When the solution becomes a problem
WellSouth Primary Health Network CEO Andrew Swanson-Dobbs
Over the years, we have seen telehealth become a viable solution to enhancing primary care services.
The conditions of COVID spurred and normalised telehealth, providing much-needed care and advice between clinicians and patients when face-to-face consultations were unavailable.
I too, have often talked about telehealth as an important tool in the armoury of the health system.
However, when a single tool is heralded as the solution, it becomes a crutch, a reason to disinvest and ignore the issues. And that is a problem, in my opinion. Here is why.
In many parts of our Southern region – and Aotearoa all over – primary care is in crisis. Access to general practice services during the day is increasingly constrained, let alone access to care after hours.
We continue to hear about long wait times and clinicians working unpaid, about doctors unable to retire as there is no replacement, and nurses who are moving into secondary care for better pay. This is compounded in our rural parts. As a PHO with almost 80 practices, around half of which are rural or at least 50 minutes’ drive from a hospital, we face these challenges more acutely than many of our counterparts across the motu.
When Health New Zealand Te Whatu Ora launched an after-hours telehealth service for rural communities, many of whom are eligible for the service at no cost, this was another tool in the care kit.
But it is not a cure-all. It does not support the fragility of the system at its core.
Existing services have been undermined, both clinically and financially, by telehealth providers funded by Te Whatu Ora. Investment is shifted to a service that affectively takes patients away from their own GPs.
Practices that can offer after hours care are now competing with telehealth. Clinicians are waiting to see their patients face-to-face, to provide much needed care, often with patients who they have known for years but telehealth services are instead directing these patients to their own online GP, taking away what limited revenue there is.
Why not support the workforce we have? If you want to reverse the trend of too few GPs, hire more GPs, fund the existing GPs adequately, rather than fund anyone from any discipline unable to provide a full service, because it is cheaper. And then put pressure on general practice staff to get on board and be part of the team.
To make matters worse, Te Whatu Ora is not just not supporting the existing primary care workforce, but is pulling GPs and nurses from practices for Te Whatu Ora roles, including in the very telehealth roles that are supposed to be the solution.
Telehealth should not be masqueraded as the solution to the workforce crises. In my opinion, it is currently contributing to the issue, and it should not be seen as an alternative to a far more superior face-to-face service.
In the news
Our WellSouth CEO, Andrew Swanson-Dobbs, was interviewed on Breakfast TV this morning about the telehealth, following a spark of conversation and comment on an opinion he posted.
Andrew talks about how telehealth is not the panacea to the general practice workforce crisis. It is simply one tool in the healthcare kit. But if it becomes a reason to disinvest in actual clinicians on the ground and ignore the issues Aotearoa is facing, then that is a problem.
“It is not a cure-all. It does not support the fragility of the system at its core,” he says.
You can watch the news clip on Breakfast S2024E157 | TVNZ here https://www.tvnz.co.nz/shows/breakfast/episodes/s2024-e157 (approx 1'10") or watch the full interview here and you can read and comment on Andrew’s opinion piece on LinkedIn https://www.linkedin.com/feed/update/urn:li:activity:7235026393711976448/
You can view the full recording here
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