An employee of a clinic in the Clutha area, who declined to be named, said patients not being able to see doctors when they needed to was causing an increase in the number of people seeing red.
"We’ve been in lockdown twice or three times probably in the last two years now, so it’s definitely escalating.
"When someone rings up and says they’re going to drive a car through reception and wipe everybody out, you’ve sort of got to take it seriously.
"In the past, I’m sure there’s been the odd time that the receptionists have had someone a little bit grumpy at the counter about a bill or whatever, but nothing to the level of what we’ve had lately.
"In fact, we trespassed two people in the same day, about four or five months ago."
WellSouth clinical adviser and Aspiring Medical Centre Wānaka general practitioner Dr Andrew Boyd said that, compared with their urban counterparts, rural general practices in the southern regions were struggling to retain staff, fill staffing gaps and keep up with demand for healthcare in their communities.
"There are pockets where practices are thriving, others where they’re just about surviving and others where they’re really struggling.
"And the ones who are struggling are struggling with recruitment, with seeing patients in a timely manner and with a cycle of burnout amongst staff members, which just compounds the problems.
"It turns into a bit of a vicious cycle."
The number of rural Otago and Southland practices affected was growing, particularly in places such as the Gore, Clutha and Waitaki districts.
"I think there’s more and more pressure on practices to do more and patient expectations are growing, which in and of itself is not inappropriate.
"But it needs to be met with adequate capacity at the provider end and that causes GPs and their teams quite a lot of stress if they’re not able to meet that expectation and demand."
Many senior GPs and clinic owners were putting in long hours and taking on extra duties to keep up, he said.
"For every 10 minutes that we’re seeing a patient, there’s at least five minutes of administration, checking results from the last time you saw them, doing referrals and that sort of thing.
"So, a lot of the work is quite hidden and with increasing patient complexity and with an overall ageing population — which we certainly have in our region — there’s more and more of that to do.
Dr Boyd said some doctors were doing very long hours.
"They’ve got more complex patients and they’re the ones who are really putting in the very long hours."
He said full-time general practice was "pretty exhausting", and he himself burned out in the job at one stage.
"It’s not a nice place to be — and it’s not good for you and it’s not good for your patients."
He was very aware of the issue and protective of other doctors showing signs of burnout.
"And if healthcare professionals are feeling burnt out and are doing 80-hour weeks, in any line of work, that’s not a safe amount of work.
"On a given day, the average GP will be seeing 25-30 patients, and then making decisions about prescriptions, about results, and all the rest of it.
"When you’re knocking on that sort of number, there’s a risk that your judgement doesn’t hold firm the whole day."
The Clutha area clinic employee said thanks to relaxation of immigration rules, plenty of nurses were available in New Zealand.
But because primary healthcare nurses in GP clinics were paid less than secondary healthcare nurses in hospitals, it was difficult to attract and keep them.
"Our ability to match the levels of pay that they get in the secondary system — that’s the challenge.
"It’s not fair on our staff who work fairly regularly at a very high level of scope, to be paid less than someone who just happens to work in the secondary system.
"The money essentially comes from the same place, but we just get less of it.
"It’s enormously frustrating."
He said many practices were running "zero budgets".
"A lot of them are pretty skinny ... and some of them aren’t even that.
"In the Clutha area, there’s six practices ... I would say two of us are in the black, one’s a going concern, one’s breaking even, and the other two would be running losses.
"We’ve got to be careful because we want people to lobby the government and put some pressure on them because the situation’s not OK, but we also don’t want to spook people.
"There just isn’t an alternative plan if any of these businesses fail."
Dr Boyd said funding for primary care was about 5% of the overall health budget, but the OECD average was 10%-14%.
"It’s just not really a sustainable model as it stands."
He said it was great that the government was "making the right noises" about primary care being the cornerstone of good healthcare — "But there’s talking the talk and then there’s walking the walk and it’s time to put your money where your mouth is.
"So, if anyone’s listening, we’re here and we’re here to serve our patients, but we could do with a bit more resourcing to make that happen."
The comments reflect a recent WellSouth primary care survey.
WellSouth chief executive Andrew Swanson-Dobbs said the situation was creating "pressure cookers" with unhappy patients who were abusive to staff, which in turn affected job satisfaction and customer service.
"We urgently need to address the rural shortfall and support those community’s health needs."
Overall, urban and rural feedback from the survey showed most general practice staff were experiencing mild to moderate burnout.
One respondent said burnout for many people needed a solution higher than just the practice support.
"The practice can’t fix the problems with the rest of the health system that cause the stress and moral injury.
"But the team is very supportive of each other — the main reason we are able to continue functioning."
Mr Swanson-Dobbs said a system-wide approach was needed, with targeted funding and workforce investment to ensure rural primary care was not just sustainable, but an attractive sector in which to work.
