Rural hospital managers had been talking for a while about a rural network of doctors prepared to move around and work where needed, but they were "getting more serious about it now", he said.
The ability to recruit and retain medical doctors was one of the ongoing challenges for rural hospitals.
He also hoped there would be more formalised use of expertise from Southland and Dunedin hospitals at the rural hospitals now there was one southern health board.
He welcomed one primary health organisation across the region, as it would have a "critical" role in the integration of hospital and community care.
At the moment, one of Gore's issues was being able to provide a complete range of outpatient clinics, something that had been dependent on the availability of consultants from Southland.
"A lot of our local community has to travel quite a bit."
Gore Health Ltd, which received $4.2 million in base funding this year, has about 90 staff to serve its community of 18,500.
Its funding had been cut by about $1 million in 2005, which resulted in staff reductions.
The service now was running "as lean and productively as we can", something that, arguably, carried some clinical risk.
The community owns the 20-bed hospital building and plant, which is leased back to Gore Health Ltd.
In the past financial year, the hospital had 6500 presentations at its emergency department, which had been described as the most oversubscribed ED in the country, Mr Metzler said.
He pointed out the hospital had a large catchment area and, with only five GPs on call, he believed another five GPs would be needed to handle the work done at the hospital.
Much time was devoted to working out how to reduce the attendances, but he was conscious of not overburdening already stretched family doctors. With lacerations, for instance, it was often easier for the hospital to treat those and free up family practices to focus on family care.
He accepted the health board was concerned it could be funding some types of care at both hospital and GP level.
If people turned up with non-urgent conditions, they were referred to GPs, and often it was not the cost of that that bothered them, but the inconvenience of the extra trip.
A solution could be to have an accident and medical centre with a GP or experienced triage nurse "at the front door".
Taking the pulse
Gore Health offers. -
• 20 inpatient beds.
• 800 admissions annually.
• Emergency Department had 6500 presentations last year.
• High-dependency unit for severe trauma and critically ill patients.
• Funded for 100 births a year.
• Variety of outpatient clinics and some chemotherapy.
• GP practice in hospital building.
• Joint DHB/Gore Health public/private dental clinic - Gore Health has private dentist chair and district health board has two public chairs.
• Has MoleMap franchise for Southland, Otago and South Canterbury.
• Minor surgery carried out on mobile surgical services bus.
• Private radiology.
