Photo: Andrey Popov 123RF
A woman received the shock of her life when she went to an after-hours GP clinic in Palmerston North and received a $260 bill just for being seen.
When her medication was added she ended up paying more than $300 at the City Doctors clinic for the weekend consultation.
City Doctors is the only walk-in option for patients seeking after-hours primary care in Palmerston North, and caters for a large catchment area.
The woman, who spoke to RNZ, said she drove 45 minutes from Dannevirke, in the nearby Tararaua District.
She knew the visit wasn't going to be cheap, but wasn't prepared to part with so much money.
"I had something crop up, which I knew that if I waited for three days to see my normal doctors on a Monday I wouldn't be in very good shape.
"So, I went over to City Doctors in Palmy, which is where you go if you live in Dannevirke and you needed to see a doctor in the weekend," the woman said.
"I waited for a few hours, saw someone, got what I needed - some antibiotics. I went to pay and [the woman at reception said]: I need to let you know that we've put our charges up.
"I thought: Everything's going up. That's okay. Thanks for seeing me.
"She's like, it's $260, and I was like, what? That's just so much money."
The woman had previously paid about $120 on such visits.
After-hours service
Earlier this year City Doctors said it was upping charges for patients enrolled at GP practices that didn't contribute staffing to its after-hours service.
The after-hours clinic is one of the most expensive places to seek care in New Zealand, costing between $225 for people with a community services card to $260 for a non-enrolled patient for a medical consultation, and between $85 for people with a community services card and $110 for enrolled patients.
On Sunday, the government announced a $164 million boost to urgent care services throughout the country over the next four years.
The announcement includes new 24/7 urgent care services for Auckland's Counties Manukau, Whangārei, Palmerston North, Tauranga and Dunedin.
New and extended daytime urgent care services will be rolled out in Lower Hutt, Invercargill and Timaru.
After-hours services in places including Dannevirke and Levin are also in for a boost.
The woman from Dannevirke said the present situation was particularly unfair for rural people, who had to fork out for travel costs too.
"I just feel like it's a huge burden for people who live rurally when you don't have any option, and it's just so much money.
"By the time you've got antibiotics and whatnot from the chemist, it was about $300."
The woman said she didn't blame City Doctors, and was grateful it had an after-hours and weekend service.
But, she worried about the feasibility for smaller GP clinics to be expected to join the out-of-hours roster or have their patients pay a lot extra to be seen.
City Doctors response
The chef executive of Tamaki Health - which owns City Doctors - Dr Lloyd McCann said the increased fees helped pay for staff, who expected to receive more for working evenings and weekends.
In Palmerston North, fewer clinical staff from other practices were contributing to the out-of-hours roster compared with its other clinics.
"One of the mechanisms by which we need to ensure the service is sustainable is to have the higher charge for patients who aren't enrolled in the practice and also for patients whose clinicians are not contributing to that after-hours roster."
Sometimes staff wiped charges or charged people less when they couldn't afford the fees, McCann said.
Funding could be better targeted
Chief executive of Manawatū's Local Health group Nicky Hart said any government boost to primary health was good.
But she said funding could be better targeted.
"There's always going to be after-hours pressure. The population's getting older. People have got more complex presentations.
"I 100 percent think if we were able to put better resourcing into daytime services it would ease the pressure quite drastically after hours," she said.
Local Health was trailing a scheme where paramedics worked with GPs on urgent presentations.
Those paramedics, for example, could see people with chest pain, when previously they'd be taken straight to hospital.
"Last count there's been probably 150 people that we haven't sent to hospital because they've been able to be dealt with here by the paramedics with help from the GPs under that pilot.
"I'd love to see more investment in projects like that, which would make a big difference during the day."
Local Health has two GP clinics in Palmerston North, one in nearby Ashhurst, and one in Feilding, which operates after-hours and weekend clinics.
Its after-hours costs are about $130.
"It's really busy and we can get 20 or 30 people between 6 and 8pm on some busy nights. It's more busy during the winter.
"It's definitely made a difference with the paramedics, but we mostly can't cope with the demand, and often they'll overflow into Palmerston North or into the hospital."
Not enough GPs
Patient Voice Aotearoa's Malcolm Mullholland said it was unclear if the government boost would help to make services more affordable.
"It's not uncommon to walk in there and see the waiting room bursting at the seams with patients, (and) there to be wait times of four hours or more. On top of that, if you are seen, there is a horrendous cost attached to that," Mullholland told Midday Report.
He said for many patients, the cost was too expensive so they went to Palmerston North Hospital's emergency department instead.
But it's not just Palmerston North experiencing costly after hours' visits.
"I've heard of horrendous costs else where, in particular, around Queenstown and Central Otago," Mullholland said. "I understand it's a common price to pay over $200 down that part of the world and I suspect it's very high elsewhere."
Mullholland said he doesn't know why the clinic costs that much, however, noted the number of doctors at the Palmerston North after-hours has reduced due to doctors retiring.
"We just do not have enough GPs in Aotearoa," he said.
The clinic is operating with a deficit of around 10 doctors, according to the owner of the clinic, City Doctors.
"[It's] putting the few GPs who are left under immense pressure, with increased workloads and longer hours," City Doctor said in a press release earlier this year.
"We have actively engaged with stakeholders in the region and continue to request support from GPs not currently contributing at an equitable level, but unfortunately, we still do not have enough clinician support."
City Doctors has been approached for further comment on their pricing.
Brown told Midday Report on Monday the government's investments in primary care will ensure new urgent care clinics are adequately staffed with doctors.
Funding had been allocated to train 50 more GPs a year, 100 overseas doctors already in NZ, and for 120 nurse practitioners per year, he said.
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