"Many areas" of Otago and Southland have after-hours medical
care that is financially unsustainable for general
practitioners and unfair to patients, according to a report
released by the Southern Primary Health Organisation
The "After Hours Initiative Report" by independent
facilitator Valerie Meyer, of Queenstown, says after hours
care "in many areas is burdening the current workforce" and
was not financially sustainable, practices "often providing
after-hours care at a financial loss".
Also, GPs were often "unable to continue with the physical
demands of delivering after-hours [care] or do not want to
work as it is seen as unpaid".
And Ms Meyer's report says patients "are not getting a fair
deal" because after-hours fees are expensive and not all
patients had access to free emergency department hospital
The report was prepared after locality meetings with GPs in
Oamaru, Dunedin, Central Otago, Clutha, Eastern Southland,
Invercargill and Western Southland.
It has yet to be considered by the PHO's advisory groups and
clinical review subcommittee.
The report does not contain specific information about the
localities or statistics related to the scale of the problem.
PHO chief executive Ian Macara yesterday said it was a "very
generic report" but the minutes of the locality meetings -
which have not been released publicly - would be the basis
for looking at "specific locality issues".
"We've started meetings in Upper Clutha, Central Otago and
Invercargill." The report was "pretty much a stocktake" and
there was nothing new in it, Mr Macara said.
"All that's in the report has been sitting around for years,
really." Ms Meyer says in her report the workshops with GPs
were designed to be a "warts and all conversation".
One of the common views was Southern District Health Board
staff were very "hospital centric" in their thinking and were
not applying a whole-of-system approach.
The workshops described the relationship "in some areas"
between GPs and emergency hospital staff as "divided or
The report includes 15 recommendations on how after-hours
care might be improved, including a more "collegial approach"
between GPs, primary care nurses, and hospital doctors and
It suggests hospitals operate emergency overnight services -
between 10pm and 8am - to enable GPs to turn off their phone
at night, while areas without health board-funded emergency
care facilities be funded accordingly so patients are not
The report also recommends a closer look be taken at St John
services, to see which areas require more support or
And it recommends the health board and PHO "consider the
viewpoint of the patients" if change were implemented.
"A level of consultation may need to be considered," the
Among 21 "challenges" for clinicians listed in the After
Hours Initiative Report, seven described as "workforce" are:
• On call for long hours: Difficult if called out during the
night and have a full session the following day.
• After hours: Many disenchanted and at the point of walking
away from providing after-hours care.
• Introduction of the under-6s free after-hours GP visits
deemed last straw for some.
• Rosters: In some areas unsustainable.
• Recruitment: Difficult in some areas because of after-hours
expectations and frequency of calls.
• Young doctors: Not interested in (unpaid) after-hours
• Women: Generally more female than male trainees, which will
inevitably affect workforce long-term as many women will
elect to take time out from their careers to focus on a
• Locums: Difficult to attract to rural areas.