Fears for patient care after Palmerston North hospital’s last expert leaves

Source: Radio New Zealand

• Last permanent doctor at Palmerston North Hospital gastroenterology department worries about patients with chronic conditions when he leaves
• Dr James Irwin says temporary staff will offer transactional care
• One patient feels left in the lurch
• Health NZ says its recruiting to the service and it’s doing its best to minimise effects on patients

A long-term patient of Palmerston North Hospital’s gastroenterology department is concerned about the care he will receive when the last permanent doctor leaves next month.

Over recent years the service, which focuses on patients suffering from problems with their digestive systems, has struggled to attract specialists to work there.

One left for another hospital on Friday, and the last doctor finishes in June.

Temporary and locum doctors will fill the gaps, and Health NZ said it had sent out offers of employment to new recruits. It said it was committed to making sure there’s only a minimal effect on patients.

‘Left in the lurch’

Brett Cribb was diagnosed with irritable bowel disease 11 years ago and has since been under the care of the department.

The 45-year-old Palmerston North educator, assistant principal at Monrad Intermediate, is concerned about the loss of permanent staff. The last specialist, Dr James Irwin, finishes in a few weeks.

Cribb worries chronic patients will be left in limbo.

“It’s pretty hard for us. Where are we going to go? Yes, there are other people in there, but when you go to see an expert you want an expert in that field.

“I would feel sorry for someone having to read through 11 years of my notes, because they’re pretty full-on, but [ Irwin] knows them like the back of his hand.”

Cribb said he would like to see specialists incentivised to work at smaller centres.

“Are there any sweeteners that can be given? Who is training to work in gastro?

“I think that’s probably the biggest part – yes people finish, like us in the education sector, but there is a little bit of a sustainable plan at the end. I feel like we’re probably been left in the lurch a little bit here.”

Cribb praised the work of all the specialists he had seen down the years and was gutted to see them leave. Initially, he was facing the removal of his bowel, but has instead been given different medications to control his condition.

“To be able to lead the life I live, I’m pretty normal. I can get up, I can go for a run. I can play touch, rugby league, tennis. I’m not restricted at the moment, but I am regularly taking blood tests.

“Dr Irwin’s monitoring me. I get to see him probably twice a year.”

Risk in transactional model – doctor

But Irwin has handed in his resignation, citing workload pressures, a lack of colleagues and frustration that Health NZ had not found a way to attract specialists to the provinces.

The Palmerston North service was funded to employ 5.6 full-time equivalent specialists.

For Irwin, the care of people with chronic conditions worried him the most when the department was staffed only by temporary specialists.

“There’s far less of a focus on chronic disease management, although as a gastroenterologist more than half my time is spent managing people with a chronic disease, like Brett – so people with inflammatory bowel disease or people with chronic hepatology conditions.”

It was unlikely locums could provide long-term continuity of care, he said.

“In our department we’ve got about 1100 people who are waiting [for] an appointment in our clinic. There’s really little capacity to provide that service.

“At the moment those people, like Brett, are out in the community, really without a lot of supervision for their condition. If they’re well, no trouble. When they become unwell it’s more difficult.”

Health NZ said 280 patients were waiting for a first appointment with a specialist, as at 14 April, and 913 were waiting for treatment, including endoscopy procedures.

Irwin said conditions at smaller hospitals needed to improve. Specialists at larger hospitals were on call less and had more non-patient-contact time.

If nothing changed, Health NZ would have to keep providing temporary solutions, because there wasn’t an incentive for specialists to move to smaller regions.

“I think that the plan is to pay well to people who are prepared to come and deliver some service. The risk is that it’s a very transactional model. People will come, see patients in clinic and leave, and not really be available to provide long-term advice.”

Patient Voice Aotearoa’s Malcolm Mulholland said it was a “terrifying proposition” that a region as large as the one served by Palmerston North Hospital would have no permanent gastroenterology specialists.

“There has to be questions asked about how it was allowed to get to this point.”

Stop-gap measures in place would cost the taxpayer more.

Mulholland said Patient Voice Aotearoa was looking at holding a public meeting about the issue next month.

Employment offers made

Health NZ central region director Chris Lowry said it was looking at ways to attract specialists to smaller centres, and employment arrangements differed because they were historically negotiated at a district level.

“We acknowledge that with a shortage of gastroenterologists at Palmerston North Hospital, there will be concerns from patients with chronic conditions about continuity of care,” she said.

“We remain committed to maintaining safe, continuous care for our patients, ensuring minimal impact to service delivery.”

Among the temporary measures in place were using a doctor from another region to run clinics and sending patients to private hospitals for procedures such as colonoscopies.

In May there would be up to four assessment clinics each week using a doctor from the northern region. These would be run face-to-face and virtually.

And new senior nursing roles would increase capacity for clinics led by nurses and for procedures within their scope, Lowry said.

“A new gastroenterologist will start at the service in September. Offers have been made to three other specialists and we are exploring locum arrangements with two other overseas doctors,” she said.

“Health NZ continues to look at ways to attract specialists to smaller centres. This work is being undertaken at a national level.”

Checkpoint asked how much is being spent on temporary or locum doctors, but Health NZ did not provide figures, saying employment agreements were confidential.

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