RACGP President calls for national pandemic plan

Matt Woodley

18/02/2020 2:37:30 PM

Mixed messaging, inconsistent advice and communication breakdowns have marred the response to the coronavirus.

RACGP President Dr Harry Nespolon
Dr Harry Nespolon believes general practice should be included in planning for public health responses to potential pandemics.

RACGP President Dr Harry Nespolon has warned public health failures in the wake of the coronavirus outbreak must not be ignored, and again called for a national pandemic plan that involves GPs and their practices.
‘This isn’t the first and won’t be the last [pandemic] – if we don’t address these problems now, we’re risking people’s health,’ he said.
‘While we have a national plan for pandemic influenza, it has not been implemented. Not implementing a plan is as good as not having a plan.’
Dr Nespolon said GPs and patients across Australia have battled a range of problems, including inconsistent advice from state and federal health agencies and unpredictable availability of protective equipment, such as face masks.
‘To take one example, there has been confusion about the type of face masks that GPs need to wear. This protective equipment is vital to keep GPs and their patients safe and stop the spread of this disease,’ he said.
‘We are also getting different advice from the states and territories on the tests for coronavirus and who should be taking them – should they be done by a GP in a clinic or should they be done in a hospital in a negative-pressure room?
‘So, at a time when GPs are on heightened alert and may be seeing more patients than usual, we have the extra burden of needing to call around to various health agencies to work out what the current advice is.
‘It has taken too long for state health agencies to update their advice in line with the federal advice. GPs have faced weeks of confusion trying to figure out which guidelines they should follow. It’s undermining the critical work GPs do in caring for patients and in controlling outbreaks like coronavirus. 
‘It’s essential that we are receiving timely, evidence-based and consistent advice from the outset of an outbreak, so we can continue providing safe and high-quality care.’

The latest advice from the Department of Health is that GPs should wear a surgical mask for consultations with patients who have mild or no respiratory symptoms, however; GPs were previously advised to use P2/N95 masks when taking specimens from all patients suspected of having coronavirus.
In addition to the changing advice, Dr Nespolon expressed frustration at GPs being unable to source appropriate equipment.
‘We have heard that some GPs are still finding it difficult to get their hands on protective equipment like face masks,’ he said.
‘The Federal Government acted on our call to release face masks from the national emergency stockpile; they have provided surgical masks, and some states have also released P2/N95 masks.
‘While we welcomed the response from government and appreciate this is an evolving space, the problem again was the lack of consistency. What it means for GPs on the ground is that some are receiving both masks while others are missing out.’
Dr Nespolon said GPs are being asked to take on greater responsibilities without adequate consultation, planning or remuneration.
‘GPs are called on to do more and more without much thought given to how this affects our day-to-day work,’ he said.
‘For example, some of the states have told people to call their GPs if they suspect they have coronavirus. The problem with that is GPs who are booked out are going to have to stop seeing practice patients and act as a free telephone triage service.
‘We are not remunerated for that and it can take up a lot of time. It’s just another instance of why we need a consistent nationwide approach.
‘The questions we are now asking are how can we solve these problems and how can we do better?
‘GPs are at the frontline in the fight against coronavirus. It’s absolutely critical that they have the right information, the right resourcing and the right support to help their patients and control not just coronavirus, but any potential pandemics we will face in the future.’
Dr Nespolon has called for general practice to be included in federal and state government planning for public health responses to potential pandemics.
‘When our country faces a potential pandemic like coronavirus, the first place people turn to is their GP,’ he said.
‘General practice is fundamental to the response, clearly we need to be included in all of the planning for disease outbreaks, yet we are not involved. It’s a massive oversight and risk to people’s health.’
The RACGP has more information on coronavirus available on its website.
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Dr Rosa O'Kane   19/02/2020 6:25:22 AM

This strong message and request for a coordinated plan is vital and welcome.
General practice is mostly run a private business. GPs working for corporates will be reliant on the corporate directors willingness to address this isssue. The chasms in communication with state and federal Health Departments and lack of coordination in a plan to deal with a pandemic are putting health professionals and the public at risk .

Dr Suganthi Thangaraju   19/02/2020 6:59:59 AM

I strongly agree with Dr Nespolon. We need a nation wide approach and GPs need to be part of the planning who are the first stop for health problems.
GPS should be equipped with adequate PPE for them and equipments to use on pts to prevent the spread.

Dr James Courts   19/02/2020 7:52:31 AM

Sorry Harry but I thought "General practice is prepared to tackle coronavirus"

Dr Gary Ronald Franks   19/02/2020 8:12:56 AM

totally agree on this article.We are wasting valuable unpaid time trying to seek reliable and consistent information only to find it is ambiguous.
I work in Rwanda each year- a developing country and we are not far behind in our responses to situations that we face as GP's that should by now be standardised ,
workable, consistent, evidence based and renumerated.
When we will learn-same issue as our involvement in th bushfire crisis.

A.Prof Christopher David Hogan   19/02/2020 12:08:48 PM

Part one -In recent times we have heard governments use the rallying cry “See your GP” all too frequently as a knee jerk response to widespread fear of a pandemic. This has been done on the assumption that we would know what to do & have the resources to do it.
Questions:- Are we educated about disaster management & rehearsed in its processes?
Is there information available & readily accessible on the safe design of medical premises to contain infection e.g. no touch entry & exit, minimal fomites, separation of reception staff from patients and safe design of air conditioning systems to prevent cross infection as well as rooms designed to cope with biological contamination?
Is there information available & readily accessible on safe work practices by doctors, staff & others to prevent spread of infection including safe cleaning of the premises & dealing with biological contamination by bodily fluids?

A.Prof Christopher David Hogan   19/02/2020 12:11:59 PM

Part 2 Is there information available & readily accessible on safe work practices by doctors, staff & others to prevent spread of infection including safe cleaning of the premises & dealing with biological contamination by bodily fluids?
Is there information available & readily accessible on what resources & equipment we need to stockpile? How we maintain those stockpiles in date?
Are we FUNDED adequately to be able to survive economically if we institute the above suggestions?

There are similar questions when it comes to the management of bushfires, thunderstorm asthma, smoke cloud asthma & respiratory disease.

We are all on a steep learning curve here & criticism for the sake of criticism is not helpful

Dr Edward Thomas Wu   19/02/2020 9:28:32 PM

Having the opportunity to observe the out break and evolution of the present epidemic at a closer proximity (but at a safer distance from the epicenter of Wuhan) in Shenzhen China allowing closer insights, I applaud strongly of Dr Nespolon's advocate for a better coordinated national pandemic plan that involves GPs and their practices. As early soul searching begin to simmer out, the sudden massive demands for service and care for seemingly minor symptoms of URTI but potentially fatal in a small number of patients seemed to have overwhelmed a system of health service based on large hospitals resulting sudden depletion of resources and massive infections of a significant proportion of their staffs thus disabling their more essential functions. Australia is very fortunate to have a system of clinically competent general practitioners able to command sufficient public trust to avoid what happen in Wuhan. All we need is a well coordinated system of mutual coordination and support.

Dr Edward Thomas Wu   19/02/2020 9:45:36 PM

I also support strongly Prof Hogan's words of wisdom : We are all on a steep learning curve here & criticism for the sake of criticism is not helpful. While there are always lessons to be learnt in every disaster, it is better to do it in a positive manner rather than just pure finger pointing.
Maybe the same can also apply with this epidemic in China. Observing the variety of reactions from various sources, our focus should be more sympathetic and learning from their misfortunes rather than trying to "put more salt in their wounds". I have not observed people in China putting out any similar comment on the recent bush fire disaster in Australia.

Dr David Zhi Qiang Yu   20/02/2020 9:44:35 PM

I support our president to have national pandemic plan.

Dr Christina Wong   26/02/2020 5:46:07 PM

I agree with you Edward Wu. There is little to be gained in criticism. China's efforts and containing the viral transmission should be applauded (see Canada's response, a sensible voice:, and there is much we can learn from them, including telehealth when appropriate. Simon Judkins has tweeted our ED's are under-resourced to cope with a local outbreak. I agree we need a coordinated and planned response.

Assoc Prof Michael Gerard Burke   9/03/2020 11:58:05 AM

I strongly believe telehealth supported services are a key and essential part of our national response.