Government aims to deliver city-level services to rural communities
The Government wants to make sure that rural communities get a level of service that people who live in cities often complacently expect.
Dr William Ferguson has been involved in the Kumeu region of West Auckland since 1979, when he did his summer medical studentship with local GP Steven Calverley and his wife Jill Calverley.
"This was over my medical student summer holidays to help develop a designated information resource area of the medical centre," says Ferguson. "This was so people could just call in, look up their problem and get some information without necessarily seeing the GP."
Ferguson says back then the medical centre was at the end of a dirt road, before being relocated to the shopping village in 1984, when he joined as a GP. He recalls back then Kumeu was so out of the way, it didn't even have traffic lights.
He explains that in those early rural days, the local general practice was a fundamental foundation of the health system.
"In those days, when you were on call over the weekend, you would be flat out literally day and night. Hardly a weekend would go by you wouldn't see someone fall off a horse, crash their bike at Woodhill Forest or do something to themselves with a chainsaw."
Fast forward 40 years and the character of the town is almost unrecognisable. With Auckland's expansion, Kumeu went from having a population in the low 1000s in 2013 to almost 7000 today. Formerly a sleepy rural area, Kumeu is now zoned as a future urban area with multiple chain stores.
However, Ferguson does not seem to view this change as progress. He feels that while the township has gotten larger, the community has shrunken.
"People have lost touch with the good old family GP; they just think you go to the hospital or accident and medical centre.
"A lot of on-call has fallen away. I'm not complaining about that because it was never much fun getting up at 3am and having to go down to the medical centre, but that hardly happens now."
He specifically recalls how back in the day there were a lot of wineries in the region, reflected in the gifts GPs used to receive from grateful patients. As many regional industries have relocated out of the region to be replaced with multi-national corporations, those sorts of gifts have dried up.
"When people know they're part of a rural community, they have those strong links to healthcare and everything else. As it becomes more urban, a lot of that seems to fall away."
While this loss of community could be balanced out with increased medical options and stronger health outcomes befitting an urban society, Ferguson thinks that hasn't happened either.
While Kumeu's network of practices was small, Ferguson says it was also tightknit, meeting regularly after hours and engaging in ongoing education.
"But the other surrounding practices have been bought up by various corporate entities. They have high staff turnover so we're often not sure who the doctors are that come and go from some of these practices. People don't know who their GP is either; they just see whoever they can when they get an appointment."
Infrastructure Woes
Despite the rapid population growth, Dr William Ferguson says infrastructure has not met demand.
"Our books have been closed for years now, we're at capacity. The receptionist spends quite a bit of their day telling people, 'I'm sorry, you could try the practice down the road'.
"When an accident and medical opened across the paddock from us, we were happy because for a while, that gave us a place just next door, we could tell patients to go to. But they quickly reached capacity as well."
Making matters worse is the town planning, with a massive influx of housing but little change to the roads and traffic.
"Even if you left before 6am, it was taking over an hour to get out of Kumeu and into the beginning of the motorway. Just this massive log jam of cars from Riverhead, Whenuapai, etc.
"A lot of people buy places thinking 'this is pretty close to Auckland' and then when they find themselves having to make the commute they think 'goodness me, why did we do this?'
"Patients often arrive to their consultation late and stressed because of the traffic getting into Kumeu, and they arrive with higher blood pressure because of worry about getting to their appointment on time."
Ferguson further explains that nominally having medical services and quick access to the city has, paradoxically, hurt patients more than helped.
"You ring the ambulance and if they know it's a medical centre, sometimes it doesn't get priority because they think at least the patient has a doctor on hand there. But we can be waiting hours for an ambulance to turn up.
"On a number of occasions, we've realised the safest thing to have done is tell the patient or family member to stick them in the back of a car and go straight to hospital.
"That may be quicker than waiting for an ambulance when there's a limit to what we can do for you if things go pear shaped, but depending on traffic it could still take up to an hour to reach [Waitakere] hospital."
Poor Planning
When asked if he could see any positives to the recent demographic shift, Dr William Ferguson did not mince words.
"I don't think there's been any advantages. The planning hasn't been in any way commensurate with the speed with which orchards and vineyards have turned into tiny boxes with houses."
While the Kumeu practice has run into financial trouble despite being flat out with what it does have, Ferguson says the problem is not unique to his practice.
"There's been no meaningful adjustment to general practice base funding for decades, with costs rising.
"We had to reduce some of our nursing staff and hours to rebalance the books. We've had to put fees up, but it's still a struggle.
"There are GPs around the country that have literally gone bust. That's not very attractive for young doctors coming out of their training with student loans, who look at what's on offer and think they'll settle for a nice specialty somewhere. I'm very concerned."
Ferguson expressed his admiration for Kumeu's remaining farmers and gardeners, while pointing out the necessity of rural healthcare.
"It's great keeping the food producing aspect of Kumeu alivem particularly in recent times.
"There will always be rural areas that require a GP to have a more than usually wide array of medical expertise to deal with the sort of emergencies that simply won't happen in Remuera."
