The struggle is real to see a doctor in the Hutt

Saturday, 6 July 2024

The local family doctor is a community staple, but what happens when a clinic falls over, and there’s no where to go?

Twenty black chairs hug the walls of Lower Hutt After Hours reception area. It’s morning, the doors are locked and the place is empty.

But come 5pm, “it’ll be chokka in here”, according to general manager Mark O’Connor.

“We could have 30 people queued outside the door. That 30th person is probably a two-hour wait. And we’re running four doctors.”

The clinic doesn’t open on weekdays until 5.30pm, but they have started unlocking the doors earlier so the queue of people on the street is not stuck in the cold.

Mark O'Connor, general manager at Lower Hutt After Hours, says each night the clinic is seeing 50 to 60 patients.

This out-the-door queue is where Wainuiomata couple Jessica and James Hoskin ended up after their GP clinic, High Street Health Hub, shifted to an almost entirely virtual model when most of its GPs left.

“It was $100 to get in [to after hours]. We waited three hours and the place was packed,” Jessica Hoskin said.

“By about 6.30[pm] they had a sign up that said, ‘we’re now closed’ because they just couldn’t take everyone.”

Each night the clinic is seeing between 50 and 60 patients.

An electronic sign in the doorway of the clinic warns patients to manage their expectations before they enter: “Due to high patient demand we may not be able to see all patients prior to closing.“

Jessica Hoskin was a patient at High Street Health, but has been forced to enrol with a GP in Wellington city when the practice moved to a virtual only service.

Those patients will sometimes end up over the road at Hutt Hospital, O’Connor said, as will some who cannot access their GP.

Health NZ’s acting hospital operations director at Capital, Coast & Hutt Valley Kaye Hudson cited a struggle to get GP appointments as one reason both Wellington and Hutt emergency departments were seeing “higher than usual” numbers.

Other reasons included increased frailness, complexity and acuity, winter ailments and children with respiratory illnesses.

“Demand seen at both EDs during June was higher than the same time last year – with Wellington seeing a 5% increase, and Hutt seeing 15% more.”

Expect to spend seven to eight hours at Hutt ED, and about nine to 10 hours at Wellington ED at this time of year, Hudson said.

The Hoskins are an two of an estimated 9000 patients who were cared for by High Street Health Hub and now have very few options for face-to-face care.

Of the 22 general practices across the Hutt Valley, only one – in Upper Hutt – is taking on new patients, according to the organisation that runs the local primary care network, Te Awakairangi.

Some are taking patients in exceptional circumstances, others are keeping a waiting list, but 12 have books firmly closed.

Green Cross Health, the company that owns the practice, said three to four GPs had left in the course of the past year. It bought the practice 14 months ago.

Just one remains on the practice’s website, and she works out of a different clinic in Upper Hutt.

Green Cross said the population of that size should have five full time GPs.

No-one from Green Cross Health would be interviewed for this story. After several days of back and forth requests, it provided some written responses.

High Street Health Hub shifted to an almost entirely virtual model when most of its GPs left.

Medical operation manager Andrew Tucker said the company was focused on GP recruitment to rebuild clinical capacity at High Street Health Hub.

“While we do this, we have bolstered our virtual care team to ensure that our patients’ health and well-being is not impacted.”

He blamed underfunding for difficulties in recruiting. “We are seeing that it’s harder to recruit and retain doctors and nurses due to the current funding model not being able to compete with the more desirable terms and conditions that are being offered overseas.”

But Hoskin didn’t buy this: “I understand the shortage of GPs and the difficulty of getting GPs, but High Street Health Hub had GPs. They lost them … all of them.”

Green Cross is based in Auckland and also owns 342 Unichem and Life pharmacies across New Zealand. It recorded a $45.2m net profit last year after tax.

Beth Te Wiata Vale, a former patient of High Street Health Hub, is trying to come down off controlled medications and is having to do it without any supervision.

Asked if the company was putting profit over people, Tucker replied: “Our general practice teams are professionals who care deeply about their patients and are dedicated to providing high-quality care to their communities.”

Tucker said the expectation at Green Cross was that the workforce would be rebuilt within three months.

But in the meantime, one of the clinic’s patients, Beth Te Wiata Vale was left to come off a controlled medication without a GP’s supervision.

She had tried to persevere through telehealth, but “it just rings and rings and rings”.

“I approached a couple of other practices and one said, ‘Look, we're not even keeping a waitlist anymore. We have at least 20 new patient requests every single day’.”

When she branched out to Upper Hutt she was told she wasn’t eligible to go on the waiting list because she was “technically enrolled” at High Street Health Hub.

Bridget Allan, the outgoing chief executive of Te Awakairangi primary health organisation, says general practice needs a major funding boost to prevent more people falling through the cracks.

“I sort of gave up.”

Bryan Betty, chairperson of General Practice NZ, empathised. “It’s an incredibly difficult situation for the patients, and it's one that Green Cross needs to move very quickly to resolve.”

Bridget Allan, the former chief executive at Te Awakairangi, worried about the impact of corporate ownership, as opposed to practices that were locally owned and operated by GPs or iwi networks.

The PHO had worked extremely hard since December last year to get Green Cross to acknowledge problems and take action, but it clearly hadn’t worked, she said.

“From observing what has happened in the Hutt Valley over the last eight months, I don’t think the corporate ownership model has been looking after patients properly.”

Outside of the High Street Health Hub situation it was estimated there were up to 8000 people in the Hutt Valley who were without a GP, Allan said.

Te Wiata Vale has made a complaint to the Health and Disability Commissioner, concerned about safety for people more vulnerable than her.

Latest official data shows the number of people enrolled in a general practice fell 2.4% in the past three months, from 96.8% to 94.4%, according to the latest Health NZ – Te Whatu Ora quarterly report.

Betty said an estimated 250,000 New Zealanders were not enrolled and it was a growing issue. A long term strategy for increasing the number of general practitioners was desperately needed, he said.

The High Street Health Hub situation, was “the canary in the coal mine” in revealing the stress the system was under.

Hoskin was forced to enrol in Wellington city, where she was able to get a face-to-face appointment quickly.

“Lower Hutt is a big city. You should absolutely be able to have a doctor in Lower Hutt, if you live in Lower Hutt. That’s quite simple.”