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Data to be presented to a Southern District Health Board commissioners meeting today showed there were slightly more than 38,000 presentations to Southland Hospital emergency department from January 2018 to February 2019.
During the same period, Dunedin, with more than twice as many people, had just 5000 more emergency presentations.
The Invercargill GP practice with the highest number of registered patients going to emergency had 1100 more presentations than its Dunedin counterpart.
A report to be presented to commissioners said that ''concerted leadership on the part of the primary health organisation'' WellSouth had generated a series of meetings held in Invercargill, and an led to an agreement reached for a structured programme of work to tackle the issue.
''A closer examination of data indicates that there are significant disparities in the way that services are accessed in Invercargill and Dunedin,'' the report said.
''The rate of after-hours presentations in Invercargill is double that of Dunedin, and the rate of working hours presentations to ED in Invercargill is more than double that of Dunedin.''
The report said local GPs had previously disputed there were issues with provision of services, but the new data ''tells a compelling story about access''.
WellSouth chief executive Andrew Swanson-Dobbs told the Otago Daily Times that the research was in part inspired by a study of Maori health outcomes in Southland which showed concerning results, particularly relating to respiratory health.
''That was one of the issues which saw us ask the question what is really going on in Invercargill in terms of access to care,'' he said.
''It has been a huge project with the GPs and the leaders in Invercargill to better understand the patient flow.''
The cost of a doctor's visit might be a barrier for some patients, but there were likely other factors in play, Mr Swanson-Dobbs said.
''The paper highlights six or seven issues in that region that we need to address; while none of them are surprises no doubt, some of them are pretty clear.
''I think with the right clinicians in the room and helping to design the right solution, that will see us right.''
Fees posted on the SDHB's Southern Health website suggested the price for an adult without a community services card to see a GP was in the region of $40 to $50 in both cities.
Dr Andy Doherty, chairman of Invercargill after-hours committee, said research in Britain had shown that country, with lower GP fees, also had high rates of emergency department attendance.
''ED attendances are rising throughout the Western world, not just in Invercargill, and there is work being done by the PHO to find out the local reasons,'' Dr Doherty said.
''It is hard to know what the future will bring, but continuing communication between all parties should lead to better health outcomes for our population, and that has to be our primary goal.''