Researchers say around 5000 new patients each year are being declined specialist services like surgery when referred by their GP, with the co-author of a new report on the issue calling it a "national scandal".
The 5000 additional patients being rejected are on top of a base of around 85,000 patients being declined each year.
One doctor told researchers they had to "manage a patient into the grave" because of they couldn't get them the specialist care they needed.
Wellington woman Cherie Jeffs-Leipst has needed a new hip for two years. She has limited mobility and, as she's waited for surgery, she told Newshub the pain had become unbearable.
"Everybody deserves quality of life. It gets to the point sometimes of no return. You know, you just end up crying."
Cherie is on the official wait list for surgery, but was initially rejected after being referred by her GP.
She didn't know why she didn't get accepted for the referral but it's likely because she didn't meet specific criteria set by Health New Zealand.
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The rate of rejection, and the impact on general practitioners, was the focus of research at Otago University.
Research co-author, Professor Robin Gauld, says the constant waiting and push backs for people who need specialist services has become accepted as normal in New Zealand which is wrong.
"I think it's a national scandal, I think that we have people everyday up and down the country who are not able to access necessary health care services," he told Newshub.
The research on unmet need found that between 2018 and 2022, there was a 5.2 percent increased risk of patients being declined specialist services after being referred by their GP.
That means over that period 17,500 new patients were rejected on top of normal decline rates even though referral numbers were stable.
Professor Gauld says the number of patients being declined is continuing to go up at a significant rate.
"We would predict, also based on our research, that about 5000 new referrals will be declined each year from here out if there are not changes to the system."
However, the numbers being declined is not a figure Health New Zealand reports. It only reports numbers of those on waiting lists - not on those yet to make it to the list.
General Practice New Zealand (GPNZ) chairman Bryan Betty says that's wrong as it means critical information is hidden.
"There's a lack of transparency about the number of people who are being denied access to specialty services."
Health New Zealand acknowledged the concerns raised by GPs.
Director of Programmes Delivery Unit for Hospital and Specialist Services, Duncan Bliss, told Newshub they're working on getting more complete data.
"Health NZ is focused on improving its communication and transparency around waiting times with general practice," he said.
Bliss said a more complete data system is planned.
"We are working hard to develop a national data platform that gives us a better understanding of patients who do not meet the criteria for a specialist assessment."
When patients can't get specialty care, primary care doctors are left to manage the fallout.
Betty says that's a huge challenge.
"There is already overflowing demand for general practice. It is putting extra burden on practices and practitioners across the country."
The research says GPs are put at "significant risk" and put under pressure managing patients with unmet needs, there's "no additional payment" for extra work, and some GPs knowingly don’t refer due to the likelihood of getting declined.
One GP spoken to as part of the research said: "I just managed one patient into the grave."
He said he couldn't get her in to see a cardiologist, she deteriorated and died.
The doctor said some patients get better, some don't, and some die.
He said: "That's not dramatic, that's the issue."
Betty says he's had reports of people dying because they couldn't get care.
"Certainly, that quote from the research is a very real example of that happening," he said.
The Southern area topped the list as the area with the highest rates of rejections, following by Nelson/Marlborough and the Lakes regions.
When it comes to specialties, ear, nose and throat services had the highest overall rate of declined referrals from GPs.
But neurology, gynecology cardiology and general surgery had the sharpest increases in terms of patients being declined services.
Bliss says work is being done to clear backlogs accumulated during the pandemic.
"Since March, we have seen the first reduction in first specialist assessment waitlists which is forecast to continue," he said.
"Last year, 18,000 more people had their first specialist assessment than in 2022, so we know that our plan is working," he said.
Health Minister Shane Reti acknowledged the health system was in "crisis", and reaffirmed that work is underway to get better information about patients being rejected for specialist services.
Reti said he's aware of the challenges GPs are facing and a review of the funding model for primary and urgent care was also underway.
"I have been assured that they (Health New Zealand) are committed to working closely with general practice to address the pressures and complexities they are facing so they can continue to provide vital care to their patients and communities."
