Practice manager Nadine Whitton (centre) and her team (from left) receptionist Carol Carter, Dr. Nina Fransham, Dr. Narimahn Bahrinipour and practice nurse Nicole Dugmore. Photo / Michael Cunningham
General practitioners are fearful over the falling rates of Northland consultations during the Covid-19 lockdown period.
Statistics from Northland primary health entity, Mahitahi Hauora, indicate the number of general practitioner (GP) consultations has reduced between 30 and 90 per cent across its 41 practices during the alert level 4 lockdown.
A Whangārei practice recorded the highest drop in patients (90 per cent), with multiple others recording up to a 70 per cent reduction.
Pre Covid-19, 95 per cent of consults were conducted in-person but during lockdown, that figure had reversed with 95 per cent of consults now via computer or phone.
Normally, a GP would see about 40 patients in person in a eight-hour day, but now GPs might only conduct one in-person consult per day.
The figures were gathered in a recent survey that assessed the impact of the Covid-19 pandemic and the ensuing lockdown on Mahitahi Hauora's patient volumes.
Last week, the Northland District Health Board reported a 36 per cent reduction in presentations to Northland hospital emergency departments since alert level 4 started on March 25.
The number of patients admitted acutely to medical wards was also down by the same volume.
Between March 25 and April 15, Northland hospitals saw 1807 presentations to emergency departments, a decrease of more than 1000 on the same time last year (2818).
However, the NDHB said it was reassured by an uptick in presentations last week. From April 13-19, there were 722 presentations to emergency departments, a reduction of 197 compared with the same time last year (919).
Nevertheless, Northland's medical professionals are encouraging people to continue contact with their GPs, hoping to dispel the apparent fear people have regarding in-person consults.
"Don't be afraid to come in to see you doctor," Whangārei's Rust Ave medical centre practice manager Nadine Whitton said.
"We've got the time and we've made arrangements to make it really safe for you to visit the medical centre."
The number of daily consultations at the Whangārei practice had dropped at least 50 per cent, Whitton speculated.
With more time on their hands, doctors at the practice had been contacting their most vulnerable patients to ensure their health needs were met.
"I think it's really nice for the doctor because they certainly worry about their most vulnerable patients," Whitton said.
"We are just concerned about [the patients] and we realise they may be anxious about coming in and we are just checking they are well, any health needs."
During the lockdown, the practice had been spilt in two areas, one catering for those considered potentially infectious and the other for those with everyday health needs.
Whitton said best practice for someone seeking medical attention was to call their GP and set up a phone or video consult if required. From there, a GP would assess whether an in-person consult was necessary and if so, the patient would be taken through the appropriate steps for arriving at the practice.
As one of the first practices in the country to implement video consults about 18 months ago, Whitton said they were well-placed to address the 90 per cent of consults that could be done via phone or video.
Kaikohe doctor Taco Kistemaker was another of Northland's health professionals concerned about the impact of Covid-19.
"I do worry for some of [my patients]," he said.
"I almost feel like I'm not doing a good job at the moment, I start to become worried about my patients."
Kistemaker is a co-owner of Broadway Health, which has practices across Kaikohe, Okaihau, Waipapa and Kaitaia. The doctor, who has operated in Northland for 14 years having previously worked in Holland, freely admitted he has never seen anything like the Covid-19 pandemic.
"Knowing that doctors die just as much as other people, it is a bit scary for me I must admit."
Kistemaker's concerns for his patients' safety got so high, he has been calling to check on the most vulnerable of his roughly 2500 patients.
• Covid19.govt.nz: The Government's official Covid-19 advisory website
Kistemaker believed much of the reluctance to come into practices was borne out of conflicting messages from Government and GPs, confusing people regarding the safety of in-person consults.
While he accepted it was a high stress environment early in the lockdown, Kistemaker said some Northland healthcare practices were wrong to advise people against seeing their GPs in person.
"In the beginning, everyone was scared so you can't really blame the GPs. It doesn't come from a lack of wanting to help people, I think it just comes from being scared," he said.
"It's the way that you say it which conveys the message and I don't think we've done that correctly.
"The message has been 'GPs are closed'. No, that is not the case ... we are open and we'll keep you safe. It's really important that people know that we are here."
Kistemaker has been conducting most of his current consults over telemedicine tool Doxy.me and over the phone, as well as getting patients to take photos of any physical ailments.
However, Kistemaker said Northland's biggest obstacle in achieving successful virtual consults was poor cellphone and internet coverage, worsened by expensive phone and internet plans.
"If I drive from home [in Kerikeri] to work, my internet stops working six times, there are complete patches of non-coverage.
"My patients, many of them change cellphones all the time because they can't afford the plans so no, we are completely unequipped for this kind of crisis in Northland and New Zealand."
Kistemaker said when the pandemic was over, the Government had to improve Northland's ability for distance consults in anticipation of a similar health crisis in the future.
Mahitahi Hauora chief executive Phillip Balmer said his practices had been working hard to ensure their virtual consultation capabilities for further resources still being supplied.
Balmer said the reduction in consultations was alarming, citing an article from The Guardian earlier this month which pointed to a spike in non-Covid-19 related deaths in Scotland attributed to the public ignoring signs of other diseases.
Although he admitted it was hard to tell if such an effect was being seen in New Zealand, Balmer said it was a possibility.
"I think we can just assume, if you look internationally, there's a real risk of it happening here."
Balmer advised people to trust their instincts and to call their GP if they believed they needed attention.
"If someone is really unwell and they feel like they need to go and see a doctor, no one should stop going to a practice because [the staff] understand infection control, they make sure practices are safe."
For practice contact information, visit www.mahitahihauora.co.nz/practices
The hīkoi is expected to arrive at Parliament around midday.