Waiheke Island's only after-hours medical clinic has closed its doors, leaving thousands in the community in the lurch.
Patients were told on Friday that the Oranga Urgent After Hours clinic was shutting immediately and in the future there will be no local doctor available to see people at the weekends or after 5pm on weekdays.
The Piritahi Hau Ora Trust - which runs the Oranga Urgent After Hours clinic - told RNZ it could not comment, and referred RNZ to the Auckland PHO.
RNZ understands that Piritahi Hau Ora Trust is not the only trust involved in running the clinic.
Te Whatu Ora said it had already told the service its contract was being renewed for the current financial year and it would not comment on the provider's "operational decision" to close.
Waiheke Island locals have been blindsided by the announcement, saying they have had no explanation why the service has closed.
Waiheke Island's only after hours medical centre shuts
The Waiheke Medical Centre, the Piritahi Hau Ora clinic (both owned by The Piritahi Hau Ora Trust) and the Ostend Medical Centre have told patients their options after hours are tele-healthcare, Healthline, or to call 111 if they were experiencing severe symptoms.
They said they were working at pace to consider long-term options to provide urgent after-hours services to the community.
The Ostend Medical Centre told patients that Hato Hone St John will continue to provide services, but urged people to work together to protect the ambulance service from being overwhelmed during this time.
Jessica Culpan - who has lived on Waiheke for 14 years - said many in the community were feeling anxious about the change.
"I know that many people are really worried, and some of them are quite frightened, there are a lot of young families on the island," she said.
Culpan said she had often used the after-hours service for herself, her children, and her mother who once broke her wrist late on a Friday.
She wanted to know what was behind the closure.
"I'm really confused, there's a real lack of information around what's happening. I understand that people are trying to hard to work it out, but we don't know anything, we haven't heard anything," she said.
Culpan said her mother, who is in her 70s, may consider moving off the island, and other older people may have that on their minds too.
Rob Kay - who has previously worked as a GP on Waiheke and been an on-call doctor after-hours - said he was worried that some patients could be put at risk.
He said in the past, people needing after-hours care could call a number, be triaged over the phone, and then see the on-call doctor at the clinic.
Kay said the in-person assessment can now only be done by ambulance staff, whose resources are already stretched.
He predicted there would be more transfers to hospitals on the mainland, by helicopter, or possibly by police boats or coastguards - but access will be limited and weather dependant.
Kay said some conditions would be difficult to assess by telehealth and there could be serious consequences for patients.
"Abdominal pain in an elderly patient, or an appendix in a younger patient, that haven't had the required assessment, and it is a difficult judgement call in that - if you miscall an acute abdomen, then the consequences of that aren't very good...you can end up with twisted bowel, perforated bowel," he said.
Kay said families with young children could also be among those most impacted.
"Children are prone to accidents and infections, and asthma attacks, and that is a significant proportion of after-hours work," he said.
He said there were lots of accidents on Waiheke Island, particularly around Christmas when there can be tens of thousands of visitors.
He was not sure how ambulances will deal with the surge in demand without an urgent care service.
Te Whatu Ora said it was working at pace to consider long-term options for the Waiheke community.
Hato Hone St John said the service would continue to operate for Waiheke Island residents who should call 111 for an ambulance if it was an emergency.
In a statement, its operations manager Auckland north west Angela Jardine said when it was not an emergency people should access healthcare through their GP, Healthline, Plunketline or their local pharmacy.
"Hato Hone St John has had an ambulance station on Waiheke Island since the 1980s and currently has a team of eight paid ambulance staff and a dedicated team of volunteers. We are also supported on the island by our emergency service colleagues and rescue helicopter services."