‘Uncharacteristic’ Queensland CHO letter leaves GPs confused

Matt Woodley

12/03/2021 5:35:50 PM

Dr Jeanette Young encouraged GPs to see more patients face-to-face, including those with respiratory symptoms, suggesting a lack of in-person consultations has led to a rise in ED presentations.

Queensland Chief Health Officer Dr Jeanette Young
Queensland Chief Health Officer Dr Jeanette Young said it is ‘safe’ for GPs treat patients with respiratory symptoms in person. (Image: AAP)

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.’
Log in below to join the conversation.

coronavirus COVID-19 emergency departments telehealth

newsGP weekly poll What areas of healthcare were you hoping would get more funding in this year's Federal Budget?

newsGP weekly poll What areas of healthcare were you hoping would get more funding in this year's Federal Budget?



Login to comment

Dr James Courts   13/03/2021 7:05:26 AM


I sent a reply on Wednesday, particularly more pertinent due to Friday’s announcement of an infected colleague at the PA.

Effective triage, maintenance of testing facilities and high levels of observation for Covid are still needed. Priorities are now vaccination whilst keeping strong surveillance.

An unusual slip for the office that has been so strong and effective so far.

Dr Michael Lucas Bailey   13/03/2021 7:21:23 AM

I haven’t got my letter yet. But Princess Alexandra Hospital in Brisbane went into lock down on Friday due to a staff member testing positive for COVID-19.

Steve   13/03/2021 7:38:08 AM

My personal practice has been to triage respiratory illnesses over the phone, bringing in only the patients who need examination, usually being young children with worried parents. I see all other patients in person.

Unfortunately despite appropriate ppe and precautions I am already on my second urti of the year. Most years GPs would work through, however at present any respiratory symptoms means swabs and staying home. This has already cost both me and my practice a significant amount in lost billings due to a lack of paid sick leave for GPs. A return to seeing all respiratory patients in person is not only going to compound this problem but will also put other patients in the waiting room at risk. My practice is small and not set up to be run as a respiratory clinic,isn't this exactly what the respiratory clinics were set up for?

Perhaps if the health minister could offer GPs paid sick leave this would be a more viable option.

Dr Michael Charles Rice   13/03/2021 7:49:48 AM

The epidemiology and the virology may be en pointe (or not, given news from PAH overnight) and now is a good time to think about psychology: GPs, being human, are moved by our own feelings and not purely by someone else's science.

From the outset, GPs sensed a "you're on your own" message from the State while at the same time reading "We never want a Queensland Health nurse to ever have to worry ever again if they will have the mask that they want" eg

We have felt that the National PPE Stockpile was quarantined for hospitals, apart from a trickle through PHNs that we felt we begged for. We felt that hospitals had enough of the "good gear" to make their own staff safe. Some felt exposed where respiratory infection comprised a large part of our caseload, and our business models. Some of us felt devalued in access to vaccination and conscripted by mandatory bulk-billing telehealth and vaccinations

Examine GPs' ideas, concerns and expectations. Works for us!

A.Prof Christopher David Hogan   13/03/2021 10:47:20 AM

It seems there are several issues
* A discussion with GPs rather than blunt assumptions would be more useful
* The work of Good GPs is invisible- not so good GPs - not so much!
* All doctors are currently under pressure & to assume one group is having an easier run than another is ....... optimistic
* Any doctor who gets an URTI must be tested & absent themselves from patient contact.
* General Practice is currently underfunded & under resourced- it is time everyone realised this & also realised things are getting worse

Dr Jeanine Suzanne McMullan   13/03/2021 10:54:51 AM

Someone is labouring under the misapprehension that we are Qld Health employees. We are self employed with no sick leave entitlement or workcover provision if we get long Covid.
We have a duty of care to our staff and patients.
We were not given PPE. Gp. Respiratory clinics are funded for this purpose and I direct patients to these resources.
We are not vaccinated and there is no Qld. Health plan to enable this.
Cairns hospital on code yellow. Brisbane metro north also. Covid positive doctor in suburbs around south Brisbane. Positive sewerage tests at luggage point and Fairfield.
I am not hearing good things out of PA hospital in terms of provision for permanent ramping in ED and staff safety.
Winter is coming....

Dr Michelle Diane Bonnici   14/03/2021 7:51:24 AM

I have been seeing about 98% of my patients face to face for a few months now. Even though we try to minimise the risk we do expose ourselves to possible COVID or other respiratory illnesses Getting ill means being off work (unpaid) and unable to care for patients. General practice is not considered to be a frontline health service for the COVID vaccine even though it is the first port of call for most patients
I think the CHO s office is out of touch with what is happening in primary care

Dr Karin Hage   14/03/2021 9:31:33 AM

I still remember the slap in the face of GPs by the same person who stated -- GPs are private businesses and should get their PPE from the free market. At the height of a pandemic.
And yes, we are NOT QH employees and have no sick leave and have not received vaccination as a matter of urgency.
And yes, EDs have been understaffed and overworked for as long as I can remember. So is General Practice.