Nine senior doctors employed by the Southern District Health Board at the Lakes District Hospital say they are "absolutely" opposed to GPs being the gate-keepers of the proposed health centre's emergency department, deciding who would qualify for free emergency care.
Six hospital administration staff said the hospital suffered huge financial loss from non-resident patients who had no insurance and no ability to pay for care.
They said the proposal would require additional administration staff if the board stopped providing human resources, information technology and accounting administration for the hospital.
"It seems clear to us that before any options are considered there must be enough time allowed to get it right.
This cannot be rushed through, especially as this is such a totally new concept in health care.
We all want change for the Wakatipu that is positive for health care workers, residents and clients of the proposed Integrated Family Health Centre," they said.
The Wakatipu Health Trust said it had "serious concerns" about the lack of a strategic plan, equity of access to services in Queenstown, a lack of transparent funding and remote management and governance.
Queenstown Medical Centre (QMC) chief executive Richard Marcharg made a submission on behalf of all the centre's doctors.
"It would be insensitive and publicly unacceptable for QMC to bid for a tender encompassing all of Lakes District Hospital services," he said.
He proposed a model similar to Dunstan Hospital, at Clyde, under which the board would provide secondary care services through a contract with a newly created Queenstown Health Trust.
Entry to the hospital would be administered through a general practice co-located on the site.
QMC wanted to provide general practice, nursing and out-patient clinics at the centre.
"Such an integrated centre would not only best serve patient care but also provide for the possibility of further services including surgical intervention, maternity, health professional teaching and training, mental health."
QMC wanted to run a general practice at Lakes District Hospital to reduce the workload on staff immediately while options were being considered.
He was investigating the co-location options to allow the commercial viability of primary care services as well as public ownership of the hospital facilities and services.
Wakatipu Medical Centre owners Valerie Miller, Nigel Thompson and Tim Milliken said they did not support the proposals.
"The proposal does not provide adequate transparency for the process of appointing the service provider.
Current evidence suggests a large local general practice is already earmarked to take over the management of Lakes District Hospital.
This apparently monopolistic proposition is untenable," their submission said.
However, public/private co-operation should be encouraged to enhance services.
They said Lakes District Hospital staff provided a top-level service and the board had no evidence to back up a change in the way the service was delivered.
They also raised concerns about the conflict of interest in a general practitioner being the gatekeeper of the emergency department.
Plunket said some families accessed emergency department care because of the cost of GP appointments.
Preventing non-emergency cases from being admitted would result in "poor health outcomes" for families.
Plunket wanted more input and consultation on how it could provide services at the Integrated Family Health Centre.
"There is no reference to maternity services in the consultation document.
We strongly advocate for the retention of a birthing unit at Queenstown Lakes District Hospital," the submission says.
Mobile Surgical Services Ltd manager Mark Eager said the board could include "share mobile" options in the new model.
The company provides mobile surgery to Gore, Balclutha, Oamaru, Dunstan and Queenstown.
The surgical buses allow health services to be provided closer to home and to reduce the pressure on the hospital.
It could also provide remote video consultation services to patients and GPs.
The New Zealand Nurses Organisation said it wanted more local control of health services.
"However, this document does not provide evidence of robust strategic thinking or planning for the future community health needs in this area."
It was concerned about the lack of consultation with staff at the hospital and the proposal to decrease access to the emergency service.
The document lacked "analysis and costings".
"The lack of depth of this document ... indicates to our members that you wish to divest yourselves of this service in the easiest and cheapest way possible, without giving up control."
The proposal did not future-proof the needs of a growing resident and tourist population.
"There is a need for far more information and detail about the proposed governance structure, other possible models of service provision and funding of health services before any decision can be made regarding the efficacy of this proposal," it said.
The Queenstown Lakes District Council supported the Integrated Family Health Centre model being managed with more community participation.
St John southern regional manager Doug Third said he was concerned about the change to the triaging system at the hospital.
"By limiting access to health care, patients will present more acutely ill ... this will add significant risks to St John as we are responsible for transporting these patients at their most dangerous time clinically," he said.
Fewer acute long stay beds would lead to St John making more acute emergency transfers to other hospitals.
"St John would be unable to provide any additional capacity without a significant increase in funding."
Proposed changes:
• Refurbish and add a storey to existing hospital
• Establish an integrated family health care centre as a one-stop-shop for health services
• More aged-care beds, specialist outpatient clinics, day-case elective surgery and community nursing services
• 24-hour general practice services
• A GP triage system for access to the emergency department
• Centre governed by community representatives and providers
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