Chris Reid: Is this the end of after hours doctors?

Dr Chris Reid.

It is widely acknowledged that the increasing average age of rural GPs means there is a workforce crisis on the near horizon. Kicking hard-working GPs in the teeth will only hasten this.

Ask most people about 'urgent care' and 'after hours primary care' and they will assume they are the same thing.

With respect to Northland, they are for the most part correct. Rural GPs simultaneously provide for after hours care and urgent care, with the help of a wider multi-disciplinary team, including St John and hospice nurses, not forgetting our hospital-based colleagues in Kaitaia and Kawakawa.

The Auckland model is somewhat different, in that specific urgent care clinics are run and staffed by specialist doctors with a qualification in urgent care, but not necessarily qualified as a GP (primary care).

Confused? It appears the new Minister of Health David Clark is. I really hope he is confused, because if he is not, then his answer to Whangarei MP Dr Shane Reti's question puts Northland (and all of New Zealand) after hours care into chaos.

Question: Does the Minister support primary care after hours services requiring vocationally-trained urgent care specialists? Reply: Yes.

If he really means this, then fully-qualified, competent, experienced Fellows of the Royal New Zealand College of GPs cannot provide after hours care, because the vast majority of GPs do not hold an additional post-graduate four-year qualification from the College of Urgent Care Physicians. The Minister's answer would in effect mean no after hours care in Northland.

I asked Dr Reti, a GP in Northland for 20 years, for his comment.

"Requiring GPs to also be urgent care specialists is impossible, and will irreparably damage after hours care in the North and across New Zealand ... Minister Clark is clearly out of his depth in spreading Auckland's after hours issues across all of New Zealand. The Royal New Zealand College of GPs is the best organisation to address these issues."

Strong words maybe, but it does show how important it is to understand the workforce and the challenges of retaining a highly skilled primary care team in rural New Zealand.

While I would welcome a complete overhaul of the structure and funding model in the health sector, one always has to be mindful of the differences between an urban and rural setting.

It is widely acknowledged that the increasing average age of rural GPs means there is a workforce crisis on the near horizon. Kicking hard-working GPs in the teeth will only hasten this.

Virtual health (the ability to have an online consultation) is not going to fix this. While I am sure it can augment the primary care team, if the Minister thinks he doesn't need to train more GPs and respect the current ones, we will only increase the inequity of care between urban and rural settings.

A lot of hard work has been done by the Northland DHB and Te Tai Tokerau PHO to develop, with GPs, a more proactive multi-disciplinary team. Alongside the GPs we now have nurse practitioners, practice managers, nurses, health coaches, pharmacists, physios and more, all working at the top of their scope. I hope we do not see this dismantled.