Improving access to care

Currently GPs in each of our districts get frustrated when they hit barriers when seeking interventions from other providers. There is a perception that DHB services are becoming more difficult to access and that different DHBs have different levels of service available to their communities. This was abundantly evident in the responses received when we asked practices to share their experience of barriers in accessing care for patients in 2019, and since then we now hear stories of difficult access every week from across the network and across many specialities form our GP members.

Barriers usually present as a rejection letter from the referred provider, sometimes with explanation and further guidance, sometimes without any solution to support further patient care.

We know GPs do not seek help for a patient without good cause, however "rejection" arises for a number of reasons:

• the provider believes the service / intervention can be provided in primary care
• the intervention is rationed and cannot be provided for someone with this acuity of problem
• there is not enough information for the service provider to prioritise the issue.

Currently the options for GPs is to re-refer, discuss private options with their patients, connect directly with the DHB and seek support, or support the patient to advocate with local MPs and others for the service to be improved.

GPs from time to time involve Pinnacle support services in their advocacy and find we can help by:

• supporting members to advocate for individual patient care
• seeking system improvement with referred providers
• identifying areas of systematic gaps in care.

We think we can do more to help. We want to support members to:

• effectively to access patient care
• gather information about the services under pressure in the DHB systems.

With more involvement we may be able to add value through strategic services such as extended GP teams and specialist in the community roles to help reduce pressure on services.

The New Zealand Medical Council provide guidance for doctors working in resource constrained environments, as follows.

"As a doctor you have a responsibility to advocate for your patients, to seek the provision of appropriate resources for your patients' care and report any deficiencies to the appropriate authorities. Where these deficiencies are serious, the report should be made in writing."

They also state that when allocated resources

"the prioritisation systems should be fair, systematic, consistent, evidence-based, equitable, sustainable and transparent."

We have therefore developed a system to support your advocacy and to help identify areas where we can support our resource constrained partner DHBs.

Here are our expected time frames when you contact us with details of a rejected referral.

• Immediate response to indicate we acknowledge we received your concerns.
• Initial opinion and advice will be provided from our medical director within three working days.
• Clinical governance opinion within two weeks.