‘Sometimes hospitals don’t realise what GPs can do’

On Sunday 20 February, GP Dr Michelle Johnston received a call from the Sunshine Coast Hospital and Health Service’s (HHS) COVID Virtual Ward, requesting she attend the local residential aged care facility (RACF).
 
With a number of staff furloughed due to COVID-19 and more than 10 residents having tested positive, the facility was overwhelmed.
 
The local public health unit was contacted, with the next natural step likely to be having the patients transferred by ambulance to the emergency department and admitted.
 
But thanks to Dr Johnston’s involvement that didn’t eventuate.
 
Instead, the Sunshine Coast GP, who is also a GP Liaison Officer at the local hospital, stepped in to review each case individually.
 
‘I was actually able to attend the aged care facility to talk to the staff, to review advanced health directives and the wishes of the patients and the families,’ Dr Johnston told newsGP.
 
‘I also assessed whether those residents had good GP support available – so their GPs were local, available and could look after them.
 
‘In some cases it was very clear that the GP was right on track with things; there were clear pathways in their advance health directives, which was really helpful. So with those residents we basically just left them under the care of the GP.’
 
If there was any ambiguity, Dr Johnston admitted the patient to the COVID Virtual Ward so that the team could keep an eye on them until confirmation was received that their own GP could oversee their care.
 
Through this approach, Dr Johnston and her team were able to prevent the patients from being hospitalised, and in doing so, avoid the associated clinical risks and financial costs.
 
It also meant all of the patients were able to recover in their own environment, bar one, who was palliative and being reviewed by their GP every 1–2 days.
 
This scenario, Dr Johnston says, is just one example where GPs can help prevent unnecessary strain on emergency services.
 
‘What has become very clear to me is that sometimes hospitals don’t realise what GPs can do, and vice versa,’ Dr Johnston said.
 
‘Sometimes the best solution is not to admit the patient, and I think it’s really important for hospitals to realise when they’re not needed.’
 
It is the flexibility of GPs – which Dr Johnston has come to notice and appreciate even more in her role as GP liaison – that she says allows them help patients without the structural advantages offered by a hospital.
 
‘[GPs] proved to be an absolute blessing when COVID came along because we were able to use them in all sorts of situations – and more importantly, they are actually integral to … improving that understanding,’ she said.
 
‘Our Virtual Ward is run and staffed by GPs, which I think is really important because GPs are well able to think on their feet and work across those boundaries of primary and hospital systems to find solutions that work for the patients and the residents.’
 
Sunshine Coast HHS’s COVID Virtual Ward was set up in early 2020 to manage patients at high risk of deterioration, in partnership with the local public health unit, primary health network and general practice.
 
Once a person is diagnosed with COVID-19, they are run through a risk matrix that considers their symptoms, vaccination status, comorbidities and psychosocial situation.
 
While the majority of patients can be managed in the community, between 20–30% on any given day will need additional care, which is provided primarily by GPs through the Virtual Ward, while others are escalated to a physical inpatient unit or ICU.
 
The Virtual Ward’s Medical Lead, GP Dr Sandra Peters, said it has managed close to 4500 patients since the first patient was admitted on 17 December 2021.
 
‘Our escalation rates into hospital for those people is very low, so it’s been a really effective solution,’ Dr Peters told newsGP.
 
‘We wanted to make sure that we have that seamless patient journey so that if people were being managed by their GP and they deteriorated or their GP looked at the risk assessment … and decided that their risk profile is different because of social reasons or comorbidity, then they could refer seamlessly into Virtual Ward and we could manage them for them, and then return them to their care.
 
‘Obviously, the GP knows their patient better than anyone.’
 
Dr Peters says the integrated system is also an acknowledgement that no one part of the health system is the answer alone, and that if an effective solution is already in place it should not be overridden.
 
‘There are many moving parts in the health system and it’s about how we integrate together to provide care for the patients,’ she said.
 
‘For example, aged care facilities are all standalone businesses, and they all have their own COVID preparedness and surge plans in place.
 
‘Where they have a good relationship with a GP and the GP is managing those patients, we don’t need to get in the way because all we do is add this paternalistic overlay … which is often not needed.
 
‘All of our senior medical staff in the Virtual Ward are GPs … who have that understanding of what our colleagues in the community are capable of, and also the sensitivity to know that it’s not appropriate to just override where there’s an existing relationship and a care plan in place.’
 
Dr Johnston’s recent involvement, Dr Peters says, is a great example of the different parts of the system working together so as to avoid duplicating any effort.
 
GPs’ ability to effectively manage patient care in the community is recognised by the RACGP’s Vision for general practice and a sustainable healthcare system. A PwC Australia report, commissioned by the college in 2020, found that further investment into primary care would result in significant savings, including through the prevention of hospitalisations.
 
With the pandemic having highlighted just how much pressure health systems are under, Dr Johnston says it is clear that ‘it will crumble’ over the next few years if things do not change.
 
To avoid its collapse, she says efforts like the HHS’s Virtual Ward are just one example of how primary and secondary care can work together.
 
‘Not just with COVID, but in so many cases if we work collaboratively, we can avoid a lot of hospitalisations and a lot of those associated costs,’ Dr Johnston said.
 
‘And patients generally prefer it; they don’t want to be in hospital most of the time.’
 
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