A Taranaki nurse practitioner has worked for free for two and a half years for a youth health service forced to close its doors through lack of funding – despite it having 3,500 regular clients on its books.
“If we got capitation funding for those 3,500 clients, then we’d be more than sustainable,” said Waves founder and prescribing youth health NP Lou Roebuck. “But we can’t get that as that funding has to go through a GP.”
Roebuck lobbied to set up the youth one stop shop in 2007 after seeing unmet health needs amongst New Plymouth’s young people, and until the free NP-led service closed its doors on October 19, it was seeing 30-40 young people a day.
“97 per cent of those clients at Waves were seen by an NP or a registered nurse (the rest by a volunteer GP),” says Roebuck. “We’re doing everything that the research and the government is asking yet we can’t get funding.”
She said the majority of Waves clients – including young parents and teenagers with mental health issues – could not afford GP services. She feared the long-term health fallout from closing Waves’ health services when young people couldn’t or wouldn’t access conventional GP services, including increased hospital admissions through untreated scabies turning into cellulitis, increased pregnancy terminations through inadequate education, and contraception and mental health issues.
Roebuck said Waves usually saw five young people with mental health issues a day and at least once a fortnight or sometimes up to once a week called in the mental health crisis team to help severely depressed young people at risk of suicide.
“I hope the suicide rate doesn’t go up and more severe mental health issues … as those young people are now going to present later and be more unwell.”
Roebuck said Waves had an excellent collegial relationship with local GPs, who often referred young people and their families to the one stop shop because it had the time and skills to focus on complex psychosocial issues.
“The business model of general practice doesn’t work with this population group.”
She said tensions between providing the Waves holistic model of care and the medical model of the Midland PHO (primary health organisation) had led it to withdraw from a funding contract with the PHO last year. Attempts to get transitional funding from the Taranaki District Health Board while it sought a sustainable funding base had been unsuccessful leading to the health service having to close. (see related News Feed stories)
Roebuck said she worked for the first year for Waves for free and again for a further 18 month period when Waves was cash-strapped.
“It’s certainly been a financial struggle for me, and my family sometimes say why don’t you get paid what you're worth. But I see it as a gift to the community – I just know from working with young people when I was a public health nurse, when there was nowhere like Waves to take them, that I often ended up putting my hand in my pocket to pay GP fees and prescriptions myself.”
She said she and the volunteer GP Don McKee had both offered again to work for half-a-day for free but the Trust had declined their offers, saying it wasn’t sustainable.
She said it would certainly be helpful if she as an NP could be self-employed and receive government capitation funding for the youth clientele she serves. “These young people are probably registered with a GP somewhere and that GP is getting the money for them while we see their clients.”
Charity funding for the centre, including $350,000 sponsorship from Contact Energy over the last four years and government contracts, means Waves will continue to offer some youth development and social services. But Roebuck said it was also determined to re-open its health services within five months and was currently working on gaining sustainable funding for the service. She would continue to work unpaid to support the trust’s work and lobby for new funding streams.
She believes one answer that should be explored is all the country’s youth one stop shops forming a primary health organisation to ensure sustainable funding for youth health across the country and not just Taranaki.
Meanwhile, she has a few hours work with local Family Planning and the chance of further part-time work as an NP for local polytechnic WITT.
