Doctors' views on the impact of the absence of an in-person rheumatology service at a major New Zealand hospital.

Aim: To describe the views of doctors in one hospital service about the impact of the lack of an in-person rheumatology consultation service and to identify service improvements informed by those views and services at comparable district health boards (DHB).

Methods: Qualitative study using focus groups of resident and senior medical officers (RMOs and SMOs) from the general medical service at Wellington Regional Hospital. A national survey of DHB heads of rheumatology was also used.

Results: Three major categories emerged from the focus groups with 16 RMOs and 15 SMOs: 1) a negative impact on quality of patient care, which is inequitable to other nearby DHBs; 2) workarounds are found; and 3) doctors' knowledge of rheumatology and education opportunities suffer. Best practice was considered to be an in-person rheumatology consultation service, as offered at the six DHBs surveyed.

Conclusions: Lack of an in-person rheumatology consultation service in this large hospital had perceived negative impacts on patient care and doctors' education and competence. Providing an in-person consultation service seems highly desirable but would need more rheumatology capacity regionally. The themes identified may also be relevant to other hospital or specialist services that are not equitably accessible in other parts of the New Zealand health system and thus inform the transformation of the health system required by the Pae Ora (Healthy Futures) Bill 2022.