A Vision for the future

The idea of an integrated health centre came from thinking about how Golden Bay can continue to enjoy a high standard of care in the decades beyond 2010.

Golden Bay is lucky to have a good range and high standard of health professionals.  But like the population, some are approaching retirement and we are struggling to attract new doctors, and at times nurses - even to this beautiful place.

Why?  Doctors and nurses work differently these days and many no longer want the pressures and isolation of working without good support from their professional peers, especially in a remote rural area.  They want to be able to bounce ideas off each other, compare notes and to work more efficiently.

These days doctors are increasingly becoming salaried employees so they can get on with what they became doctors to do - practise medicine. They work in teams, complementing specialist nursing skills; acute or emergency medicine, district nurses monitoring the chronically ill; others with expertise with the elderly, or the very young, or those in hospital, or who focus on preventative medicine like education, or smear tests.

With an integrated facility, all calls would come to a qualified nurse with immediate access to patient files who could advise them either over the phone, or provide immediate assistance when they turn up at a properly equipped warm and lit centre.  They would call the doctor, get the patient comfortable, and if necessary, call the emergency helicopter.  If a doctor needed to attend an accident he would also have 24-hour access to records and backup through a staffed central reception.

Struan Clark, who originally floated the idea of better integration, believes we can make much better use of doctors' skills and that nurses are much under-valued.

"Rural doctors run themselves ragged doing jobs which they should not have to do e.g. many aspects of chronic disease management, and at the other end of the scale minor trauma, infections etc, plus admin and form filling galore."

He has a vision of much of the day-to-day work being led by teams of nurses specialising in different areas (acute care, prevention, chronic management etc).   They could share information where their work overlaps and would be better able to learn from each other‚s experiences.

So what would doctors do?  Struan says the rural doctor has been reinvented. "They will still do clinics as usual and provide traditional personal medical care, but with longer appointment times and less-frequent clinics. The emphasis will be their special medical skills as diagnostician, management planner, prescriber, advisor, teacher and doer of more specialised procedures.

Doctors will become more of a resource to nursing teams and would have much more support with on-call and after-hours responsibilities.  This is in line with Government thinking about having family health centres and the latest moves of focusing on front-line services.  A big emphasis is on prevention and health promotion; helping people lose weight, stay mobile and generally be well".

The proposal is also the only likely way rest home services will remain in Golden Bay, because of the ability to combine some overheads and services.
 
All of the services represented on the interim group - the community hospital, the Joan Whiting Rest Home and the medical centre - can see the opportunities for efficiency and cost saving, in addition to more comfort.   An integrated centre only needs one phone system, one computer system, one kitchen and can achieve efficiencies with cleaning, grounds maintenance and equipment.  There are savings in rates, insurance, purchasing the everyday consumables, and the costs of driving between the different facilities.