Napier medical centre issues warning as sector hits breaking point

A Napier medical centre has warned there is "significant risk" its ability to fulfil its after-hours commitments may be reduced as pressure continues to mount in the healthcare sector.

The Tamatea Medical Centre issued a section 14 alert to its management and the Government days out from the Easter break, according to an email obtained by 1News.

The section 14 alert – a legal, formal step providers are contractually obligated to take if they become aware of any significant issues – was sent out on March 27.

Tamatea Medical is one of a number in the area that's required to help staff a separate clinic that operates after-hours healthcare. But the centre's practice manager Wayne Walford said with a roster that's about two to three doctors short, it's proving difficult to do.

"It's onerous for us at the moment," he said. "We are also trying to work at our practice, minimise the wait for patients, and when they (doctors) have to do hours outside their usual clinic time. It puts pressure on them."

While things came to a head in the days before Easter, Walford said the lack of staff is a long-standing issue. He's been looking for new doctors since early last year, but the hunt has proved fruitless.

Currently, no decision has been made, but when asked if he might need to pull back on providing staff to the after-hours service, he replied, "possibly".

"It'll depend on the work the doctors have to do in the coming months, where we sit with that, and if we will have to start making strategic decisions about our sustainability."

The situation is just the latest example of how the health sector is struggling with a chronic lack of nurses and doctors.

General Practice Owners Association (GenPro) chairman Dr Angus Chambers said that's helped drive a reduction in the facilities that can provide healthcare after hours.

"Seems to be generally services are in decline and getting harder and harder to maintain," he said.

Recent examples he cited included Invercargill After Hours that closed this month due to what it described as a lack of funding and an inability to keep up with the workloads. Another clinic in Palmerston North closed last year for similar reasons.

Chambers said holiday weekends like Easter can simply add pressure on an already "fragile system".

"All it takes is for one person to get sick and things get sticky."

He said across the advocacy group's members there seems to be a rise in those who have issued a section 14 because of similar staffing issues.

"The situation in family doctor services is getting more challenging. Services are struggling to find staff to operate, and they are also struggling to be competitive in what they are able to afford to pay staff due to ongoing underfunding."

In Auckland, GenPro Deputy chairwoman Dr Stephanie Taylor said after-hours facilities are already struggling to get through high caseloads and patients this weekend could face waits of more than six hours.

"Obviously if people need care, that will be provided. But there will be long waits."

While she acknowledged there are financial constraints in the current climate, Taylor said appropriate funding is vital for both the sector and patients.

"We're the people that patients have seen the most often, so anything we can do to improve that workforce is beneficial for the whole country."

While emergency departments are an option after hours, patients can often face lengthy wait-times. Both Dr Chambers and Dr Taylor said it's better to have the opportunity to treat patients before they get too sick, as that can save lives, but also save the health system costs.

Healthline is also another free option for staff with any health concerns and is open 24 hours a day, seven days a week.

In a statement Health New Zealand / Te Whatu Ora's national director commissioning health, Abbe Anderson, acknowledged the vital role general practice plays in the healthcare system.

She said the organisation was aware of the section 14 notification issued by Tamatea Medical Centre, but that the funding relationship for the after-hours service was between the practice and its Primary Health Organisation – Health Hawke's Bay.

Anderson added a recent review of primary care led to a rapid cash injection of $17 million per year into urgent care services across the country.

Health Hawke's Bay chief executive officer Irihāpeti Mahuika said the situation at the Napier clinic is symbolic of the workforce shortages and pressures on primary care.

Mahuika said the model that requires the clinic to provide after-hours staff is "outdated" and has led to these kinds of pressures and issues.

The region is working on better utilising telehealth services to help ease some of that pressure, she said, as well as working with Te Whatu Ora to look at how the after-hours issues can be better managed.