Late last year criteria was introduced in both Otago and Southland for referrals to the ORL head and neck facial plastics department (ORL stands for Otorhinolaryngology) because the department had been struggling to meet Ministry of Health treatment times.
The ministry has a variety of requirements about surgery provision, including that patients should have their first specialist appointment within six months of referral, and if then assessed as needing surgery they should receive it within six months.
Boards must show they are meeting requirements consistently if they are to be fully funded.
Figures provided on the service to the Otago District Health Board hospital advisory committee in November showed that in October 39 ear, nose and throat patients had been waiting for treatment longer than six months and during the previous year that monthly number had been as high as 58.
In the December newsletter to general practitioners, head of department Dean Ruske said the department realised returning patients to general practitioners resulted in difficulty for them and less than adequate management of the patient's condition.
Mr Ruske said it was understood there was potential for missing "some important pathology" but he hoped good communication between specialists and GPs could keep such cases to a minimum.
If financial pressures were well controlled by the measures introduced, the department would try to see more routine referrals "as allowed by management", Mr Ruske wrote.
The criteria would be reassessed, as it was recognised some conditions, such as tonsillitis, did have significant quality of life and work-related issues associated with them.
Tonsilitis was one of the 11 conditions listed where routine referral letters were likely to be returned to GPs, but it was noted letters should include time off work or school, the frequency of infections and other quality of life issues so they could be individually assessed.
Other referrals likely to go back included some forms of tinnitus, vertigo and hearing, nasal obstruction without other symptoms, chronic cough, inflammation of the outer ear (unless acute) and those seeking cosmetic treatments.
Patients with snoring problems will also have to come with a history of obstructive sleep apnoea or a study of their sleep (available from an organisation called Edensleep at a cost of $300) before they will be seen.
The October figures showed the specialty was second only to orthopaedics in the number of patients who were considered to benefit from treatment and were under what is referred to as "active review" because they cannot be treated within the six-month time.
They are not supposed to be on this list longer than 18 months without either receiving treatment or being referred back to their GP.
Orthopaedics had 109 patients in this category, compared with the ORL total of 77.
In November the ORL service returned 22 routine referrals to GPs and to mid-December had returned a further seven.
