Telehealth: replacing or supplementing in-person care?

FEATURE - eHealthNews editor Rebecca McBeth

Primary care leaders are worried that telehealth is shifting from being a complementary tool into being seen as a replacement for in-person general practice, putting continuity of care at risk, particularly for rural and remote communities. 

The case for continuity  

GenPro has launched its election policy manifesto, Seven Steps to Restore General Practice and the second step is ‘Support long-term GP–patient relationships’. 

The organisation says face-to-face consultations should remain the foundation of primary care, with telehealth used to complement rather than replace in-person care. 

Christchurch-based GP and chair of GenPro Angus Chambers believes there has been a shift in the way Health New Zealand has positioned telehealth in its messaging. 

"The words are often that it is meant to be an enhancement, but it is clearly being positioned as a replacement in many ways," he says. 

“Continuity of care is not just about convenience, it contributes to better health outcomes and can reduce avoidable pressure on hospitals.” 

A national telehealth service 

Chambers tells eHealthNews there is no evidence that the new 24/7 telehealth service launched in July 2025 is reducing demand on Emergency Departments as intended. 

The national Online GP Care service has released its first full year of data, showing the 24/7 service delivered just under 96,000 funded video consultations in the year to June 2026. 

When launching the service health minister Simeon Brown said it would help to ease pressure on emergency departments by treating non-urgent issues earlier and in the right setting.  

“This digital service is giving people greater access to the care they need, but does not replace the critical role of GPs, who are responsible for their patients’ continuity of care,” he said at the time. 

Andrew Swanson-Dobbs, chief executive of WellSouth PHO says the data shows the busiest period for using the service is ordinary daytime hours when general practices are already open and the most common reason patients give for using it is that they could not get a timely appointment with their own GP. 

"When a patient turns to a national video service because they cannot see their own GP, we have not solved an access problem, we have relocated it and separated that patient from the thing that makes general practice effective: continuity," he says. 

“This is not a new front door to the health system, it is an overflow valve and the pressure it is relieving is pressure we created by under-investing in the front door itself.” 

A question of funding 

Swanson-Dobbs says that when set against the more than 20 million consultations general practice delivers across New Zealand every year, the Online GP Care figures represent a narrow slice of total demand, but the service is getting around $40 million in annual public funding. 

Chambers is also concerned about the funding model, saying telehealth providers can receive up to four times more in government subsidy than a GP would receive for seeing the same casual patient in-person and the disparity "completely perplexes" him. 

"We do not think we are investing in the parts of the health system that we need to in order to mitigate the problems we have got," he says. 

There is also concern that the financial attractiveness of telehealth is drawing the clinical workforce away from in-person practice.  

"Telehealth is definitely easier and pays better, and people are being taken away from in-person care in clinics," he says. 

Chambers says there is a significant difference between ad hoc virtual care and telehealth delivered within an existing patient-practice relationship. 

Swanson-Dobbs agrees saying a one-off consultation with a clinician who has never met the patient simply “deals with the presenting issue and returns the patient to the same queue they started in.  

The technology is not the problem, or the solution 

Ruth Large, chair of the NZ Telehealth Forum, says the issue is not telehealth versus primary care, as telehealth should be “an and, not an or”. 

She argues that the focus should be on systemic primary care reform rather than getting caught up in debates about which technology is used to deliver healthcare. 

"Telehealth is supposed to be an extension of healthcare," Large says.  

"It is not helpful for us to concentrate on the mode of care delivery when we should really be thinking about what patients need." 

She says continuity of care is an issue even within practices as patients often cannot see their own GP within a reasonable time. 

The workforce concern is a real issue as particularly younger doctors are drawn to telehealth roles for their flexibility, reduced administrative burden and ability to work remotely. 

There is also no evidence that offering telehealth can reduce pressure on emergency departments, as shown by a number of trials in EDs around New Zealand that have failed to scale. 

"The majority of the problem with emergency departments is not the patients coming into the waiting room, it is getting beds in the hospital," she explains. 

A broader redesign 

Large says there is a tendency to treat telehealth as a quick fix rather than part of a broader system redesign.  

"We keep doing the same thing, we just add a layer of technology over the top without actually saying ‘we know what the problem is, what are innovative ways of solving it?’, she says. 

Questions also remain about availability of a patient’s health record and the impact on population health outcomes, such as whether children seen via telehealth are still being asked about other health need such as vaccinations. 

"Primary care arguably is the place that you will have the biggest impact in healthcare provision," Large says.  

"That is where you are going to prevent disease, particularly if you can do continuity of care." 

Swanson-Dobbs is not advocating abandoning virtual care, but wants investment to go where the data says the need is, which is in general practice capacity, workforce, and funding.  

“Virtual care works best as a tool in the hands of a patient’s own practice, not as a substitute for one,” he says. 

If you have any questions re the above feature article, please contact the editor Rebecca McBeth.

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