After Hours Medical Care Denied to Increasing Numbers of New Zealanders

An ambulace outside a NZ emergency department. Courtesy CCDHB.

Porirua is a city of 62,400 people, just north of New Zealand’s capital, Wellington. While it once had a reputation as a lower socioeconomic area, comprised mostly of Polynesian and Māori families on low incomes or benefits, in the past few decades it’s managed to shed that image. Its median earnings of $70,092 (in the year to March 2023) were still lower than for the whole of New Zealand ($74,754), but grew by eight percent over the previous year.

But those raw figures mask a significant disparity. The city still has more beneficiaries per capita than the New Zealand average. Significantly, the population scores far lower on a range of health indicators, from life expectancy (25.9/100 versus 44.4/100) to road fatalities (95.2 versus 78.6).

But now, health officials are considering replacing the overnight doctor at the city’s only hospital—Kenepuru—with a telehealth service. Anyone advised to seek medical attention would then face a 25-kilometre drive to either Wellington or Lower Hutt hospitals—assuming they have a car.

A medical centre owned and run by the local Māori iwi (tribe), Ngāti Toa, already covers Thursday nights and the weekends. It’s chief executive, Helmut Modlik, said it could provide the doctors needed to cover the rest of the week, but only if Health New Zealand paid them.

“It’s just signalling to them and everybody else in our community that we just cannot accept that there will be a stepping back from making those services available,” he said.

Closures and Cutbacks a National issue

Porirua is far from the only place with an after-hours medical service that’s struggling to remain open in the face of GP shortages and funding constraints.

Further north is the small town of Greytown. It has a brand new medical centre, but can’t find a doctor to run it. It’s been struggling for almost nine months to recruit a GP to care for a population of 3,000 to 5,000. Currently, people are being seen by three nurse practitioners, but some have to travel to other towns. The only night GP service between Whangārei and Auckland’s North Shore closed in March, leaving an entire region without after hours care.

Executive Director of the Association of Salaried Medical Specialists, Sarah Dalton, said the same thing was happening in other regions.

“What is a reasonable level of public health provision, given that we know that people don’t always get acutely unwell or deteriorate quickly between the hours of 8 a.m. and 5 p.m.?” she asked.

The Cahir of General Practice New Zealand—Porirua GP Bryan Betty—said patient care would invariably suffer.

“It does lead to problems in terms of late presentations and presentations to emergency departments which puts pressures on already overstretched services.”

Documents obtained under the Official Information Act show that 24 practices had to reduce hours or close their doors due to critical staff shortages and cost pressures in the first eight months of 2023, reported RNZ. In the 13 months to August, urgent care clinics in Auckland were forced to close early nearly 200 times due to staff shortages.

Health New Zealand said it was planning to look at urgent care as part of the wider primary care sector and pointed out that a range of telehealth services were available. Any patient in need of urgent treatment could always visit a hospital emergency department, a spokesperson said.