‘Uncharacteristic’ Queensland CHO letter leaves GPs confused

The letter, signed by Queensland Chief Health Officer Dr Jeanette Young and sent to Queensland GPs on Wednesday, said they should return to conducting face-to-face consultations ‘to the greatest extent possible’.
 
‘With no interstate COVID-19 hotspots and nil evidence of community transmission in Queensland, it is safe to once again start treating patients in person, even those with respiratory symptoms,’ she wrote.
 
‘It is crucial that general practitioners get back to seeing patients; this can build community confidence [on] our road back from COVID-19, get patients back to primary care where their holistic health needs are being met, and ease the pressure on our emergency departments [EDs].’

Townsville GP and RACGP Rural Chair Dr Michael Clements told newsGP he was left confused by the implications contained in the letter, but suggested it was poorly worded, rather than a direct attack on GPs.
 
‘This doesn’t make sense. It’s uncharacteristic ... because we certainly have had good support from the chief health officer in the past,’ he said.
 
‘It seems like the letter was implying that because GPs aren’t seeing patients face-to-face that the EDs are overrun … and we’d flatly reject that.
 
‘GPs have been working harder than ever, using a good mix of telehealth and face-to-face services to do the best they can for their community.’
 
Dr Clements said he would also ‘flatly reject’ any suggestion that GPs’ use of telehealth contributed to a rise in presentations to Queensland EDs.
 
Instead, he suggests that avoidable ED presentations have been a long-term issue across the country, and that the underfunding of general practice and limited coordination between hospitals and primary care are greater contributors.
 
‘The rise in ED presentations is multifactorial … and what we’re seeing is the long tail of COVID and the effect of people delaying and avoiding healthcare during the worst of the pandemic,’ he said.
 
‘We would be very happy as a college to engage with Dr Young to discuss how Queensland Health can work with the GPs on coordinated care [and] look at novel funding methods to increase the capacity of general practice to look after these patients.’
 
RACGP Queensland Chair Dr Bruce Willett told newsGP he is disappointed by some of the implications contained in the letter, but reaffirmed that the college is keen to work with authorities to help improve healthcare in the state.
 
‘There was a roughly 30,000 increase in year-on-year ED presentations, a third of which could have gone to the GP,’ he said. ‘But, of course, that means two thirds of presentations were deemed to be appropriate. So there is actually an issue of increased demand.
 
‘I think most GPs feel that we’re now reaping the consequences of people not going to their GP a year or six months ago, and the fallout of that is increased presentation to emergency departments.
 
‘So it really shows the importance of supporting a well-funded, well-resourced general practice system to keep people out of expensive hospital care.’


RACGP Queensland Chair Dr Bruce Willett would like to work alongside Queensland Health to improve healthcare and ease pressure on the state’s hospital system.

Queensland Health did not respond to specific questions related to the implication of the letter, but a spokesperson told newsGP ‘every part of the health system’ underwent substantial change in 2020.
 
‘Hospitals had to change their approach to seeing some patients last year because of COVID-19. So did GPs. We’re now seeing Queenslanders seeking a return to normal,’ the spokesperson said.
 
‘This year our emergency departments are in high demand – and why wouldn’t they be, when they provide free access to high quality healthcare?
 
‘That’s why we want everyone to know that it is safe to return to business-as-usual practices. And we want Queenslanders to be able to access the right services for minor acute conditions.’
 
According to Dr Willett, while it is possible to safely treat patients with respiratory symptoms in-person, it also requires a high level of organisation.
 
‘That’s something that we should be discussing and promoting how to do it, in a way that minimises risk to everyone,’ he said.
 
‘I’ve [also] talked to Jeanette Young about getting some help with provision of masks for patients, and that’s something that she’s said that she’s willing to look at.’
 
However, Dr Clements said he would like to see more clarification.
 
‘There clearly are protocols and procedures recommending adequate personal protective equipment and avoidance of high-risk consultations – those are still the clear guidelines,’ he said.
 
‘I simply just don’t understand where that recommendation is coming from, when we’ve still got an unvaccinated population and an ongoing threat.
 
‘We certainly would like more clarification … because our GPs are still providing very safe care for themselves and for their community by minimising contact with potentially infective people.
 
‘It just seemed poorly worded, because it seemed to be implying that GPs weren’t doing their job and need to do better.’ 
 
Meanwhile, Dr Edwin Kruys, a GP who works at a Queensland Health General Practice Liaison Unit on the Sunshine Coast, told newsGP that even though hospital presentations are at record levels, everyone is ‘feeling the pressure’.
 
‘Listening to my GP colleagues, everyone is busy looking after their patients, including face-to-face care,’ he said.
 
‘We’re certainly flat out in our practice and I see the overwhelming majority of my patients in-person in the consultation room.’
 
Dr Kruys said Queensland is fortunate to have a well-organised, active general practice liaison network within the state’s health apparatus. He encouraged decision-makers to engage with this network and develop collaborative models of care between general practice and hospital teams, to jointly manage an increasing workload which is ‘not likely to go away anytime soon’.
 
‘It goes to show that in healthcare we don’t work in isolation,’ he said.
 
‘Changes in one part of the sector often have a flow-on effect on other parts … [and] we have to be careful to imply that general practice – or any other party – is at fault.
 
‘It would be more helpful to look at how we can support each other.’
 
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