic system that is not responding as well as it needs to, to meet patient need and demand.”

McMenamin said the growing strain on both primary and secondary care services was directly impacting the healthcare experience for the community.

Eva de Jong is a reporter for the Whanganui Chronicle covering health stories and general news. She began as a reporter in 2023.