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Rural people at risk from failing health services

Monday, 27 November 2000

Dr Ralph Wiles Chairperson

Rural people at risk from failing health services, GPs say

People living in rural areas, and even those in some provincial towns, are now “at very real risk from inadequate health services and grossly overworked general practice staff,” warns the Royal NZ College of General Practitioners.

“The situation in Kaitaia (which may fall to five GPs when it should have 15, and where the largest surgery is about to close) is merely the most extreme so far,” says College Chairperson Dr Ralph Wiles. “Rural GPs have been signalling for years that they are burning out, simply because there are not enough of them. It’s not uncommon to have a situation where one doctor is doing the work of three or four, unable to have a holiday and, equally importantly, unable to spare the time to continue their medical education, which is vital to maintain their competence.

“Many rural and provincial GPs know that when they come to the end of their time in their current practice, they will be unable to sell. Insufficient numbers want to enter rural general practice because the situation in those areas is well known… so the result is a self-perpetuating spiral where fewer and fewer newly qualified doctors are going to work in rural and provincial areas and those who remain are placed under increased pressure. It’s even more alarming when similar problems are beginning to be observed in some urban areas.

“Something has to give, and inevitably patient safety will be compromised,” Dr Wiles predicts. “Doctors want to be able to give good, safe service, and would rather walk away than fail to do so. It’s not an issue that can wait for the Minister of Health’s Workforce Advisory Committee to consider once it’s formed next year. It must be addressed now. In the immediate term, support needs to be offered to GPs doing unsafe levels of on call work. That might be a salaried rural locum service, it might be incentives to newly qualified doctors to choose to locum in rural areas, it might be community ownership of facilities – there are any number of options, and these need to be explored with local communities. Innovation and new ideas should be encouraged.”

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However the College cautioned against filling the gaps with substandard care. “Fast-tracking the process for approving the qualifications of doctors who have trained overseas and whose training may not meet the same standards as applying to New Zealand-trained doctors is not the answer,” Dr Wiles cautioned. “Rural communities need to be served by health professionals of the same quality, including cultural understanding, as are urban communities. The urgency of the problem does not mean it justifies the creation of a ‘two tier’ health system.

“In the longer term, however, a comprehensive rural primary care strategy must be implemented. That starts with the government funding a sufficient number of training places, and finding a way of ensuring that a percentage of graduates choose rural or provincial practice. At the same time, the government must work with communities to address issues of retention and working conditions.

“Doctors and practice staff are struggling to provide quality medical care to their rural and provincial patients, and are signaling they need help. If those signals are ignored, it will be the government which is culpable for the outcome,” Dr Wiles said.


Contact: Dr Ralph Wiles (07) 886-5239 or (021) 658-564 or: Rex Widerstrom (04) 496-5962 or (025) 549-637

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