11 January 2011

The increase in patients attending emergency departments (EDs) for minor ailments, instead of visiting their general practice, highlights the problem of access to after hours primary care which the Government must urgently address, says New Zealand Medical Association (NZMA) Chair Dr Peter Foley.
 
 “In recent times it has become worse and the problem cannot be left for each DHB on its own to resolve,” says Dr Foley. 
 
 “Providing after hours care is costly and for many patients unaffordable. As we’ve seen over this summer with both the Waitemata and Auckland DHBs reporting markedly increased pressures, with many patients choosing to go to their nearest ED instead of their general practice or A & E clinic. It’s a similar story at many other hospitals throughout the country.”
 
 The NZMA calls on the Government to develop a national strategy for after hours care and for general practice to be the cornerstone of this strategy.
 
 Dr Foley says that the Government must find ways to extend the current capitated patient subsidy to lower the cost to patients of after hours care.
 
 The NZMA has advocated on the issue of after hours care for many years but funders had not understood the importance of the need to better fund general practice to provide after hours care for patients, says Dr Foley.
 “General practice is often best placed to see patients as they know them better in terms of their health, family and community contexts. They have a better information base to make the diagnosis, even if they still lack access to higher level diagnostic tools.”
 
 Dr Foley said that there needed to be an approximate $25 reduction in the cost of a patient seeing after-hours doctors and nurses as it cost more to keep practices running 24/7.
 
 “In the first instance the Government needs to relook at funding general practice, before it considers other options which may be more costly and not necessarily effective at reducing ED presentations that then tend to result in higher numbers of short term hospital admissions.”
 
 Dr Foley pointed out that cost was not the only factor in these increasing presentations to EDs, with patient perception that they would have access to greater and more helpful investigations to sort their perceived problems, also contributing. 
 
 “Examples of minor injuries which should be funded in primary care, presenting unnecessarily to EDs, must be discouraged. The “E” stands for emergencies, and the staff in our hospital EDs need to be left to deal with those emergencies.” 
 
 “General Practice teams are the best gatekeepers to our busy and expensive hospitals, but it costs more to have them open after hours to meet this patient need.”