What do the experts say about the primary care disaster response?

Doug Hendrie

23/11/2020 3:37:17 PM

From fires to COVID, GPs have responded to the challenges and learned as they went, according to a GP20 plenary and panel.

Firefighter in bushfire
This year has been hit by a string of disasters, starting with the Black Summer bushfires. (Image: AAP)

‘The world is wearing a mask. People are wading through floodwaters to get groceries. We are learning to live with disasters. And GPs help their community survive and thrive as an increasing number of disasters affect our community.’
That is GP and disaster medicine expert Dr Penny Burns speaking at the GP20 plenary on Saturday 21 November.
It has, Dr Burns observed, been a year of disasters – from bushfires to floods to the pandemic.
‘The Black Summer bushfires arrived after the hottest, driest year on record, and they arrived in winter,’ she said. ‘Penrith became the hottest place on earth. We had floods, hailstorms, the threat of measles.
‘While the fires burned, we saw the first cases of COVID. GPs were again on the frontline and adapted. We saw extraordinary innovative changes in primary care, from the change to telehealth to the complete rearrangement of practices, people seen in car parks, changes to face-to-face consults, 149 GP-led respiratory clinics around the country.
‘In the words of disaster manager colleagues, we’ve had two decades of disasters rolled into one year.
‘During this year, we saw GPs stepping up despite that adversity, with real strength and courage and demonstrating why GPs need to be the heart of healthcare.’
In her presentation, Dr Burns noted that person-centred care – focusing on what the patient in front of a GP needs – is critical during disasters, especially given GPs may be the only healthcare available when towns are cut off during disasters.
‘GPs are on the ground when disaster strikes,’ she said.
‘There are hundreds of examples of GPs stepping up quietly and then going back to normal care. GPs working out of tents after the Victorian bushfires. GPs working from carparks in Christchurch (New Zealand) after the earthquake.’
Dr Burns listed the variety of ways disasters could affect health. 
‘There are few systems of the body not affected by disasters. The vast majority of effects are seen in general practice,’ she said.
‘It’s the chronic disease management; acute deterioration of chronic disease triples in disasters. It’s the need for change in medications, the ongoing support.
‘The endocrine system is affected by increased stress. Pregnant women have an increased risk of gestational diabetes.
‘And disasters have an incredible effect on the heart, from heart attack syndrome to hypertension to increases in myocardial infarctions, even years later.’

For Dr Burns, one silver lining has been the doors thrown open to primary care as the nation grapples with a novel tide of disasters.
‘Over the last few months there have been invitations to GPs to contribute to discussions around disasters, including the bushfire royal commission, which concludes with a recommendation for the inclusion of primary care in disaster responses at all levels.
‘How can we use this opportunity to drive further integration with GPs and disaster management?’
Dr Burns was joined by a panel of high-profile GPs, including such as Professor Michael Kidd, Deputy Chief Medical Officer at the Department of Health and former RACGP President, as well as Dr Mukesh Haikerwal, a former president of the Australian Medical Association, with facilitation by Dr Lara Roeske, Chair of RACGP Specific Interests. 

Clockwise from top left: Dr Mukesh Haikerwal; Dr Penny Burns; Professor Michael Kidd; Dr Lara Roeske.

Professor Kidd praised the ‘very strong involvement of GPs and the college’ throughout the pandemic, including five RACGP members who sat on the influential Australian Health Protection Principal Committee.
‘We had a specific primary care response to COVID-19 funded by the government to the tune of $2 billion, ensuring GPs were supported to support the community,’ he said.
‘That was based on the recognition we are the people who look after those most vulnerable, we provide care to the majority of those who don’t require hospitalisation, we did respiratory clinics and a lot of testing,.’
But Professor Kidd said it is important to understand COVID is far from over, and people will have to live with the virus for some time yet, despite encouraging news from the vaccine push.
‘The role of GPs will be just as critical through the recovery as through the pandemic. There will be a lot of catch-up for people who postponed their care,’ he said.
‘We know there’s a lot of people afraid to leave home. There will be a long tail of mental health concerns.’
Professor Kidd hopes the forthcoming final report from the aged care royal commission will include have a focus on the fundamental role GPs play in this area of healthcare.
Dr Haikerwal said the ‘catastrophic’ impact of the pandemic in aged care could have been anticipated, given Europe had already had significant issues containing the virus in that sector.
‘It shouldn’t have been a surprise but, unfortunately, it seemed to be that way,’ he said.
Dr Burns called on GPs to document their experience of the pandemic and how they responded to this disaster, to help deal with the fallibility of memory.
‘We need to capture this moment. In two years’ time we may not have much memory of what happened. We need to document it, research it and create guidelines,’ she said. ‘In Christchurch, there was a tremendous [GP] response, but no documentation – it’s all in people’s heads.
‘The next disaster really is on its way. We need to sit down and think it through as if in two weeks’ time this event will occur. What will I do, and how will I do it, in a one-page quick-and-dirty plan.’
The Department of Health has embedded research into its primary care response, according to Professor Kidd.
‘We had a team of researchers from the Australian National University documenting what we were doing, the decisions being made, the evidence reviews to support policy development, so the next time we face an emergency like this we can say, what did we do last time?’ he said.
Dr Haikerwal said GPs will again have to rise to the challenge when a reliable vaccine for COVID becomes available.
‘Now that immunisations [may be] coming … GPs do this every season, and we can do it again. We just have to be given the tools and the go ahead,’ he said.
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