Some Whanganui medical practices have introduced a virtual doctor service to help cope with demand. Photo / 123rf
More patients with non-acute needs are accessing an urgent after-hours service in Whanganui as people face lengthy wait times for appointments at general practices.
Whanganui Accident and Medical (WAM) clinic – an urgent and after-hours service located at Whanganui Hospital - has an increased number of patients accessing primary health care.
In the past year, 48% of people who attended WAM were there due to accidents and injuries; the remaining 52% were for medical-related reasons.
Adults under 39 years and children were the most frequent attenders at WAM in the 2023/24 year.
Whanganui Regional Health Network (WRHN) chief executive Judith MacDonald said it was not clear if people were presenting to WAM in preference to general practice because they could not get a timely appointment, or if this age group demonstrated a preference for drop-in services.
“I think you can honestly say the demand really stretches all of our resources in all general practices across our region,” MacDonald said.
Te Waipuna Health service manager Jamie Procter said they used nurse triaging and had daily urgent appointments available, but the reality was a sector “under pressure”.
“We use our Manaaki Hauora and Community Nurse teams as much as possible and carry an extensive list of standing orders to reduce wait times for a doctor,” Procter said.
“But the reality is the entire primary care sector is under pressure and for those practices that don’t have adequate general practitioner workforce, they will be struggling.
“We are using locums a lot more frequently because of the demand, yet this will add financial pressure in the long run. "
Wicksteed Medical Centre practice manager Rosalie Glynn described a workforce under pressure, particularly over the winter months, with the team short of two GPs out of seven.
The practice has implemented a virtual doctor service – Practice Plus Book on Behalf – where the clinic books an appointment for the patient if they are unable to access an in-centre appointment.
“To mitigate the impact on patients, we have employed telehealth locum doctors at considerable expense and we have ring-fenced urgent appointments in clinic daily.”
Impilio Family Clinic lead nurse Rochelle Palmer said they ensured children were always seen and used phone consults when convenient, as well as keeping urgent appointments available.
“Unfortunately, when life gets busy with patient care volume, then the back-office stuff doesn’t get completed in a timely way, such as recalls,” Palmer said.
“If patients are aware they are due recalls for an immunisation, cervical screening etc, then we suggest they should book in and not wait for us to call them.”
MacDonald said WRHN practice members tried to meet acute and urgent requests with an appointment on the same day or within one to two days.
“If the system is clogged and access to general practice is poor, then people will also have problems accessing hospital services as this often needs a referral from general practice.”
A higher ratio of female doctors, more doctors reaching retirement age and less interest in the traditional business ownership model is changing the way general practices are run across the Whanganui region.
Since 2003, WRHN has had a number of practitioners walk away and hand over their practice to the network; in most cases, this was due to doctors reaching retirement age.
MacDonald said patients still wanted to see “their doctor” but that was not necessarily available any more.
General practices now often worked in larger teams of nurses, nurse consults and doctors who saw all patients.
“That demand has outstripped the resource that we have available, and then you have an older workforce who may not work fulltime any more.”
A routine check-up, such as a baby being monitored for an ear infection, could be done by a nurse, which would allow a doctor to be available to see a highly complex patient in a more timely fashion, MacDonald said.
“Something has to give, we have to do something differently... because what we do know is that if we don’t do it well early, then people will fall through the gaps and end up being sicker.”
Asked what this would mean for patients concerned that losing a family doctor would require them to constantly explain their medical history, Macdonald said technology would have to fill this gap for general practices.
“A portal like Manage My Health allows you to go in and see your lab results and converse technically with general practice teams.”
There was hope that technology would shift stretched general practices away from having to do additional work, such as ringing patients with their lab results.
“That’s not to say that the general practice traditional model won’t continue – we do know there are some people that are still interested.”
MacDonald said people with “really complex pathology” who were very unwell wanted to know their doctor was available to them, and it was important GPs maintained that level of care.
Eva de Jong is a reporter for the Whanganui Chronicle covering health stories and general news. She began as a reporter in 2023.