What role should GPs play in managing COVID-19 cases?

‘A great opportunity to be collaborative.’
 
That is how RACGP NSW&ACT Chair Associate Professor Charlotte Hespe frames the discussion on how GPs could help ease pressure on a health system under severe strain.
 
Sharply rising in case numbers in New South Wales and Victoria this week has increased the focus on treating patients with COVID-19, both in hospitals and the community.
 
But while Associate Professor Hespe believes there ‘is absolutely a role’ for general practice in the management of care, she told newsGP those lines are yet to be fully defined.
 
‘I am having conversations with NSW Health about this. They are right on the edge of their capacity to cope,’ she said.
 
‘This is an opportunity for GPs to play a real role in making sure the health system stays afloat, but we do need the Federal Government to support us in doing that.
 
‘We could do the Level 1 patients without any issues with a team to support us with any queries, and then anyone who becomes sicker goes up to the next level of being managed through Hospital in the Home or being fast-tracked to admission.’
 
Patients with acute sickness in New South Wales are currently being managed through 35 different hospitals, while a growing number are also being cared for through the state’s Hospital in the Home system. This number increased by more than a third in the past week, rising to 2248 patients from 1644 in the previous seven days.
 
The Hospital in the Home system exists in all states and is now being employed to manage the majority of acute COVID-19 cases in New South Wales.
 
Adding to the strain is a growing number of healthcare workers who are unable to work due to being in isolation. According to the latest COVID-19 Risk Monitoring Dashboard published by NSW Health, there are 1429 healthcare workers currently in isolation, a 12% rise in one week. 
 
But even though GPs could potentially help, Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), said their role needs to be clearly defined in the context of the current outbreak.  
 
‘This is one of the gaps that we really need to fix,’ he told newsGP.
 
‘As COVID continues through the community, GPs are going to have an increasing role in managing these patients either when they present or as they recover.
 
‘That’s a growing anxiety for us because we haven’t had much communication to date and I think it is a really important gap we need to rectify.’
 
Dr Wright says GPs need to understand how these patients will be managed, especially as their numbers increase.
 
‘If people don’t need to be admitted to hospital then GPs need to know how patients will be managed in the community,’ he said.
 
‘And if they are discharged, if they are isolating at home, GPs need to be aware of what problems patients might have.’
 
For Dr Wright, the first step is to ensure there are clear lines of communication between hospitals and general practice, including GPs being notified when their patients present with COVID-19.
 
‘It is important as the pressure on our health system grows [that] we can keep treating it as one health system,’ he said.
 
‘What we need to do is all provide the right care for our patients, whether it’s in general practice or in the hospital setting, it’s important that everyone communicates so that we know what’s happening.’
 
Associate Professor Hespe also identified communication as an issue.
 
‘The real battle at the moment is even [being told] that our patients have got COVID,’ she said.
 
‘Each of the local health districts have their own approach. Where one might be good, the other is appalling.’
 
And while Associate Professor Hespe emphasised the role of telehealth in providing safe care in an outbreak setting, she is concerned some GPs have been put off by recent experiences, such as the  controversial compliance letter campaign and the fact that telehealth consultations are not being counted towards Practice Incentive Program Quality Improvement (PIP QI).
 
‘We’re seeing our patients as much as we can, we’re being proactive, but we’re going to be penalised for having created a system of safe care and looking after both our staff and patients,’ she said. ‘I find it very frustrating.’
 
In the meantime, Dr Wright says further involvement in managing COVID-19 cases is possible for general practice, provided GPs receive appropriate support and there is workforce capacity, given many are already heavily involved in testing and the vaccine rollout.
 
‘It’s a very difficult time at the moment, our patients are stressed,’ he said. ‘Many of us GPs, we’re worn out. It’s been a long 18 months of trying to keep our patients safe, our staff safe and our doors open.
 
‘It’s important GPs get clear messaging for what their role is. GPs are up for it – we’ve got the skills but we need to be resourced to do it properly.’
 
The RACGP has published home-care guidelines for adult patients with mild COVID-19.
 
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