At least 85,000 people each year turned away from seeing specialists, some dying as result

At least 85,000 New Zealanders a year are being turned away from seeing a specialist, some of them dying as a result, a University of Otago study has found.

The researchers have described it as a national scandal.

One general practitioner (GP) told the study they had managed a heart patient “into the grave” because she could not get the care she needed.

Another talked about their fear of trying to care for teenagers with serious mental health problems, including hallucinations, who could not get into a psychiatrist’s clinic.

Researchers used nationwide Health New Zealand Te Whatu Ora data to conclude it was getting harder every year for New Zealanders to access specialist doctors.

They also conducted detailed interviews with 43 GPs about the impact on their patients.

“I just managed one into the grave. Couldn’t get her in [to cardiology], and she just got worse and worse, then she got liver failure and three days later she died,” one said.

“You can only manage them so much, maybe they get better, maybe they don’t, maybe they die. That’s not dramatic, that’s the issue. If you go through any GP, they’ll be able to tell you they’ve had at least 10 versions of that every year.”

Another doctor, new to the profession, told researchers they were scared they would do the wrong thing.

They had been treating teen patients who could not get in to see psychiatrists, and were advised by the community mental health team to prescribe strong psychiatric medicines.

The pressure was strong to treat outside your comfort zone, the GP said.

The study, done in collaboration with General Practice New Zealand, found 14.2 percent of people, about 85,000, were declined specialist care even though their GP referred them.

That was up from 11.4 percent in 2018, representing an increase of 17,000 people.

One of the study’s authors, health systems professor Robin Gauld, said the upward trend was continuing and was a “national scandal”.

It was “appallingly bad” for patients who could be in pain or disabled because their condition could not be treated, Gauld said.

“We have thousands and thousands of people around the country not living life to their full potential,” he said.

The study found women were more likely than men to be declined care.

The postcode lottery was still evident, although most of the period covered was before Health NZ was formed to try to fix that, in July 2022.

The former Southern DHB had 2408 (54 percent) of referrals declined in 2022.

Mid-Central was next, with 6441 (26 percent), while Wairarapa was the lowest with 145 (2.9 percent) declined.

Many of the doctors surveyed talked about how hard being turned away was on patients.

One told the researchers about patients who had waited for years for shoulder treatment and could not work.

“And they’re in pain, and they’ve got to be on strong opioids or whatever it is to get them through the day. So they’ve got no quality of life, they come in to see us every three months, it’s costing them money, they’re on a benefit, mental health, huge impact,” they said.

Those who could not see a specialist had to pay for frequent GP visits and prescriptions to try to manage their condition.

Others doctor talked about working in their own time, ringing around trying to get patients help, with one saying once she had children she no longer had time.

They spoke about the “moral injury” they felt not being able to get their patients the care they needed.

Gauld said urgent action was needed now.

The initiative announced by Shane Reti where GPs could refer patients for diagnostic scans like CTs and x-rays directly without seeing a specialist was a great start, he said.

But, much more funding and ideas were needed, he said.

In a statement, Te Whatu Ora said it was committed to working closely with general practice to address the pressures and complexities they faced.

It acknowledged the multiple pressures GPs were currently experiencing, director of programmes delivery unit for Hospital and Specialist Services, Duncan Bliss, said.

Health Minister Shane Reti said he was aware that both general practice and hospital care had “been under pressure for quite some time”.

The government had announced $30 million to increase access to radiology services and ensure that primary health providers could refer patients directly, rather than waiting for a specialist assessment, he said.

“This initiative will support faster diagnoses and more efficient access to specialists. Our ambition is that this will go some way towards addressing the unmet need this report refers to.”

Health New Zealand also had work underway to better understand patients who did not meet criteria for a specialist assessment, Reti said.