Dunedin emergency department nurses are uncomfortable
with a new GP referral system they have to implement from next
week, ED specialist John Chambers says.
''I know our nursing staff do feel unhappy about it.''
The nurses' union confirmed to the Otago Daily Times
it had received complaints from members over a lack of
consultation and education about the controversial scheme.
From Monday, the emergency department is expected to refer up
to 20 patients to GPs each day, giving them a voucher if they
cannot afford the appointment.
The system was agreed between Southern District Health Board,
and Southern Primary Health Organisation, in a bid to reduce
patient numbers. However, Dr Chambers expects the scheme to
have little impact on ED patient numbers, which were rising
for ''complex reasons''.
He did not think anything like 20 patients would be
redirected each day.
Nurses would administer the scheme, and many felt
uncomfortable having to ask patients about money.
''It could be an uncomfortable conversation - it's not one
that our nurses particularly want to have [about money].''
Patients would be spoken to in a respectful way; no-one would
be asked to leave the department if they did not want to go.
Dr Chambers, who is also an elected health board member, said
the voucher scheme had sparked a call from an irate member of
the public, the first call he had had from a member of the
public complaining about a local health matter.
A similar scheme in a North Island board's ED had not
generated many redirections to GPs. New Zealand Nurses
Organisation professional nursing adviser Suzanne Rolls said
the union had received complaints from some members, because
of a lack of consultation and education.
Ms Rolls said nurses must not feel pressured to turn away
patients from ED, and she believed more education was needed
before the system took effect.
Health professionals were accountable for their actions, and
they would not turn away anyone if they felt the patient
could not access appropriate services elsewhere. Central to
the programme's success was adequate access to community
level health services.
Ms Rolls said patients would be assessed before the GP
appointment. Redirecting a patient would not take place
during the triage process, she said.
A Southern District Health Board spokesman said the board had
received no complaints from staff about the scheme.
Dunedin GP Katherine Hall, of Maori Hill Clinic, supported
the scheme because it would help people access primary health
care. Cost was a real barrier for some people, she said.
However, she agreed with Dr Chambers it would not have a
significant overall effect on ED pressure.
The bulk of resources in emergency departments were used up
by the most serious cases, which would always have to be
dealt with. She felt for hospital staff having to administer
the scheme, and deal with money issues on top of their other
''We're trained to treat everybody. We're trained to treat
need without judgement.''
Dr Hall suggested elderly patients might be unwilling to
admit they need financial assistance to see a GP.
She said GPs knew their patients well, and were adept at
assessing which were in financial difficulty. These patients
were often charged less or given free appointments, she said.