GP concerned over ‘dire shortage’ of staff at Palmerston North Hospital’s gastroenterology department

Source: Radio New Zealand

• Manawatū GP concerned about shortage of staff at Palmerston North Hospital gastro department
• Dr Nicola Barrack says patients are feeling the effects of a service under pressure
• Health NZ says it’s recruiting for staff, while supporting the service the best it can in the meantime

A Manawatū GP has spoken out about her concerns over the dire shortage of permanent staff at Palmerston North Hospital’s gastroenterology department.

RNZ has previously reported that only two doctors were working fulltime at the department, which focuses on patients suffering from problems with their digestive systems. It’s funded for just under six positions.

Of the two, one was about to leave and the remaining specialist, Dr James Irwin, said he was also going to depart due to workload pressures.

Feilding Health Centre general practitioner Dr Nicola Barrack said this has meant patients’ diagnoses are getting delayed, and that the region urgently needs a functional service.

Health NZ said it’s doing all it can to recruit staff and that the service offered by the department hasn’t changed.

‘Dangerous delays’

Health NZ has acknowledged the challenges it faces in recruiting permanent, specialist staff to the department. Only a few years ago there was seven gastric specialists there.

As that number has declined, Barrack said the effect on patients was noticeable.

“There are significant delays in investigations, in gastroenterology reviews and, as a result, increasingly long, stressful, and sometimes dangerous delays in diagnoses,” she said.

“I have some patients who have been waiting over a year for surveillance colonoscopies, or patients with serious red flag symptoms for bowel cancer waiting over six months for endoscopy.”

Some patients who desperately needed to be seen were declined by the service or were placed on long waiting lists, without a scheduled appointment.

If patients could afford to go private, or had insurance, they’d have to travel outside the region because there was no private gastroenterologist in Palmerston North, she said.

“This is a huge change as we used to have at least three private specialists, plus more in the public hospital.”

Barrack said there hadn’t been any communication from Health NZ to GPs about the situation at the department. Instead, they’d receive information secondhand, or through the media.

GPs would often call hospital specialists for advice during consultations.

“We are no longer able to call and speak to gastroenterology at Palmerston North Hospital. Being unable to do this makes it very challenging to treat patients who are sitting in front of us, often with time-sensitive conditions.

“The option we have now is to go through a liaison. When I tried that I got an answer machine.

“We are left making snap decisions in our consultations.”

Barrack said that could include sending patients to other already-busy areas, such as general medicine, or the emergency department.

“Doing nothing is not an option. We are here to help our patients and advocate for their care.

“When I am desperate I have reached out directly to gastroenterologists I know personally for acute advice, in their own time,” Barrack said.

“To say that we are worried about the potential of having no local gastroenterologists is an understatement.

“The service is so fractured with locum staff plugging the gaps. We need a functioning, sustainable service that is well supported so more gastroenterologists can be recruited to the region.”

She said GPs respected Irwin’s commitment to the region and he needed urgent support.

Service unchanged – Health NZ

Interim group director of operations for MidCentral Katherine Fraser-Chapple said despite pressure on the department Health NZ was committed to safe and continuous care for patients, and making sure there was “minimal impact to service delivery”.

While it was recruiting permanent staff it was doing as much as possible to ease pressure on the unit.

These measures included bringing experienced specialists from across the central region to Palmerston North to help in the short term, outsourcing colonoscopies when suitable, and “actively managing” waiting lists for surveillance and symptomatic colonoscopies so patients were appropriately prioritised.

Fraser-Chapple said Health NZ was working to set up the service in the long term. It was recruiting specialists from overseas, working with training colleges on ways to increase the number of doctors in training, and looking at ways to attract specialists to small centres.

By the end of April it was looking at introducing the Faecal Immunochemical Test (FIT) for Symptomatic programme. This would reduce demand for non-urgent procedures and ease pressure on the service.

“It’s a tool to support clinical decision making and to help manage demand on colonoscopy services by identifying who needs a colonoscopy most urgently – [at a] higher risk of bowel cancer – and who is at lower risk of bowel cancer and may not need one.

“It is for patients with bowel symptoms who are either on the non-urgent colonoscopy wait list, having previously been referred for bowel symptoms, or who have been referred with bowel symptoms by their GP,” Fraser-Chapple said.

“While there have been staff changes, the services provided by the gastroenterology department haven’t changed and acute services are being maintained, which is why GPs have not received communications on this issue to date.”

She said updates would be sent to primary and community health providers in due course.

“In the meantime, GPs can continue to contact the service for advice, and on-call support remains available for urgent concerns.”

She said waiting times for surveillance colonoscopies differed for all patients. It depended on their initial procedure and risk assessment, which would determine when a follow up was due.

As at 23 March, MidCentral has 214 patients due for such a procedure. Since 1 July last year 304 had been performed, including 146 that were outsourced to the private sector.

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– Published by EveningReport.nz and AsiaPacificReport.nz, see: MIL OSI in partnership with Radio New Zealand