News
‘The health system will collapse’: GPs call for policy change to keep practice doors open
As case numbers and exposure sites increase, there are fears that requiring fully vaccinated practice staff to isolate is becoming unsustainable and risks the entire health system.
While remote access can allow GPs to do telehealth from home, Dr Umber Rind says it has challenges and limitations.
Over the past two months, Dr Joe Garra can’t recall a single week where at least one of his practice staff hasn’t been directed to isolate, either due to unknowingly coming into contact with a COVID positive patient or visiting an exposure site.
The most recent instance came on Monday, when one of his colleagues – who is fully vaccinated – was directed to isolate for two weeks after administering a vaccine to an asymptomatic patient who later tested positive.
‘It’s crazy,’ Dr Garra told newsGP.
‘We’ve just had a doctor come back from being off for two weeks and a receptionist just came back last week.
‘In a small general practice it’s hard to backfill; we’re not a hospital where you can just call-in casuals. It’s a big problem and the policy has to change.’
Dr Garra’s experience is not unique. There are currently more than 500 exposure sites listed in Victoria alone, including four general practices.
Under the current guidelines, any practice staff exposed to a COVID positive patient while not wearing an N95 mask are deemed a close contact, regardless of their vaccination status.
However, in day-to-day general practice, Dr Garra says full PPE can be impractical.
‘It means you’ve got to either bunch up all your face-to-face appointments together and your phone calls together [because] when you do phone calls people can’t hear you if you’re in full PPE,’ he said.
‘The same sometimes happens face-to-face … because some of the elderly I’ve realised half lip-read when you talk to them. But if you take your mask off, you’re supposed to throw it out.’
Earlier this month, Dr Umber Rind’s practice, which is located in a COVID hotspot in Melbourne’s north, was listed as a Tier 1 exposure site.
The practice was ordered to close with all staff, despite being fully-vaccinated and wearing PPE, required to isolate for two weeks, resulting in all of their vaccine clinics having to be cancelled.
‘That was the biggest problem for us,’ Dr Rind told newsGP.
‘We have a lot of people from culturally diverse backgrounds … and they will only come here for the vaccine because they trust us – to the point where they want me to give them the injection.’
Both Dr Garra and Dr Rind believe there is a need for a policy change, and that vaccination and other precautions being taken by the practice should be a consideration.
With the Federal Government having flagged the widespread introduction of home-based rapid antigen testing from 1 November, there are questions over whether the tests could also play a role in keeping practices open.
Currently, there are 33 rapid tests approved by the TGA for use under direct supervision of a qualified health professional, which offer a result within 30 minutes.
Dr Garra says in the instance that a fully-vaccinated practice staff member is identified as having come into contact with a COVID positive patient, it would make sense for them to undergo a PCR test, followed by a rapid antigen test.
‘If the rapid test is negative, I could put on full PPE for that day and work or stay home for one day until we get the PCR back,’ he said.
‘If they’re both negative, you go back to work and you do a daily rapid test for a week, just to prove that you’re still negative – and maybe do a PCR every three or four days if they’re really nervy about the slightly reduced accuracy of the rapid antigen test.’
Compared to PCR, evidence suggests rapid antigen tests are more likely to return a false positive or false negative result, which could have consequences.
However, Dr Rind says keeping the policy as is comes with its own consequences.
Beyond delaying the vaccine rollout in COVID affected areas, she is concerned people are already delaying important health screening appointments for fear of being exposed to the virus, not to mention the important role GPs play in managing mild COVID cases.
‘As the cases rise in Hume, [so does] the burden of mild COVID patients who need care via telehealth. General practice will need to take up that responsibility because I can see ambulances rushing past on the main street,’ Dr Rind said.
‘I went and had a look at the Northern Hospital ED two days ago, just to see how bad it is, and there’s queues of ambulances.
‘So we need to take some of that burden away from the emergency departments and the staff there. But how can we do it if we’re closed for two weeks?’
With the easing of restrictions on the horizon, Dr Garra fears that the prospect of cases continuing to climb will see the current policy have far-reaching consequences on the broader health system.
‘We’re fully vaccinated; you can’t keep sending fully vaccinated GPs, receptionists and nurses home for two weeks – it’s ridiculous. You’re cutting down the people we can see face-to-face, [and] the health system will collapse if you do that – it’s collapsing already,’ he said.
‘The current policy was set up when there was no vaccine and low numbers of COVID, so it can’t work going forward.’
But should the policy change, how will patients feel? Will they understand, or will they feel they are at risk of exposure?
Dr Rind is optimistic.
‘If we’re taking all the precautions and we’re wearing full PPE for all necessary face-to-face consultations and we’re double vaccinated, the risks would be relatively minor,’ she said.
‘Things that can be done in the carpark, we will try and do it that way.
‘There’s more harm closing down than the risk of a potential COVID spread.’
Log in below to join the conversation.
COVID-19 fully vaccinated healthcare system hospitals PCR test rapid antigen testing
newsGP weekly poll
Do you think the Federal Government’s expansion of Distribution Priority Areas will make it harder to recruit GPs to regional and remote Australia?