Continuity of care and succession planning will be on the agenda when associate health minister Matt Doocey comes to Te Kūiti during the Rural Health Roadshow.
Part of a nationwide tour, the September 24 event is intended to help the government formulate its rural health strategy. The result should be policy that ensures country doctors – and country patients, by extension – are not a dying breed.
While he doesn’t have a bone to pick with the minister, Kāwhia’s Dr John Burton said he is passionate about rural medicine and hopeful Doocey will listen to medical professionals on the ground.
“It’s great that Mr Doocey is visiting rural areas to get a feel for rural health issues, so our response shouldn’t be to hit him on the head,” said Burton.
“But it saddens me that primary care is being eroded by workforce shortages that were foreseen 20 years ago and yet governments have not been prepared to act on them. We now have areas where there is no afterhours cover and patients are having to wait weeks to see their GP.”
Early diagnosis permits early treatment, which can make all the difference between life and death.
“When a rural practice is operating well, most problems can be dealt with close to home and there is less demand on emergency departments. More severe problems are picked up earlier, when they are easier to treat, and often with better outcomes,” he said.
Working in a country practice can require staff go above and beyond. One of the key differences between rural and urban general practice is the depth of the relationships within the community, Burton said.
“There is no closing the door at 5pm. I’m always on call when I’m in Kāwhia and I’ve been involved in most people’s medical emergencies over the last 33 years. This fosters a special relationship within the community. Working here is more than a job for all of us – we rejoice when good things happen and grieve when people are hurt.”
Access to primary healthcare tends to be more difficult in rural areas, often due to greater travel times.
“Our availability is very important for patients. We are a long way from anywhere, especially in the middle of the night,” said Burton.
“Continuity of care is crucial for primary health care everywhere, but there are greater risks in a small community where we have to rely on fewer providers. If one of us moves away or retires, it is much harder than in urban areas to find someone to take up the reins.”
Improved forethought is needed to replace medical staff in rural regions.
“We need more people who have the skills and desire to work in rural areas, and those already working rurally need time to mentor trainees. But this gets harder as numbers decrease due to retirement. A succession plan is not always easy.”
The New Zealand Graduate School of Medicine is set to open in 2028. Specialising in rural medicine, it is expected to support regional practices.
“A medical school with a special focus on rural areas should have been opened years ago,” Burton said. “Students will be together in Hamilton for a year before they go out to rural areas. How many graduates will carry on to work in our region will depend on how much energy is put into attracting them.”
The school at Waikato University’s Hamilton campus will prioritise clinical placements in rural communities.
The school could prove invaluable in ensuring rural practices can survive even when country doctors retire. Fortunately, Burton is not closing his doors yet.
“I don’t have any plans to retire, but it will depend on my health and my wife’s, and how long my energy levels are up to the task,” he said.
Ironically, whether Burton will share his insights with Matt Doocey at the Rural Health Roadshow is reliant on whether Kāwhia Health Centre can spare him, even just for a couple of hours.
“I have put my name down to attend. But it still all depends on my being able to get away on the day.”
