Editorial: GPs the key to rest home care

Switzer home building renovations.

Let's be clear. No one, to the writer's knowledge, is criticising the general practices in Kaitaia that have ceased enrolling new patients. That measure, extraordinary and damaging as it might be, is their understandable response to workloads that they say have become intolerable.

It might also be seen as a last gasp effort to retain some attraction for Kaitaia in terms of recruiting and retaining GPs. And the problem is not unique to Kaitaia. Small communities around the country are finding it increasingly difficult to provide primary health services, although the issue seems to have so far flown under the political radar in Wellington.

Having said that, no one in Kaitaia seems to doubt the potential ramifications of the practices closing their doors to newcomers. With no ability to enrol for primary health care, it will be even more difficult for the town to attract all sorts of people it needs, like police officers, school teachers, those engaged in any occupation one can think of. And of course it makes the town a much less attractive option for any kind of investment that might create jobs or build on the town's services.

In time it will even make it difficult, if not impossible, to staff the town's rest home.

It is a genuine crisis, one that the Northland DHB and PHO, somewhat belatedly, say they are now addressing. The DHB said last month that it was moving to take responsibility for after hours services from the general practices, the same model that had been implemented in the Kaipara and Mid North, but for reasons unexplained not in the Far North, to enable primary care doctors to focus on managing the wellness of their "population" during the day.

CEO Dr Nick Chamberlain said the DHB would provide an urgent service for unenrolled patients, who would be required to make a "co-payment". The DHB would continue to work "urgently" with the PHO and general practices to explore solutions to ensure that patients would be able to enrol with a general practice as soon as possible.

Sounds good. It isn't clear why the "urgent" service has yet to kick in — the Northland Age understands that the new system will begin on July 1. Better late than never. And it has been told by one general practice in the town that when that system starts, it will go a long way to reducing the demands on its GPs to a manageable level. The immediate problem, to at least some degree, will be solved.

However, as of Friday last week it seemed that the prospect of workloads being eased was not going to benefit an 88-year-old Kaitaia woman (Mrs H), who was in a rest home in Whangārei, and, if she turns out to be the exception rather than the rule, it might not help others who find themselves in rest homes outside Kaitaia because they do not, or no longer, have a GP in Kaitaia.

This is cruel. However much sympathy we might have for the problems general practices in Kaitaia are facing, however we might accept that this is a crisis not of their making, however we might understand that they had no choice but to close their doors to new patients, it is unconscionable that anyone should find themselves living far from family and friends because of a breakdown in the primary health system.

Four years ago the Claud Switzer Memorial Trust moved to spare Kaitaia's elderly this ordeal. Prior to that it was standard practice for those who needed care in a secure unit (which 88-year-old Mrs H does not) to find themselves in homes in Kaikohe, Whangārei, Auckland, or even further afield. So Switzer built a $1.4 million secure unit of its own.

There are no guarantees that that unit will be able to cater for every Kaitaia resident who needs it, given the rate at which demand is growing, but that is another issue for another day.

Mrs H, who was born lived in Kaitaia and returned to the town some 20 years ago, was discharged from hospital recently, and was assessed as in need of care. There was no bed available for her at Switzer, so she moved into a home in Whangārei, temporarily. She needed a GP in the city to do that, so her medical records were transferred from Kaitaia. (Standards of care under which rest homes are contracted demand that every resident have a GP, who will visit them every three months, or more regularly as required. This service, and any tests, medication, etc, that might be required, are paid for by the rest home.

No one who is not enrolled with a GP can be admitted to a rest home. That, effectively, is the law).

Three weeks later a bed became available at Switzer for her, but she could not return to Kaitaia because she no longer had a local GP. The practice, where she had been a patient since it opened six years ago, had disenrolled her. However much pressure the practice was under, that was outrageous.

Closing their doors to new patients is one thing. Divesting themselves of long-time patients over what is a technicality is another. The practice owed a duty of care to Mrs H, and it has failed to meet that obligation.

The practice told the Northland Age last week that making an exception for Mrs H would "open the floodgates". Really? Switzer Residential Care says it knows of five Far North residents, including Mrs H, who are in care outside the district because they do not have a local GP and so cannot return. Even if those five are all former patients of this one practice that is hardly a flood.

In this case the practice was open to discussing continued care for its patients who found themselves at Switzer. If any such discussions are not fruitful, the alternatives will be that another general practice in Kaitaia enrols those patients, or they will go into care in another part of the country where they can find a GP who will have them.

However intolerable Kaitaia GP workloads might be, one would have expected a much greater display of empathy than this. It seems that Mrs H was disenrolled at the first opportunity. And if a general practice cannot find it in its heart to allow its patients to remain in Kaitaia, with their families and friends, it might at least recognise the fact that while no one can be legally enrolled at two general practices, there is provision for a temporary enrolment with another GP.

That is exactly what Mrs H did. She enrolled, temporarily, with a GP in Whangārei, fully intending to return to Kaitaia when a bed became available at Switzer.

It goes without saying that all Kaitaia's general practices should play their part in catering for patients who go into care at Switzer. To not do so shifts an extra burden on to another practice, or, in the worst case scenario, means the would-be resident has to leave the district.

It is even more difficult to understand this extraordinary decision if indeed the new after-hours primary health service is to begin on July 1. And it seems there has been no change of heart. The Northland Age understands that Mrs H has been enrolled by another Kaitaia practice, which perhaps has a greater understanding that Mrs H and others in her predicament are much more than statistics, and should not be punished because of circumstances beyond their control.

There is a price to pay for the shambles that general practice in Kaitaia appears to have become, but the frail elderly should be the last to suffer.