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Waikato After Hours' Medical Services Overhauled

Media information
For immediate release

Date: August 26, 2008

Waikato After Hours' Medical Services Gets An Overhaul

Taumarunui is the latest of Waikato District Health Board's largest rural communities to implement a 'telephone nurse triage service'.

The changes to the delivery of after hours' medical services in the King Country town start on Monday, September 1.

The new model sees people ring their local medical centre between 5pm-8am as they have always done.

But now they will speak to an experienced triage nurse who can quickly assess their ailment, identifying the best course of action over the phone.

The system is also in place in Thames-Coromandel and Tokoroa.

Previously, general practitioners were required to be on-call 24/7, posing a problem in recruiting and retaining GPs in these towns.

"Sustaining after hours primary care services in rural communities has been an issue for many years," said Waikato DHB change manager Grant O'Brien.

"Specifically, these issues are having enough GPs to form a roster and reducing demand for after hours' care, which came as a result of the introduction of low cost access, where many more could afford to go to their doctor during the day.

"We believed that for a number of people, affording the visit to a doctor was difficult, therefore they put up with their illness until it reached a point where they needed to see a GP in the middle of the night."

Mr O'Brien said the introduction of low cost GP access has changed after hours demand.

In some areas, this has reduced from high numbers in a 24-hour period to less than one call-out a night on average.

The Ministry of Health required DHBs to develop sustainable after hours planning and funding strategies. Completion of the Waikato document took place in 2006/07.

"The strategy has a focus of reducing the burden of after hours care on GPs through sharing the load with rural emergency departments," said Mr O'Brien.

"Thus, the establishment of after hours' hubs at our rural hospitals is a major component of the Waikato plan."

Consultation with stakeholder groups took place during many months. These groups included Waikato PHO, St John, rural hospitals' emergency department staff, GPs, nurses and GP spouse representatives.

Consultation of the plan then took place among rural and urban GPs and their communities through the DHB's community health forums.

"The introduction of the telephone nurse triage services has allowed GPs to turn their phones over to this expert service at 5pm each day, rather than take the calls themselves," said Mr O'Brien.

"Telephone triage services are able in most cases to deal with the enquiry on the phone and 80 per cent of calls treated in this way have a standard outcome.

"We are extremely happy with the outcome of this project in both Thames and Tokoroa and believe it will prove its worth in Taumarunui as well."

Mr O'Brien said communication with the communities is important in order for people to know what is happening and ensure the confidence of services will be available when they need them.

"GPs in Tokoroa and Thames are now enjoying peaceful evenings, weekends and quality time off without disruption."

For many, this is the first time in their working lives they have not been burdened by the need to be on-call 24/7.

"We believe this will increase the longevity of many rural GPs and serve as a positive recruitment incentive for attracting new GPs to the Waikato," said Mr O'Brien.

The DHB pays for this tele-service, meaning it is free to users, and the advice people receive over the phone is high quality clinical advice.

GPs in Thames have expressed their gratitude by expressing an interest in working some shifts in Thames Hospital ED.

"This is a great outcome and cements the collaborative relationships we want to develop between the rural hospitals and GPs in these areas," said Mr O'Brien.

With the Thames and Tokoroa hubs now in operation, about 50,000 people are already benefiting from this service.

"Demand on EDs is being monitored and to date, this has been lower than expected."

The telephone nurse triage service is just one project implemented as part of a wider primary care project by Waikato DHB:

* The allocation of an additional $20,000 to the Order of St John appeal hopes to boost St John ambulance volunteers in rural communities. Volunteers are an important part of the rural health infrastructure and dwindling numbers in recent years has threatened the viability of these services

* The 'after hours working group' is considering establishment of further hubs in more rural and remote parts of the region as part of two-year activities, and

* A total of $100,000 of new funding for the eastern seaboard of Coromandel Peninsula in an attempt to support local solutions to after hours care.

Addressing after hours' services in Hamilton city has not escaped the attention of this Waikato DHB strategy either.

"The working group is focussed on ensuring an appropriate service is also available to Hamilton residents and we are looking at the interface between the accident and medical centres and Waikato Hospital ED," said Mr O'Brien.

Implementation of the Waikato plan will take about three years.


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