It’s almost hard to believe that urgent care - an area of medicine that is now so firmly established within Australasia and other parts of the world - was nothing more than an emerging concept a mere twenty-five years ago. Had it not been for the temerity and forward thinking of a group of New Zealand doctors, there would not be the bridge between general practice and emergency care that we have today, says Dr Afraz Adam.
”Thank goodness for these doctors - because what they established has paved the way for doctors like us, who always felt like we were in a limbo of whether to practise a full-time hospital medicine role or whether to step into general practice, where you do take the tensions of your day-to-day work home.”
He says it was clear that there was demand for a medical area that acted as an intermediary between the day-by-day service of general practice and the more serious conditions that would, by default, require an often lengthy visit to a hospital emergency department.
“The idea was to offer care to those patients who wanted to walk in after their job. They could find their usual practice was closed but they didn’t want to go to ED and wait eight hours to be seen for a nasty sore throat that had developed that morning - but where could they go? It was clear there was a need, not just for doctors to have a speciality, but for patients to have an affordable, convenient point of care which was available to them as a one-off when they wanted it.”
And so the College was born. Initially formed in 1992 as the Accident Medical Practitioners Association, it would go through a number of iterations before becoming the Royal College of Urgent Care in 2013, when the Queen granted her Royal decree to use the title, a milestone that was commemorated with an elaborate function at Government House.
Bridging the gap for both patients and doctors was indeed the impetus behind the establishment of urgent care as a medical field, as Dr Adam explains.
“I like to look at urgent care like a venn diagram, where you have a hospital emergency department on one side, and your family doctor or general practitioner - who’s treated you for life - on the other side. We are smack-bang in the intersection in the middle - we are urgent, but not an emergent condition, so if you have an urgency you come to urgent care, if you have an emergency you call an ambulance and go to the hospital. That’s the way I describe urgent care to patients.”
As Dr Adam explains, the emergence of urgent care benefits not just patients, but doctors working outside of the urgent care field as well, with a positive impact on general practitioners.
“A GP can go home with peace of mind that if one of their patients becomes suddenly unwell they would not necessarily have to end up in the hospital setting. They would have a practice where they could go and get treated and they would be very well informed about what’s happened overnight. So when they open the doors the next day they find an additional summary that says, for example ‘your patient with asthma who you saw during the day just suddenly got worse at night and we managed to stabilise him, he’s back at home and he’ll come back and see you tomorrow. But he was in safe hands and he’s fine’ - I would like to think that gives general practitioners reassurance that their patients are well taken care of after hours.”
Dr Adam is very positive about the position the Royal New Zealand College of Urgent Care is in and the prospects the future holds.
“The future is looking very bright for the College, the future looks challenging as well in terms of the fact that I think we’re going to be one of the fastest growing colleges in the near future. Our numbers are increasing steadily.”
As the numbers continue to increase, so too does the amount of interest in the College, not just locally but also internationally.
“We’re getting a lot of recognition from doctors in places like Australia and Canada who are joining our training programme, they’re coming to New Zealand for a few years because it’s an area of need in most of countries that’s perhaps not yet recognised, and a lot of doctors do want to undergo training in this and then take it back to their own countries as well.
Dr Adam is quick to emphasise the continued need for an after hours service in the country, as it allows patients a comfortable and positive experience, as well as giving general practitioners peace of mind and in turn keeping the load off the hospital system.
“It’s an area that’s irreplaceable; what’s more exciting though is that there’s so much more recognition in urgent care now compared to what it would have been twenty years ago. We’re really going from strength to strength.”