Better Sooner More Convenient Primary Care - New Zealand Doctor

The service views the great majority of requests as being appropriate. There are times when
locums and nurses (with GP sign off) appear to be quicker to x-ray rather than using time as a
diagnostic tool to determine whether an x-ray is necessary.
Current volumes of primary care ordered plain films and ultrasounds: 5000 per annum,
increasing by about 200 per year. No national comparative data is available from the Ministry
of Heath 48 .
Ultrasound
Open access is available from primary care for all ultrasound examinations except
musculoskeletal. Current capacity is full and further sonographers and ultrasound machines
would be required if access was made available for musculoskeletal investigations, which
generally take longer, (eg. a shoulder ultrasound takes twice as long as an abdominal ultrasound).
GP ordering of ultrasound is viewed by the service as being generally appropriate.
There is no access to ultrasound in Westport currently, although this has been possible in the
past.
There are plans to introduce generalist medical ultrasound in ED in Greymouth, for use by
clinicians in caring for patients acutely. This may have a small effect on the number of
diagnostic ultrasounds ordered (generalist medical ultrasound is useful to aid doctors in ED
management, however it lacks the sensitivity and specificity of a diagnostic ultrasound done by a
trained sonographer, and is not reviewed and reported on by a radiologist).
If a GP thinks a musculoskeletal ultrasound is required then a referral for an orthopaedic First
Specialist Appointment (FSA) can be made, potentially adding to the cost of care if the
ultrasound result proves the FSA unnecessary. Alternatively, a number of patients, either with
injuries covered by ACC or with medical insurance, travel to Christchurch to access
musculoskeletal ultrasound. On occasions this is linked in with private specialist appointments in
Christchurch and subsequent procedures that might otherwise have been carried out at Grey
Base Hospital and paid for by ACC.
CT scans
Currently the only access for primary care to CT scanning is for CT urogram for renal colic.
However GPs can on occasions phone a Senior Medical Officer (SMO) and obtain verbal consent
for the ordering of CT scans (this is more likely to happen if the GP knows the SMO, and is able
48 Personal communication, Andrew Downes, Portfolio Manager, Elective Services
Business case appendices V12 AC 25Feb2010 Page 72