Werewolf report by Gordon Campbell
Earlier this year I happened to overhear an elderly woman talking to the receptionist at the Newtown Medical Centre in Wellington. Since the woman had just moved to Newtown, she said she’d now like to sign up, and switch her care to a local doctor. Sorry, the receptionist said, we’re full up – so much so that the Centre hadn’t been operating a waiting list for the past eight months.
The receptionist offered a helpline number instead. “Oh well,” the elderly woman said philosophically, “ so long as I’m still healthy enough to get on the bus over to Khandallah, I suppose I can keep on seeing the doctor I had over there.”
The incident was troubling. Surely, someone so frail should be being cared for locally. The known health benefits of continuity of care – as this woman gets older – mean that when her health deteriorates, she should be already settled in at Newtown, and not still trying to bus across town to Khandallah in winter for primary care.
She is not alone in this respect. Newtown has a low income, ethnically diverse and transient population with a relatively high number of migrants and students. If they didn’t have ready access to GP care, where were they going – to the local hospital’s accident and emergency department, given that the nearby after hours clinic would almost certainly be too costly to afford?
The known reality is that if people are denied ready and regular access to primary care, they will be forced into deferring treatment until their condition worsens, and then forced by an emergency to take themselves or their family members to clinics they can’t afford.
The Newtown situation comes on top of substantial funding cuts by Capital Coast and Health DHB to the low income Newtown Union Health Service, a decision that has already resulted in the sacking of the team that provided obstetric care to (a) the suburb’s substantial refugee population, and (b) to those local residents coping with special needs arising from poverty and addiction.
At a wider level, New Zealand’s health strategy is supposed to be based on primary (ie GP-based) care, and on its integration with other health services – although for obvious reasons, the primary care system seems driven as much by the profit margins of the providers, as by patient need. For demographic reasons, the GP workload is set to increase. Our population is ageing and the early detection (and treatment) of chronic conditions at GP level is becoming the chosen path for a health system that is chronically short of funds. So much so that the early stages of cancer treatment appear likely to be devolved to GPs, and paid for by their patients. In its early stages at least, cancer is going to become more and more of a user pays disease.( See “General Practices To Take On Cancer Care” NZ Doctor magazine, 29 August 2012.)
At the same time, core government policies are based on the assumption that access to primary health care is readily available to all. Come next July for instance, the next stage of the government’s welfare reforms will – at least nominally – require beneficiaries to ensure their children undergo a series of quarterly childhood health checks with doctors, thereby putting additional strain onto GP workloads, and onto the existing primary care system as a whole.
So far, this issue has been debated largely in terms of affordability to patients – but what about the barrier of GP availability?
The Newtown incident made me curious about just how widespread the problem of GP availability and closed waiting lists at medical practices may be. Initial research indicated that in some parts of the country, the problem has existed for some time.
Read Gordon Campbell’s full Werewolf report here