Part 6: Pharmacy services and diagnostic services

District health boards: Availability and accessibility of after-hours services.

In this Part, we discuss:

Summary of our findings

Sometimes, people need more than an after-hours consultation with a GP. They might need pharmacy services or diagnostic services.

Overall, DHBs should do more to consider patients' access to pharmacy services within after-hours plans.

What district health boards were required to do

The 2009/10 Service Coverage Schedule requires DHBs to "use best endeavours to ensure a level of access to after-hours pharmacy services that meets the reasonable needs of their populations".18 Further, in 2006, DHBs agreed to consider "access to pharmaceuticals"19 in preparing after-hours plans.

We reviewed DHBs' after-hours plans to see how DHBs had considered patients' access to pharmacy services.

Access to pharmacy services

Most DHBs could be clearer in their after-hours plans about the extent to which pharmacy services are available, including patients' access to pharmaceuticals.

It is important that patients can access pharmacy services after hours when they need to. For some patients, the benefits of access to timely medical assistance can be reduced by a lack of access to pharmaceuticals.

In some instances, patients may not have ready access to pharmacy services after hours. For example, pharmacy services may not be available overnight or may be some distance from where the patient has visited the GP or nurse. However, we have been told that GPs, particularly those in rural areas, may manage this by holding pharmaceuticals at their practice.

In most cases, DHBs had not included clear information in their after-hours plans about issues that patients may have in accessing pharmacy services. The two clearest plans we saw:

  • briefly outlined the pharmacy services available after hours in the district;
  • included information about gaps and issues in these services; and
  • specified actions that the DHB or others were taking, or intended to take, to address these gaps and issues.

Eight DHBs identified within their after-hours plans initiatives that they had in place, or proposed to take, to improve patients' access to pharmacy services after hours. Figure 9 sets out two examples of these.

Figure 9
Examples of district health board initiatives to improve patients' access to pharmacy services after hours

Bay of Plenty DHB stated an intention in its after-hours plan to work with providers to ensure that after-hours pharmacy services were available.
MidCentral DHB stated an intention in its after-hours plan to ensure that a local pharmacy was available when regular after-hours clinics were held. This DHB had also arranged for GPs to carry a range of common medicines that they could dispense.

Eight DHBs did not identify issues with patients' access to pharmacy services within their after-hours plans. Access to pharmacy services is an important factor in providing patients with after-hours care. In our view, DHBs need to consider this further as part of their after-hours planning.

Access to diagnostic services

We have not audited the availability of diagnostic services after hours. However, not all after-hours services have the same level of access to diagnostic facilities, and it is not always reasonable to expect that they do.

Where a required diagnostic service is not available after hours, patients may be referred to another service, or may have to travel to hospital to receive the care they need. This means that, although patients may be able to get to an after-hours service within 60 minutes' drive, in practical terms, they may not be able to get to an after-hours service that fully meets their needs within that time.

At the time of our audit fieldwork, the Ministry of Health was seeking expressions of interest for the Government's Better, Sooner, More Convenient primary health care initiative. This work was intended to achieve faster implementation of the service model improvements envisaged in the Primary Health Care Strategy. This included devolving more treatment and diagnostic services from secondary health care services (such as hospitals) to primary health care services. It is too early to comment on what any changes resulting from this initiative will mean for patients accessing after-hours services.

18: Ministry of Health, 2009/10 Service Coverage Schedule, page 32.

19: Response to Recommendations of After Hours Primary Health Care Working Party, published 9 March 2006 on the Ministry of Health's website,

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