GPs seek clarity on impending role in managing COVID patients

As people in many parts of Australia look forward to the easing of COVID-19 public health measures, GPs are bracing for high infection rates and a growing workload.
 
Despite the promise of an 80% full-vaccination target, data shows uptake is not equally dispersed among communities, leaving hundreds of thousands vulnerable.
 
With hospitals already pushed to the brink, including in parts of the country without the strain of COVID, Department of Health (DoH) Secretary Professor Brendan Murphy has flagged that ‘community care will be the mainstay of treatment with COVID’, and that the details of such care are being worked through.
 
But with general practice resources already stretched between the vaccine rollout and playing catch-up on delayed regular care, Queensland GP Dr Kat McLean is concerned about the impending workload.
 
‘We are in quite a different position from obviously New South Wales and Victoria,’ she told newsGP.
 
‘But it does feel like there is going to be a significant amount of work that has shifted on to general practice with a real absence of planning around how that happens, how that’s funded and what that interface is between primary care and hospitals.
 
‘I’m being approached by GPs with exactly these questions and that fear that we are going to be trying to manage that in a really resource constrained environment.’
 
In New South Wales, where restrictions have already eased significantly since the state hit its 70% vaccination target last week, Dr Alam Yoosuff, a GP based in Murrumbidgee in the state’s south-west, has also noticed the silence around planning.
 
He believes there has been a disconnect between the state’s public health response and general practice.
 
‘Even for a simple matter, like if somebody gets tested in a public health hospital or a public health unit, the vast majority of general practice can’t access the results unless they go through so many phone calls,’ Dr Yoosuff told newsGP.
 
‘We just don’t have the time to do that.
 
‘But one day when they don’t get extra COVID funding, which is not going to be far away, that day they’ll wash their hands of it and we will have a system in limbo and nobody knows what to do.’
 
Looking at the international experience in highly vaccinated countries, it is anticipated that infection numbers will rise in Australia. Vaccinated people reportedly accounted for 12% of Victoria’s 2179 infections on Thursday 14 October.
 
Dr Yoosuff expects eased restrictions will see an increasing number of practices exposed to COVID-positive patients and feels that planning and support are needed to curb risks to vulnerable patients and staff.
 
‘We are going to have quite a few COVID-19-positive patients come through our clinics – that is going to be a normality,’ he said.
 
‘But what is the assurance that I can give to my 92-year-old comorbid patient who is coming to see me for an annual blood check-up that she won’t get COVID-19 in my clinic?’


Queensland GP Dr Kat McLean is concerned about the impending workload as Australia starts to open up. 

The DoH recently issued updated guidance, making it easier for practices with fully vaccinated staff and adequate PPE to stay open in the event of becoming an exposure site.
 
However, with many scenarios reliant on access to higher grade PPE, there are questions over whether practices will have access to the national medical stockpile.
 
Dr McLean, who has been a vocal advocate on PPE access and fit-testing, said while her local PHN is now taking steps to support practices with fit-testing, there is still a way to go to ensure practices are as safe and prepared as possible.
 
‘I really haven’t seen resources or guidance to practices around how we can improve our ventilation, how we can use Hepa filters and how we can monitor and audit the processes that we’ve got,’ she said.
 
GPs also anticipate that telehealth, including longer telephone consultations, will be crucial to minimising risk to patients, but uncertainty remains over how it will be funded and any bulk-billing requirements.
 
‘Is telehealth going to be funded for long-consult item numbers? Can we do certain care plans over telehealth? Is it just a 23 equivalent item number for telehealth?’ Dr Yoosuff said.
 
‘And if that’s the case, is it viable to run a general practice?
 
‘There will also be a lot of telephone calls … talking to the patients who are in a hospital-in-the-home situation where we don’t have access to clinical data … but we will end up needing to do prescriptions. How do claim for that time?
 
‘Those are questions which might end up coming in the long run if we don’t prepare well.’
 
Meanwhile, with reports of COVID-positive patients dying at home in New South Wales and Victoria, Dr McLean says there may need to be an indemnity arrangement similar to the one announced for vaccination.
 
‘We know that COVID-positive patients can deteriorate quickly and there can be other complications that will change the course of that condition and there are constraints; I don’t know as a GP if I would be able to access stat monitors for my positive patients in the community,’ she said.
 
‘We want to be able to provide the best care that we can, but we’re scrambling to actually work out what that is; the framework and the medicolegal side of it, all that stress that you carry if you’re managing patients in the community.’
 
Dr Yoosuff also suspects general practice may eventually have to be more involved in everything from testing patients to informing them of their COVID-19 status, as well as ensuring information is disseminated to their close contacts.
 
A 100-page report outlining the state of Australia’s health system, including plans to use more community care, was reportedly put forward to National Cabinet in late September, with the RACGP involved in talks with government.
 
Dr McLean is pleased to hear of advocacy going on behind the scenes, but believes the time has come for GPs ‘to actually see something tangible’.
 
Dr Yoosuff agrees and says as a section of the workforce projected to be living and dealing with COVID for years to come, it is important that general practice plays a bigger role in planning and decision-making.
 
Otherwise, he fears GPs will become increasingly dissatisfied.
 
‘The vast majority of GPs will struggle to look after their patients because no matter what financial incentive and involvement, about 80–90% are emotionally attached to their patients,’ Dr Yoosuff said.
 
‘So we’ll see GPs getting burnt out and GPs spending a lot of time which they are not remunerated [for].
 
‘There will be disgruntled GPs and there will be general practices that will have to close down. We already don’t have enough GPs, particularly in the rural and remote context, and they will have even less time to give.’
 
newsGP contacted the DoH for comment but did not receive a reply prior to publication.
 
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