Wednesday, December 6, 2023

Rural health at point of collapse, says network chair

Neal Wallace
Services struggling with a shortage of doctors and lack of access to diagnostic services.
In some cases it is impossible for people to register with the general practice when they move to a rural area.
Reading Time: 3 minutes

Rural health services are collapsing, the body representing the sector warns.

“It is not too dramatic to say we are seeing a collapse of health services in rural areas,” Fiona Bolden, Hauora Taiwhenua Rural Health Network chair and a general practitioner at Whangamatā said.

Bolden said the rural services are struggling with a shortage of health professionals, an ageing workforce and a lack of access to diagnostic services.

In addition, rural health providers are struggling to provide emergency and afterhours care, the management of complex health conditions, rural hospitals are under pressure and access to diagnostic services is limited.

She said recent workforce surveys by the Royal College of GPs confirm the network’s concerns.

They reveal that the median age of all GPs is 52 with 14% over 65, of whom a disproportionate number work in rural practices.

Overall, a third of GPs intend to retire within five years and 50% within 10 years, but that metric is more stark in rural areas, where 46% of Northland GPs and 57% in South Canterbury intend retiring within five years.

“In some areas it is impossible for people to register with the general practice when they move to a rural area,” Bolden said.

Four in five rural doctors say they have suffered burnout to some degree.

The rural sector relies heavily on foreign-trained GPs, with 83% gaining their first medical degree overseas compared to 35% of those working in urban practices.

The lack of GP cover is leading to afterhours care being unavailable in some rural areas, requiring patients to travel to a hospital.

Bolden said few young people are training to be GPs with even fewer intending to move to rural practices.

Overseas evidence is that those raised in rural areas and exposed to rural health services while training are more likely to return there to work.

“It’s about the whole pipeline and it goes back to school and exposing rural pupils to science and encouraging them to pursue careers in health.”

Solutions are complex and not solely the domain of the government.

The network visits rural schools to promote health sector careers but Bolden said those efforts would benefit from support such as scholarships and placements in rural practices and hospitals.

“That is crucial.”

Effort is also needed to improve working conditions and payrates.

Rural patients tend to be older with multiple complex health problems but Bolden said the capitation payment does not fund the length of consultation required.

A resolution to afterhours care is also needed.

The network is working with groups to find solutions but said Health NZ (Te Whatu Ora) reforms are diverting the attention of officials, and staff churn means they are constantly having to brief new staff on issues.

Solving this issue is crucial for the New Zealand economy.

“Rural healthcare is fundamental for rural NZ and if it is lost, then we will not have people living in rural communities or working in rural industry.”

Health Minister Dr Ayesha Verrall said finding solutions to the challenges facing rural health providers is a priority within the interim NZ Health Plan.

“Initiatives are underway, including rural-specific funding for GPs, recruitment support, rural sustainability funding, and other wider workforce support options,” she said.

These include a Rural Health strategy to address failings within the medical education system resulting in workforce shortages in rural areas, a voluntary bonding scheme and financial incentives for GP trainees who take up rural training placements.

Verrall said in a statement that she is aware of burnout issues.

“Workforce is a one of my top three focuses, along with winter and reducing waitlists.”

That includes attracting foreign GPs, increasing to 300 a year the number of GPs trained by 2026, increasing salaries for GP Registrars and a financial incentive for general practices that offer community-based attachments for post-graduate year 1 and 2 doctors from 2023.

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