‘Clearly not practical’: Practices overwhelmed following PM’s direction to call GPs

Anastasia Tsirtsakis

6/01/2022 4:38:20 PM

Scott Morrison has directed people with a positive rapid antigen test result to contact their general practice – but GPs say no suitable system has been established.

Man wearing mask on the phone
GPs say they have no way of capturing positive rapid antigen test result in the system so people can access COVID-19-positive pathways.

Already-stretched general practice staff were left blindsided on Wednesday evening after Australians who return a positive rapid antigen test were directed to contact their GP to have their case registered with the health system.
Speaking to newsGP on Thursday, RACGP President Dr Karen Price said GPs have been left feeling ‘overwhelmed’ and practice phone lines are likely ‘in meltdown’ given exploding infection rates, particularly in New South Wales and Victoria.
‘It’s clearly not practical for every single patient who’s got COVID to call their GP, and we won’t be able to drop everything and do a telehealth consultation right away,’ Dr Price said.
‘We are flat out delivering booster doses and from Monday we will be delivering vaccines to children – a difficult task – all while managing and treating patients who have delayed or avoided care during the pandemic, including those with mental health concerns.
‘While the timing is not ideal – which it undoubtedly never is in a pandemic – the last thing we need is another new announcement without detail.’
The announcement, made by Prime Minister Scott Morrison late on Wednesday following a national cabinet meeting, revealed significant changes to testing requirements that mean people who test positive on a rapid antigen test will no longer need to have their result confirmed by a PCR test, in a bid to take pressure off testing resources.
‘They should let [their GP] know because that is the principal point of care under the primary health network. They are in a position to provide further advice and telehealth is put in place to support that,’ Prime Minister Morrison said.
‘And your GP would be able to assist you through telehealth if you need to go and get further treatment in hospital.’
Prominent Melbourne GP Professor Kerryn Phelps was among those who took to Twitter to express their frustration, indicating the announcement was an example of general practice being informed of a policy change alongside the public. 

While the changes to testing requirements suggest that COVID-positive patients will be able to gain access to care pathways with a rapid antigen test result, GPs have been left navigating how to record patients’ results in the absence of a suitable system.
A GP, going by the name of ‘KB’ on Twitter, said they have no access to a system that can ensure patients have access to the clinical care they need.  
Despite COVID-positive patients being directed to contact their GP, when questioned further about the process during Wednesday’s press conference, Prime Minister Morrison said the Government is ‘working on a system through our GPs and other processes for people to report whether they’ve got a positive test’.
Dr Price said there is an urgent need for state and federal governments to find a suitable system, adding that GPs ‘certainly can’t manage this process on our own’ given their existing workload.
The RACGP President did say, however, that the college has since been in contact with the Federal Health Minister’s office to discuss possible options, including QR codes on rapid antigen tests that can be recorded through Services Australia.
‘I know in the UK there are sites where patients can manually upload the results themselves either using photographs or just a manual entry of barcodes into the system,’ Dr Price said.
‘But at the moment, I’m not sure which system we need to upload it into and that’s something that has to come from the Government.’
In addition to concerns about patients being able to access timely care, it has also been noted that without a system in place to record positive rapid antigen results there is no way for the health system to know the true number of positive cases in the community in order to prepare accordingly.
In the meantime, for patients with asymptomatic or mild COVID-19 that could be safely managed at home, Dr Price said she is advising that people hold on to their positive test with a record of the date and that they have the result recorded in their file the next time they see their GP.
‘We’re in disaster mode,’ she said. ‘We can’t manage uploading people retrospectively for mild or asymptomatic disease.
‘It’s important but, at the moment, it’s really important to look after those who are most severely affected.’
What also remains unclear, according to Dr Price, is whether GPs seeing COVID-positive patients in person based on a rapid antigen test result would be eligible for the $25 fee through Medicare.
‘That needs to be clarified and we’re working with the Government on that,’ she said.
‘We’re also working on whether that bonus should just apply for face-to-face care, or whether it should be for over the phone care, too. What I’m hearing from many GPs is that the telehealth involved in managing COVID-positive patients is significantly long and detailed, as you would expect.
‘So we have also asked for an emergency Level C telephone item number for telehealth because we have to manage as many of these people from home as we can.’
Thanks in large part to high vaccination rates, the majority of the more than 220,000 positive cases recorded in Australia so far this week are expected to be mild and self-managed at home.
Dr Price said the latest development again highlights the importance of the Federal Government having clear lines of communication with general practice.
‘We know at the moment that GPs are under enormous pressure and that they are responding as best as they can,’ she said.
‘In many instances, there are general practices who have enacted their disaster plans and so we need to state very clearly to the Government, to the public and to our patients that this is not business as usual.
‘This is a wildfire of infectious disease, and we need to respond at that level.’

To support GPs and their patients, the RACGP has updated its Home-care guidelines for patients with COVID-19, as well as a guide, action plan and symptom diary that doctors can share with their patients.
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Dr James Courts   7/01/2022 9:00:15 AM

Not sure clarifying if the $25 sweetener applies to RATs is the priority here - bear in mind the amount is a disgrace and an affront to our profession.

Maybe appreciate that we have had to deal with a multitude of changes whilst balancing a vaccine rollout, booster program and now child covid immunisations.

I don' t think many of us would argue that we shouldn't have a role in dealing with covid positive care, it's just the fact that when large sum health initiatives are set up, then predictably fail, the back up always seems to be "see your GP".

Maybe the RACGP can use this to fight for our profession to be valued and paid appropriately in line with other specialties, rather than our current bottom of the leader board position.

Dr Amanda Alice Maitland   7/01/2022 10:37:20 AM

Surely the existing state-based QR code scanning apps (e.g. Service NSW) could be modified to allow people to report a positive test. They could scan both the QR code on the test packet and upload a photo of the positive test cartridge. This seems simpler than doing it via Services Australia. There will still be some people who cannot use an App who will need to phone a central number.

A.Prof Christopher David Hogan   7/01/2022 12:22:04 PM

As a pragmatist with too much experience in disaster planning & response., I see no point in blame- keep that for the inevitable Royal Commissions.
We are in a disaster situation where our resources do not & cannot meet the ongoing clinical need.
We cannot do everything for everyone, so do the best for most. We must triage.
Expecting RAPID high level intervention is optimistic as that takes time -so start with self-help now
Reorganise your practice so that you can select who you directly help- start triage.
the main tasks are
* Fully Immunise as many as possible
* Detect which of your patients who contact you have moderate to severe Covid and establish follow up for those who need it.
* Detect which of your routine patients need to be seen for other illnesses or conditions.
Start with a whole of practice meeting to discuss how that can be achieved.
Be aware that many of your staff will be off sick but may be able to act remotely

A.Prof Christopher David Hogan   7/01/2022 12:42:04 PM

High Level Interventions
Government needs to sit down with GP representatives (PHNs are for instituting policy not deciding it)
Topics of conversations

1. How to communicate with GPs
a. How to convey the seriousness of the situation to Government & to GPs
b. How to put routine practice on hold & establish a triage based medical system
c. How to ensure GPs have access to the critical information they need
2. Need to streamline the bureaucratic burden of practice in a pandemic
3. There will be a great shift to Telehealth but there is a major need for face to face for Immunisation & for assessment of critical patients.
4. GP staff who handle the communication between patients & practices will need enormous support. At least give them protocols to screen patients & enable patients to have access to critical information at least on a website.
5. There is no point promising resources that cannot arrive in time. Tell the damn truth so that GPs can respond accordingly.

Dr Horst Paul Herb   7/01/2022 1:00:14 PM

At least the government is consistent in their clueless and plan-less approach

Dr Bruce Watts   7/01/2022 5:37:30 PM

I currently have Covid, with some background immunosuppression. Guidelines suggest home management with the NSW Health Covid Support line supervising ( they will call you regularly, supply pulse oximeter, advise if hospital treatment needed etc).
This phone number currently just rings out or goes to message bank with no return calls after 6 days.

Dr Tamson Alice Walpole   7/01/2022 5:41:08 PM

Saw a covid patient -positive rat-in covid tent; cant claim extra amount because not pcr but gov want us to register it as positive/probable; also; who are we supposed to call for advise? for the person who is covid + on rat and has melena and refuses to go to hospital; of the patient with brittle asthma and covid-there used to be a covid pathway you could call for advise but they have been disconnected! It is like bailing out a leaking boat with a teaspoon!