Gisborne primary care in crisis: No new enrolments, no after-hours service

Dr Hiria Nielsen, managing partner at Three Rivers Medical Centre, says it was a difficult decision to end its after-hours service and "close the books" to new patients. Inadequate funding, patient safety and staffing issues led to the decision. Photo / Wynsley Wrigley

Gisborne’s primary care sector is in crisis, with a waiting-list-only option for new enrolments and no after-hours service from next month.

Three Rivers Medical Centre - the only GP centre within the city still offering an after-hours service - “closed its books” to new patients on August 5 and will not operate after hours from September 1 because of inadequate funding, increased patient demand and an inability to retain and recruit staff.

Three Rivers managing partner Dr Hiria Nielsen said the impact on Gisborne Hospital’s emergency department was of major concern.

A recent Gisborne arrival, who required medical care, rang every GP centre in the city yesterday morning without success.

He was able to get treatment at a rural GP centre, while Ūawa Community Health Clinic was prepared to see him today.

“It’s unfair I am feeling a bit of shame that I did not sort this out before I became unwell,” he said.

“It’s bewildering to move to a different city in Aotearoa and not be able to receive a service that should be available to everyone.

“It feels instead like moving to a country with a completely different healthcare system.”

The Doctors Te Whare Hapara states on its website it is taking enrolments but has “a backlog of enrolments at the moment, with at least a three-month waiting list”.

City Medical, De Lautour Medical and Te Puhi Kai-ti Community Health Clinic are not taking enrolments, and the only after-hours services available in the city are virtual GP telehealth-type services.

Three Rivers has notified Health Minister Dr Shane Reti it has identified a “significant risk that is likely to materially reduce or affect our ability to meet our obligations”.

In Clause 14 of the Contractor Provider Agreement notification it provided Reti and Health New Zealand - Te Whatu Ora, Three Rivers states it will:

• Cease the enrolling of new patients until such time as more staff can be recruited;
• Stop providing face-to-face consultations over the weekend, public holidays and after hours;
• Cease the enrolling of new patients until such time as more staff can be recruited;
• Redirect patients to telehealth services for out-of-hours care.

Three Rivers, in its letter to Reti, attributed the above decisions to “the increasing demand, increasing complexity and an inability to recruit and retain workforce due to inadequate funding”.

The actions were being taken to ensure patient safety “as the prime consideration”, but there were also concerns over workload and staff burnout and “staff harm”.

Three Rivers’ Nielsen told Radio New Zealand Three Rivers had previously been open 365 days a year as an equity measure to decrease barriers to access.

The decision to end the after-hours service had been a response to decades of underfunding totalling in the millions.

The service was important in “trying to keep the pressure off [Gisborne Hospital’s] emergency department”.

“We held on to that, held on that and held on to it for years and years and years for a couple decades.”

It was costing Three Rivers “hundreds of thousands of dollars a year” and placing staff under pressure.

Nielsen, speaking to the Gisborne Herald, said “the doctors who are here are the doctors who are here”.

“The calvary is not going to come and save us. Whatever impacts us, impacts them [those in the ED]. Whatever impacts them, impacts us.”

Three Rivers has seen a number of patients every weekend after hours.

“Those patients will have to go somewhere. That is mainly the hospital.

“The [after-hours] phone triage was great in some circumstances.”

However, face-to-face meetings allowed doctors to pick up patterns of issues which might not be picked up in a one-off meeting.

The doctor-patient relationship was important and unregistered patients had much worse health.

“It’s sad that we can’t offer face-to-face after hours.”

An Otago University study shows 80% of general practices in Aotearoa New Zealand stopped enrolling new patients at some point between 2019 and 2022.

While the pandemic had exacerbated the issue, it was not the only cause, Professor Jackie Cumming said.

“The key reasons for not enrolling new patients included workforce shortages, high workloads and staff burnout, funding issues, concerns about quality of care, and insufficient physical space.”

Te Whatu Ora - Tairāwhiti has been asked for comment.