It has certainly been a very busy time of late with the latest lockdown. Recent advice from both Ministry of Health, and the Royal New Zealand College of GPs, is that as health professions, we need to continue to deliver healthcare in a different way. We have been encouraged to continue –

• Offering where possible telehealth – while many patients want to see their doctor ‘in the flesh’, if your symptoms can be managed without coming into the clinic and being exposed to other potential illness, this should remain an option for you;
• Physical distancing within the clinic – we are staggering appointment times for face-to-face (in-clinic) appointments to minimise the number of people in the clinic at any time;
• Separating patients that have flu-like (respiratory) symptoms & illnesses from those that do not. Answering ‘yes’ to any of our screening questions does not mean you cannot come in, it just allows us to manage the best care pathway and timing for you, so that we can continue to minimise any risk; and
• Ensuring masks are used while patients are in the clinic – please do not be offended if our staff ask you to wear a mask, even if you are not feeling unwell.

Please – do not come into the clinic unless you have to.

Getting access to healthcare in NZ is becoming increasingly difficult. Demand is rapidly outstripping supply. New Zealand GP practices have had to look long and hard at how we deliver healthcare to our communities. There is a national shortage of doctors, and Kapiti seems to be one of the hardest hit areas.  COVID has also added a further layer of difficulty to how we operate.

We are now embarking on the final phase of our planned transformation into a Healthcare Home (HCH) practice. This has slowly been happening for the last 4 years. The object is to improve access to care.

We often hear our community say that if you cannot get an appointment for something non-urgent, then what happens when they suddenly become unwell. Under HCH there are different booking pathways for urgent (or unplanned care), and planned care.

We acknowledge that in the last two years, getting a routine/non urgent appointment with your preferred GP has been challenging. There are many reasons for that: COVID, doctor shortages (and inability to recruit new doctors from abroad) and an ever-increasing level of demand as our population ages and grows.

We also recognize that trying to fit everything into a 15-minute consultation time is not a good fit for everyone – it is not safe for patients or staff.

Over the last two years we have attempted to recruit doctors from New Zealand and from overseas. We have been successful to some degree, but we still do not have enough doctors for our patient base of more than 10 000. Our current doctors are working more hours than what is safe, and are at serious risk of burn-out. The hours currently worked by our GP owners would not be allowed at DHB level.

We recently consulted with other practices that have gone through the same challenges, one in Palmerston North and another in the Wairarapa, also with large patient populations.

They found that splitting their clinical team into workgroups, or pods significantly improved access for their patients to clinical services. While patients are still registered with their preferred GP, some services may be delivered by others in the pod.

It is a reality that some of our doctors work part-time, and even a full-time doctor has at least one day (equivalent) off each week. We also need to cover for sick and annual leave. This adds a further workload across our doctors, as many times those who are covering have no background around the patients they are caring for.

We have now implemented a similar system, where we will have three pods. Each pod will have a lead GP with a number of other GPs, and our locum doctors, nurse practitioners and nurses will work across all of the pods, providing support where required. Our aim is to provide more accessibility, and more continuity of care across a smaller team of doctors.

The workgroups/pods are:

This system will not limit your ability to book with another doctor that may have a special interest.

Telephone assessment for requests for appointments on the-day will be managed by the pod should your GP not be available.

The most significant benefit to the pod structure relates to planned care. Did you know that over 40% of our patients are living with one or more chronic medical conditions that needs regular review (this includes a repeat prescription) and currently these patients are taking up about 70% of our GP appointments? With the pod structure –

• We are implementing specialty clinics for conditions like diabetes, cardiac and heart disease, COPD, etc. These clinics may involve seeing your doctor, or a combination of a doctor and nurse, or they may be nurse-led or in the form of a shared medical appointments (SMA). If you have more than one medical condition, you may be required to come to different clinics;
• We are reviewing each patient’s medical history to develop an annual careplan, outlining when they will be needing review, what that review looks like, and who will be involved;
• Where possible we will be pre-booking appointments at least 3 months ahead for medication and assessments relating to specific medical conditions;
• We will be proactively arranging for any tests required prior to your review appointments

We will start these clinics over the coming months – if you are affected, we will be in touch soon.