A plan is needed to sustain the provision of GP after-hours urgent/emergency care in New Zealand.

I worry about the future of general medical practice in New Zealand.

GPs in both urban and rural environments seem increasingly reluctant to provide urgent and out-of-hours cover for patients. Historically they have always organised 24/7 care for their practices. Some GPs, especially in rural areas, continue to offer a full rostered after-hours availability, but arrangements vary widely. Expectations of virtually infinite availability are no longer realistic but how urgent care is best organised so as to provide a satisfactory balance between patients’ needs and doctors’ working conditions is far from clear.

Both in urban and rural areas there is increasing reliance on hospital emergency departments for many problems that used to be the province of general practice. This is not popular with emergency physicians. It places undue extra pressure on already overworked hospital emergency departments.1

Assessment of urgent presentations by a local generalist doctor should make it easier to organise prompt definitive care and may reduce unnecessary ED visits.1,4 Not all headaches are strokes, not all fevers are meningitis and not all chest pain is life-threatening coronary thrombosis, but it may take a doctor to spot the difference.

The situation is made worse, particularly in rural and high needs areas, by the higher GP co-payments paid “up front” for out-of-hours service. If you’re trying to get by on a benefit, what are you going to do if you need medical care urgently or out of hours or both if the choice is between a free service at a hospital ED (with free investigation or admission if needed) or $50 or more to see a GP? Even a community services card doesn’t cut that bill to zero! A&M urgent care centres are hardly the answer unless they offer a full overnight service—and they aren’t cheap either.

Any practising GP should be able to deal competently with the initial assessment and treatment of potentially serious medical problems.

On call remains an inescapable part of community medical care and GPs can and should do it.

It all costs money but the whole point of an organised primary care system is the best use of all the capabilities of medicine for the population served. Strong primary care systems deliver better outcomes overall than pure specialist systems and probably more cheaply too.2–4

It is important that the commitment of GPs to urgent, emergency and out-of-hours care remains part of this.

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A plan is needed to sustain the provision of GP after-hours urgent/emergency care in New Zealand.

I worry about the future of general medical practice in New Zealand.

GPs in both urban and rural environments seem increasingly reluctant to provide urgent and out-of-hours cover for patients. Historically they have always organised 24/7 care for their practices. Some GPs, especially in rural areas, continue to offer a full rostered after-hours availability, but arrangements vary widely. Expectations of virtually infinite availability are no longer realistic but how urgent care is best organised so as to provide a satisfactory balance between patients’ needs and doctors’ working conditions is far from clear.

Both in urban and rural areas there is increasing reliance on hospital emergency departments for many problems that used to be the province of general practice. This is not popular with emergency physicians. It places undue extra pressure on already overworked hospital emergency departments.1

Assessment of urgent presentations by a local generalist doctor should make it easier to organise prompt definitive care and may reduce unnecessary ED visits.1,4 Not all headaches are strokes, not all fevers are meningitis and not all chest pain is life-threatening coronary thrombosis, but it may take a doctor to spot the difference.

The situation is made worse, particularly in rural and high needs areas, by the higher GP co-payments paid “up front” for out-of-hours service. If you’re trying to get by on a benefit, what are you going to do if you need medical care urgently or out of hours or both if the choice is between a free service at a hospital ED (with free investigation or admission if needed) or $50 or more to see a GP? Even a community services card doesn’t cut that bill to zero! A&M urgent care centres are hardly the answer unless they offer a full overnight service—and they aren’t cheap either.

Any practising GP should be able to deal competently with the initial assessment and treatment of potentially serious medical problems.

On call remains an inescapable part of community medical care and GPs can and should do it.

It all costs money but the whole point of an organised primary care system is the best use of all the capabilities of medicine for the population served. Strong primary care systems deliver better outcomes overall than pure specialist systems and probably more cheaply too.2–4

It is important that the commitment of GPs to urgent, emergency and out-of-hours care remains part of this.

‍