Some people cannot afford the GP visits that will
increasingly replace hospital visits, a specialist told health
leaders in Dunedin this week.
Rheumatologist Prof John Highton said the gap between the
''haves and the have nots'' meant some patients could not
follow care plans involving more GP visits. The move to
transfer more services to GPs was difficult to implement
because ''we live in an increasingly polarised society''.
For patients with no money, a system requiring more GP visits
and fewer to hospital posed difficulties. While the idea of
community care made sense, ''we start by having one hand tied
behind our back'' because of the reliance on GP visits.
He believed the cost of GP visits was a major factor in the
number of patients attending the emergency department.
A new health team is preparing to shift more services to
primary care providers through an alliance between the
Southern District Health Board and the Southern Primary
Representatives of the Southern Health Alliance Leadership
Team answered clinicians' questions after a presentation at
Dunedin Hospital on Wednesday, and met a sceptical response
from some in the audience.
Independent chairman Prof Robin Gauld urged patience, as it
was very early days for the team. Other parts of New Zealand
were experiencing similar teething issues with the health
alliances, which were now mandatory.
Some in the audience questioned a lack of communication about
what the new team was doing.
Co-presenter Dr David Tulloch, the board's chief medical
officer, said the initiative was crucial because health
funding was static while patient demand increased.
The leadership team would be able to allocate funds where
they were most needed, he said.
Something had to change and ''this is the structure that
allows us to do that'', Dr Tulloch said.
Co-presenter PHO deputy chairman Dr Doug Hill said there was
''something wrong'' with the health system. As a
Dunedin-based GP, he had seen serious cases turned away from
hospital, while routine referrals were accepted. He cited
ophthalmology, where recently a patient turned away from
hospital had cataract blindness, while the department was
carrying out routine checks.
Dr Hill said that as ''private businesses'' GPs were
understandably concerned about upcoming changes, but at
present knew little about the new initiative. Clinician Dr
Andre Smith questioned Prof Gauld about the lack of
He said there was a ''disconnect'' between Dunedin Hospital
and GPs, who did not know that some new ''pathways'' for
directing patient care were already in place. Rural nurse
Kirsty Murrell-McMillan questioned a lack of rural
representation on the team. The DHB serviced a huge area, but
despite this often acted like a ''big city DHB'', she said.
After the meeting, the Otago Daily Times asked Prof Highton
if he feared the changes amounted to increasing privatisation
of health. In response, he said: ''I have not been that
philosophical about it as it is more a matter of
''A feature of rheumatology is that we accumulate patients.
This is because a significant proportion of the patients that
we see as new patients are diagnosed with an illness that
requires ongoing management.
''In order to keep seeing a good number of new patients, we
therefore need to get as much as possible of the follow-up
work done by GPs. This would be entirely appropriate but
patients often do not attend their suggested GP appointments
because of cost considerations.''
Contacted after the meeting, Prof Gauld, a University of
Otago health systems authority, said the GP fee problem was
garnering attention at a national level.
''It's one of the oddities of the New Zealand healthcare
system that we have this financial barrier to see a GP,''
Prof Gauld said.