Three Rivers Medical part owner Dr Fergus Aitcheson and general manager Michelle Te Kira. Photo / James Pocock
Some of Gisborne’s primary healthcare providers are not interested in picking up Health NZ’s tender for a new after-hours care service in Tairāwhiti due to clinical and financial risks and concerns around a hasty and “prescriptive” process.
There has been no after-hours primary healthcare service operating in Tairāwhiti since the start of September after Three Rivers Medical Centre closed its after-hours care service due to inadequate funding, increased patient demand and an inability to retain and recruit staff.
Submissions on a tender for an after-hours primary care service in Tairāwhiti opened on the GETS government website on October 15.
The overview from Health New Zealand Te Whatu Ora specified it was looking to contract a provider to deliver a “Nurse Led, GP supported service” for the weekends and public holidays, with a minimum of four hours of face-to-face operation a day for the Gisborne Tairāwhiti population accessing primary healthcare.
According to the overview, the stated purpose of the tender was to relieve the pressure on emergency departments, facilitate seamless integration with existing healthcare services, ensure a sustainable financial model to maximise resource utilisation and support the delivery of the broader outcomes.
Initially set to close on November 8, the tender deadline was extended to November 14.
Three Rivers Medical Centre general manager Michelle Te Kira said Three Rivers had asked to be funded to continue after-hours care and for a collaborative approach before the tender was put out, but no more funding was offered at that time.
“We felt like we were being shafted sideways. We had these large hui with national Te Whatu Ora people involved with co-design, how are we going to help this whānau, this community, and then ‘boom’ there is this [request for proposal],“ Te Kira said.
Three Rivers Medical Centre part owner Dr Fergus Aitcheson said practices were concerned about the “haste” and short timeframe of the consultation process, and the “prescribed” top-down approach stipulating a nurse-led, GP-supported service.
Aitcheson said there was no “appetite” from local providers for signing on to the tender due to the short timeframe and the clinical and financial risk involved.
“There is now some taxpayer money over there to fund it and some willing providers over here to do it and in the middle, a complex and risky tendering process that nobody is really familiar with.”
Aitcheson said Three Rivers would welcome the opportunity to work collaboratively with the successful tenderer if there was one, but he was still concerned this was running parallel to a national process looking at after-hours care and the tender was only set for 18 months.
Pinnacle clinical director Jo Scott-Jones said the tendering process worked best when there were well-resourced organisations which could compete to deliver a specified service.
“That isn’t the situation in Tairāwhiti. We don’t have services that are well-resourced and able to compete with each other to deliver a service. A key concern from the practices, and that I have as the clinical director for Pinnacle, is that a tendering process was never the right way to approach solving this problem,” Scott-Jones said.
“It would be much better to take a collaborative, co-operative approach, saying: ‘Here are the resources that we’ve got, how can we best work together to meet some sort of service requirement based on those resources?’”
Scott-Jones said it wasn’t clear what the available funding was, clinics did not know if they had the staff available and the practices he had spoken with did not feel a nurse-led, doctor-supported model was the best approach.
“For that reason, the practices chose not to engage with the tendering process.”
Scott-Jones said nurse practitioners were a highly capable and important part of primary care, but patients got more efficient and effective care under a doctor-led, nurse-supported system with the most qualified person “at the front door”.
He believed Tairāwhiti’s population deserved a fully funded urgent care service.
“In most other communities, or certainly a large number of communities around New Zealand, there are urgent care services which are contracted and provided by Te Whatu Ora. Gisborne seems to be a big gap for that.”
He appreciated the urgency of the tender ahead of the holiday season, but said if the bid was won there would still need to be negotiations around price and time to employ people, which could take three to six months in the current job market.
“The assumption is that anyone who puts in the bid already has the staff sitting and waiting to take these positions, but as I said, why we are in this situation is because we don’t have the staff.”
Aitcheson and Scott-Jones understood Health NZ Te Whatu Ora was concerned the lack of an after-hours service meant people who should be seen in primary care were presenting to ED, but both said data showed no measurable increase in ED presentations during after-hours and the weekends since the primary healthcare clinics stopped providing the service in Tairāwhiti.
A Pinnacle spokesman said Pinnacle was part of a collaborative steering group - along with Health NZ Te Whatu Ora, iwi leaders and hauora Māori providers - which was working on a few initiatives to provide services where there were gaps in Tairāwhiti, particularly after hours.
The tender was one of the group’s workstreams, but the group was also exploring other initiatives to help local whānau, he said.
The Gisborne Herald asked Health NZ Te Whatu Ora several questions, including why it settled on a competitive tender process as opposed to exploring co-operative options; whether it would consider a co-operative tender bid; why a nurse-led, GP-supported service; and how the length of the tender process and funding was decided.
Lisa Gestro, Health NZ group manager of regional system integration, said Health NZ Te Whatu Ora was limited in any further detail it could provide while the tender process was still under way.
“In response to feedback, we have extended the timeframe for responses to November 14,” Gestro said.
“Health New Zealand Te Whatu Ora looks forward to considering the responses.”
In a statement issued last month, Health NZ Te Whatu Ora said it was working with community health providers, primary care teams, hospital services and local primary health organisations to ensure Tairāwhiti had access to the right health services at the right time.
“We acknowledge that continued consistent delivery of after-hours primary care has been a challenge, and collectively we are working towards solutions,” the statement said.
Health NZ was required to follow regulated procurement processes for all significant services and the tender was part of that, the statement said.
“We not only hope to find a way to better support access to after-hours care in the short-term, but are aiming for a more secure future for these services.”
James Pocock joined the Gisborne Herald as chief reporter in 2024 after covering environmental, local government and post-cyclone issues in Hawke’s Bay. He has a keen interest in finding the bigger picture in research and making it more accessible to audiences. He lives near Gisborne. james.pocock@nzme.co.nz.
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