Rural communities around New Zealand will soon have access to overnight GP appointments as Te Whatu Ora rolls a new telehealth primary care service.
Ka Ora – the provider contracted to carry out the work – has already partnered with 20 general practices but says it’s working hard to on-board as many as possible before the holiday season.
The initiative is specifically aimed at supporting rural health staff and improving access for patients living rurally, but it’s likely to create benefits for the rest of the health system, too.
However, one rural health leader said telehealth won’t be the silver bullet to fix New Zealand’s rural health workforce shortages.
Ka Ora Telecare is a partnership between three well-established telehealth providers: Reach Aotearoa, Practice Plus and Emergency Consult.
General manager Jess White says it's important for practices to know that they aren’t there to take patients, but to support practices by creating extra capacity.
Her team are working hard to create trust with GPs and help them understand their role, she says, adding that besides overnight support, Ka Ora could also take on overflow patients during usual hours and help unenrolled or casual patients.
Many Ka Ora staff work day jobs within the public system and do top-up shifts with the service, which means workforce resources can be distributed or shared across the country.
Jess says that patients could either phone an 0800 number or their GP – in which case the call would be forwarded to the service.
They would be greeted by a kaiāwhina to gather personal information, like where they are from, before being triaged by a nurse, who would decide if a video or telephone consultation is necessary, she says.
The service is subsidised by Te Whatu Ora and nurse consultations are free, but a co-payment will be charged for GP consultations.
Between 10pm and 8am, when patient acuity is usually higher, patients will be put straight through to the nurse.
Ka Ora will be connected to practice systems to access patient records, so the experience should be like speaking to another doctor from your practice.
South Taranaki Rural Health General Practice GP Dr Chris Heatherton says the initiative could potentially make a “huge difference” for rural doctors.
Many practices have had to close their books because they simply don’t have the staff to take on new patients.
Chris’ practice has started the onboarding process.
He anticipates Ka Ora will be especially beneficial for patients whose ailments are not serious enough to warrant a trip to the emergency department, but need advice or reassurance outside of practice hours.
Most ED physicians say a lot of the work they do after hours could be handled in primary care, says Chris.
GPs didn’t always have relationships with ED doctors, but they will be able to build them with Ka Ora doctors, which will give patients continuity of care, he says.
Originally from the United States, Chris believes this is an innovative approach to supporting rural communities that he hasn’t seen before.
“It should be recognised for what it is, which is quite ambitious.”
Gore Health chief executive Karl Metzler welcomes the initiative but says its success will come down to access to a patient’s records.
“We’ve used virtual access to doctors over the years with varying success,” he said, adding that the service would be particularly welcomed in remote, isolated practices.
However, connectivity in these areas could be a barrier, Karl says, adding that this is even a problem in parts of Eastern Southland where internet networks were antiquated.
He believes that serious work is needed to strengthen New Zealand’s health workforce.
“All too often we try to solve a workforce crisis with technology,” he says, “We need to be more strategic.”
Pointing to the “enormous pressure” on primary care, Karl says: “Anything that can be part of a solution and enable better access is a good thing.”
Te Whatu Ora’s national clinical director of primary and community care Dr Sarah Clarke acknowledges the workforce shortages around the country and globally.
“Any capacity we can put in to support people living rurally, and the rural workforce is exciting.”
Access to after-hour care for rural communities was variable across the motu, Sarah says, and “part of the value of Te Whatu Ora is understanding the variations and what’s planned and reasonable and what’s consequential.”
This is an exciting first step towards creating equitable access to healthcare for rural people, she says.