Surge in bespoke telehealth services reflects unmet need in primary care

NEWS - eHealthNews.nz editor Rebecca McBeth

Thousands of patients are turning to bespoke telehealth providers every week as pressures mount on busy general practices, leading to significant unmet need in the community.

Numbers provided to eHealthNews show primary care telehealth providers Practice Plus, CareHQ and Bettr NZ are together delivering more than 100,000 appointments a year.

A number of hybrid or ‘digital-first’ providers are also providing regular GP appointments via telehealth, such as Tend Health, Doctors Online and online locum GP services such as Remedi.

A recent Health Quality and Safety Commission Te Tāhū Hauora report says the ‘tide’ of telehealth following the Covid-19 pandemic was smaller than might have been expected and never went beyond 20 percent of appointments in primary care.

However, concrete data on the use of telehealth in primary care is unavailable because much of it is not coded as such by GPs, and many appointments are conducted through bespoke telehealth providers who do not officially report their numbers.

Jess White, general manager Practice Plus, says the organisation has seen a sharp increase in users over the past 12 months with nearly 35,000 appointments throughout the country between July 2023 and July 2024.

More than half of patients are referred to the service by their GP and in around 90 percent of cases the doctor was able to resolve the problem over telehealth, she says.

White says consults through Practice Plus will not be recorded through a practice’s practice management system as a consult and practices differ on how they code telehealth appointments, which will also affect the numbers.   

Ruth Large, chair of the NZ Telehealth Forum, says telehealth tends to deliver more episodic care for lower complexity patients.

The lack of good data and reporting is a “continual frustration” as it means people do not know who is receiving telehealth services and who would best benefit from them.

Large adds that many things are unknown about the use of telehealth in New Zealand, including the impact of these services on the in-person workforce.

“It is still doctors providing the service, so why is it that we can suddenly provide on the day appointments virtually, and we cannot provide them on the ground?” she asks.

“Anecdotally, there is a large number of people moving into telehealth and out of physical general practice, because it is seen as easier.

“Are we seeing an increase in telehealth appointments because that is a choice that our clinicians have made versus the choice that our patients have made? I am not saying that is right or wrong, but we should know these things so that we can design for the future.”

CareHQ, a joint venture between ProCare and Southern Cross Health Insurance, provided virtual care to more than 43,000 patients over the last 12 months, up 78 percent on the previous year. 

Reza Jarral, chief medical officer CareHQ, says the HQSC report indicating a decline in the use of telehealth in primary care does not align with his experience locally or of colleagues internationally.

“Limited access to primary care services is a key driver for users presenting to CareHQ. With wait times often exceeding weeks (in some extreme cases, months), and closed books in some parts of the motu, our users are increasingly seeking virtual care as an alternative to their local urgent care centre or ED,” he explains. 

“Increasingly health consumers see our service as a viable episodic bridge, receiving trusted care from experienced GP Fellows (in the case of CareHQ) before being passed back to in-person GP visits with their enrolled provider.”

Understaffed practices are also using virtual support for overflow capacity, inbox management and escalation and CareHQ is seeing an increasing number of non-enrolled patients who are not able to get enrolled locally due to closed books. 

“While physical General Practices may be conducting fewer telehealth appointments than before, we are seeing our appointment numbers go up quarterly,” says Jarral.

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