GPs being forced to fill gap

Aurora Health Centre GP Dr Susan Johns says current workloads are unsustainable for GPs being...
Aurora Health Centre GP Dr Susan Johns says current workloads are unsustainable for GPs being left to manage patients who have been declined specialist care. PHOTO: PETER MCINTOSH
More and more patients are being foisted on to GPs rather than getting the specialist help they need, a Dunedin doctor says.

Dr Susan Johns said the growing number of declined referrals had been especially obvious over the past year, leaving increasingly strained GPs to do their best for suffering patients.

This follows the release of a damning University of Otago study, which found the risk of being declined by specialist services after a GP referral in Southern was 54% in 2022.

Dr Johns, a doctor at Aurora Medical Centre, said much of what used to be provided by the hospital had been passed on to GPs.

"We’re managing complex pain issues now, and decreasing mobility, because patients aren’t getting their hip replacements at a reasonable timeframe."

In some instances she had to wean patients off morphine because they had been on it for so long.

However, mental health was probably the biggest issue, she said.

"We’re managing patients who sometimes have suicidal risk, have severe depression or anxiety, and we can’t get them into secondary care services."

The departments would often respond, saying the patient’s condition did not meet their threshold or they would like to accept the patient but they had no room — explanations that made no difference to the patient.

Being managed by a GP instead meant the patient often had more pain, more disability and had to make more frequent visits.

As a result, GPs were much busier — it was hard to see patients with complex health issues in a 15-minute slot.

Aurora was still enrolling new patients because more doctors had joined the centre, but this was the exception to the rule, she said.

The issue also impacted on the sustainability of general practices, as much of the work they were carrying out was unfunded.

This, along with the shortage of specialists, needed to be addressed.

"We can’t keep managing this workload with the funding that we’ve got.

"We’ve got a lot of older GPs that are leaving earlier than retirement age because we’ve just had enough.

"It’s going to get worse if GPs aren’t replaced, because people are going to end up at hospital more because they can’t actually be cared for by the GPs.

"If we fall over, the whole system is in deep, deep, deep trouble, which is the bit that doesn’t get a lot of attention."

She agreed with the university study, released earlier this week, but said the situation seemed to have worsened in the time since it ended.

The study was commissioned by General Practice New Zealand and investigated unmet need within the general practice and primary care sector, and the impact on doctors and patients.

Researchers found, between 2018 and 2022, the number of referrals from GPs to public hospital specialists remained stable, but there was a decline in access to referred specialist services.

The risk of being declined following the initial GP referral increased by 5.2% per year over that time.

The study found 14.2%, or about 85,000 people, were declined specialist care in 2022 despite a GP referral.

However, this varied by district health board area, and the former Southern DHB had the highest decline rate at 54%.

Co-author Prof Robin Gauld said the situation was having "a significant detrimental effect" on patients and primary care health workers.

"There is no additional payment to the primary care sector for this work, no extra support from the secondary sector, no formal factoring into the workload of the primary sector, and it requires GPs to manage patients who have a genuine and clinically determined need for specialist care.

"In some cases, GPs are not referring patients to secondary services as they know that there is time involved doing so and the referral ultimately will be rejected. In other cases, GPs are being required to work beyond their usual scope of practice and expectations."

Prof Gauld said although last week’s Budget did not outline specific initiatives to address issues outlined in the report, the $2.12 billion for primary care, community and public health provided an opportunity to do so.