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Joanne Carroll / Things
Greymouth’s new hospital opened in 2019.
Changes in the medical workforce on the West Coast will put patients at risk and reduce their access to specialty care, says the physicians union.
The warning comes from the Association of Salaried Medical Specialists (ASMS) when the West Coast District Board of Health (DHB) begins implementing a staffing model known as rural generalism.
The DHB announced the move earlier this year, saying it would allow physicians with additional training to work flexibly in hospitals on the West Coast and in GP clinics in the region.
That would reduce the board’s costly reliance on locums and provide much-needed continuity of care in cities like Reefton, the board said.
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But the documents show that only one of the four rural general practitioners being hired is fully focused on general practice and the model eliminates Coast-based medical specialists.
One position is that of women’s and children’s health, with extensive training in obstetrics; one is for inpatient and rehab at Greymouth Te Nikau Hospital with some GP jobs; a third is for acute care (ED) with training in anesthetics; and one is for a rural primary care physician, who supports Buller, South Westland, Reefton, and nursing homes.
Supplied
The executive director of the Association of Salaried Medical Specialists, Sarah Dalton, says that both rural generalists and hospital specialists are needed on the West Coast.
Under the proposal, obstetrics, gynecology, internal medicine and anesthetics will become part of the “transalpine” departments of the Canterbury DHB.
All three areas will be served by rural generalists with some specialized training in each field, and the specialists will be “transalpine in nature,” meaning they will be based in Christchurch.
The Greymouth emergency department will have rural general practitioners who will also work in other areas, such as anesthesia and obstetrics.
According to the proposal, general medicine and primary care “lie at the heart” of the rural generalism model.
But it does not go so far as to guarantee a solution for GP problems in the region.
“According to the proposed model, there should be a greater capacity for primary care coverage than currently exists, including support for rural clinics.”
Rural generalism will provide the coast with a stronger public health system, with a workforce that can “flex” from primary to secondary care, the DHB said.
“At a time when it is more important than ever to ensure that we use resources in the most effective way possible and are accountable for how they are allocated, it is imperative that we embrace this model that … distributes healthcare resources to where they are. most needy. “
CHRISTEL YARDLEY / Stuff.co.nz
Flinders University Professor Paul Worley, dean of the School of Medicine, said a graduate medical program has proven valuable in filling rural physician vacancies. (Video first published June 2017)
The comments from the ASMS, which represents seasoned physicians, were scathing.
“These are weasel words,” a union representative replied, “basically this paragraph lets the cat out of the bag. The proposal has to do with money. “
ASMS had supported the rural generalism strategy, but said it was supposed to support specialized services on the Coast, not replace them.
Of particular concern was the loss of in-house specialists from the obstetrics and anesthesia departments.
“This will leave coastal women without access to specialized obstetric and gynecological services … this diminishes their equity in medical care compared to women in cities.”
Some rural generalists with obstetric training were highly qualified, but could not provide gynecological services and were not specialists, the union said.
The same applies to those who completed a JCCA qualification, a 12-month course in anesthetics.
The JCCA did not allow anesthetics to be administered to children or adults at risk, the union said.
“This proposal sees a great clinical risk for those patients in an acute situation. It is a serious degradation of equity in adequate and safe health care for coastal children and vulnerable adults.
ASMS Executive Director Sarah Dalton said the union wanted a system that would provide access to equitable care for West Coasters and, more importantly, continuity of care in primary settings.
“While we accept that some specialty services will remain in Christchurch and some will involve Christchurch’s support, we cannot support a model that sees rural generalists versus hospital specialists in one setting or the other. There is a need for both. “
DHB has begun consulting staff whose jobs will be affected by the proposed changes.
