This year, Rotorua Hospital reached full capacity - twice. The beds were tight, more people showed up in the ED, patients already there needed to stay longer and staff were sick. People with the flu were urged to stay at home and make an appointment with their GP if the symptoms persisted or got worse. But for some, it's not that easy as more medical centres have needed to close their books for new registrations.
About a quarter of the medical centres in Rotorua are full and are not taking new registrations.
A small workforce, high demand for GPs in the district, a rapidly growing population, and difficulty recruiting new clinical staff to the area were the leading factors.
Rotorua Area Primary Health Services chief executive Kirsten Stone said more GPs than ever now have full patient books.
There are 15 medical centres in Rotorua, including rural centres in Murupara and Mangakino, and four are closed to new registrations.
Statistics NZ estimated the population of Rotorua to be 72,500 at June last year, an increase of 800 people compared to the year before, and an estimated 4400 increase from 2009.
Last year, the 47 fulltime GPs in the Rotorua Area Primary Health Services network delivered nearly 250,000 consultations.
This equated to about 102 patients a week per GP and Stone said this year was looking much the same.
More up-to-date figures would be available in October.
"The average ratio of patients per GP in Rotorua is very much higher than the national average," she said.
Stone said the GPs also worked together to staff the after-hours service through Lakes PrimeCare, which added to their strained workload.
She said the priority was to work closely with the Lakes DHB to support capacity in primary care and ensure the balance in clinical safety, user satisfaction, and preventing burnout of the existing workforce.
"We are also hopeful that the national Health Review will be recommending support for longer-term system changes to support service capacity," she said.
Longer-term strategies to combat the shortage included education scholarships for young locals to study medicine.
A programme of work with Lakes DHB in another long-term strategy planned to reduce demand for services. This could be through co-ordinated care for people with long term conditions, Stone said.
A medical centre owner and doctor, who spoke on the condition of anonymity, said the practice had not taken on new registrations in the past year.
She said it was a matter of safety for registered patients to see a doctor in a timely manner and the centre aimed to provide same-day appointments to current patients.
A Ranolf Medical Centre spokeswoman said the centre hoped to open its books in about six months, depending on the number of doctors available.
Three Lakes Clinic practice manager said the centre had closed registrations, as the doctors had reached maximum capacity.
"This is to provide an appropriate and clinically safe service for our registered patients."
Registrations were reviewed regularly, she said.
Lakes PrimeCare Medical Centre operates on a walk-in basis and provides out of hours general practice accident and urgent medical care.
People who were not registered with a GP were charged $102 for a consultation, or $75 with a community services card.
A Lakes DHB spokeswoman said some people would go to the emergency department even though they were better seen by a family doctor.
Lakes DHB director of strategy, planning and funding Karen Evison said the DHB worked closely with RAPHS and Pinnacle Midlands Health Network around service models and enrolment options.
She said new workforce roles were being introduced by PHOs to assist GPs.
This would be through nurse practitioners, clinical pharmacists, social workers to "name a few", she said.
She said the Lakes population was not growing at the same rate as other DHBs and had a specific shared project in place to help people who were not enrolled with a GP.
"There are a number of reasons people are not enrolled and this project is investigating those and to date finding solutions within the capacity in Rotorua," she said.
Evison said work was ongoing with the Ministry of Health and primary care leaders to look into how PHOs, including GPs, are paid.
"This work includes looking at the models of care and options to ensure there is a sustainable primary care system," she said.
"Workforce sustainability is a key issue across most areas of the health sector, and this includes primary care."
Ministry of Health community and ambulance manager Andrew Inder said there was an ongoing relationship with the Royal NZ College of General Practitioners.
"The ministry is working with stakeholders, including the college, to examine models of care in the future that can optimise the skills of all health professionals as well as use clinicians' time more effectively," he said.
The ministry would continue to work closely and constructively with the college on future workforce planning, including work to increase the number of medical graduates seeking to become GPs, he said.
Health Workforce data showed approximately 190 new general practitioners were being trained every year to enter the workforce.
Budget 2019 also provided additional funding to train about 30 more GPs in rural locations.
GPs were also being increasingly supported in the workforce by broadening scopes of practice across other practitioners, he said.
There are still practices that are open in Rotorua and Rotorua Area Primary Health Services could help find a GP.
Those who cannot get to their family doctor could also call Healthline, which provides phone-based assessment and advice from specialists and experienced nurses.