It’s well known that the Hutt Valley has a GP shortage but Dr Liz Fitzmaurice is convinced initiatives being taken now to tackle that will pay dividends well into the future.
The Hutt Valley District Health Board appointed Dr Fitzmaurice, who has worked as a GP for 20 years, to drive initiatives to improve liaison between primary and secondary health care.
The problem that hit the headlines last year is that we have one of the worst ratios of GPs per head of population of any urban area in New Zealand. Overwhelmed practices were unable to enrol new patients. It was estimated that around 3,000 people couldn’t enrol with a GP in the Hutt Valley.
A pilot project run by the DHB over summer found that an average of three people a day attending Hutt Hospital’s Emergency Department were not enrolled with a GP.
A centralised ‘Access Co-ordination Service’ has been established. Instead of people who have moved to the Hutt having to phone around all the different practices to find a GP, now there is a single phone number (570-9462). The service, fronted by Joanne Doherty, liaises with practices and can offer advice to people about where it’s worth trying to enrol or go on waiting lists. If there is an urgent medical situation, care will be arranged.
At last week’s DHB meeting, chairman Peter Glensor said it is misleading to describe local GP practices as “closing their books” to new patients. “They’re managing their registers; that’s a more accurate way to describe it. When someone goes off their list they’re putting others back on but they’re using waiting lists to do it.”
He is encouraging people without a GP to register with the DHB’s access service.
Dr Fitzmaurice says the number of people not registered with a GP is “fluid.
“Since November, we have been starting to centralise a process. We have someone phoning those patients and some of those early ones who came on (to our register) are now with GPs.”
But she stresses that the problem is not solved.
“I don’t want people to think there are enough GPs in the district now, because there aren’t. This service isn’t about ‘you ring me, and I’ll find you a GP today.”
The service is about co-ordinating a process to manage the shortage and to ensure if the medical situation is urgent, care is arranged at the Emergency Department or the After Hours medical centres in Lower Hutt or Upper Hutt.
“We do get people telling us ‘but I rang that practice a month ago’. We encourage them to see it is worth ringing back and joining the waiting list. Just the other day there was a call from someone in that situation to tell us, ‘you’re right, I’m in’.”
Dr Fitzmaurice says everyone involved with primary care in the Hutt Valley is working to overcome the access issue, including the general practices and Primary Health Organisations.
“We gave them glimpses of primary and secondary care, and our multidisciplinary team. They went out to Kokiri Marae and some of our outreach services and saw that primary care is wider than just General Practice.”
She says the students’ enthusiastic feedback bodes well for the hope that the Hutt Valley is on their radar as a place to work once they graduate.
Another initiative is funding ongoing education and offering other support for GPs with their Primex qualifications who must work for another two years as senior registrars. There are two enrolments on that programme.
“They’re doing some clinics in the hospital for half days, and multidisciplinary learning.
“Unashamedly, it’s about building our workforce. It can be quite a shift from being supported in training to being out on your own as a GP. Having finished their two years (with us), we’re hoping they’ll choose the Hutt Valley over Wellington or somewhere else and stay for the medium or long haul.”
But, she says, PHOs have also been working very hard to attract more GPs to the Hutt in a really competitive environment internationally. As at last month, there were 116 GPs working in the Hutt Valley (76.4 full-time equivalents). That’s a slight increase on the number late last year.
But Dr Fitzmaurice is blunt: “There are never going to be enough GPs in New Zealand to continue to do what we were doing.” Not only is our ageing population requiring more care, but the health workforce is ageing.
“For a whole lot of reasons – the obesity epidemic, health costs – our traditional model of medicine can’t continue to work well, so we need a new model.”
Health Minister Tony Ryall regularly speaks about the push to devolve secondary services to primary health care. One new model is a team approach to issues such as diabetes, obesity and respiratory illnesses, instead of a lack of co-ordination as patients are bounced between specialists.
“What does the ‘integrated family care centre’ that Tony Ryall talks about look like? That’s what we’re thinking about at the moment.”
Dr Fitzmaurice sees her role as “increasing the conversations” between primary and secondary care providers. She says such conversations have happened in the past “clinician to clinician” but now there needs to be a smooth, formalised and regular process underpinning that liaison.
A GP Clinical Reference Group has been established. GPs, and practice nurses and Hutt Hospital clinicians once a month get together to talk about making it easier for primary patients to access hospital services, such as a section of care within the hospital. The aim is to help them get better access for their patients to x-rays, to mental health, outpatient clinics – and vice versa.
“It’s an opportunity for primary care and secondary care clinicians to talk together about helping each other do things better for the benefit of the patients.”
A Long Term Conditions Think Tank, involving primary and secondary care doctors, nurses, allied health and social workers, management and the non-government organisation sector, is also meeting to discuss more effective, co-ordinated care options.
These aren’t simple issues. But the fact that Hutt Valley DHB is the first in the country to appoint a GP to report directly to its chief executive on improved primary/secondary liaison shows the problem is being taken seriously here, Dr Fitzmaurice says.
“I think if you improve communication between primary and secondary, we’re 90 per cent of the way there.”
Finding it hard to get a GP in the Hutt Valley?
NZ Doctor notes that doctors and nurses in general practice average 50 years of age
At least 3000 patients are without a Doctor in the Hutt Valley
The Medical Council’s 2006 workforce survey, showing low GP coverage in areas such as Hutt Valley, where the DHB estimates 3000 people are not enrolled in a general practice.
Compared with the survey’s average of 73 full-time equivalent GPs per 100,000 people in 2006, Hutt Valley had only 60.
Hutt Valley DHB is working on a recruitment pilot scheme among other possible solutions to its GP shortage. That’s encouraging but the more immediate difficulty is a lack of locums that is depriving GPs of time off. Local MP Chris Hipkins also shows concern on this matter last year before election.
The current situation is still highly unsatisfactory, and as Winter approaches the difficulty continues for many Hutt Valley recent arrivals. Given the survey was undertaken in 2006, one wonders as to the current shortage, which I’m sure to hear in mainstream media as the winter deepens.