Board chief operating officersaid addressing the issue of people attending the emergency department when they could be seen elsewhere was ‘‘ quite urgent'', and over the next three months management would be having a serious look at the alternatives to the existing system.
She said 20% of the people attending the department could be treated elsewhere and, even if staffing was not an issue, the department was seeing 37,000 patients a year when it was designed to take between 12,000 and 24,000.
She acknowledged that having a GP on the premises was controversial when suggested in proposals aired several years ago, and there were legal issues with a private practice operating from Crown facilities, but it had to be viewed as a ‘‘very serious option''.
Under such a system, patients would be vetted and directed to the GP centre if it was felt they did not require emergency level care. That proposal also involved establishing an accredited accident and medical centre to replace the existing Dunedin Urgent Doctors and Accident Centre.
When this option was last mooted it drew criticism from Dunedin Hospital's emergency department clinical leader Dr John Chambers, who feared the drop in hospital patient numbers would not be as great as hoped and that it could lead to cuts in his staffing.
Board chairman Richard Thomson said management would come back with a range of proposals for consideration. If there was a perfect solution the board was yet to find it.
Some people might believe simply providing more money for the department and making it bigger would reduce the waiting time, but that could have the effect of further increasing the number of people who used the service.
Whatever conclusion was reached was not likely to suit everyone.
Mrs Blake said the pressure on the emergency department was not just from people attending in person. There were also phone calls from rest-homes and other places when other services were not open.
The board would have to sit down with primary health organisations (PHOs) and work out how to better manage the situation. Better education of patients about when to use the emergency department was also needed.
South Dunedin GP Dr Jill McIlraith said one of the issues which has always concerned her regarding after-hours care was that, despite repeated requests the Ministry of Health had never identified what proportion of the funding received by doctors related to it.
Dunedin Hospital provides care from 11pm to 8am for many GPs (although the Mornington PHO does have a doctor on call).
This situation has been in place as an interim measure since 2004 and there have been protracted negotiations between the board and PHOs over payment for the service. To date they have not been paying for the service.
It is understood that the three PHOs in the area, Well Dunedin, Mornington and Strath Taieri will meet this week to discuss a draft proposal for settling this issue.
Newly elected chairwoman of the New Zealand Rural General Practice Network Kirsty Murrell-McMillan, who lives near Invercargill and practises in Roxburgh, sees after hours care as the biggest issue facing rural practice; an area which had been neglected for too long.
The network was in very tense negotiations with the Ministry of Health over the issue and she did not want to jeopardise that but communities were seeking support to provide services which suited them and which did not see them disadvantaged compared with city practices.
It was important to have teams which were sustainable. Research showed the single biggest deterrent for health practitioners going into rura areas was the requirement to provide on-call emergency care after hours but most practitioners in the field would say they found it impossible not to provide those services, she said.
