Telemedicine not total healthcare solution

Telemedicine consultations, like this 2020 session between Southern Rehab chief executive and...
Telemedicine consultations, like this 2020 session between Southern Rehab chief executive and physio Mark Shirley and client Bevan Ellis, have their place but are not an inevitable replacement for a community GP, Dr Angus Chambers says. PHOTO: ODT FILES
Te Whatu Ora says half of GP consultations could be virtual, but that won’t make it easier to access a GP, doctor Angus Chambers writes.

Telemedicine allows patients to access healthcare services through the internet or by phone.

It is quick, convenient and sometimes lower cost, especially for those with mobility issues or in remote areas.

The main drawback is the limited ability of doctors to use all diagnostic tools, conduct physical examinations, and detect subtle symptoms not visible by screen.

But also, frequently telehealth providers have no relationship with the patient or any knowledge of the community.

To be clear, telehealth has a place in the future of medicine, especially as a fallback to face-to-face consultations prevented by distance or epidemic, but its future should be determined by patient demand and preferences, and what’s best for individual health outcomes. The virtual exchange should not be touted as the logical and therefore inevitable replacement for community GPs.

And it certainly won’t solve workforce issues in general practice. Each doctor on the end of a line is a doctor not in a clinic.

For these reasons, general practices are concerned at views held by Te Whatu Ora that 40%-50% of GP consultations can be delivered at a distance and another 20% delivered by alternative providers.

These statements undermine the future of GP services. Community and rural GPs are already deciding enough is enough and retiring or closing their practices. Spurious claims about expansion of telemedicine could accelerate that process.

The reality is that many communities have or will soon lose their local medical, injury, and mental health service, or it will lack the key component, an experienced GP.

With a misguided view that face-to-face general practice is an anachronism or no longer fit for purpose and should be replaced by online consultations with doctors, or — as has been suggested — other health roles, Te Whatu Ora minimises the role of GPs and the team-based environment.

It has limited understanding of what happens in a face-to-face general practice consultation, and clearly misunderstands and undervalues GPs and their teams’ work.

For GPs the solution to better community health outcomes is not a virtual consultation or visiting a physio instead of a GP.

Using these modes of treatment, while possibly a solution for demand spikes and stop-gap measures, are no substitutes for high-quality care through general practices.

The best approach to sustainable care is proper investment in general practice and increasing the numbers of GPs. Multiple reports show that the current GP funding model is broken.

For example, about one in three GP practices is losing money. Fixing the situation will require investment to retain the shrinking workforce, attract doctors to general practice, and recognise the quality and continuity of care they deliver.

We are at a tipping point. Access to general practice will be lost if underfunding and undervaluing of GPs and their teams are not addressed immediately.

More than 50% of family doctors are due to retire by 2030 and there isn’t an available workforce to replace them. Of the 300 places open for training future GPs, only 238 were filled in 2023.

A greater percentage of the $26.5 billion health budget needs to be directed to frontline services in primary care.

People with a long-term relationship with their GP live longer and cost the health system less. The model used to fund general practice needs updating and the government’s own reviews into funding have recommended increases of 10%-20% on average to reach sustainability, let alone address some of the unmet needs and inequities accessing healthcare.

Successive years of increased labour costs, demand, expectations, regulation and compliance have significantly increased the running costs of general practice without a commensurate increase in funding.

General practice owners are "footing the bill" for those increased costs.

Telemedicine has a place, but let’s not assume that it answers the real problems with access to GPs and community healthcare.

And let’s not plan to use it as a substitute for communities to have their own general practice.

 - Dr Angus Chambers is chairman of the General Practice Owners Association of Aotearoa New Zealand.