Funding GP clinics may be cutting hospital visits

Reduced hospital admissions in South Auckland may be an early sign that pouring millions of dollars into primary healthcare is making a difference.

Cheaper GP visits are meant to keep people healthier in the community and reduce expensive hospital stays.

With the extra spending yet to reach large parts of the population, it is unclear how the nation's health has been affected - a major evaluation will be released by Victoria University in several months - but statistics from Kidz First in Counties Manukau are already encouraging.

The hospital, which opened in 2000, has recorded a sustained drop in admissions of sick children.

"Winter last year was a definite downward trend for medical admissions," said Kidz First general manager Nettie Knetsch. "It has continued through the year to be lower. That's been surprising - and really good.

"We've been talking to the paediatricians and population health people about what this might mean."

No one had come up with proven answers, she said, but it was most likely linked to declining rates in the community of a respiratory virus that often sent young children to hospital.

It could also reflect the new health policy of increased access to primary care through primary health organisations (PHOs), as well as better housing.

Counties Manukau was one of the first areas where PHOs were set up. This enabled local clinics to tap into increased Government cash and reduce primary care fees for all enrolled patients.

Ms Knetsch also cited increased Well-Child checks for high-need families, the pre-PHO schemes that paid GPs to treat people in the community if possible rather than referring them to hospital - for problems such as skin infections - and the MeNZB meningococcal vaccination programme, which began last July.

As a result many children under 5 saw a doctor three times.

Figures are scarce on whether more people are going to health clinics or going more regularly. However, the three ProCare PHOs covering 600,000 Aucklanders said their number of patient consultations was 12 per cent higher in the last October-March period than in the same period a year ago. They attribute this largely to new patients - Maori, Pacific Islanders or from low-income areas - and say it appears not to be driven by increased subsidies.

While most of the new state cash for PHOs goes on reducing fees, some is spent on expanding primary care in other ways.

One of these schemes is the Waitakere-based HealthWest PHO's offer of free cardiovascular screening to the district's 14,000 Maori, Pacific Islanders and residents of the poorest areas who are in the higher-risk age groups, which start at 35, 45 or 55 depending on race and sex.

"This is how we are going to reduce cardiovascular disease," said the project's medical director, Dr Lannes Johnson. "I believe it will be showing a reduction in mortality and morbidity [sickness] within five years."

The patients, who have no symptoms, are screened by a nurse or GP when they visit a clinic or after being called in by letter. They are assessed for risks including family history of cardiovascular disease, body mass, cholesterol levels and blood pressure. A computer program calculates their risk of having a heart attack or stroke within five years.

Of the 3100 screened since the programme started last November, about a quarter, as expected, are at medium or high risk. Those at medium risk are given a "green" prescription, which can include lessons in healthy cooking, a variety of exercise programmes or a gym subscription discounted by the city council.

Those at high risk are given the same lifestyle help and will see a GP for free, who will usually prescribe drugs such as aspirin and cholesterol-lowering statins.