Proposal sees 'great risk' for some West Coast patients

Changes to the medical workforce on the West Coast that have been touted as the answer to the region's GP woes and reliance on locums, will put residents at clinical risk, and cut their access to specialist care, the doctors' union says.

That warning comes from the Association of Salaried Medical Specialists (ASMS), as the West Coast District Health Board begins to roll out the staffing model known as 'rural generalism'.

The DHB announced the move earlier this year, declaring it would allow doctors with additional training to work flexibly in West Coast hospitals and at GP clinics around the region.

That would reduce the board's costly dependence on locums and provide much-needed continuity of care in towns like Reefton, the board said.

But documents obtained by the Greymouth Star show only one of the four rural generalist doctors (RGMOs) being recruited is entirely focused on general practice and the model does away with medical specialists based on the Coast.

One position is for a RGMO for women's and children's health, with extended scope (training) in obstetrics; one is for inpatient and rehab work at Te Nikau Hospital with some GP work; a third is for acute (ED) care with anaesthetics training; and one is for a rural primary care doctor, supporting Buller, South Westland, Reefton and aged care homes.

Under the proposal, obstetrics and gynaecology, internal medicine and anaesthetics will all become part of "transalpine" departments under the Canterbury DHB.

In future, all three areas will be staffed by rural generalists, who have some specialist training in each field, and the specialists (consultants) will be "transalpine in nature" meaning they will be based in Christchurch.

The emergency department at Greymouth will also be staffed by RGMOs who work in other areas as well, including anaesthetics and obstetrics.

According to the proposal, general practice and primary care "sit at the heart" of the rural generalism model.

But it stops short of guaranteeing a fix for the region's GP problems.

"Under the proposed model there 'should' be greater ability for primary care cover than currently exists including support of rural clinics."

Rural generalism will provide the Coast with a stronger public health system, with a workforce than can "flex" from primary to secondary care, the DHB says.

''At a time when it is more important than ever to ensure we use resources as effectively as we can and are accountable for how they are allocated, it is imperative that we move to this model that ... distributes health resource to where it is needed most."

Feedback from the Association of Salaried Medical Specialists, which represents senior doctors, was scathing: "These are weasel words," a union representative responded.

"Basically this paragraph lets the cat out of the bag. The proposal is all about money."

The ASMS had supported the rural generalism strategy, but it says that was supposed to support specialist services on the Coast, not replace them.

"We have been part of this work for three years, but we have noted throughout that the RG model should not mean that specialist services are lost to Coast patients on a daily basis."

Of particular concern was the loss of in-house specialists from the obstetrics and anaesthetics departments.

"This will leave the women of the Coast no longer having access to specialist obstetric and gynaecological services ... this lessens their equity in health care compared to women in cities ..."

Some rural generalists with obstetric training were highly skilled but they could not provide gynaecological services and were not specialists, the union said. The same applied to those who completed a JCCA (Joint Consultative Committee on Anaesthesia) qualifications — a 12-month course in anaesthetics. The JCCA did not allow for giving anaesthetics to children or at-risk adults, the union said.

"This proposal sees great clinical risk for those patients in an acute situation. It is a serious degradation of equity in safe appropriate health care for Coast children and vulnerable adults."

ASMS executive director Sarah Dalton said the senior doctors wanted a system that delivered access to equitable care for West Coasters and, importantly, continuity of care in primary settings.

"While we accept that some specialist services will remain in Christchurch and some will involve support from Christchurch, we cannot support a model that sees rural generalists set against hospital specialists in an either/or scenario. There is need for both," Ms Dalton said.

The DHB has already begun consulting staff whose jobs will be affected by the proposed changes.

 - Lois Williams (Local democracy reporter)