Dargaville Hospital loses its only full-time doctor
Photo:
RNZ / Peter de Graaf
Dargaville Hospital has lost its last full-time doctor, the latest setback in a staffing crisis affecting many rural hospitals around the country.
Health New Zealand said the doctor's departure is unfortunate, but it has enough staff to keep the hospital running on the current roster, and there won't be any change to staffing levels in place since late last year.
The 12-bed Northland hospital came close to shutting down last October when it could no longer find enough doctors to fill the 24-hour roster.
The inpatient ward now runs without a doctor most nights.
Instead, overnight care is provided by nurses backed up by a telehealth service, in which a doctor at another location offers advice via phone or video call when needed.
Hopes of returning to 24-hour medical cover slipped further out of reach at the end of June with the loss of the hospital's only remaining full-time doctor.
Rural medicine specialist Josh Griffiths, a member of the ASMS doctors' union, said the hospital now had two-and-a-half full-time-equivalent (FTE) doctors, when four were needed.
"We were already not in a great place, staffing wise. When she was here, we were down to about two thirds of our job-sized FTEs. With her gone, that takes us down to about half."
Dr Griffiths said the doctor's departure was a blow because she was committed to Dargaville - she had even bought a home in the town - and had specifically sought a position in rural Northland when she was recruited from the US about three years ago.
Dr Griffiths said the remaining doctors were doing extra day shifts to fill the roster, but that was balanced by fewer night shifts now the hospital no longer had a doctor on duty 24 hours.
They had, however, hoped to return to 24-hour cover at some point.
"This just takes us a step further away from reinstating full services, which is really disheartening," he said.
Dargaville Hospital serves about 27,000 people living in the town (pictured) and surrounding Kaipara District.
Photo:
Peter de Graaf/RNZ
Mike Shepherd, acting deputy chief executive for Health NZ's northern region, said Kaipara residents continued to receive the same level of service from Dargaville Hospital as they had since November.
"We have received the resignation of one of our doctors and clearly that's unfortunate, but we continue to have enough doctors to staff the roster without impacting the service for patients," he said.
"We're continuing to actively recruit to further staff, as you'd expect, and we don't anticipate any change to service to the community."
Shepherd said Health NZ had yet to decide whether to try to reinstate 24-hour cover.
"We're having that conversation... Our priority at the moment is to continue to provide what we are providing. We think we're providing a good service during the day, and a safe service overnight using the range of treatment and staff that we have."
Shepherd said the number of calls nurses were making to Emergency Consult, the hospital's telehealth provider, had decreased as they became more skilled at managing issues in the ward overnight.
Meanwhile, Dr Griffiths said he had mixed views on telehealth.
He believed it was safe and essential, because it was filling a gap that could have otherwise forced the hospital to close.
"But it doesn't always work out great for patients. We now transfer anyone unstable to Whangārei but that means a massive increase in the use of ambulance transfers, which is a problem for St John who are also struggling with staffing in rural areas. It's also problematic for patients who want to be cared for close to home."
Dr Griffiths said it also put extra strain on Whangārei Hospital, because patients that could have been treated in Dargaville were now sent there.
Another problem was that patients who were not particularly ill could not be sent home because they could not be fully assessed overnight.
"So they're either transferred to Whangārei or kept in Dargaville overnight where they can be monitored, and the next day the doctor has an increase in workload because stuff's been deferred from overnight... So, it's safe, but it's clearly sub-optimal, and a lot of patients tell me that they're dissatisfied because they can't really be dealt with by telehealth, they're just deferred or transferred."
Dr Griffiths said he was "really proud" of the way Dargaville's nurses had stepped up.
"It's resulted in a lot of upskilling, and nurse management has taken a proactive stance by trying to get people through courses to educate them more on managing emergencies in a way they wouldn't have had to previously, because the doctor would have taken the lead," he said.
"Some of them have taken to it really well. Others are not really happy because it's different to what they signed up for. I'm also worried about our senior nurses, because they're compensating for the lack of doctor cover by being on call for critical issues 24/7, and sharing that amongst themselves."
Dr Griffiths acknowledged that recruiting doctors was difficult worldwide, not just in Dargaville.
"But I do think there are specific things that could be done better, which we've pushed for, and we've had a really lacklustre response."
In particular, he said Health NZ should increase the rural recruitment and retention bonus paid to doctors who took up jobs in hard-to-staff places like Dargaville.
As for the improved after-hours medical service promised in May by Health Minister Simeon Brown, Dr Griffiths said it was a positive move, but he was surprised no one at the hospital had heard about it before the announcement.
He hoped officials would talk to locals and find out what was needed, rather than impose a top-down solution.
Brown told RNZ the $164 million programme to expand and strengthen after-hours healthcare across the country would be rolled out during 2026 and 2027.
He said Health NZ was currently considering the model and specific timing for the service.
Within Northland, better after-hours access would be provided in Dargaville, Hokianga, Kaikohe, Kaitaia, Kawakawa, Mangawhai and Waipapa.
Health NZ was also working on improved access to daytime urgent care in Dargaville, he said.
Brown said he also expected Health NZ to continue recruiting clinical staff for Dargaville Hospital.
"I have received assurances that Health NZ are doing so, and that existing services for patients will be maintained while this is underway," he said.
Dargaville Hospital serves a population of about 27,000 people.
The nearest secondary-level hospital is at Whangārei, about an hour's drive away on State Highway 14.
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