GPs keen to share vision

Covid-19 has been the abiding concern of the health profession for the past few months, but it is far from the only concern.

Before the enormous upheaval brought about by the pandemic disease, a different kind of upheaval was anticipated — either with delight or dread, depending who one talked to.

The health system, much criticised before the management of Covid-19 suggested that it might not be as bad as is often made out to be, has been under comprehensive review for some months.

The investigation, by a very capable panel lead by former prime ministerial staffer Heather Simpson, delivered part one of its brief last year — a comprehensive and useful stocktake of the health system as it stands.

However, the second and more important facet of its work, an assessment of what needs to change and what needs to stay the same, remains a mystery.

It was delivered to Health Minister David Clark some weeks ago, with any fanfare it might have received having been well and truly drowned out by Covid-19.

In his office the review remains, receiving "careful consideration".

General practitioners meanwhile, have had enough of waiting for the as yet unconfirmed due date for the report’s release and last week released their own "Manifesto For General Practice".

The manifesto is a bold document, for patient, doctor and the health system alike, as it calls for nothing less than a transformation in how general practice works.

As a key stakeholder, the Royal New Zealand College of General Practitioners will undoubtedly have had its say before Ms Simpson’s panel, but that would have been before Covid-19 changed everyone’s lives, including those of family doctors.

Virtual consultations are now being used by GPs who once shunned such technology, and other valuable lessons about the role of the GP have either been learned, or received a timely reminder.

GPs were swift to react to Covid-19; well aware of their vulnerability at the front line of the health service their clinics were in Alert Level 4 lockdown mode before such alert levels became part of everyday life.

The new system has flaws — most notably, doctors are still trying to work out how to make telehealth economically viable — but the GPs’ manifesto rejects any idea of going back to the way things were.

"Having made enormous changes to cater to the wellness of our patients, why would we change back to something that had not been providing adequate or equitable service for many," the doctors ask, not unreasonably.

However, it is also reasonable to ask if the touted alternative is also adequate or equitable.

Technology is all very well, but its price and its ease of use are both barriers to access which need to be addressed.

So also is the subsequent loss of visual clues to diagnosis; a good doctor can tell a lot from a patient’s body language, information not always apparent from conversing with a digital headshot.

Much is also to be said for the psychological value of a visit to a trusted GP, especially for those who are vulnerable, lonely and unwell.

Many of these issues have already been traversed in the South, when WellSouth and the Southern DHB consulted on the primary and community healthcare strategy.

They too sought the laudable aim of equity of access, but breaking down long-established barriers is easier said than done.

Also, there has to be a will over and above the one expressed by report writers for those barriers to be broken down.

More importantly for the hopes expressed in the GPs’ manifesto, the Simpson report — and the minster yet to finish his deliberations on its findings — will need to share their vision for the future.


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