‘The health system will collapse’: GPs call for policy change to keep practice doors open

Anastasia Tsirtsakis

29/09/2021 4:38:59 PM

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.

Stressed GP working from home.
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.’
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Dr Pearly Upendra Cooray   30/09/2021 6:41:11 AM

We have to find evidence base approach to exposure risks . One fit for all is not sustainable. Data analysis of different Covid exposure risks and assessing the highest to lower and then redoing this tier exposure categories is important to any medical or none medical business.
It is frustrating laid back and no science in this type of fit all approach

Dr MT   30/09/2021 6:55:27 AM

I agree with Dr Garra. Health care workers and staff who are fully vaccinated and practicing all necessary precautions should not be put in isolation for 2 weeks. It is even harder for solo practices . The rule for “close contact” should be changed

Dr Suresh Gareth Khirwadkar   30/09/2021 7:17:44 AM

Once a certain % vaccination rate is reached, it makes no sense medically or politically to keep these policies, and they are dangerous to individuals, businesses and the system as a whole. I'm not sure the politicians really care though.

Dr Jacqueline Chapman   30/09/2021 8:24:43 AM

I had the same experience- minimal contact with a patient who tested positive the next day. I was double vaccinated for some months, masks etc worn but had to do full 2 weeks isolation. Public health, who are under the pump I recognise, were totally inflexible (despite the NSW Health risk matrix as far as I could see needing 5 days only isolation and regular tests proving negative) but it was hard to get someone in Health to make the call. Our vaccination rollout was adversely affected with prolonged isolation totally counterproductive for what was desperately needed at the time.
If COVID infection is to become more commonplace as things open up we need a much more reasonable response for what are frontline health services. We are one of the few professions that have turned up to work day in day out throughout the past 18 months and as such, we need a tailored response from public health that recognises the disruption very cautious and inflexible isolation requirements pose.

Dr Jeanine Suzanne McMullan   30/09/2021 9:24:48 AM

I’m not sure if small general practice will survive a Victorian style department of health $95 million law suite by staff or patients.” Seventeen of the charges relate to failing to provide and maintain, as far as reasonably practicable, a working environment that was safe and without risks to health for its employees.

Another 41 charges are allegations of failing to ensure, so far as was reasonably practicable, that persons other than employees were not exposed to risks to their health and safety arising from conduct of its undertaking.”

Where is the policy on indemnity for small general practice?
The Commonwealth has regarded us as its defacto employees during this rollout with enforcement of bulk billing provision of service and the limitation of Telehealth use.
We need protection and provision for these state based occupational health and safety regulations.
Where is the small Business Survival package for General Practitioners?

Dr Ian   30/09/2021 12:37:43 PM

Once the state gets to 80% double vaccination the rules will likely change for doubly vaccinated heath workers but the rate limiting step is the burden on hospitals hospital in the home and the ability to care for mild Covid and act if there is deterioration to get oxygen support going .
The monoclonal antibodies given by infusion and subcutaneously in some countries are a bridge to the medications taken orally which companies are hoping they are close to .
But in viral infection they need to be taken early even post and preexposure and so diagnosis early particularly for at risk people will be needed .

Dr Ian   30/09/2021 12:56:34 PM

In the United Kingdom from 16 August 2021 Doubly Vaccinated Health workers in contact with a Covid 19 patient do not have to isolate .
But if they get Symptoms they must isolate .
Also they have to have a negative PCR test and do daily Rapid Antigen tests for 10 days .
UK Health Security Agency Guidance Covid 19 exposure of health staff : 23 August 2021 :

A.Prof Christopher David Hogan   30/09/2021 3:34:29 PM

Disasters are different from routine practice.
It is not our job to individually examine all the evidence & for us to make individual decisions on the management of Covid.
It is the role of the Chief Health Officer (CHO) not to be universally correct but to MAKE DECISIONS .
There are many potential options but the role of the CHO is stop paralysis by analysis & chose the general path of action. These decisions are subject to the force of law.

In this circumstance it is our role to petition the CHO to change their mind.

Dr Sonia Foley   1/10/2021 4:15:57 AM

I was told by my medical educator that if we wear full PPE (gloves, N95 mask, gown, face shield) for all consultations (no matter if we touch the patient or not), then if a patient tests positive for COVID later, we simply have COVID19 test. If that COVID19 test is negative then we can then continue practising and not be isolated for 14 days. The room obviously needs a deep clean prior to going back to work if we are going back to the same room.

I have been wearing full PPE for all my patients since then. It has been a challenge, especially for hard of hearing patients, so I project my voice. Yes, it is hot and uncomfortable, however, I figured that the doctors and nurses in the hospitals have the same frustrations.

So, is this not correct? If you are wearing full PPE for all consultations, if a patient later tests positive, and you get a COVID test, can you not continue working?

Dr Tamson Alice Walpole   2/10/2021 2:50:28 PM

My ill father in law was unable to see his regular gp because the clinic was closed because of having a CoVid+ patient in clinic. We need an agreed protocol and level of ppe which allows us to do our jobs, see patients and not get closed if one of them turns out to be positive