Earlier intervention with less invasive treatments can restore health and even prevent the need for elective surgery. Photo / Matthew Kay, File
Earlier intervention with less invasive treatments can restore health and even prevent the need for elective surgery. Photo / Matthew Kay, File
Opinion by Craig King
OPINION:
There are growing calls across the medical community to address the increasing backlog of elective healthcare needs (aka planned care) across the country, and to therefore provide long-term, sustained differences to the way we provide care.
Additionally, there is a need to address the issue of increased access tocare in the community via primary and community care to better prepare people for elective surgery.
This would improve positive outcomes for patients and mean earlier intervention, with less invasive treatments, that can restore health and, in some cases, prevent the need for elective surgery at all.
Improving care in the community would in turn help reduce the time people sit on wait lists to receive care and help to reduce the number of people turning up at emergency departments (ED) for treatment that could have been prevented. This last point is especially important when we’re already hearing stories across the country of EDs at capacity when we’re in the so-called “quiet season”. When we hit the middle of winter and we’re dealing with flu and other respiratory illnesses, it’s even more important that primary care does everything it can to take the load off secondary care.
Call it the ambulance at the top of the cliff approach if you like. What we really need is a solutions-focused approach to planned care in order to best support communities, take the pressure off hospitals, and get those who need support or more certainty around their illness the care they need.
One way of doing this is by empowering general practitioners to access investigations and treatments that already exist in the community to support people earlier in their illness. This then prevents the need for referral to hospitals, and in some cases, the need for elective surgeries. It might also prevent us from needing more beds in hospitals or having to build more hospitals.
ACC already empowers general practitioners to take this proactive approach by way of ordering MRIs for patients. This has reduced wait times for care significantly for all patients and increased access for Māori and Pacific patients – all huge wins from a patient perspective. Ironically, this is not something that GPs can do in other parts of the healthcare system. Imagine if we could just have these sorts of efficiencies across the entire healthcare system for MRIs, let alone other tests or treatments.
To access these investigations and treatments, GPs would assess their patients against agreed and evidence-based clinical pathways – something we proposed as part of our primary care feedback to the Minister’s Planned Care Taskforce.
Dr Craig King. Photo / Supplied
Undertaking such an assessment would mean general practitioners can provide the analysis of unmet needs, as well as intervene early to give certainty and, in some cases, alleviate the suffering and stress associated with waiting for planned care services.
People on wait lists for planned care at our hospitals, still require ongoing primary care to support their conditions and manage their pain and anxiety as they wait. This increased demand effectively takes up capacity that would otherwise have been available for others who are acutely unwell or who need important preventative care such as immunisations or cancer screening.
By giving GPs access to investigations and treatments available in the community, based on agreed clinical pathways we would be able to give people more certainty about their diagnosis through investigations and give them earlier access to some treatments that are available in the community as an alternative to the hospital setting. Not only does this approach benefit patients, but it also over time reduces the workloads of both primary care and hospitals.
Our experience of working with radiology clinics and physiotherapists in the community has also shown that this approach adds to the building of some of the important relationships between healthcare providers and opens even more opportunities to improve the effectiveness of our health system.
Enabling this would be a win for patients and a relief for general practices. It would also be a positive, solutions-based move to improve the performance and sustainability of hospital services and would help to reduce people ending up in ED unnecessarily.
Lastly, it would align with some of the key priority actions from Te Aka Whai Ora (Māori Health Authority) and Te Whatu Ora (Health New Zealand) as outlined in Te Pae Tata – the Interim New Zealand Health Plan: Place whānau at the heart of the system to improve equity and outcomes (priority 1); keep people well in their communities (priority 4); and develop greater use of digital services to provide more care in homes and communities (priority 5).
