Shifting some treatments traditionally performed in hospital to a community setting is an exciting move with benefits for both patients and doctors, Otago District Health Board GP liaison officer Dr Anne Worsnop says.
One such project was trialled last year - to treat minor skin lesions - and its success means it will continue this year.
Under the $83,520 project, seven specially trained general practitioners could receive referrals from fellow GPs to remove patients' minor skin lesions, work usually handled by hospital consultants.
Dr Worsnop said the special clinics, known as GPSis (General Practitioner with Special Interest), were offered in Dunedin, Outram, Oamaru and Wanaka.
Patients paid for the initial consultation with their GP but did not have to pay for the removal of the lesion or later follow-up.
The pilot programme covered 360 procedures last financial year and the same number will be carried out this year.
In the previous year, hospital services had undertaken 492 minor skin lesion operations.
The lesions treated at the GPSis clinics were those which were probably malignant and which could be removed under local anaesthetic.
Cases considered more serious would still be referred to consultants.
Some changes to payments for consultations have been suggested by Dr Worsnop because the original arrangements did not allow for situations where the doctor did not remove the lesion because it did not meet the project criteria.
Dr Worsnop has also suggested it would be worth expanding the service so hospital services could refer patients to it, which would free up consultants within the hospital system for more complex cases.
GPSis clinics allowed patients to be seen more quickly and were also a great way of encouraging doctors who might have a particular interest in one area of general practice to develop their skills.
Asked whether the clinics might be depriving some GPs outside the GPSis of work they usually did and received payment for, Dr Worsnop said some patients with minor lesions would still choose their own GP for the work - it depended on the relationship they had with their GP.
Dr Worsnop can see possibilities for other conditions being treated in the community.
Planning has begun for a scheme which could allow GPs to treat cellulitis where patients require the administration of intravenous antibiotics.
Traditionally, patients with this condition have had to attend the emergency department for such treatment which, with waiting times, could involve several hours for each of three or more visits.
Some changes to this will be introduced next month which would allow more patients to be returned to the community for review, with repeat doses of the intravenous antibiotics administered by district nurses.
Ways to improve the speed with which patients can be seen at hospital have also been under consideration.
Changes introduced recently include allowing direct access to ultrasound scans for suspected cases of deep-vein thrombosis, if certain criteria is met, and allowing wider availability of a drug which was formerly only available from the hospital.
In the past, patients suspected of having the condition spent an average of three hours and 36 minutes in the emergency department.
Last month, a fast-track clinic for patients suspected of having lung cancer was also introduced, with the aim of improving the prompt investigation and assessment of such patients and allowing treatment to start earlier.
Dr Worsnop said it was quite an exciting time to be looking at possible ways of changing how services were provided in hospitals and the community.
"I feel there is an ear to this and it is being heeded".
