Sharing after hours care in a rural New Zealand community - a service utilization survey

Introduction: As the rural general practice workforce in New Zealand changes, after hours services are under pressure to change. This is an international problem. This article reports on an initiative in a rural New Zealand community to meet the need for after hours care. First contact for patients is with a community nursing team operating from the local health centre, complemented by on-call advice from GPs and GP clinics twice daily at weekends. Objective: To report on the demand for after hours services generated by a geographically defined community in New Zealand. Methods: Design: A prospective cross-sectional survey of after hours utilization over a one month period using questionnaires was completed by the full range of healthcare professionals providing care. Setting: A single geographically defined rural community of 9200 people in the North Island of New Zealand. Participants: Rural GPs, community nurses and the ambulance service. Results: Only 90/204 patient contacts were seen by the GPs with the remainder being managed by the nurses or ambulance staff. Nurses referred more patients to the base hospital but overall 87% of contacts handled by the doctors and nurses were managed locally. Estimated out of hours contact rate was 320/1000 persons/year (including telephone consultations). For direct face-to-face contact the rate was 245/1000 per year: for Maori the rate was 425/1000 per year while for non-Maori the rate was 151/1000 per year. Ambulance services provided an urgent call service at the rate of 29/1000 persons per year. Conclusion: A collaborative service providing after hours care to a rural community is described and utilization rates assessed. The model of first on-call nurse with GP back up provides a sustainable service and reduces the burden on rural doctors without reducing patient access.