Luke Bradford: Royal College of GPs' Medical Director on EDs diverting patients with vouchers for urgent care clinic consultations

There's a belief EDs could be diverting patients away with vouchers for urgent care clinic consultations, more than they are. 

It's believed Auckland's Waitakere Hospital is sending away around 25 patients a day with vouchers due to long wait lists. 

The Health District's total voucher spend jumped 60% between 2022 and last year. 

The Royal College of GPs' Medical Director, Luke Bradford told Mike Hosking there's pressure on EDs to meet Health NZ's target of seeing patients within six hours. 

He says it's cheaper to hand out a $150 or $200 voucher, considering the average cost for a visit is 800. 

Bradford says it’s a reasonable way to help manage the flow of EDs, and vouches are a solution to managing a recession and a lack of resources. 

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Episode Transcript

Speaker 1 (00:00):
We've got new data out this morning that shows there's
a mess. I think we already know this in our ED.
So what happens is occasionally in your ED you'll get
at voucher and the use of vouchers and that allows
you to go to an after ours clinic and the
voucher covers costs of up to two hundred dollars. Now,
the number of vouchers issued at why Tackery Hospital, for example, alone,

(00:20):
just y Tackery Hospital in Aucklands, RI is nearly sixty percent.

Speaker 2 (00:23):
Now.

Speaker 1 (00:23):
Luke Bradford is the Royal New Zealand College of a
GP's medical director. And here is well, this looked very
good morning to you morning, Mike. Are numbers kept on this?
Would all hospitals? Have you know we handed our X
number of vouchers for X number of dollars or not?

Speaker 2 (00:37):
Yeah? They should do. They should do those who are
running the schemes with no okay?

Speaker 1 (00:42):
And so do we have any idea whether y Attacker
is an outlier at sixty percent? Orere everyone's handing these
things out left, right and center.

Speaker 2 (00:48):
I think the sixty percent increases is probably fairly typical
for a couple of reasons. I think probably the total
volumes quite high at White tach recompared to a lot
of other places in the country.

Speaker 1 (00:58):
Okay, the discipline and are we having an understanding? Are
they handed out with alacrity or do they go, look,
this is a desperate time that here is a voucher.

Speaker 2 (01:09):
Certainly the experiences I've had from the hospital's ideal within
they have plenty and rotor they're handed out more when
things are desperate. In fact, probably a little bit underused.
So when the weights get up to a long level
and people are going to have to sit there for hours.

Speaker 1 (01:24):
So people are cognitive that there's money involved in this
and we just can't hand out the sort of money left,
right and center.

Speaker 2 (01:31):
I think that was the initial case. I think now
that the pressure is on for six hour target, that's
probably where we're seeing some of the shift. And so
we know that that one of the five targets is
that you're in and out ved within six hours. So
that Sevelle used the vouchers and actually they in that
whole economics and they use it. It's probably cheaper to give

(01:53):
out a one hundred and fifty dollars voucher or two
hundred dollars. Voulcher given them the average GD costs for
a visitors eight hundred.

Speaker 1 (02:00):
And if we got to the bottom of this, when
you're handing out vouchers and the cure is long, is
the Q long because there are people dying who in
desperate need of help, or some people have got a
few sore things that they thought might pop in and
have a look at.

Speaker 2 (02:13):
Yeah, it completely varies on the day. So if the
medical teams are all involved with people who are really sick,
then everyone else is waiting. But a lot of people
do end up in d when perhaps they wouldn't need
to be there, it wouldn't be the optimum place, but
when it's expensive to be seen in the community, often
choose that option.

Speaker 1 (02:29):
So it's a miss, like a big, fat, ugly miss.

Speaker 2 (02:33):
Ah. No, I think it's probably a reasonable way of
trying to help the flow of things learning what we
have is a recession and increased health need and probably
under resource dds and so this is a solution that's
been thought up.

Speaker 1 (02:49):
Yeah, I appreciate it very much. Luke Bradford, who's the
Royal New Zealand College of General Practitioners EDS, I can
tell you a few stories about eds though I can't,
but I'd like to. But maybe one day I will,
maybe on my second to last day, I will because
we've had experience at the public hospital lately, and I
can tell you it is a shit show in there.

Speaker 2 (03:09):
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