19

WHO YOU

GONNA

CALL?

Predicted critical shortages of family doctors

are revolutionising primary healthcare.

Is general practice terminally ill or can it

be saved? Donna Chisholm reports.

GET

TY (^) I
MA
GES
AUGUST 10 2019 LISTENER

I

n the waiting room of Health Te

Aroha, just off the rural North Island

town’s main drag at the base of its

famous mountain, a push-button

feedback machine is a metaphor for

the changing power base in primary

care. Where once patients might have

gritted their teeth through lengthy

waits alongside the children’s toy box and

water cooler before a rushed 15-minute

appointment, now they can tell their doc-

tors, anonymously, what they really think

by pushing the sad or smiley face button

on the “Happy or Not” machine on their

way out.

Four hundred patients a week are having

their say, and as one of the practice’s four

GPs, Dr Hayley Scott, examines the previ-

ous fortnight’s results on a midwinter day

when the Listener visits, she’s troubled. The

satisfaction ratings have fallen from their

usual 97% to about 77%, with one unprec-

edented dip to 64%. Within a day or two,

Scott has called a meeting in the town’s

theatre for early August, between the doc-

tors, their patient-focus group and locals,

5400 of whom rely on the practice for their

primary healthcare, to find the cause of their

discontent and how to address it.

Te Aroha was one of the first general prac-

tices in the country to adopt a new model of

patient care designed to make better use of

GP time, give patients alternatives to face-to-

face consultations yet better access to their

doctors and health records, and to ensure

the sickest patients are seen first. It’s turn-

ing the traditional patient interaction with

general practice – phone up in the morning

to make an appointment, see the doctor the

same day – into something its supporters say

will future-proof access to primary care in

the face of looming doctor shortages, par-

ticularly in poorer and rural areas.

Now, patients who ask for a same-day

visit will get a call back from their doctor to

talk about why they need the appointment,

whether they can get advice by phone, be

seen less urgently or seen by a nurse. It’s called

triaging – the sort of thing that happens in

hospital emergency departments – and it’s

being credited for doctors rescheduling

20-30% of same-day bookings.

Before triaging, Scott says, she was rou-

tinely seeing patients who didn’t need to be

seen in person, but were taking up the time

that could have been given to much sicker

people. Te Aroha had big problems attract-

ing GPs. The local doctors were “120%

booked” and seeing about 28 patients a day

each. Now, they’re down to about 20 a day,

appointments tend to be longer if required,

they have better work-life balance and their

income hasn’t dramatically fallen.

The recent blip in patient dissatisfaction

may be the result of doctor sickness causing

longer waits. In the past, though, not only

would the practice have been oblivious to

the complaint, but also it wouldn’t have

been able to do a lot about it. “Now, we say

it’s not about the doctor. If the patient is

having this problem, we need to fix it. We

can reschedule people who aren’t urgent

and deal with it in a different way.”

For patients such as Eileen Joyce, 69, the

changes have been transformative. “It used

to be quite regimented, very formal. You’d

make an appointment to see the doctor

and that was it. Coming in to see them was

the only way you could have contact with

them.”

Now, through an online portal for

patients, Joyce can read her notes, check

“It’s been amazing.

I like to know what’s

going on and now I’m so

much more aware. It’s

no longer a case of the

doctor is the boss and

they tell you what to do.”