Choose well - the right care in the right place

15 October 2017

Tui is a 21-year-old first-time mum. Her 10-month-old son has been grizzly all night and he has a rash under his nappy. Tui rings her GP for an appointment.

Mary is a busy mother who works full-time and loses money if she takes time off work. Her seven-year-old daughter Arihia has a sore throat. After work, Mary takes Arihia to ED to get it checked. 

Lance is a 25-year-old rugby player who injures his leg at Rugby practice. After practice, he drives to ED to get it looked at. It is a busy night and so he is in for a long wait.

Waiting rooms at GP practices across Tairāwhiti have been full for months, the Emergency Department (ED) is seeing record numbers of people presenting and finding a bed at Gisborne Hospital can be a real challenge some days.

For many people working in the frontline of health, the pressure has been described as unrelenting.

A group has been meeting since February to look at ways this increasing demand for health services can be met. The Managing Demand Group aims to ensure that people like Tui, Mary and Lance get the right care at the right time in the right place.

The group is led by Three Rivers GP Dr Fergus Aitcheson and includes representatives from all local GP Practices, St John, ED and the Hauora Tairāwhiti Planning and Funding Team.

If demand continues to increase, resourcing will have to increase to meet it says Fergus. “We all want to see people getting care closer to home and often that means at their family doctor. Yet if the number of people presenting at ED continues to grow that is where the resourcing ends up even though people who are not acutely unwell would get more comprehensive care elsewhere.”

“Analysis of trends shows there is a real spike in young people visiting ED in the evenings (4pm – 10pm) even though it is free to see their family GP if they are under-13 at anytime or day.

Is this spike due to cost, convenience or something else? What are the driving factors for Tairāwhiti people accessing ED for non-emergencies? To better understand these, the group has commissioned a short-term research project.”

We are looking for solutions throughout the whole health system. Nurse services in schools, pharmacies, and physiotherapist-led intervention for minor injuries, all have a part to play. There has also been discussion around non-urgent ambulance callouts; there are up to five per week. With clear guidelines, these could be redirected to General Practice rather than ED.

“We are looking at new pathways for care particularly around people who are ‘frequent flyers’ at ED. These people are often very unwell but with the right planning and package of free primary care in place - these people may be able to avoid ED altogether and have better health.”

We are working on a publicity campaign to encourage people to “choose well”. By choosing the Tairāwhiti health care service that’s most appropriate to their symptoms means people get the right treatment in the right place.

By ‘choosing well’ Tui could have seen her local pharmacist. Mary could have had her child’s throat swabbed for free by a nurse at her GP Practice and Lance could have seen either a Physio or GP after hours.