West Coast health cut details revealed

Lee Scanlon of

By Lee Scanlon of

West Coasters seeking primary healthcare at weekends will need a referral from a telehealth provider to see a doctor or nurse in person from 1 October.

Primary health organisation West Coast Health (WCH) on Friday confirmed telehealth provider, Ka Ora, would replace the weekend urgent GP clinics.

WCH said Coast GP practices were no longer able to provide weekend clinics due to "significant financial and workforce challenges".

WCH had promised a media release on the change, but had not provided one before The Westport News went to print. However, The Westport News obtained a copy of WCH's decision document.

It shows primary care patients will need a referral from Ka Ora to see a clinician in-person at Buller or Te Nīkau Greymouth hospitals at weekends. The in-person service will not be available to walk-in patients.

The document said WCH would allocate extra resources to Buller and Greymouth hospitals for three months to ensure staff in their acute/emergency departments were not overwhelmed.

WCH staff would also be stationed at Buller and Greymouth hospitals for the first six weeks to show patients how to use Ka Ora.

In Northern Buller and South Westland, Ka Ora would provide triaging services for rural nurse specialist teams who would remain responsible for urgent and after-hours care.

Reefton would have an on-call in-person service, available at Reefton Health and only for patients referred by Ka Ora, the decision document said.

Ka Ora would operate as an extension of the practice patients were enrolled with.

All patient consultation notes would go back to the patient's enrolling practice. Ka Ora team members would have access to information about Coast health services.

The document does not say what will happen to patients who aren't enrolled with a primary practice.

At present, patients attending weekend GP clinics can obtain urgent medicines there. WCH initially proposed one Coast pharmacy would open at weekends and couriers would deliver medicines. Health professionals said that wouldn't work.

WCH chief executive Caro Findlay told The Westport News last week WCH was talking to Health NZ West Coast about making urgent medicines available at local hospitals.

However, WCH's decision document returns to the criticised pharmacy/courier option.

For the first 12 weeks, urgent prescriptions would be filled by Westland Pharmacy and couriered directly to patient's homes on Sunday, WCH said.

Ka Ora would need to lodge urgent prescriptions with the pharmacy by 11.45 am on Sundays.

The courier would pick them up at noon and deliver that afternoon. No opioids would be delivered by the courier.

Routine prescriptions would be sent to the patient's preferred community pharmacy for the patient to pick up on Monday.

WCH would cover all costs related to this service for 12 weeks.

A small group of people would be appointed to review medication supply and identify possible alternatives to the courier system.

The decision document said GP practices would continue to remain on duty to provide death certificates and Last Days of Life Care - but only to their own enrolled patients. Practices could choose to subcontract these services to other providers, with the approval of WCH.

Practices could claim for the services from WCH at the same rates as the Extended Primary and Community Care programme.

The document does not say who would deal with unenrolled patients.

In aged residential care facilities, residents were under nursing care and must have on-call, emergency and medical services provided, the document said. The Aging Well team wanted to know of any residents presenting inappropriately to ED and would follow up with the rest home concerned, the document said.

Lack of consultation

The Association of Salaried Medical Specialists and the New Zealand Nurses Organisation both submitted against the GP clinic cuts.

The discussion document does not address many of their concerns, including the weaknesses of telehealth services, the Coast's lack of broadband coverage or devices for telehealth consultations, and the extra pressure on GP weekday practices.

WCH has not consulted West Coasters on the service cut. It said promotional material explaining the new system had been printed and would be delivered to every Coast home before the weekend of 5/6 October.

A small review group would meet weekly on Tuesdays to review the previous weekend's operations and any complaints.

The new service aimed to ensure: no patient suffered preventable harm because of the weekend clinic closures; broader service failure/closures were avoided and workforce and financial sustainability pressures in primary care were reduced, the decision document said.

The reduced Ka Ora prices for West Coast patients will be:

• Kaiāwhina/care navigators assessment and advice: free
• nurse assessment and advice: free
• GP consultation under 14s: free
• GP consultation 14-65-year-olds: $50
• GP consultation over 65-year-olds or community service card holders: $19.50.