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An Otago study sheds lights on the impact of unmet patient care needs on health professionals in the primary care sector.

Not getting access to appropriate specialist healthcare is having a significant detrimental effect on patients, health professionals and general practices, a University of Otago report has found.

Commissioned by General Practice New Zealand (GPNZ), the study set out to understand how common unmet need is within the general practice and primary care sector, and the impact it has on doctors and patients.

Robin Gauld
Professor Robin Gauld

Co-author Professor Robin Gauld, Co-Director of Otago’s Centre for Health Systems and Technology (CHeST), says unmet need occurs when people who need specialist healthcare services do not receive them, or receive inadequate or inappropriate care.

“It can have negative consequences for individuals and society, such as poor health outcomes, high spending, productivity loss, and health inequalities in access, processes, and outcomes,” he says.

Measuring it is important for monitoring the progress and performance of health systems and achieving universal health coverage, yet it is under-researched both nationally and internationally.

“There is a lack of insight into unmet need in New Zealand, its occurrence and impact on health services, particularly in the general practice and primary care sector which, by default, is managing a growing number of patients with unmet needs.

“This study provides important new information as well as some policy options which could be usefully pursued.”

The researchers found, between 2018 and 2022, the number of referrals from GPs to public hospital specialists remained stable, but there was a decline in access to referred specialist services.

“The risk of being declined following that initial GP referral increased significantly – 5.2 per cent per year – over that time,” Professor Gauld says.

Females experienced significantly increased risk of being declined compared to males. However, those in younger age groups (0-9 years, 10-19 years) and in the oldest age group (80 years and over) had significantly lower risk of being declined; Māori and Pacific peoples also had significantly lower risk of being declined.

“These findings have implications for equity and national consistency but also for the impact on managing the growing number of declined referrals in the general practice and primary care sector.”

Case studies of six general practices, including two kaupapa Māori practices, also revealed the heavy burden GPs are under because of this unmet need.

“It’s having a significant detrimental effect not only on patients, but also health professionals in the primary care sector who are caring for these patients.

“GPs, in particular, are being put at significant risk and under additional pressure managing patients with unmet need.”

This pressure increases as patients who have needs that are not being met by the secondary sector are told to seek support from the primary care sector.

“There is no additional payment to the primary care sector for this work, no extra support from the secondary sector, no formal factoring into the workload of the primary sector, and it requires GPs to manage patients who have a genuine and clinically-determined need for specialist care.

“In some cases, GPs are not referring patients to secondary services as they know that there is time involved doing so and the referral ultimately will be rejected; in other cases, GPs are being required to work beyond their usual scope of practice and expectations.”

The report’s authors believe the research raises important questions around whether it is appropriate, in terms of health system design, for secondary care to be required in primary care settings without formal arrangements and policies in place.

While last week’s budget did not outline specific initiatives for resolving the issues raised in this report, Professor Gauld says the $2.12 billion for primary care, community and public health provides an opportunity to directly allocate new funding to management of patients with unmet need in primary care settings.

“The budget also allocates $3.44 billion for hospital and specialist services and there should also be an explicit focus here on working with GPs on managing unmet need through improving access to specialist services and supporting GPs to manage patients with secondary care needs.”

He is pleased the study verifies and shines new light on a longstanding set of challenges for the health sector.

“The findings will be of widespread concern to all health professionals, policymakers, managers and, very importantly, the general public and those who have not been prioritised for public hospital specialist services,” he says.

Report details:

Quantifying and understanding the impact of unmet need on New Zealand general practice

Professor Robin Gauld, Dr Jerram Bateman, and Dr Nick Bowden

Commissioned by General Practice New Zealand (GPNZ)

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