Inequities mean patients are ignoring health issues till they reach 'crisis point'. Photo / Getty Images
Inequities mean patients are ignoring health issues till they reach "crisis point", a Merivale community advocate says.
There is a nationwide GP shortage, including in parts of the Bay of Plenty and as practices reached the limits of enrolments they can take on at one time, books shut.
Patients may need to find a less ideal alternative, which can involve longer distances to travel to appointments and more expensive fees.
Merivale Community Centre acting general manager John Fletcher said there were inequities in accessing healthcare.
He described Merivale as a low-decile community, with high rates of poverty and deprivation.
Barriers such as cost and services not being nearby meant healthcare, including medical and dental care, was not made a priority for some community members.
Economically, people were stretched, he said.
He said people would leave health issues until they became a crisis, and instead go to the emergency department for help.
"If we saw all health outcomes the same across society, then we would know inequity was addressed."
He said this was exemplified in Covid-19 vaccine uptake.
The community centre worked to enrol residents in a clinic.
Bay of Plenty District Health Board chief medical officer and Fifth Avenue Family Practice doctor Luke Bradford said the GP shortage and pressure on the health system generally impacted patients in a number of different ways.
He said the impact was felt disproportionately heavily by high-needs communities, and by Māori and Pasifika.
"Getting into a GP is often hard, and with the extra duties of Covid and with an attempt to offload hospitals by managing more in primary care - together with the delayed treatments by the hospital system due to Covid - there is a building health need."
He said doctors and nurses were struggling under the current system.
"We know that the best healthcare and outcomes are delivered when there is trust and knowledge shared between clinician and patient.
"This is especially true for Māori whānau where the building of a trusted relationship takes time."
He said if patients can't regularly see a trusted clinician, they were more likely to delay seeking healthcare and instead present to the emergency department for "patch-up" treatment, instead of fixing the underlying problem.
Bradford said there were various options when cost became a barrier, but knowledge of the options and people's readiness to ask about them was a barrier in itself.
"We need to build a system where silly things like chasing down financial support don't prevent people getting early, holistic primary healthcare."
Ngāi Te Rangi chief executive Paora Stanley spoke strongly on the issue.
He said the problem was worsened by the impact the pandemic had on staffing and demand for both primary and secondary health providers.
"My theory is this: when you have a person with mild health issues and they don't get monitored or treated ... they go from moderate health issues to medium, then from medium to chronic health issues."
Some of those people would die, he said.
"When you talk about health inequities, the end result for Māori people is death through lack of monitoring because of Covid and other inequities that mount up.
"It angers me greatly."
Urgency was needed, he said, and suggested a focus on technology and self-monitoring, similar to rapid antigen tests, would help.
Interim Māori Health Authority chairwoman Sharon O'Shea said the frontline workforce did an exemplary job looking after people.
Primary health providers saw inequities on a daily basis, she said, and awareness of them was a central driver for change in the health system reforms.
The establishment of the Māori Health Authority was to hold the whole health system accountable for Māori health outcomes, she said.
"In the future, service delivery across the system will be different, more responsive to whānau preferences for support and more aligned with approaches that work to tackle inequities linked to prevention, diagnosis, treatment and recovery."
A recent report from The Royal New Zealand College of General Practitioners showed that in 10 years, at the current rate, New Zealand will be short by 300 GPs.
Medical director Dr Bryan Betty said the issues the community centre faced were happening across the country as practices reached capacity.
"It exacerbates equity issues in access to healthcare, there is no doubt about it."
For patients, if there was no clinic nearby it meant lack of access to healthcare.
"What we do know, communities that are adequately served by general practitioners ... have better health outcomes long-term."
Western Bay Of Plenty Primary Health Organisation chief executive Lindsey Webber said there were significant Māori populations for whom the rising cost of living, including fuel and transport costs, can impact their access to timely healthcare and equity of health outcomes.
"Healthcare costs can also be a barrier for some Māori and Pasifika communities."
The Health and Disability System Review focused everyone on population health and the need to address inequities for Māori, she said.
Factors at play included advances in technology, population growth, the increasing complexity of health needs, the changing expectations of patients and the demands of responding to a pandemic. She said the organisation was driven to examine how its network and iwi partners, Ngāti Ranginui and Ngāi Te Rangi, can better support the Bay population, especially its high-needs, low-income communities.
Webber said it embraced new models of care and partnered with a range of organisations, including kaupapa Māori health providers and NGOs.
"This mahi is our primary focus, demonstrating our commitment to creating equitable primary health services."
To encourage engagement with health services before patients reach "crisis point", the PHO funds, in partnership with Ngāi Te Rangi, a mobile primary healthcare service called HbU, she said.
It delivered free after-hours care across several high-need communities including in Katikati, Welcome Bay, Mount Maunganui, Merivale and Pāpāmoa.
More than 2000 people accessed it each year, 70 per cent of them Māori.
It also partnered with Ngāti Ranginui to fund a 12-month pilot programme that supported a whānau ora model of care, with mobile nursing and kaiāwhina teams working with people living with long-term health conditions to help them reconnect with general practice.
A Ministry of Health spokesperson said it acknowledged the difficulties of enrolling into a general practice provider for some people.
"It is important to note that most medical practices in New Zealand operate as private businesses and work with the primary health organisation (PHO) and district health boards (DHBs) that they are affiliated with on capacity and workforce planning matters."
They said increasing the medical workforce remained a priority for the health sector to boost access to healthcare for everyone in New Zealand.
The ministry was working on several initiatives to increase the capacity and capability of the workforce, they said.
The CarePlus funding initiative may assist people with a long-term health condition, or frequent GP visitors may apply for a High User Health Card, they said.
More information for help can be found on the Health Ministry's website.
Ministry for Social Development support included Special Needs Grants, which could cover health travel costs; the Disability Allowance, which was a weekly payment for people who have regular, ongoing costs because of a disability; and help with prescriptions and health practitioner costs for those on a low income.
The jury's marathon deliberations ran for two weeks.