GPs say patients who desperately need hospital treatment are increasingly not even making it onto waiting lists.
An excerpt of a letter to a GP from Palmerston North Hospital's orthopaedic clinic earlier this year - obtained by RNZ - confirms some referrals are being knocked back due to "lack of resources".
The letter read: "Thank you for your referral. We are not able to offer this patient an orthopaedic clinic appointment. This decision is forced upon us by a lack of sufficient resources to enable us to see all patients referred to us within the limits of the Ministry of Health waiting time targets."
Until recently, former Palmerston North mayor Heather Tanguay, 80, was one of those people living in limbo, waiting for a specialist appointment about her painful hip.
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"I would lead a hīkoi, if I could, of those waiting for surgery, but sadly we would not make it - so many are now unable to leave their homes," she said.
Her condition suddenly deteriorated a few weeks ago.
"It was horrible - it felt as though my hip was going to collapse, so I went to the [Waitakere Hospital] emergency department].
"The fantastic doctor apologised for the situation, that it would take 300 days to be seen in the public system, and then he could not say, when or if even, I would ever have surgery."
Her GP tried to get her bumped up the list.
"We were told there was no way, they were not reprioritising anyone."
Tanguay's only option was to pay privately for a hip replacement.
She felt fortunate that she was able to afford the $25,000 to $35,000 operation, but said it made her angry to think of how many older New Zealanders would not have the money.
"It's neglectful, shocking. It is a sad state of affairs when those who have given so much in the past to their country, now lie in their homes in pain waiting, waiting and waiting."
Association of Salaried Medical Specialists executive director Sarah Dalton - who represents senior hospital doctors and dentists - said such "rationing" was the reality in almost every department.
"So a terrible letter to receive and not a great letter to send, but we do spend quite a bit of time with our members who are saying, 'We can't cover our service, we can't see our patients, we haven't got enough staff to cover the clinics, plus we've just lost another colleague to burnout.' "
The union was urging other specialists to be honest about their limitations, Dalton said.
"[We say] we need to work out what you can safely - or relatively safely - stop doing, so you can manage your workload."
Wellington doctor Samantha Murton, president of the Royal New Zealand College of General Practitioners, said GPs "don't refer for fun".
"They do it because those patients need treatment, which can only be provided in a hospital.
"[It's] a total waste of time for me to refer someone three times when each time they say, 'Yes, your patient needs [a referral] and no, we can't do it, so go back to your GP and get referred again.' "
Te Whatu Ora director of health targets Duncan Bliss said referrals for first specialist assessments were "individually assessed using documented clinical acceptance criteria".
"Other factors, such as lack of resource, health targets, or wait list lengths, are not part of the referral assessment process."
Those patients who did not meet the threshold to see a specialist may be referred back to their GP or another health professional, such as a physiotherapist, where their continued care was "most appropriately managed", Bliss said.
"General practice can be assured that every referral will continue to be assessed using appropriate clinical acceptance criteria."
However, Tanguay - speaking last week on the eve of her private surgery - was deeply sceptical.
"This makes me so mad. I paid my tax for over 60 years, I served my community, I was given a QSO [Queen's Service Order] for service to my community. But still Dr Reti is prepared to leave the hundreds of seniors waiting in pain for their replacement surgery," she said.
