Health New Zealand is reviewing healthcare delivery on Stewart Island after a survey revealed serious concerns about the cost and difficulty of accessing medical care.
The island has been without its own GP for at least a decade, relying instead on a nurse practitioner and two clinical nurse specialists based at Stewart Island Health Centre in Oban to provide all care for the island's 480 residents.
A survey of 78 residents last year exposed frustration with the expense and stress of accessing mainland healthcare, as well as concerns about burnout among the nurses keeping the system running.
Official Information Act documents revealed the island was left without any healthcare workers for three days last year when both nurses fell sick and no cover could be found.
While residents praised the nurses as "amazing", "superheroes" and "dedicated", the biggest complaint was the difficulty seeing a GP.
Angela Karaitiana said each mainland clinic visit cost hundreds of dollars including transport. "You can't just pop to the doctor here - you have to get a flight. It takes you a day out of work and your life," she said.
She described the stress of tight flight schedules conflicting with clinic delays, saying her husband recently faced missing his return flight due to a late-running medical appointment for his fishing licence.
Shona Sangster said GP shortages on the mainland made things worse. "I'm registered with a practice in Invercargill and it's six weeks to get an appointment with my GP. And then, if for whatever reason, I can't get over there because the weather packed in and the plane can't fly or the boat can't go then I have to wait another six weeks," she said.
Bruce Ford echoed the frustration with long waits. "You tend to be a bit cautious about what you want and even now if you want to have an appointment they say 'oh we can see you in three weeks' time' and a fat lot of bloody use that is if you've got something bad," he said.
The Health NZ survey found elderly residents and pregnant women were being forced off the island for care, services were stretched during tourism peaks, and there were "feelings of neglect by the system".
Health NZ said it had started working with local providers and the Stewart Island Health Committee on improvements including better links to mainland GPs, more digital support and options for visiting doctors.
Three nurses now work 1.6 full-time equivalent roles with one typically on duty and on-call after-hours care available.
However, Health NZ said it was not considering a full-time GP and encouraged locals to enrol with an appropriate mainland doctor.
Sangster said a resident GP would be "the Rolls Royce option" but questioned whether the population justified it.
Ford recalled an effective past system with a monthly visiting GP. "You just had to save your ailments up for a month and that sort of worked," he said.
He warned the island's culture of stoicism could be dangerous, with residents pushing through illness rather than seeking help until requiring emergency evacuation.
But Helen Cave defended the current system, saying the nurses were "a genuine asset" and the trade-offs were part of island life. "They've got good backup, they're communicative, they do your blood tests. I think we've got a better service than if you were in Invercargill," she said.
Health NZ declined interview requests but said future changes would consider community and provider views.