The rise of telehealth in Aotearoa, how it can help a stressed healthcare workforce, and what comes next - Dr Stephen Child
There’s no denying the coronavirus pandemic created fundamental changes in many facets of our lives – mask wearing every day is now commonplace, we’re making bread from scratch1, dog ownership is at an all-time high2, we’re actually not going to work when ill, and many office-based workers are now working remotely, including our GPs.
Calling patients to discuss health conditions over the phone was not a new concept for doctors in 2020, but the directive by the Royal College of General Practitioners that GPs were to move to video or phone consultations at the height of the pandemic required the primary health workforce to mobilise telehealth services over a single weekend.
Several telehealth providers launched services direct to New Zealanders around that time, with several businesses now well-established in the marketplace including Tend, Bettr, PracticePlus and CareHQ.
While continuity of care and the trusted relationship between a GP and the patient remains best practice, New Zealanders and clinicians today are increasingly seeing value in a virtual service that helps people access care they need, when they need it, if they can’t see their usual GP.
Switching to telehealth has been a reasonably big change for many patients and doctors to get used to. But, given many people are comfortable doing most things online, it makes sense we are seeing an increase in people accessing a virtual appointment to get onto something they’re worried about, more quickly than they may have in the past3.
This change is against a backdrop of pressure on the primary health workforce.
Before Covid-19 our general practices were coping with a measles epidemic, with little respite before the pandemic hit. This is a workforce that was (and is) tired, and because of the pandemic, like many other sectors, we just don’t have enough people available to meet demand. We are also seeing many GPs retiring4, with not enough younger GPs coming through to replace those leaving the workforce.
Succession planning for the primary care workforce is less straightforward today than it was 30-40 years ago, when traditionally the GP owned their own general practice, and at retirement, younger GPs would take on ownership of the practice.
Today many younger GPs, faced with large student debt, high housing costs and a steadily increasing cost of living, are less interested in saddling themselves with more debt by getting into practice ownership, preferring to work as salaried employees. This has resulted in a rise in the number of GPs selling to corporate health organisations - an increasingly competitive marketplace.
The opportunity for telehealth and the health workforce is that the GPs wishing to sell their practice can keep registrations up to date and enjoy what they trained to do – practice medicine. They can do this without the burden of ownership or the requirements of working in a corporate-owned general practice setting. This keeps experienced GPs in the workforce by providing flexible working options.
For example, we’re seeing doctors on extended vacation with their whānau dialling in to advise and treat patients while travelling the country.
Similarly, younger doctors today are seeking to maintain work / life balance, and find telehealth provides the opportunity to provide healthcare services in a way that allows for flexibility in their home and work life.
So, what’s next for telehealth?
While a key trend is how telehealth may stem some of the staffing issues in the community, we may be able to use it in some cases to support triage for A&E patients in our hospitals – the tertiary sector.
Importantly, we’re also seeing how telehealth consults are contributing to positive outcomes in mental health. One of my team has personal experience with an adult child having successfully used virtual mental health consults through Raise to work on anxiety issues.
The patient is based in Te Whanganui-a-Tara Wellington, and the consultant lives and works in Ōtautahi Christchurch. The patient tells us the sessions have been amazing and being virtual actually helped them feel more comfortable and at ease, as they were in their familiar home surroundings, with a professional able to see their situation too.
Advanced telehealth is happening now – we share images through the cloud and we’re able to access expertise all over the country. Surgeons are now regularly using robotics for keyhole surgical procedures with advice and direction from anywhere in the world.
Telehealth isn’t a panacea, but it is a very viable option to support people getting onto their health needs more quickly and to support a stretched health workforce.
1 Southern Cross Healthy Futures research shows 58 per cent of us are cooking from scratch, an increase between 2020 and 2022 of four per cent
2 Our Healthy Futures research also shows 33 per cent of New Zealanders own a dog – the highest rate ever
3 Telehealth is well regulated with standards in place for consumers and practitioners: