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‘Great inclusion’ of GPs urged by bushfire royal commission


Anastasia Tsirtsakis


6/11/2020 4:10:15 PM

Experts welcome the commission’s recommendations, but say they must be implemented urgently as Australia heads into another bushfire season.

Firefighter bushfire
The royal commission into the summer bushfires has warned that similar events are likely to take place in the future. (image: AAP)

‘The summer of 2019-2020 – in which some communities experienced drought, heatwaves, bushfires, hailstorms, and flooding – provided only a glimpse of the types of events that Australia may face in the future.’
 
That is the warning issued in the Royal Commission into National Natural Disaster Arrangements’ (bushfire royal commission) final report on the horror summer that resulted in the loss of life and destruction.
 
Among the 80 recommendations, the commission has backed calls by the RACGP for greater GP involvement in disaster management, recommending that GPs and Primary Health Networks (PHNs) be represented on relevant emergency planning committees at the local, state and territory, and national levels.
 
The acknowledgement of GPs as important players has been welcomed by Dr Glynn Kelly, Chair of the RACGP Specific Interests Disaster Management network, and Dr Penny Burns, Chair of the RACGP’s General Practice Disaster Management Committee at NSW&ACT, both of whom contributed to the college’s submission to the bushfire royal commission.
 
‘The section on including GPs on relevant disaster committees and plans is particularly important to me,’ Dr Burns told newsGP. ‘Actually embedding GPs in the systems is crucial.’
 
The report follows a series of submissions and accounts the commission received of the bushfire season that saw more than 30 people die, 417 excess deaths as a result of smoke exposure, and thousands of hospital admissions.
 
The involvement of GPs was said to be ‘ad hoc’, varying between local areas and jurisdictions, and in some cases they were ‘actively excluded’.
 
‘We had cases of GPs turning up to help and being told to basically [go away],’ Dr Kelly told newsGP.
 
‘This is crazy – these are skilled GPs.’
 
Dr Burns says this situation was a consequence of the lack of pre-planning and failure to include GPs in the formal planning processes.
 
‘What we have to remember is that disasters are dangerous environments and there’s a lot going on. The danger is not only to the people that are experiencing the disaster, but also the health professionals and [they] need to be protected,’ she said.
 
‘So it’s really important as health professionals, if we’re going to go in and help in a disaster, that we understand what’s going on and that we’ve linked into the system so that we’re kept safe.’
 
The report from the bushfire royal commission suggests PHNs could take a formal coordinating role in disaster management, providing training, advice and support to primary care professionals, as well as identifying and prioritising emerging issues during the recovery phase.
 
As an already established model, Dr Burns says much of the approach taken by the Nepean Blue Mountains PHN could be further developed and applied elsewhere in Australia.
 
‘They’ve got their list of volunteers. The volunteers have an understanding of what’s required, what they’ll need to do, what they can’t do, who they need to call when they have an issue, and how to keep themselves safe,’ she said.
 
‘There’s no need to reinvent the wheel. If it’s happening in one area, you can just roll it out in other areas.’

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Australia’s summer bushfires saw more than 30 people die, 417 excess deaths as a result of smoke exposure, and thousands of hospital admissions. (Image: AAP)

The report also recognised the need to prioritise mental health during and after natural disasters, suggesting that services be delivered locally through primary care by ensuring GPs receive appropriate training in trauma-informed care.
 
‘Some basic level mental health training is good because often a lot of victims … don’t need a lot of intervention, but they do need some early and appropriate intervention to support them in a difficult time,’ Dr Kelly said.
 
‘If they don’t get that … it can turn into a major issue.
 
‘But that means it also needs to be funded. It’s all very well for the Federal Government to say we’re putting X million dollars into extra psychologists when if a psychologist is not available who do you refer to? The GP is frontline.
 
‘And let’s not forget that GPs are often victims themselves in these communities. They need support as well.’
 
Based in Queensland, where residents in Dunmore have been issued a watch and act warning as a fast-moving bushfire threatens, Dr Kelly says the true value of the report for communities is dependent on how much action is taken to implement the recommendations.
 
‘My take on this is that the RACGP has put a very strong submission into the bushfire commission. Great. The bushfire commission has basically agreed with most things that we’ve said. Great. Now something needs to be done, and it needs to be driven,’ he said.
 
‘Otherwise they’ll just sit on a shelf – as many reports have done in the past – and [nothing] may get done.
 
‘Please do not let this report sit on a shelf. Let’s do something about it.’
 
With a number of GPs involved in Australia’s coronavirus pandemic response, such as Deputy Chief Medical Officer Professor Michael Kidd, Dr Burns hopes it has set the benchmark for primary care involvement in the future.
 
But she too fears that complacency may set in.
 
‘People are very keen to support GPs at the moment because they’ve seen their value and they understand how important they are in communities, particularly in rural communities,’ Dr Burns said.
 
‘But the danger is that as that memory fades and people think, “Oh, we won’t have another disaster”. It’s forgotten and it’s not enacted, and we end up back where we started. I’ve seen that happen a number of times.
 
‘I always say recovery begins with preparedness. We can’t choose when the disaster is going to hit and we can’t choose what type of disaster, but we can choose to be ready for it.’
 
Emergency management ministers came together on Thursday to discuss the report’s findings, with a National Cabinet expected to meet next week.
 
Dr Penny Burns will give a presentation on ‘Disasters and general practice in the spotlight’ at GP20 on Saturday 21 November at 12.20 pm, with an interactive panel discussion including Professor Michael Kidd and Dr Mukesh Haikerwal.
 
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bushfires climate change disaster preparedness emergency medicine primary care royal commission



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