The great vanishing act: locums plug rural GP gap
Saturday, 24 August 2024
As the rural GP shortage bites, some practices are operating without permanent doctors, using virtual consultations to help bridge the gap.
And new models of care are arising, based on a team approach with nurses playing a leading role.
Waihi Health Centre’s last permanent GP finished three weeks ago, and locum and virtual GPs are helping to cover the gap while it recruits for two permanent positions.
Meanwhile, Raetihi-based Ruapehu Health has a gap of almost two months before its next locum arrives in mid October for a five-week stint.
College of GPs medical director Luke Bradford said two eastern Bay of Plenty practices are also currently without GPs.
He said practices can’t be run for a sustained period without a GP or nurse practitioner because they are needed to meet contractual obligations.
New Zealand has a GP shortfall estimated at 485, and rural practices are struggling to recruit staff as an ageing cohort reaches retirement.
Telehealth has been touted as a solution, but Bradford said online consultations are not the magic bullet.
“It's been extolled as the solution to rural [shortages] - ‘we'll just put telehealth in’ - but if you're not being examined, you're not getting your screening done properly, you haven't got the ability to go and form that relationship, we know you actually get worse outcomes.”
Waihi Health Centre has advanced clinicians on site including a nurse practitioner and prescribing nurse, operator Green Cross Health said by email.
“While recruitment is underway, we are supporting the in-practice team with locum GPs, virtual GPs and nurses for patient care,” Green Cross medical operations manager Andrew Tucker said in the email.
The practice has just over 4000 registered patients, and Green Cross said it is focused on recruiting for two full-time positions, which may be filled by GPs, nurse practitioners or enhanced care paramedics.
It had up to two locum GPs supporting its permanent GP over the past 12 months.
In Raetihi, Ruapehu Health clinical service manager Tracy Mitchell said the practice has been relying on locums, including from America, after the last permanent doctor finished up during Covid, though the break till the next one is unusually long.
She said the practice has been adapting, with registered nurses working to the “top of their scope” and a team that includes roles such as health coaches and health improvement practitioners.
“GPs aren't the front of health care anymore, it's that wider, multi-disciplinary team that we need to lean on now.”
The change was starting to happen pre-Covid, but the pandemic boosted their use of telehealth.
“We learned from that and thought, actually there is a lot of things that we do in general practice that we can do via telehealth that can be really convenient for our whānau.”
Farmers don’t necessarily want the 40 minute drive into town for an appointment that could be done over the phone, and when it comes to mental health people can ring from the privacy of their own home.
In some cases, it’s more useful for a patient to have a consultation with a nurse with expertise around the likes of diabetes, or with a mental health expert, than with a GP, Mitchell said.
They have learned they can take pressure off a GP. “The patients can get a better experience and then we can utilise the GP for the things that we really need them to do like the diagnosis.”
Among other initiatives, that sees the centre using a health coach in a care coordinator position connecting cares for patients with complex needs.
The maximum a patient pays to see a GP in person or virtually is $19.50, and a standard nurse consultation is $13.50, she said. The practice has 3500 registered patients, of whom 44% are Māori.
“I'm really proud of the work that we do under, really, some stressful times. And I do put my hand on my heart and think, actually our patients get really good care.”
The New Zealand-wide shortage of GPs comes partly from an ageing cohort reaching retirement, and Mitchell said many of Ruapehu’s locums are in their middle or older years.
She said it was a known challenge 30 years ago when she started in general practice as a nurse. “We were talking about, ‘oh this is going to go pear shaped because everyone's getting older’. And we're still talking about it.”
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