New model born of town’s troubles: Upskilling nurses, adding paramedics

Coastal Medical’s vision for its new medical centre purchase in the Taranaki town of Stratford, with a population of 9800, is more than a rescue plan.

It’s also a long-term plan to build a new and sustainable rural healthcare model, says specialist GP Nick Lover­idge-Easther, a co-owner and director of Coastal. “We’re trying to establish systems that mean that we’ve got everybody working at the top of their scope,” Dr Loveridge-Easther says. In­cluding employing extended-care par­amedics, physician assistants and training its own nurse practitioners.

On a map the plan creates a triangle linking two coastal Taranaki communi­ties to inland Stratford, with Mt Taranaki sitting in the middle. Coastal already owned Ōpunake Medical Cen­tre and Ōakura Medical Centre, respec­tively – about 35 to 45 minutes’ drive from Stratford.

In July it bought Stratford’s strug­gling Avon Medical Centre, which has about 7500 patients, from Primary Health Care Ltd, a subsidiary of the Pin­nacle GP network and its PHO, Pinnacle Midlands Health Network.

The plan involves expanding the scale of Coastal, creating a more diverse workforce, and converting Avon into a parallel general practice and urgent-care centre. The company wants to build on its ability to attract GPs, and have them able to work across its network, with some virtual support added in.

Difficulties had mounted up for Avon after it had taken on the patients of two sole-GP Stratford practices whose GPs couldn’t find buyers [see panel].

In a recent interview, Pinnacle chief executive Justin Butcher says the sale to Coastal was the result of a “staffing crisis” in Stratford.

Back in May, in a press release an­nouncing Avon’s impending sale to Coastal, Mr Butcher said the clinic’s short-staffing was far from ideal.

“The lack of adequate GP cover car­ries clinical risk, puts huge pressure on the medical centre team, and has led to patients facing long wait times for routine appointments,” he said.

Dr Loveridge-Easther says Coastal’s first task at Avon has been trying to ad­dress the backlog of work.

“That was just from gigantic inboxes of thousands and thousands of results, through to…things like [patients need­ing medical checks for] driver licences that hadn’t been able to be performed and annual clinical reviews that hadn’t been able to be performed.

“We’ve addressed their short-notice booking list which is all their people waiting to be seen, possibly urgently, and we will address all of the backlog in terms of inbox management and that side of things.”

He says Avon was down to 0.6 of a full-time equivalent (FTE) GP on site, with another 0.6 FTE GP working vir­tually from Auckland, plus some very short-term locum support.

“There were days on end where there was no GP on site.”

Unable to be seen at Avon for acute care, patients were turning to an after-hours primary care service in New Plymouth and the hospital emer­gency departments in New Plymouth and Hāwera.

“The chronic condition management has just been left…People have just had medication repeats done, with no clin­ical reviews. The nursing staff have been phenomenal at maintaining the screening and the immunisation side of things, but the clinical workload just hasn’t been able to be serviced.”

Coastal now has Avon up to 2.4 FTE GPs – 1.8 on site and 0.6 FTE virtual.

“We’ve got two nurses on the nurse-practitioner pathway and four on the nurse-prescriber pathway [at Avon].

“We’ve employed two extended-care paramedics who are going to be work­ing out of an acute service that will be set up with Pinnacle’s help from November,” he says.

“Beyond that, we’ve got about three GPs, long-term locums, lined up [to ar­rive in] three or four months; they are coming for 12-month to three-year con­tracts. We’re bringing over a physician assistant and maybe [a second one] from the United States.”

Coastal hasn’t had physician assis­tants before but has discussed them with practices that have, and which found them very useful. Dr Lover­idge-Easther anticipates physician as­sistants will become mainstream and will help to address the struggle to find “sustainable GP options”.

Avon hasn’t been able to start enroll­ing new patients yet, but hopes to by the end of the year, after more new cli­nicians have arrived and the new mod­el of care begins to be established.

GPs will be able to focus on complex long-term conditions and do some sub­specialty work, while the urgent-care stream will cater for the needs of walk-in acute patients.

Coastal hopes to have an urgent-care contract with ACC eventually, and that will necessitate having an urgent-care Fellow. But the initial plan is to run the urgent-care stream under a rural ACC contract.

Dr Loveridge-Easther says the steps that led to Coastal’s purchase of Avon Medical Centre began with its being able to provide locum support. Coastal has been relatively successful in attract­ing GPs, partly because Ōpunake, and especially Ōakura, are desirable beach­side places to live. Staff numbers were sufficient last year to be able to help when Pinnacle asked for some locum support at Avon.

Coastal’s links with Avon grew and the company noticed the clinic’s good facilities, owned by a supportive trust, and its very experienced and capable nursing and administration teams.

Stratford mayor Neil Volzke says the district benefited from having a stable medical workforce for decades, with some GPs devoting virtually their whole working lives to the area. It was only in recent years that GPs had regu­larly come and gone.

He had been fielding daily enquiries from residents frustrated at not being able to get a routine medical appoint­ment. Coastal’s arrival has brought enormous relief.

“They have been a breath of fresh air; they brought a huge energy to the ser­vice they provide and they worked ex­tremely hard to clear the backlog of work. Over the next 12 months I’m looking forward to the improvements they will make.”