Hospitals the focus as GPs face increased risk of COVID exposure

Anastasia Tsirtsakis

4/01/2022 4:54:32 PM

‘If general practice falls over, everything falls over’, according to RACGP President Dr Karen Price.

Close up of a healthcare worker wearing a mask.
GPs are continuing to call for access to fit-tested P2/N95 masks.

It had been predicted that with the emergence of the highly transmissible Omicron variant and the easing of public health measures that COVID-19 infection rates could quickly escalate to numbers previously unimagined in Australia.
And they certainly have.
With the increased movement of people over the holiday period, Australia is setting new records on a daily basis:

  • 35,325 cases on 1 January
  • 32,347 cases on 2 January
  • 37,224 cases on 3 January
  • 47,799 cases on 4 January 
While all emerging evidence points to the new variant appearing to result in less severe illness, the national focus has been on hospitals buckling under pressure of increasing numbers of COVID patients.
But as GPs anticipated in October 2021, general practice is now bearing the brunt of these predominantly mild-to-moderate cases – while also managing vaccine booster delivery and preparing to immunise children aged 5–11 from next week while many staff are still on leave.
Although RACGP President Dr Karen Price acknowledges the very real challenges being faced by hospitals, she indicated that ignoring the issues in primary care is shortsighted.
‘For most people, it’s a mild illness and we can thank our vaccination program for that. But it puts an extraordinary burden on primary care and community health care,’ she told newsGP.
‘So there’s a huge cohort of COVID-positive patients in the community needing some degree of medical help and guidance.’
With as many as one in five people undergoing a PCR test in Victoria returning a positive result, the state’s COVID-19 Commander Jeroen Weimar said it can be assumed a symptomatic person is ‘probably COVID-positive’.
But according to Dr Price, the combination of narrowing eligibility for a PCR test and a national scarcity of rapid antigen tests means the reality of undiagnosed people in the community is a major concern for GPs, who are being given little support in the way of PPE and rapid tests.
‘We’re in a very resource-constrained health emergency – and I do not say “emergency” lightly – but we’ve got to make sure the health system still goes on,’ she said.
‘In most cases, I’ve seen GPs accessing [PPE and tests] privately.’
Queensland GP Dr Kat McLean, who has long been a vocal advocate for adequate PPE for GPs, has the same concerns.
‘Access to fit tested P2/N95 still out of reach of so many Australian GPs,’ she tweeted
‘More needs to be done. Feel as though I’ve been shouting into the void on this.’
Dr Price said that while some Primary Health Networks (PHNs) had stepped up to offer mask fit-testing, there is no uniform approach. Meanwhile, when it comes to accessing PPE, practices willing to see COVID-positive patients in person have been directed to their PHN, though Dr Price said the experience on the ground tells a different story.
She said the current reality means many GPs will come face-to-face with COVID-positive patients whether they are willing to or not.
‘And this is the challenge, particularly for doctors who’ve got immune conditions themselves or who may have … a high-risk family member,’ she said.
‘So all doctors should take precautions and they must look after their own wellbeing right now because we’re going to need to keep going for a few months, yet I think.’
Prominent Melbourne GP Professor Kerryn Phelps took to Twitter to express her frustration over the lack of support for the sector, saying ‘Australian GPs … need supplies of RATs to keep working safely’.
A practice staff member, identifying on Twitter as Angie Walkan, said her practice ordered rapid antigen tests before Christmas at a cost of $6500 for 20 boxes.
  Dr Price has asked the Federal Government to consider the delivery of rapid antigen testing through general practice, and she anticipates further clarity following the National Cabinet meeting scheduled for Wednesday 5 January.
She also said, however, that recent conversations with the Department of Health had indicated that the emergence of Omicron globally had put pressure on international testing supplies, and that it would likely ‘resolve towards the end of the month’.
But even if that eventuates, Dr Price said Australia will have to be ‘clever’ with its resources to ensure those who are most vulnerable have access.
‘We can’t have 25 million people doing a rapid antigen test every day. We’ve got to use them for clinical indications and for people going to see grandma in aged care and so forth … because we are resource-constrained,’ she said.
‘It’s a bit like the toilet paper: we can’t have people hoarding resources when we’ve got people who are really vulnerable. So I would expect some kind of rubric around how you can access the rapid antigen tests.’
To help adequately address the rapidly unfolding crisis, Dr Price said continued funding of telehealth is a big win, and while she praised the Federal Government’s decision to remove the 30/20 rule as ‘really sensible’, longer Level C telehealth consults are still needed.
‘We do need it because patients are anxious, and it can take a lot of time because you might be dealing with multiple people in a household and all sorts of complicated social situations that you need to manage,’ Dr Price said.
‘A longer telehealth consult would be a great plus to take some of the strain out of the system.’
Regardless, it remains clear that there is still a long road ahead to get the pandemic under control.
Dr Price says the current crisis comes back to the need for an integrated health system, one backed by the Federal Government 10-Year Primary Care Plan.
‘What we’ve seen is that at times, the fragmentation of the health system – that means the federal–state challenges of seeing a health system only in parts – has created difficulties,’ she said.  
‘If we don’t see the health system as a whole, we’re going to make the same mistakes again and again.
‘If general practice falls over, everything falls over.’
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Dr Aline Suan Lin Smith   5/01/2022 8:24:28 AM

I support free RATs for GP practices, this has been the case in NSW health to test their patients and staff. Why are GPs not prioritised as front line still ? We are responsible for not only our staff but incredible number of vulnerable patients, I want to know I am negative before seeing my elderly, home visit my disabled, etc. I'm still keen to provide F2F but with omicron circulating, lack of PPE and no fit testing of mask in my PHN still, I am in the vulnerable age group, so what should I do?
I echo the last sentance, ‘If general practice falls over, everything falls over.’

Dr Aline Suan Lin Smith   5/01/2022 9:12:05 AM

I quote an article earlier in News GP in November "Another treatment that may become part of the general practice toolkit against COVID-19 is the Merck antiviral drug, molnupiravir. On Friday, the UK became the first country in the world to approve its use.The Federal Government has 300,000 doses on order subject to its approval here, alongside 500,000 of Pfizer’s oral antiviral treatment." When are we seeing this roll out to GPs ......shouldnt we be at the forefront of this treatment ? How do you use it and when, who is eligible and what is the plan for this if any ?

Rural GP   5/01/2022 9:38:49 AM

I agree with Dr SMITH. The Politician said let it rip. NSW Health went on holidays and have let vaccinating, tracing and testing get overwhelmed. NO RAT's for patients or Practices. ! No planning.
GP's are some how meant to manage these patient without oximeters and PPE. Oh and we have just right now learnt vaccine orders have been cancelled without notice (not enough supply). Its a debacle and we will be victims of Government blame shifting to "GP's let patients die at home. " They have form . Get ready for it.