March 3, 2025 • 12 mins
Health Minister Simeon Brown has unveiled plans to launch a tele-health service, allowing patients to see a doctor or nurse from home via their mobile device.
“This service will mean Kiwis can access primary healthcare from anywhere in New Zealand, 24 hours a day, seven days a week with the ability for GPs and nurses to also issue prescriptions or make referrals for lab tests," Brown said yesterday.
Dr Bryan Betty, a Wellington-based GP, said tele-health is a good solution for those who need to see a doctor urgently for an illness like a cold or sore elbow - but isn't the answer to the problem of thousands of Kiwis not having a GP.
He joined Nick Mills to discuss the announcement.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
You're listening to the Wellington Mornings podcast with Nick Mills
from News Talks at B.
Speaker 2 (00:12):
We're lucky enough to be joined by doctor Brian Betty.
We've just snuck in the phone game McCall and he's available.
He's in between his very very busy schedule.
Speaker 3 (00:22):
Good morning doctor, Oh morning, nice to be here.
Speaker 2 (00:25):
Nice to talk to you again.
Speaker 1 (00:26):
It's been a while, it has been, hasn't it.
Speaker 3 (00:29):
Yeah, I can remember the last time.
Speaker 2 (00:31):
Tell me the difference between Tellyhealth and health line.
Speaker 3 (00:36):
Our look. Health line is basically advice, so it's just
advice into where to get assistance or help tallyhealth mean
is a more formalized consultation in terms of a patient's
problem and trying to resolve that with either a GP
or an experienced nurse. So it's more like a consult
(00:57):
but obviously it's limited in what it can do. But
it's an extension or a backup from services that are
already offered in general practice. I suppose that's the way
to think about it. It's a step up from the
advice it's given on healthline.
Speaker 2 (01:09):
What can you actually do with a video phone call?
Speaker 3 (01:14):
Yeah, look, you can in certain circumstances resolve issues and
you can initiate treatment and do things. So I think
it is limited in what it does. So it tends
to be for one off acute problems, and we know
that with an experienced GP about seventy percent of those
consultations can be resolved without referring on to a face
(01:34):
to face consultation for further assessment. So there is a
role to play with tallyhealth. My belief is it's not
not for long term ongoing medical issues. General practice face
to face consultations is what is important. But if you
can't access your general practice, there is a role to
play if it's an acute problem that needs a level
(01:56):
of experience to look at and work out whether it
can be resolved through a video or a video consultation.
So there is a role to play for it, but
it is limited.
Speaker 2 (02:06):
Me when I read the article that there's two hundred
and ninety thousand key weis aren't enrolled with a GP,
now that to me is terrifying. That's I mean, that's
the population of a major major city in New Zealand.
Speaker 1 (02:18):
Sure, isn't it.
Speaker 3 (02:19):
Look it is a problem, and we know we've had
these workforce problems and funding problems in general practice over
the last ten years that have built to reach this point. Yeah,
access to general practice or primary care in the community
is absolutely critical for a functioning health system. So the
fact that is there, yeah, I think is a real,
(02:40):
real concern. It's one we've been plaguing for a while.
But look, I would have to be positive about the
announcements yesterday that there are arrange of announcements were made
about workforce, about investment into general practice, and this telehealth
announcement as well. So look, it was I consider a
positive first step, but it is only a first step
(03:01):
to start to resolve these issues, and there's more work
that needs to be done. That's certainly. Look, I agree
with you the fact that close to three hundred thousand
New Zealanders are not signed up with general practice or
can access it. I think it has been a problem
that has been recognized on the system.
Speaker 2 (03:16):
Now you are part of a very very busy practice, right,
So yeah, how often do you use phone calls or
videos or photos? Because I said earlier in my intro
that I had a lump and my nurses said take
a photo, send it to her. The GP had to
look at it, said Ahre you better come in. But
if it wasn't seriously to say you're fine, you'll be
right tomorrow. So how often does this happen in the
(03:38):
modern world.
Speaker 3 (03:39):
Yeah, look at our practice, I estimate we do sort
of remote consule team probably about ten to fifteen per
cent of our consults at this point. I tend to
be very comfortable with doing it where I know the patient,
i know their medical history, i know the medications, I've
got access to their notes in front of me, and
I'm very comfortable doing that. And again where I can say, look,
(04:02):
you do need to come in and see me to
really look at this, or I'm happy to sort of
prescribe or work on a management planet remotely. So look here,
it is part of modern day practice, There's no doubt
about it. A lot of the evidence around is if
you know the patient, you know their history, and you
know where they're at in terms of their medical health.
(04:22):
There is a role to play. For acute one off interactions,
it has got a role to play in that situation.
But for the vocal what we do, certainly face to
face is what has to go on because you can't
do a proper assessment without that physical engagement. Physical examination
and looking at the patient one on one.
Speaker 2 (04:42):
How do you feel about the online platforms where you
just put your credit card on and you go on
and you talk to a doctor. It could be anywhere
in the world. How do you feel about those platforms?
Are they are concerned to you?
Speaker 3 (04:54):
Look, I think we've got to be very careful about
how they're used and why are they're being used. Okay,
So where I do get concerned is where there's fragmentation,
so that there's a series of different interactions with different
doctors over time, and I can tell you from experience
what tends to happen there. Things get missed. Now if
it's an if it's a cute one off problem like
I've got I do have a cold, or I've got
(05:17):
a sore elbow, or something's happened, there is a role
to play, and we've got to understand that limitation so
they can often be resolved and moved forward. But where
you're talking about ongoing medical issues, you know it's such
a diabetes, heart disease, mental health issues, cancer, continuity is
really really important and that's the issue here that you
(05:38):
do need continuity with often a regular practitioner because over
time that's where you get your best outcome.
Speaker 2 (05:45):
How how many patients? Has too many patients for one
GP to have? Now I have got a new GP.
He's had him for about seven or eight months. He
has to go to his notes every time he sees me. Now,
I grew up with doctor Waite and Wadstown who knew
everything about me. Didn't open it, didn't even open his
computer when I walked in the door. See how's your
blood breasciate? Are you looking good?
Speaker 3 (06:06):
So?
Speaker 2 (06:07):
How many is too many?
Speaker 3 (06:09):
Yeah? Look, I mean the national averages the talk is
one full time equivalent GP to fifteen hundred patients. And
that does did very depend on the base in place
like I work in sort of East Parua. Because the
complexity of the patients we see, we estimate it's about
one to one thousand. Now that's still a big burden.
(06:30):
And yeah, I hear what you're saying about that. So
patients we know, well, yeah, what you've just reflected there
with doctor Waite walking and he knows your history, knows
exactly what's going on at that point. The patients that
are intermitted and we don't know that well, we often
have to refer to our notes and things until we
get to know them pretty well. So look, yeah, look,
those numbers vary around the country and a lot of
(06:55):
practices did close their books as a result of not
having capacity to safely manage their patient patient base, and
that's a reality workforce short age. Now when that happens,
that does put pressure on emergency departments and hospitals. It
does put on pressure on hospitals because things aren't managed properly,
which is why we've seen this capacity issue in the
system where a lot of practices have closed their books
(07:17):
over time.
Speaker 2 (07:18):
Okay, a couple of real quick questions, Well, anything that
goes on and your Telly Health consultation be passed on
to your GP if you have one.
Speaker 3 (07:27):
Yeah, look, that's one of the things we're talking to
the government, the Commissioner to Health New Zealand about what's
happened here. I think there's a couple of really critical
things here with telehealth. One there is connection back into
their regular GP if they do have one. That is
critically important. And two, there is access to the medical
history in terms of medications of patient maybe on or
(07:48):
the key medical problems, so that that informed decision can
be made. But that link into general practice, I think
is the absolute critical thing here in terms of this happening.
Speaker 2 (07:59):
When will we get to a stage where your medical
records are just held in one one computer for the
whole dealing, so everything about it. So how I get
hit by a car and Wanganui I got to Walganui
Hospital neck mills. Oh my god, you've got a lot
wrong with you. We've better said, you know.
Speaker 3 (08:16):
Look, that's been talked about for a long time. Nicket's
a really complex issue. And in fact, in the South
Island they have something called Health one one, which is
the case so the hospital can log on the GP
can not go on. They can see recent medications, recent history,
recent test results, what's gone on. So that that system
actually exists in the South Island, which is really really interesting.
(08:37):
The North Island's more complex. It hasn't rolled out across
the country, but there is a lot of move towards
getting to that point. And I think if there's a
national telehealth system or whatever comes into play, the need
for that is really really important that there is access
to those single point of notes in terms of medications,
key history and what's actually happened for the patient. So look,
(08:59):
a lot of discussion on that, as said in the
South islandry exists hopefully over the next two to three
years that can be rolled out across.
Speaker 2 (09:06):
Now I'm going to put you on the spot here.
Do you think that the new coalition government's heading in
the right direction with health? Do you feel that it's
that Do you feel that we're getting getting somewhere?
Speaker 3 (09:15):
Oh? Look, Look, I think the health's been a real,
really majorish for the last five seven years in terms
of what's been happening, and we've been very consistent in
what we've been saying about the issues. Look, I think
yesterday's announcement what I was really pleased about was the
focus on primary care in general practice, which I think
has been left off the agenda for a number of
years now. So that's an encouraging first step. The devil
(09:38):
is always in the detail and let's be clear on that,
and we're going to have to work on what actually
happens here. But an encouraging first step. But there's still
a lot to do here to move the system forward.
Speaker 2 (09:49):
See me and you both agree on this, and I
say it on the show all the time. The whole
key to health, better health is getting in to be
able to see your GP. So you get into the
ground floor. What happens when you get into the ground
floor and your GP says, like my personal situation, I've
got a lump, you got to go and see a surgeon.
Now I'm on waitless and I sit there and waiting.
So it doesn't really help if you can't get the
(10:09):
whole thing complete, does it?
Speaker 3 (10:12):
Everything's connected, Nick, So to have a functioning, well performing
primary care general practice sector is critically important to what
happens in hospitals and the burden that is in hospitals.
But we also need a functioning, well performing hospital sector. Okay,
So absolutely what you've said is the absolute reality. And
(10:32):
there have been pressures we've seen on waiting lists getting
access to specialist opinions, which is GPS. We see this
on a daily basis. Yeah, so I think the two things,
the hospital issues need to be worked on, and actually
the issues in community care and general practice need to
be worked on. It's going to take time, but we
need to absolutely work on both sides of the fence
(10:55):
to start to fix some of the issues we've seen.
Speaker 2 (10:57):
Do you think just really quickly. I know you're very
busy and you've got people sitting out in the waiting
room waiting and saying, get off the bloody phone and
come look after me.
Speaker 3 (11:04):
Telly ill I please to talk to you, Nick. They'll understand.
Speaker 2 (11:07):
Tell your health. Will it actually prevent queues at ED?
Will it help that some way? So if you're feeling
really croockly ring up rather than go and sit an ED.
Speaker 3 (11:18):
Look, I mean access to acute care both during the
day at your general practice, through after our centers and
through things like tell you health supplement that or have
a role to play. Look, the hope is that they're
that will help demand. We actually have to see how
it's implemented. I still think the actual critical thing here
(11:41):
is that we are building and making sure we've got
an efficient, functional general practice sector that everyone is able
to enroll in and see their GP when they need to.
Because the big, big problem for hospitals, and we focus
on D but our hospitals are you know, gummed up
with people's chronic concessions like heart disease, diabetes, mental health, cancer.
(12:06):
Those need chronic, those conditions need ongoing medical care, and
access to a functioning general practice sector is actually the
key to it. So although it does address some issues,
it's not the full story.
Speaker 2 (12:18):
Thank you very much for taking time out of your
very busy schedule. Appreciate talking to you. Always great to
talk to you and thanks for all your health hints
on Monday Mornings.
Speaker 1 (12:27):
For more from Wellington Mornings with Nick Mills, listen live
to news talks It'd be Wellington from nine to am weekdays,
or follow the podcast on iHeartRadio
You're listening to the Wellington Mornings podcast with Nick Mills
from News Talks at B.
Speaker 2 (00:12):
We're lucky enough to be joined by doctor Brian Betty.
We've just snuck in the phone game McCall and he's available.
He's in between his very very busy schedule.
Speaker 3 (00:22):
Good morning doctor, Oh morning, nice to be here.
Speaker 2 (00:25):
Nice to talk to you again.
Speaker 1 (00:26):
It's been a while, it has been, hasn't it.
Speaker 3 (00:29):
Yeah, I can remember the last time.
Speaker 2 (00:31):
Tell me the difference between Tellyhealth and health line.
Speaker 3 (00:36):
Our look. Health line is basically advice, so it's just
advice into where to get assistance or help tallyhealth mean
is a more formalized consultation in terms of a patient's
problem and trying to resolve that with either a GP
or an experienced nurse. So it's more like a consult
(00:57):
but obviously it's limited in what it can do. But
it's an extension or a backup from services that are
already offered in general practice. I suppose that's the way
to think about it. It's a step up from the
advice it's given on healthline.
Speaker 2 (01:09):
What can you actually do with a video phone call?
Speaker 3 (01:14):
Yeah, look, you can in certain circumstances resolve issues and
you can initiate treatment and do things. So I think
it is limited in what it does. So it tends
to be for one off acute problems, and we know
that with an experienced GP about seventy percent of those
consultations can be resolved without referring on to a face
(01:34):
to face consultation for further assessment. So there is a
role to play with tallyhealth. My belief is it's not
not for long term ongoing medical issues. General practice face
to face consultations is what is important. But if you
can't access your general practice, there is a role to
play if it's an acute problem that needs a level
(01:56):
of experience to look at and work out whether it
can be resolved through a video or a video consultation.
So there is a role to play for it, but
it is limited.
Speaker 2 (02:06):
Me when I read the article that there's two hundred
and ninety thousand key weis aren't enrolled with a GP,
now that to me is terrifying. That's I mean, that's
the population of a major major city in New Zealand.
Speaker 1 (02:18):
Sure, isn't it.
Speaker 3 (02:19):
Look it is a problem, and we know we've had
these workforce problems and funding problems in general practice over
the last ten years that have built to reach this point. Yeah,
access to general practice or primary care in the community
is absolutely critical for a functioning health system. So the
fact that is there, yeah, I think is a real,
(02:40):
real concern. It's one we've been plaguing for a while.
But look, I would have to be positive about the
announcements yesterday that there are arrange of announcements were made
about workforce, about investment into general practice, and this telehealth
announcement as well. So look, it was I consider a
positive first step, but it is only a first step
(03:01):
to start to resolve these issues, and there's more work
that needs to be done. That's certainly. Look, I agree
with you the fact that close to three hundred thousand
New Zealanders are not signed up with general practice or
can access it. I think it has been a problem
that has been recognized on the system.
Speaker 2 (03:16):
Now you are part of a very very busy practice, right,
So yeah, how often do you use phone calls or
videos or photos? Because I said earlier in my intro
that I had a lump and my nurses said take
a photo, send it to her. The GP had to
look at it, said Ahre you better come in. But
if it wasn't seriously to say you're fine, you'll be
right tomorrow. So how often does this happen in the
(03:38):
modern world.
Speaker 3 (03:39):
Yeah, look at our practice, I estimate we do sort
of remote consule team probably about ten to fifteen per
cent of our consults at this point. I tend to
be very comfortable with doing it where I know the patient,
i know their medical history, i know the medications, I've
got access to their notes in front of me, and
I'm very comfortable doing that. And again where I can say, look,
(04:02):
you do need to come in and see me to
really look at this, or I'm happy to sort of
prescribe or work on a management planet remotely. So look here,
it is part of modern day practice, There's no doubt
about it. A lot of the evidence around is if
you know the patient, you know their history, and you
know where they're at in terms of their medical health.
(04:22):
There is a role to play. For acute one off interactions,
it has got a role to play in that situation.
But for the vocal what we do, certainly face to
face is what has to go on because you can't
do a proper assessment without that physical engagement. Physical examination
and looking at the patient one on one.
Speaker 2 (04:42):
How do you feel about the online platforms where you
just put your credit card on and you go on
and you talk to a doctor. It could be anywhere
in the world. How do you feel about those platforms?
Are they are concerned to you?
Speaker 3 (04:54):
Look, I think we've got to be very careful about
how they're used and why are they're being used. Okay,
So where I do get concerned is where there's fragmentation,
so that there's a series of different interactions with different
doctors over time, and I can tell you from experience
what tends to happen there. Things get missed. Now if
it's an if it's a cute one off problem like
I've got I do have a cold, or I've got
(05:17):
a sore elbow, or something's happened, there is a role
to play, and we've got to understand that limitation so
they can often be resolved and moved forward. But where
you're talking about ongoing medical issues, you know it's such
a diabetes, heart disease, mental health issues, cancer, continuity is
really really important and that's the issue here that you
(05:38):
do need continuity with often a regular practitioner because over
time that's where you get your best outcome.
Speaker 2 (05:45):
How how many patients? Has too many patients for one
GP to have? Now I have got a new GP.
He's had him for about seven or eight months. He
has to go to his notes every time he sees me. Now,
I grew up with doctor Waite and Wadstown who knew
everything about me. Didn't open it, didn't even open his
computer when I walked in the door. See how's your
blood breasciate? Are you looking good?
Speaker 3 (06:06):
So?
Speaker 2 (06:07):
How many is too many?
Speaker 3 (06:09):
Yeah? Look, I mean the national averages the talk is
one full time equivalent GP to fifteen hundred patients. And
that does did very depend on the base in place
like I work in sort of East Parua. Because the
complexity of the patients we see, we estimate it's about
one to one thousand. Now that's still a big burden.
(06:30):
And yeah, I hear what you're saying about that. So
patients we know, well, yeah, what you've just reflected there
with doctor Waite walking and he knows your history, knows
exactly what's going on at that point. The patients that
are intermitted and we don't know that well, we often
have to refer to our notes and things until we
get to know them pretty well. So look, yeah, look,
those numbers vary around the country and a lot of
(06:55):
practices did close their books as a result of not
having capacity to safely manage their patient patient base, and
that's a reality workforce short age. Now when that happens,
that does put pressure on emergency departments and hospitals. It
does put on pressure on hospitals because things aren't managed properly,
which is why we've seen this capacity issue in the
system where a lot of practices have closed their books
(07:17):
over time.
Speaker 2 (07:18):
Okay, a couple of real quick questions, Well, anything that
goes on and your Telly Health consultation be passed on
to your GP if you have one.
Speaker 3 (07:27):
Yeah, look, that's one of the things we're talking to
the government, the Commissioner to Health New Zealand about what's
happened here. I think there's a couple of really critical
things here with telehealth. One there is connection back into
their regular GP if they do have one. That is
critically important. And two, there is access to the medical
history in terms of medications of patient maybe on or
(07:48):
the key medical problems, so that that informed decision can
be made. But that link into general practice, I think
is the absolute critical thing here in terms of this happening.
Speaker 2 (07:59):
When will we get to a stage where your medical
records are just held in one one computer for the
whole dealing, so everything about it. So how I get
hit by a car and Wanganui I got to Walganui
Hospital neck mills. Oh my god, you've got a lot
wrong with you. We've better said, you know.
Speaker 3 (08:16):
Look, that's been talked about for a long time. Nicket's
a really complex issue. And in fact, in the South
Island they have something called Health one one, which is
the case so the hospital can log on the GP
can not go on. They can see recent medications, recent history,
recent test results, what's gone on. So that that system
actually exists in the South Island, which is really really interesting.
(08:37):
The North Island's more complex. It hasn't rolled out across
the country, but there is a lot of move towards
getting to that point. And I think if there's a
national telehealth system or whatever comes into play, the need
for that is really really important that there is access
to those single point of notes in terms of medications,
key history and what's actually happened for the patient. So look,
(08:59):
a lot of discussion on that, as said in the
South islandry exists hopefully over the next two to three
years that can be rolled out across.
Speaker 2 (09:06):
Now I'm going to put you on the spot here.
Do you think that the new coalition government's heading in
the right direction with health? Do you feel that it's
that Do you feel that we're getting getting somewhere?
Speaker 3 (09:15):
Oh? Look, Look, I think the health's been a real,
really majorish for the last five seven years in terms
of what's been happening, and we've been very consistent in
what we've been saying about the issues. Look, I think
yesterday's announcement what I was really pleased about was the
focus on primary care in general practice, which I think
has been left off the agenda for a number of
years now. So that's an encouraging first step. The devil
(09:38):
is always in the detail and let's be clear on that,
and we're going to have to work on what actually
happens here. But an encouraging first step. But there's still
a lot to do here to move the system forward.
Speaker 2 (09:49):
See me and you both agree on this, and I
say it on the show all the time. The whole
key to health, better health is getting in to be
able to see your GP. So you get into the
ground floor. What happens when you get into the ground
floor and your GP says, like my personal situation, I've
got a lump, you got to go and see a surgeon.
Now I'm on waitless and I sit there and waiting.
So it doesn't really help if you can't get the
(10:09):
whole thing complete, does it?
Speaker 3 (10:12):
Everything's connected, Nick, So to have a functioning, well performing
primary care general practice sector is critically important to what
happens in hospitals and the burden that is in hospitals.
But we also need a functioning, well performing hospital sector. Okay,
So absolutely what you've said is the absolute reality. And
(10:32):
there have been pressures we've seen on waiting lists getting
access to specialist opinions, which is GPS. We see this
on a daily basis. Yeah, so I think the two things,
the hospital issues need to be worked on, and actually
the issues in community care and general practice need to
be worked on. It's going to take time, but we
need to absolutely work on both sides of the fence
(10:55):
to start to fix some of the issues we've seen.
Speaker 2 (10:57):
Do you think just really quickly. I know you're very
busy and you've got people sitting out in the waiting
room waiting and saying, get off the bloody phone and
come look after me.
Speaker 3 (11:04):
Telly ill I please to talk to you, Nick. They'll understand.
Speaker 2 (11:07):
Tell your health. Will it actually prevent queues at ED?
Will it help that some way? So if you're feeling
really croockly ring up rather than go and sit an ED.
Speaker 3 (11:18):
Look, I mean access to acute care both during the
day at your general practice, through after our centers and
through things like tell you health supplement that or have
a role to play. Look, the hope is that they're
that will help demand. We actually have to see how
it's implemented. I still think the actual critical thing here
(11:41):
is that we are building and making sure we've got
an efficient, functional general practice sector that everyone is able
to enroll in and see their GP when they need to.
Because the big, big problem for hospitals, and we focus
on D but our hospitals are you know, gummed up
with people's chronic concessions like heart disease, diabetes, mental health, cancer.
(12:06):
Those need chronic, those conditions need ongoing medical care, and
access to a functioning general practice sector is actually the
key to it. So although it does address some issues,
it's not the full story.
Speaker 2 (12:18):
Thank you very much for taking time out of your
very busy schedule. Appreciate talking to you. Always great to
talk to you and thanks for all your health hints
on Monday Mornings.
Speaker 1 (12:27):
For more from Wellington Mornings with Nick Mills, listen live
to news talks It'd be Wellington from nine to am weekdays,
or follow the podcast on iHeartRadio
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