A pearl of a service for weary staff in rural practices

Just four days into New Zealand’s first national lockdown in the 2020 COVID-19 pandemic, the idea for PERL was born.

It was quickly recognised that COVID-19 would require extra support systems for the stretched rural health workforce – especially if the infection reached rural communities, says Linda Reynolds, general manager membership and services at the New Zealand Rural General Practice Network.

Ms Reynolds says there was an immediate response from the Ministry of Health.

The network, the RNZCGP, General Practice New Zealand, the NZMA and the ministry had met to discuss key issues for the sector during the COVID-19 pandemic.

As swabbing and telehealth consultations started to become the norm, it was recognised the pandemic was only going to add to the workloads of rural practices already under significant pressure, she says.

So the idea behind a new service – Pandemic Emergency Roving Locums, or PERL, was to deliver locum relief to practices affected.

The ministry was on board from the get-go and could see the sense in being prepared and having a workforce ready to provide support, says Ms Reynolds.

“The whole time, they were really responsive and there was such a quick turnaround. It was a really good experience, a good relationship – they were listening to what we were saying.”

PERL was set up within a week of those early discussions.

Rural network chief executive Grant Davidson says practices were eligible to apply for two to three weeks of locum support, if they could show they had been affected by COVID-19 in ways such as short-staffing and burnout.

The $1.5 million contract provided by the ministry covered all costs for the locums, including transport, accommodation and their time spent in the practice.

“The support was massive – it was a complete stress relief for those practices to not have to worry about the financial side of things,” Dr Davidson says.

Once the contract was in place, the real work began.

The network first identified practices it considered to be more vulnerable to the stressors of the COVID-19 pandemic – typically those with three or fewer full-time-equivalent staff members, and those in remote locations.

In the end, contact was made with almost every rural practice, with a combination of emails and phone calls from the network’s two relationship managers.

For many practices where staff had been burning the candle at both ends, this huge workload translated into burnout a few weeks later. The requests for help only grew when New Zealand made it out of lockdown.

Ms Reynolds says practices were reporting they had coped with COVID, but saying they had not had a rest and their teams needed a break.

“So we were able to continue using that funding to allow them to take a much-needed break.”

The contract provided multidisciplinary locum relief across primary care, meaning any rural practice affected by COVID-19 could apply for cover for GPs, nurse practitioners, practice nurses and practice managers.

The network’s NZLocums service has long had a pool of locums who can cover for GPs and NPs, but had never had locum practice managers.

Says Ms Reynolds: “By keeping our ears to the ground through our contacts and networks, we pulled together a small cohort.”

She says a lot of the recruitment was about making the best of the situation.

During last year’s Alert Level 4 lockdown, a number of locums became “under-utilised”.

They had been let go early from their practices as fewer patient consultations were being provided.

Now unable to travel, and still with valid work visas, they came on board with PERL in order to help rural practices struggling to cope.

Setting up the service was a lot of work, but in the circumstances it was absolutely the right thing to do, with incredible feedback from all practices involved, says Ms Reynolds.

“We responded to the critical need in the sector so quickly we were able to make a difference. It’s been extremely well received.

“I’m grateful for the amount of work the team put in. It was a huge commitment – I’m really proud.”

PERL was awarded the Blue Star Best Supplier Service, Product or Campaign at this year’s New Zealand Primary Healthcare Awards|He Tohu Mauri Ora on 15 May.

The judges said the service was an excellent example of supporting rural and isolated communities to retain access to healthcare during a national crisis.

New Zealand Wound Care Society’s annual Wound Awareness Week event was a finalist in the category.

The society’s campaign was well thought out, with clear objectives, communication and promotion plans, said the judges.

Rural general practice leaders are delighted the Ministry of Health has decided to extend the contract for the Pandemic Emergency Roving Locum service. The decision came soon after the country’s August COVID-19 cluster was revealed.

New Zealand Rural General Practice Network chief executive Grant Davidson says the challenges of COVID were still impacting rural practices before the latest outbreak.

The network had to push hard for a six-month extension of the locum service, despite there being money left over from the initial contract to 30 June, Dr Davidson says.

“The ministry had not been keen to extend the date and utilise that underspend, even though we asked for that,” he says.

“The ministry has now allowed us to access this funding, and we plan to target that funding to areas most under pressure, rural practices in [COVID-19 hotspots] Auckland and the Coromandel before taking it to others.”

General manager membership and services Linda Reynolds says the network is seeking expressions of interest from anyone keen to locum.

As for the long-term future of the locum service, Ms Reynolds says the network will continue to advocate for it when it is required.

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