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Inquiry told GPs should be ‘essential’ part of pandemic preparedness

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In a submission to the Queensland Parliamentary Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee, RACGP Queensland acknowledged that the State Government’s responses to the COVID-19 pandemic had yielded positive results.
 
It noted, however, a ‘strong sense that more could have been done – both in the early stages of the pandemic and as it has progressed – to support GPs in their role as frontline healthcare workers’.
 
The submission called for ‘further action’ and highlighted the following issues:
 

• The pandemic’s impact on patients
• Access to and use of personal protective equipment (PPE)
• Influenza vaccinations
• Aboriginal and Torres Strait Islander people
• People from culturally and linguistically diverse (CALD) backgrounds
• Preventing the spread of misinformation
• Telehealth and secure messaging
• Communication and collaboration with GPs

 
Chair of RACGP Queensland, Dr Bruce Willett, and faculty state manager, James Flynn, presented at the parliamentary hearing on Wednesday 19 August.
 
Dr Willett drew attention to challenges Queensland GPs faced early in the pandemic as a result of ‘discordant advice’ from state and federal authorities.
 
‘This caused unnecessary anxiety and confusion,’ he told the inquiry.
 
‘GPs were not adequately engaged at a community level, and reliance on proxies for engagement – like PHNs [primary health networks] – was inadequate.
 
‘This was a missed opportunity to harness the powerful good that GPs could have provided in leading the community response to COVID-19.’
 
Speaking to newsGP, Dr Willett said while Queensland Health had done ‘a lot of things really well’, it should have brought GPs into the conversation earlier.
 
‘We’ve been meeting regularly – I think it’s important to give credit where credit’s due,’ he said.
 
‘But what we would like to see in the future is that those meetings of the various state and federal health authorities happen right from the beginning rather than some way into it.’
 
Despite the challenges, Dr Willett told the inquiry that GPs had taken initiative and done ‘excellent work’ in adapting their practices to keep patients safe.
 
‘GPs have worked tirelessly in their communities, most having to rapidly pivot to telehealth consults and overcome many of the technical and system challenges in the process,’ he told the inquiry.
 
‘In just a few weeks into the pandemic, general practices had also implemented significant changes to the way they work. They have developed creative new ways of working in order to continue to deliver safe and essential care to their patient and their communities.
 
‘GPs also set up outdoor clinics to deliver influenza vaccinations, and established respiratory clinics across the state. An RACGP member survey showed that 97% of general practices remained opened during this time.’
 
The inquiry heard that GPs, to date, have provided ‘over 59% of all COVID19 testing in Queensland’, as well as necessary follow-up, ongoing care, and counselling to patients who underwent testing at hospital fever clinics.
 
‘The current pandemic has highlighted how essential the role of GPs and their teams are in responding to community emergencies and supporting the Queensland public hospitals and health systems,’ Dr Willett said.
 
Dr Willett told newsGP that despite the central role GPs have played, that ongoing issues around the supply of PPE indicates a lack of acknowledgement for their hard work.
 
‘GPs are uncared for and neglected in this process in that they really weren’t given enough assurity about the supply of PPE,’ he said.
 
‘GPs have been really anxious about the ability to continue to do their job if they can’t keep safe.
 
‘I’m putting all of this in the past tense – which it is for Queensland at the moment – but it’s all in the present tense for GPs in Victoria.’
 
During the hearing, Dr Willett also drew attention to the systemic issues underlying the National Immunisation Program (NIP) rollout, and the inadequate distribution of influenza vaccines  to general practices.  
 
‘The RACGP is aware that influenza vaccination availability for general practices lagged well behind the timing of the health promotions regarding vaccinations,’ he told the inquiry.
 
‘This resulted in some vulnerable patients becoming frightened about the availability and timeliness of influenza vaccine, resulting in them seeking vaccinations inappropriately in retail settings, with unnecessary costs and the majority were not recorded in the Australian Immunisation Register compounding this problem.’
 
Dr Bruce Willett believes that Queensland Health should have brought GPs into the conversation earlier.

Dr Willett told newsGP issues regarding the rollout had caused ‘unnecessary stress and anxiety’ for patients, and put additional pressure on general practice resources, making it ‘very difficult to do business as usual’.
 
‘We know that pharmacies are reporting less than 50% of the vaccinations to the [Australian] Immunisation Register,’ he said. ‘So it means that when those patients come to us, we looked it up and they were telling us that they had been immunised, but there was no record of that which, again, caused unnecessary confusion.’
 
This also raises concerns, Dr Willett said, for the future rollout of a COVID-19 vaccine, following news the Federal Government secured more than 25 million doses of the University of Oxford vaccine candidate.
 
‘I’d like to see recognition for the added safety and clinical processes that we have of providing vaccines in a clinical setting rather than in a retail setting – that needs to be acknowledged,’ he told newsGP.
 
In its submission, RACGP Queensland made the following recommendations:
 

• Adequate supply of influenza vaccinations (NIP and private) be prioritised for general practice before supplied to pharmacies
• The provision of NIP vaccinations be contingent on the ability to upload relevant information to the Australian Immunisation Register
• The annual supply for influenza vaccinations be calculated using Standardised Whole Patient Equivalent values

 
During the hearing, Dr Willett welcomed greater collaboration between the Queensland Government and the RACGP.
 
‘The RACGP would hope that the lessons learned here can be applied into a more cohesive response in the future especially in the planning and initial phases of disaster and pandemic preparedness,’ he said.
 
‘GPs are well regarded as one of the most cost-effective parts of our healthcare system. The RACGP welcomes collaboration with our state government in supporting greater collaboration to serve the health care needs of our communities.
 
‘Properly utilising our capabilities would see GPs as engaging solid partners to HHS’s [hospital and health services]. Future directions might include GP-led hospital-in-the-home, GP-led hospital-in-the-nursing-home, GP-led mental health services in the community and shared antenatal care, to mention just a few options.’ 
 
Dr Willett told newsGP that GPs have the knowledge and skills to step up and do more, but that they need to be supported to do so.
 
‘It makes a lot of sense to have a lot of things that are currently being done in hospitals moved back into general practice where they really belong and were traditionally done … and it needs proper funding to do that,’ he said.
 
He hopes the inquiry leads to greater ‘recognition’ of the important role GPs play in pandemic preparedness, and keeping the community safe.
 
‘I’d like to see that the central role of GPs in responding to this pandemic is acknowledged and that we’re able to build on that to extend the scope of practice of GPs – taking back a lot of the lost ground that we’ve had to other disciplines,’ Dr Willett said.
 
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COVID-19 influenza vaccine pandemic preparedness parliamentary hearing Queensland

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