‘Remarkable’ primary care response to COVID proves invaluable

Evelyn Lewin

11/02/2021 4:17:50 PM

GPs have played an integral role in Australia’s response to COVID-19, a new study featured in AJGP has found.

A GP-respiratory clinic.
Australian primary care workers have been central to developing a number of initiatives, including GP-led respiratory clinics.

‘The response of our GPs and primary care system has been remarkable and will continue to be invaluable in guiding our nation’s response to future pandemics and other serious public health emergencies.’
That is Deputy Chief Medical Officer and former RACGP President, Professor Michael Kidd.
He is talking to newsGP about a new paper he co-authored, published in The Australian Journal of General Practice, which outlines five key principles that underpin Australia’s primary care response to COVID-19.
They are:            
1. Protection of vulnerable people
2. Provision of treatment and support services to affected people
3. Continuity of regular healthcare services for the whole population
4. Protection and support of primary care workers and services
5. Provision of mental health services to the community and the primary care workforce.
‘When planning the response to this pandemic, or to future infectious disease epidemics, whether considering a geographic area or a single general practice, these principles highlight the key components that are required to support and protect the primary care workforce and the community,’ Professor Kidd said.
However, while the response has been integral to protecting Australians against COVID-19, the paper also outlines six ongoing challenges that highlight the importance of those principles and require continued work and investment.
1. Improving collaboration between primary care and public health
Although primary care and public health are complementary primary healthcare initiatives, the authors note that epidemics are ‘largely considered to be public health emergencies’, with little emphasis on the critical role of primary care in providing first-contact care.
‘A primary care voice at decision-making tables enables activation of the five principles from the beginning – identifying vulnerable populations, health workforce needs and appropriate response planning,’ the authors wrote.
‘Without this, it is impossible to gain sufficient understanding of the issues that will influence primary care response strategies for health sector preparedness.’
Professor Kidd says Australian primary care workers have played a pivotal role in managing COVID-19, as well as the development of initiatives such as GP-led respiratory clinics.
‘GPs have been an integral part of why Australia has done so well in suppressing COVID-19,’ he said.
‘Australia has been very well served by engaging primary care from the outset, in the planning and response to the pandemic.
‘We also know GPs will be central to the COVID-19 vaccine rollout over the course of 2021.’
2. Including primary care–tailored guidance in pandemic preparedness plans
‘While some countries have developed primary care consensus standards for COVID-19, internationally, primary care clinicians have reported enormous clinical and emotional burden in responding, with many feeling ill-informed regarding how to fulfil their roles,’ the authors wrote.
‘While they have been creative in response – developing local health professional hubs, sharing workforce, establishing dedicated clinics, introducing or expanding digital consultation methods and triaging COVID-19 from non-COVID-19 care – their call for clear and consistent guidance is resounding.’
Dr Evan Ackermann, past Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP that despite a lack of clear guidelines at times, GPs have worked tirelessly to inform patients about COVID-19 and the measures they need to take to reduce the risk of transmission.
‘Clinical guidance and reassurance from a trusted GP has been a key component of behavioural change management in the pandemic,’ he said.
3. Ensuring provision of regular primary healthcare
‘The principle of ensuring continuity of regular healthcare services for the whole population protects those who are most vulnerable, including people with new and existing mental health problems,’ the authors wrote.
According to Dr Ackermann, the regular provision of primary healthcare is critical, and the implementation of measures such as telehealth has helped ensure this continues, even during a pandemic.
‘System changes within practices including waiting room changes, protective shields for front desk patients, ensuring provision of regular medication and alternate payment methods were also embraced,’ he said.
‘Whilst there is some evidence that preventive health screenings declined, the coordination of care between GPs, specialists and hospitals overall remained quite good.’
4. Using alternative consultation modalities to provide healthcare
The widespread uptake of telehealth internationally has helped ensure protection of vulnerable patients and clinicians while providing regular healthcare services.
However, the authors note telehealth has its challenges and may not work for some patients with complex needs.
Dr Ackermann agrees there have been those for whom telehealth has not been optimal.
‘There are some detractors and some people have misused it, but overall it’s been … one of the big things to come out to help healthcare,’ he said.
‘The introduction of telehealth has been brilliant.’
Professor Kidd says the ‘unprecedented focus’ on telehealth has led to a significant change in the model of care delivery in Australia, but added it is important that face-to-face consultations remain available whenever needed.
‘We have learnt a great deal through the delivery of telehealth,’ he said.
‘Early and rapid implementation of telehealth has protected vulnerable healthcare workers and allowed them to continue consulting with patients without the risk of infection.
‘This has assisted in alleviating concerns about passing COVID-19 onto family members and other loved ones.’
5. Improving approaches to sourcing, stockpiling and distributing personal protective equipment (PPE)
Concerns regarding a lack of adequate and appropriate PPE for primary care workers have been rife throughout the pandemic.
The authors acknowledge this, saying the impact on the health workforce has been ‘significant’ and includes elevated anxiety levels.
‘The Australian Government has prioritised implementation of the fourth principle, the protection and support of primary care workers and services, to address this,’ the authors wrote.
Dr Ackermann says there have been issues with adequate sourcing of PPE during the pandemic in Australia, and that concerns surrounding use of adequate PPE – and what constitutes that – ‘has led to a lot of stress’.
‘We should have lines of supply based on Australian manufacture for critical health supplies including personal protective equipment,’ he said.
6. Supporting the mental health of the primary care workforce and patients.
The authors note there have been many issues that have impacted the mental health of primary care workers during the pandemic.
These include high levels of stress, fears around contracting or passing along COVID-19 to patients, job losses or being forced to work reduced hours.
The authors believe vulnerable clinicians and patients need to be identified and access to mental health support should be offered, either virtually or face-to-face if needed.
‘As a GP I know that this can be an incredibly stressful role, and many of the challenges have been exacerbated by the pandemic,’ Professor Kidd said.
‘This was especially hard for GPs during the second lockdown in Victoria, when they were supporting the physical and mental health and wellbeing of a traumatised population.’
Professor Kidd says Australian GPs have stepped up to the challenges of caring for the community during the pandemic.
He points to the development of TEN – The Essential Network for health professionals, launched in May 2020, as one ‘important initiative’ aimed at supporting healthcare workers. 
‘Australia has responded proactively to the mental health needs of both primary care workers and people working in all other health sectors,’ Professor Kidd said.
‘Additional demands on the health workforce due to COVID-19 were acknowledged early in the pandemic and incorporated into the national primary care response.
‘Having access to relevant resources is important for healthcare professionals, so we can support ourselves as well as our colleagues and our patients.’
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