Specialist GP Nikki Vadgama provides some tips to make your next paediatric eczema consult easier. She includes a review of new guidelines, resources, websites and medications for paediatric eczema management
New model born of town’s troubles: Upskilling nurses, adding paramedics
New model born of town’s troubles: Upskilling nurses, adding paramedics
![Coastal Medical Ltd Gps.jpg](/sites/default/files/styles/cropped_image_16_7_/public/2022-09/Coastal%20Medical%20Ltd%20GPs.jpg?itok=axMktBxf)
Here at New Zealand Doctor Rata Aotearoa we are on our summer break! While we're gone, check out Summer Hiatus: Stories we think deserve to be read again! This article was first published on 26 October.
Chosen by Martin Johnston: Stratford in Taranaki is inhaling a fresh breath of medical air. GP-entrepreneurs from a practice elsewhere in the region are implementing a medical centre rescue plan in the town and building what they will hope will be a sustainable rural healthcare model
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.”
Stratford in central Taranaki has lost two solo medical practices in a little over five years.
Specialist GP Manmohan Singh, in 2017, sold his practice to Primary Health Care Ltd (PHCL), a subsidiary of the Pinnacle primary health network that includes Pinnacle Midlands Health Network PHO. The clinic’s patient register was transferred to the town’s Avon Medical Centre, already owned by PHCL.
The company last year bought specialist GP Gerard Radich’s sole-practitioner clinic. By the time he retired several months later, a replacement for him hadn’t been found. The practice was merged with Avon.
Stratford has one other general practice, Regan Street Health Centre, where specialist GP Albertus Jordaan is the sole doctor.
Specialist GP Nick Loveridge- Easther, co-owner of Coastal Medical that now owns Avon, says Pinnacle stepped in when Drs Singh and Radich couldn’t find buyers.
He says the merging of Dr Radich’s clinic left Avon with an unsustainably high workload, making it difficult for Stratford to attract and retain GPs.
PHCL, which began in 2006, currently owns 13 practices. Former Pinnacle chief executive Helen Parker says PHCL came into being to buy a Waihi Beach practice whose owner couldn’t find a buyer.
“Pinnacle didn’t want to see that community without a practice so bought it. It’s an option for Pinnacle members who are owners – an option for sale if they can’t find another buyer or can’t find another buyer that they want to sell to.”