Are there enough GPs in the Waikato region for the number of patients living here?
The managers at the Waikato District Health Board can't tell you, because they don't know. Not yet, anyway.
What appears to be a giant gap in the organisation's knowledge of its own resources was exposed at a health board meeting at Waikato Hospital last week by board member Ewan Wilson.
Mr Wilson, who is running for the Hamilton mayoralty, as well as retaining his seat on the health board in the local body elections, took the opportunity during a report on primary health care to ask why there was no information on the ratio between the number of doctors and the number of registered patients.
Such information should be a key performance indicator in the board's relationship with primary health organisations (PHOs), which GPs and medical centres are members of, he said.
"We have PHOs that get paid for the number of patients on their books, yet there is no key performance indicator on the number of GPs. It's a very unusual business model . . . I wish I could be in business with a number of clients I get paid for, but I don't need to service or see them."
Mr Wilson said it was evident there were many people who experienced problems trying to get seen seen by a GP, which in turn created problems at Waikato Hospital when they then turned up at the hospital's emergency department, creating a burden on the already stretched staff and resources there.
"I want to know why we are scratching for that information. Are the patients registered with a PHO getting access to a doctor in a timely manner?"
Planning and funding general manager Brett Paradine and chief executive Craig Climo said while they did not have such information at hand, it should be able to be determined by collating different sets of data from each of the PHOs.
There are four PHOs in the Waikato District Health Board area: The Midlands Health Network, the Hauraki Primary Health Organisation, the Toiora PHO Coalition and Raukura Hauora o Tainui. The latter two are members of the National Hauora Coalition.
Mr Climo said they did have information such as which doctors had more attendances, however board member Sharon Mariu said the issue required "more of a depth dive", and asked that a comprehensive analysis of the situation be reported to next month's community and public health advisory committee.
Martin Gallagher, another board member, said getting a better idea of whether patients were able to see their doctors was a great move.
He had seen signs posted outside medical centres stating "We are seeing no more patients today" and patients who had to see a GP they were not enrolled with often faced hefty fees.
"We have a lot of Ministry of Health targets we have to meet. Can you imagine a situation where we put up a sign telling them ‘We have too many patients - go away'?"
NURSES TO EASE PRESSURE ON DOCTORS
Focusing on the number of general practitioners in the Waikato region is missing the point, a Hamilton physician says.
Navin Rajan reckons a raft of changes - including patients seeing nurses and "physician assistants" rather than a GP as a rule - are due to ease the load on doctors.
There is an arbitrary ratio of 1500 people per GP in urban areas, and rural practices can be as high as 2200 to 2500 per GP, but Dr Rajan said that was half the picture and big changes were on the cards.
Practitioner nurses already carry much of the workload and less well-qualified nurses will soon be able to prescribe basic medication for simple maladies, such as urinary tract infections.
"Physician assistants", based on an American model, are also being trialled in the Waikato to potentially carry 90 per cent of an individual's consultation.
Dr Rajan, who is standing for a seat on the Waikato District Health Board, said there had been a shortage of GPs for years and the Ministry of Health had been working on ways to plug the holes.
By the end of the year, nurses will be able to prescribe basic medicines without having to "jump through all the hoops" to become a qualified nurse practitioner who can roughly prescribe everything a general practitioner can.
There is also a pilot under way trialling "physician assistants".
When a patient arrives at a practice the assistant will take their history, do an examination, come to a conclusion and draw up an appropriate medication list which they will print out and the GP will sign off - basically doing 90 per cent of the work, Dr Rajan said.
An influx of doctors had arrived in recent years to escape the economic strife of the European Union so GP numbers had risen, yet the ministry did not want to keep doing the same thing again.
"If we rely only on doctors to meet the need, we'll end up with the same problem if there's a downturn.
"They're trying to develop an alternative pool . . . to slowly develop over a number of years, so in the event of a negative availability of doctors we can at least call on the other groups of practitioners to meet the need."
Dr Rajan expected some changes to be implemented by the end of the year.
"I understand that for 90 per cent of people GPs are currently providing healthcare services but this is not the picture that will be there always," Dr Rajan said.
Hamilton East Medical Centre business manager Nicola Greenwell said that of the 14 doctors at her practice, six of them had their books open for new patients.
"So six of them are not at capacity so therefore, do we need any more in Hamilton?
"No, not until our books are full."
She said the number of patients over winter had been no more than in other years.
"Every day is full but most of the time people can get in and see a doctor on the day.
"We've managed to have doctors have holidays during the winter as well, so it's been controllable."
- © Fairfax NZ News
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