Northland's general practices are asking patients for more kindness and patience as clinical staff work under immense pressure and increasingly have to deal with abuse.
Throughout the pandemic, the public health response focused on keeping patients out of the hospitals but with the rising number of cases primary healthcare is now under the pump.
As medical centres juggle long work hours, staff shortages and financial restrictions, they also have to deal with abuse by anxious and angry patients.
Managers of six general practices in the Whangārei district came out and said patient health is always at the heart of their community doctors. However, the pandemic meant the way they provide care has changed.
Of the 30 years Bream Bay Medical Centre manager Kay Brittenden has worked in healthcare this is the first time she has been spat on, sworn at, and had things thrown at her.
Brittenden, along with practice managers of Te Aroha Noa Medical Centre, Central Family Health Care, Te Whareora o Tikipunga, Bush Road Medical Centre and West End Medical Centre, said patients had to manage their expectations while clinical staff worked to the best of their ability with limited resource.
"To expect the same level of service as they [patients] got pre-Covid is very difficult. We are working with the same or fewer team members and doing much more work. Please be patient."
Brittenden said the days when patients could ring their GP in the morning to get an appointment later the same day were over.
"We're working really hard to do the service that needs to be happening. The clinicians are making the decisions as to who is most at need and that's not necessarily the loudest person."
All managers reported reception staff were abused verbally over the phone by angry patients daily.
Central Family Health and West End Medical even had their windows smashed by frustrated people.
West End Medical Centre's Iain Watkins said the level of abuse towards his 18-year-old receptionist was "totally unacceptable".
"Sometimes the doctors have to step in and get the person to back off. It's starting to feel like not a safe workplace."
The practice managers acknowledged the current situation was difficult for the community because people are being deferred from the hospital, there could be extraordinarily long waiting times on Healthline and at White Cross, and unless their case was acute patients often can't get a same-day appointment with their doctor.
Watkins wanted to assure patients that everybody who rings their GP practice will be triaged and will receive the care that fits their needs.
Under phase three of the public health response to Omicron, the Ministry of Health expects most positive cases will be self-managed while clinical care is focused on people with high needs.
Primary healthcare providers are at the forefront of the Omicron outbreak. They are currently managing the majority of the near 3000 active Covid cases in Northland in addition to their regular services.
"At business as usual we're already at capacity and we've got Covid on top of this," Ruth Redfern, practice manager at Central Family Health Care, said.
"For a lot of us, we've got even less staff than we've had before. Even if we try and recruit, there is nobody out there."
Te Whareora o Tikipunga's Joseph Mihaka added while patient anxiety was increasing, so was the anxiety among staff and the current climate made it hard to recruit.
Meanwhile, Redfern said the general practices aren't funded adequately to do the extra work.
The Government at the start of the pandemic spent an extra $50 million to support GPs and primary care and $20m to improve video conferencing and telehealth consultations.
But whilst it wasn't bad money, "it doesn't reflect the amount of after-hours and other work that the team have to do", Redfern said.
"Everything that we get, we try to put forward into providing services for our patients. Certainly, there is no fat on the lamb anymore," Watkins added.
He said their workload increased as the Government redirected additional health care responsibilities, such as maternity care, into the hands of GPs. However, no appropriate funding followed those extra tasks.
"It flows through to the patients – with the length of time waiting for an appointment and the way we deliver care services."
Bush Road Medical Centre manager Della-Maree Trask said the Government "knock" their money back constantly, leaving doctors to "work harder and longer for less".
"They [clinical staff] are totally in it for the heart because it has nothing to do with money."
Workload issues and funding shortfalls also stem from patients booking incorrect consultation times.
One of the main issues at Te Aroha Noa Medical Centre was high needs patients with complex health conditions - requiring a long consultation - often booking 15-minute visits instead, practice manager Martin Brookers said.
"What this means is that the practice is funded for X number of visits, but many consults are forced to be funded by the practice themselves as the capitation formula does not compensate adequately.
"We do, however, suggest that the patient might need to book a longer appointment for such times which is often not acknowledged," he said.
The stress put on the workforce is exacerbated by the threat Omicron poses to their own staff.
Clinical teams already stretched thin could be further reduced if they become household contacts or test positive.
Mihaka said patients need to get used to the idea of telephone consultations: "it's the same care, the only difference is that people don't sit in traffic to see their GP."
Plus it poses less risk on clinical staff and helps manage their workload.
Additionally, the practice managers asked people to utilise their prescription services over the phone rather than asking for a face-to-face appointment which isn't often required for a new script.
General Practice Owners Association of Aotearoa New Zealand chairman Dr Tim Malloy not only knows of the dire situation medical centres find themselves in, but as a Northland GP, he experiences patient anxiety and anger, as well as stress amongst his colleagues.
He reiterated medical centres were doing more work with "very little resources" and staff found it increasingly difficult to deliver care.
"Additionally, practices are dealing with constant change," Malloy said – especially Omicron means regulations are suddenly abandoned and new rules introduced.
"Patients also have to adapt to this rapidly changing world. We are simply implementing government regulations."