Some low-income families face barriers to accessing healthcare. Photo / Getty Images
A community advocate for one of the country's most deprived areas says a Rotorua GP shortage highlights inequity and ''systemic racism''.
Rotorua, along with other areas in the Bay of Plenty and New Zealand, is experiencing a general practitioner shortage.
As practices reached the limits of enrolments able to be taken on at one time, books have shut.
Patients may need to find a less-ideal alternative, which can involve longer distances to travel to appointments and more expensive fees.
Fordlands Community Centre whānau connector Heidi Symon said this added barriers to low-income whānau's access to healthcare.
She said they had been connecting 65 whānau with clinics, and about 90 per cent were not enrolled or hadn't been before being helped.
Recently, she was working with three people wanting to sign up to doctors but had not been able to find somewhere appropriate.
The whānau she worked with had difficulties accessing transport, a mobile phone or with appointment fees. Many had limited funds.
Symon explained the average yearly household income in the community was about $16,500.
There were no doctors' practices within walking distance.
"Why should it be so hard? It's another thing ... you shouldn't need money to access it."
"It's just another example of inequities whānau face. It's not fair ... it's another system that's let them down."
Health became a lower priority when clients dealt with added barriers such as family dynamics, she said, and obstacles such as cost and transport did not help.
She said in her opinion: "We see it time and time again with systemic racism within so many systems that a number of our whānau face daily."
The centre helped inform the community there was help available in accessing services and financial aid to cover it, but Symon said there were many who still did not know.
Of the Rotorua Area Primary Health Services members, six are accepting enrolments, some with restrictions. Seven are not accepting although there may be some exemptions.
A recent report from The Royal New Zealand College of General Practitioners showed that in 10 years, at the current rate, New Zealand will be short 300 GPs.
A Lakes DHB spokesperson said it was aware access to GPs in its area was difficult for some patients, in part because of numbers being insufficient for the population.
It had a working group that looked at options to increase GP numbers but said this would take time.
"Patients benefit from good access to primary care and the impact on hospitals when this is not possible is real and well documented."
They said Emergency Department staff worked with patients to understand why they were there instead of with a GP, as well as to help to remove barriers that may be preventing primary care access in the future.
Rotorua Lakes councillor, Whānau Ora director and Lakes DHB board member Merepeka Raukawa-Tait said accessing health services had always been a problem for many local Māori whānau.
People may owe for previous visits and are reluctant to visit with debt outstanding, she said.
"But mainly they struggle daily with life's challenges and so often health is put on the back burner."
She knew Māori whānau were looking more to Māori Health Providers.
In her view: "Systemic racism and hostile judgmental attitudes are common and still prevalent, even with all the talk about improvements."
Interim Māori Health Authority chairwoman Sharon O'Shea said the frontline workforce did an exemplary job looking after people.
Primary health providers and others on the frontline like GPs saw inequities on a daily basis, she said, and awareness of them was a central driver for change in the health system reforms.
The establishment of the authority was to hold the whole health system accountable for Māori health outcomes, she said.
Future service delivery would be more responsive to whānau preferences for support and more aligned with approaches that work to tackle inequities, she said.
Medical director Dr Bryan Betty said the issues the community centre faced were happening across the country as practices reached capacity.
"It exacerbates equity issues in access to healthcare, there is no doubt about it."
For patients, if there was no clinic nearby it meant a lack of access to healthcare.
"What we do know, communities that are adequately served by general practitioners ... have better health outcomes long-term."
Rotorua Area Primary Health Services (RAPHS) chief executive Kirsten Stone said these were important issues.
She said the workforce shortage nationally and locally had been impacted by extra pressures of supporting the Covid response, as well as border changes impacting labour supply.
Systemic racism operated independently of intentions and actions of individuals so that even if individual racism is not present, inequities for racial groups exist because of systems and programmes across society, she said.
"With Covid impacting all parts of our community and health system, there is a risk of unequal impact for people living in the most deprived areas."
Practices only close for new enrolments when they do not have the capacity to safely cater for the needs of additional enrollees, she said.
The service worked with the DHB on both support for the workforce and enrolling patients.
She said those seeking information can contact the service, while those without a phone can be helped by the RAPHS Extended Care Team, which can take a referral from any community provider to support the processes necessary to become enrolled with a practice.
It was also soon to open a new walk-in health service centre in Tutanekai St.
She said it regularly assessed service access for people enrolled with RAPHS practices.
"For the majority of age-cohorts, for both GP and Nurse consult utilisation of RAPHS general practice services is greater for Māori than non-Māori."
It also provided five years of consultation data from member general practices for the period to the Ministry Of Health Maori Health Insights team for analysis vs Acute Stay in Hospital.
"No inequity in access to general practice by life stage for Māori service users enrolled in RAPHS was identified in this analysis."
Stone said it participated in a national patient experience survey and consistently performed higher than the national average on measures of satisfaction, access and equity.
Ministry for Social Development support included Special Needs Grants, which could cover health travel costs, the Disability Allowance which was a weekly payment for people who have regular, ongoing costs because of a disability, and help with prescriptions and health practitioner costs for those on a low income.
A Ministry of Health spokesperson said it was aware there were challenges involved in enrolling with a practice in Rotorua, and most practices will see people on a casual basis until they are able to take on new enrolments.
They said increasing the medical workforce remained a priority for the health sector broadly to increase access to healthcare for everyone in New Zealand.
It was working on several initiatives to increase the capacity and capability of the workforce.
CarePlus may apply to people with a long-term health condition, or frequent GP visitors may apply for a High User Health Card, they said.
More information for help can be found on its website.
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