Inquiry finds GPs sidelined during pandemic

Matt Woodley

5/08/2020 4:52:37 PM

Major shortfalls in Victoria’s COVID-19 response were highlighted just one day before the state announced its worst ever 24-hour case total.

Victorian Health Minister Jenny Mikakos
Victorian Health Minister Jenny Mikakos did not immediately respond to enquiries during Question Time. (Image: AAP)

A further 725 cases and 15 deaths were announced by Victorian Premier Daniel Andrews on 5 August, taking the state’s number of active cases to 7227 – and deaths to 162.
The record-breaking 24-hour period follows the release of a Public Accounts and Estimates Committee interim report into Victoria’s coronavirus response, which made 23 recommendations after identifying numerous problems, including issues related to poor contact tracing and communication with frontline GPs.
It also comes after State Health Minister Jenny Mikakos refused to answer questions related to the government’s COVID-19 response during Question Time yesterday. Minister Mikakos cited official advice from Chief Health Officer Professor Brett Sutton that Parliament should be suspended and pledged to respond in writing today, but opposition members accused her of a lack of transparency.
Monash University Professor of Primary Care Danielle Mazza told newsGP the pandemic has exposed ‘vulnerabilities’ in the Victoria’s healthcare system, particularly the lack of connection between state authorities and general practice.
‘There hasn’t been a very good interface between general practice and Department of Health and Humans Services [DHHS] because the department has had very little to do with programs rolling out in general practice, so there hasn’t been that [formal] structure,’ she said.
‘There needs to be some kind of governance structure – whether it’s a committee or a working party or something else – that can push information up, as well as comment and give feedback about initiatives that are coming down, and also help to disseminate that back out into the community.
‘Not only amongst other GPs, but also to local community groups.’
Two recommendations to the Victorian DHHS applied specifically to general practice and echo calls that have long been made by community GPs:

  • Establish better protocols to facilitate effective communication with Victorian GPs in the event of a pandemic
  • Develop measures that enable effective collaboration across Primary Health Networks (PHNs) and the state-run public health sector
 According to the report, the lack of communication between the DHHS and primary care contributed to the spread of localised clusters to other parts of the state.
One case study highlighted by the Committee was the Cedar Meats outbreak, which was eventually linked to 111 cases.
It revealed that a number of GPs were aware of the rising case numbers before it had been made public, as workers had presented for testing. Conversely, legislative restrictions meant it took the DHHS 10 days to access information that would allow comprehensive contact tracing of all staff and visitors to the facility.
An Australian Medical Association (AMA) submission to the inquiry stated better communication could have led to an earlier warning of the outbreak, enabling GPs to more effectively protect themselves, as well as be more ‘case suspicious’ and test people more vigorously.
It also said there has been ‘a lack of clear, two‑way dialogue’ and a ‘weak relationship’ between the Victorian Government and GPs.
‘A lack of support from the State Government over many years has contributed to difficult lines of communication with them,’ the submission stated.
‘In a pandemic we see that this disconnect and stress plays out very clearly. GPs seem to be ignored or excluded at times from our disaster preparedness, and this was equally true during the bushfire emergency as well earlier this year.’
However, RACGP Victoria Chair Dr Cameron Loy told newsGP that while there are longstanding communication issues between the DHHS and general practice, the college has been proactively trying to improve the working relationship.
‘Going back 10 years, there wasn’t much contact or understanding between the DHHS and the general practice sector. We were often see as an immovable or impenetrable part of the system,’ he said.
‘We did not have the access to the minister that other donor organisations secure and we were not in the public-funded system, like our hospital specialist colleagues.
‘[However], the department has been receptive to our collaborative, non-adversarial approach and we have begun many changes that will begin to take shape in the coming years, especially regarding the interface between us and the hospital system.’
Dr Loy said RACGP Victoria has had ‘ongoing meetings’ with DHHS during the pandemic and that information sharing and joint problem-solving has been improving.
‘It is a fundamental error of government to assume that the only version of general practice is one large GP service in Melbourne, and it is an error to assume that the only communication channels are the PHNs – especially when that has demonstrably not worked as well as they expected during the pandemic,’ he said.
‘The RACGP offers an interface with government that is not just one person and can capture the views, opinions and feedback of a more diverse cross-section of GPs in Victoria than other organisations.’
Professor Mazza believes one option to improve communication is a specific phone line via which practitioners could receive and relay information.
‘There needs to be some thought given to dedicated GP hotlines, in which you don’t have to go through the process of “press one if you’re the public, press two if you need an ambulance, press three if it’s an emergency”,’ she said.
‘That kind of recognition of the role and expertise of GPs, by having a dedicated line or communication channel, will enhance confidence amongst GPs that they can very quickly access the information that they need and also provide very important information back into the system.’
Despite the longstanding issues, Dr Loy said the RACGP will continue to work with Government in good faith, rather than point fingers of blame.
‘We have always stated our willingness to work with Government on solutions to problems,’ he said.
‘We have demonstrated that throughout the pandemic – we have never sought to buy political influence nor have we sought to run adversarial attacks on Government.
‘We want to make the system easier to use for our GP members and we want to help improve the health of Victorians.’
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Dr Lena Amanda Sanci   6/08/2020 12:14:22 PM

GPs are an untapped resource in the fight to curb the COVID-19 surge in Victoria. I have observed the effectiveness of local ownership of driving down community spread and communicating with patient groups in the Geelong region with a project echo organised by the PHN and run by GPs for GPs in the whole area with a local infectious disease expert . In this way best practice is shared. This sort of local engagement must be underpinned by a deliberate strategy, co-designed by DHHS, RACGP, local GPs, and PHNs and Community representatives to establish clear roles and responsibilities for GPs and clear lines of communication back to GPs about patients who have tested positive to assist with contact tracing and re-enforcing public health messages and monitoring/management of mild cases. Risk issues that have been highlighted in the individual communities such as in aged care echo forums need to result in actions that mitigate risk with the appropriate authorities and workforce .

Dr Primo Phillip Bentivegna   6/08/2020 12:19:37 PM

"State Health Minister Jenny Mikakos refused to answer questions related to the government’s COVID-19 response during Question Time yesterday.
...... opposition members accused her of a lack of transparency."

The Minister refused to answer questions...really!
Lack of transparency, I absolutely agree with the opposition.
Also note, that we are still waiting for an apology from her too!

"it is an error to assume that the only communication channels are the PHNs – especially when that has demonstrably not worked as well as they expected during the pandemic"

Yes Dr Loy, I totally agree.
PHN's are just an arm of the government, they are a waste of time and money, and should be dismantled. If DHHS want to communicate to GP's, perhaps they should start with the RACGP?

Dr Ian Mark Light   6/08/2020 1:12:59 PM

There was a great lack of masks goggles head visors and gowns for general practice and the Primary Care Networks were not allowed to requisition them from everywhere .
In fairness a lot of masks were used up because of the catastrophic bushfires and the smoke that Emergency set Melbourne and Sydney back .
Countering two catastrophes in a short space of time was very hard .
But there was time to recharge .
The best now is learn the lessons there is too much blame and recrimination and we need positive flow and creative momentum .