Provision of after hours services in Central Otago

Background Central Otago After Hours Inc (COAH) provides after hours primary care to patients living in or around Cromwell, Bannockburn, Alexandra, Clyde, Omakau between the hours of 1800-0800, 365 day per year by a General Practitioner (GP) or Nurse Practitioner. Central Otago is unique within the Southern District, as there is no local Emergency department and local GPs provide urgent care services in their communities from their general practices. Our GPs provide a high level of routine general practice care whilst also providing urgent care services during normal working hours (0800-1800) in addition to after hours. Our local general practices in Cromwell and Alexandra provide shared weekend clinics to offer urgent care at weekends between the hours of 0800-1800. Our GPs work closely with our local St Johns colleagues in assessment and management of patients in the community for emergencies. Many of our patients are treated by the Primary Care team and do not need to be transferred on to a hospital. We work closely with Dunstan Hospital when patients are required to be transferred to the nearest hospital for further management.

Current provision of after hours services Currently patients who require after hours services are advised to call 111 in an emergency or contact their normal daytime practice and be diverted to Homecare Medical Ltd. for telephone triaging. Depending on the outcome of the assessment, the patient will be offered telephone advice, an ambulance through 111 service or an appointment with a GP/Nurse Practitioner.

Issues with the current model Local GP owners established COAH with the vision of providing a sustainable after hours in Central Otago. The COAH Board have worked very hard to keep the service going despite facing staffing and financial strain over the last 3 years. However due to health and safety concerns for our staff which is contributing to the sustainability of the service, we are no longer able to provide the same level of service.

Steps taken to resolve the issues In June 2018, the Board of COAH wrote to the Wellsouth PHO (Primary Health Organisation) and other key stakeholders highlighting concerns regarding the future viability of the current after hours service.

This letter listed the contributing factors as being:

1. A shortage of local GPs able to safely contribute to the after hours roster (a 14 hour shift) in addition to providing a high-level of care to the patients at their own practices during normal working hours.

2. Health and safety concerns about working alone, isolated overnight with no support.

3. Low patient numbers using the after hours service, particularly between the hours of 2200-0800 and during the winter months. A GP is currently required to be available at all times.

A meeting of key stakeholders was held on the 19th June 2018 which included representation from the Board of COAH, WellSouth PHO, Dunstan Hospital (COHSL) and Central Otago Mayor Tim Cadogan.

The key outcomes of this meeting included:

1. It was agreed that COAH, PHO, COHSL and the Southern District Health Board (SDHB) would work together on a new, cooperative model to provide a longer term, sustainable after hours service for Central Otago.

2. The existing COAH service will continue to operate status quo for a defined period (up until 1st September). This deadline was then extended until 1st November in good faith to allow discussions to progress on a new service.

Update In good faith, COAH has been proactive and continued providing after hours care while working together with Wellsouth, COHSL and the SDHB over a period of 4 months to develop a sustainable after hours model which will provide our patients with a more equitable service as is provided in other regions. However due to continued health and safety concerns for our staff and a subsequent lack of GP staffing, we need to put in place alternative arrangements as an interim measure whilst a longer term solution is sought.

The COAH Board recently agreed to the implement the following interim measure which will take effect from 1 November 2018 until 1 February 2019 after which time we hope a longer term plan will be available:

1. COAH will continue to be proactive and work with Wellsouth PHO, SDHB and COHSL towards a longer term after hours service for Central Otago.

2. COAH will continue to provide after hours care to primary care patients with reduced hours from 6pm to 10pm daily. Patients can access this service as usual through their normal daytime practice number or through 111.

3. Patients requiring urgent after hours GP services between 10pm and 8am daily should call 111 in an emergency or contact their normal daytime practice and be diverted to Homecare Medical Ltd. for telephone triaging (as happens now). Depending on the telephone triage service assessment (HML) can offer the patient the following options:

a. Call 111 – St John will assess your medical presentation and arrange the most appropriate treatment plan.

b. Receive telephone advice and/or contact their own GP in the morning.

c. Advise the patient to travel to their nearest Emergency Department

We would like to emphasise that all patients will be triaged based on their clinical presentation and those with the most urgent need will be seen by the most appropriate service as close to home as possible. Others with less urgent need will be referred to other patient pathways.

We would like to take this opportunity to thank our patients for their patience in this matter and ask our patients to please show their support of the local GPs and our vision to provide an improved model of after hours care which is more efficient for patients and equitable with what is available elsewhere within the district.

Please also be assured that this interim measure is not intended as the longer term solution and that we will continue to work together with Wellsouth PHO, the Southern District Health Board and Dunstan Hospital to ensure a new model of after hours care progresses in a timely manner.

Any media enquiries regarding this press release should be directed to coafterhours@gmail.com.

COAH Board members will not be commenting further on this matter whilst they focus on providing care for their patients’ and working with all parties towards a longer term solution for Central Otago.

Jenaya Smith Practice Manager

Kate Dixon Chairperson