Doubts GP referral will make difference

John Chambers
John Chambers
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 duties.

''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.

- eileen.goodwin@odt.co.nz

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