Q&A with Professor Michael Kidd

As one of Australia’s most decorated and high-profile GPs, Professor Michael Kidd needs no introduction.
 
The former RACGP President has held a host of prestigious positions at academic institutions in Australia and abroad, advised the World Health Organization, and most recently stepped down as Deputy Chief Medical Officer to assume new roles with UNSW and Oxford University.
 
A past WONCA World President, he is also due to deliver a keynote address at October’s WONCA World Conference in Sydney, where he will discuss primary care contributions throughout the COVID-19 pandemic.
 
In the lead up to the global conference, Professor Kidd sat down with newsGP for an extensive interview covering the pandemic, general practice, and what he is most looking forward to at WONCA.
 
What have been the most significant contributions of primary care during the COVID-19 pandemic?
In countries all around the world, many of the national responses to the COVID-19 pandemic have relied heavily on family doctors, family practices, GPs, and general practices.
 
We use different words to describe family doctors and their services depending on which country you’re in, but regardless, the primary care response to the pandemic has been critical. It has involved the assessment of people with respiratory symptoms and the diagnosis of people with COVID-19, while the rollout of vaccinations in many countries has also been based in primary care, especially in general practices and family practices.
 
Likewise, in many countries, treatments for COVID-19 – particularly the oral antiviral medicines – have been rolled out through primary care settings. Beyond that, in every country it has been important to have primary care continue to function during the pandemic, particularly during the lockdown periods.
 
Making sure that people were still able to access their family doctor, their GP, the nurse at their practice and other health providers has also been critical. In part, that’s been through primary care services still being open and available during lockdowns, but in many countries, it’s also been through the use of telehealth.
 
We saw a rapid adoption in many countries of widescale telehealth services by family doctors and their staff in the early phases of the pandemic, which has become an enduring change in healthcare.
 
Meanwhile, pressure has been placed on primary care due to people who have put off presenting with symptoms or delayed their regular checks for the management of chronic diseases.
 
We are now dealing with a backlog of patient needs, but also the impact of delayed diagnosis and interruptions in treatment programs for people.
 
We’ve also seen primary care make a significant contribution towards looking after the mental health of patients.  As we know, people everywhere in the world experienced anxiety and worry and distress during the pandemic. Many people had their lives significantly disrupted, lost their livelihood, and many young people experienced major disruption to their education with schools and universities closed. Many people lost loved ones during the pandemic as well, especially older family members and people with chronic disease. So, there’s a big burden of mental health concerns as a consequence of the pandemic, which are being managed through primary care as well.
 
Outside of the clinical backlog and additional mental health burden, did the pandemic have any other major impacts on primary care that you’d like to mention?
Primary care continued to operate during lockdowns and when there were global shortages of personal protective equipment, which was especially prevalent during the early stages of the pandemic.
 
We know that during a during a pandemic, the same level of protection should be provided to people working in community based primary care services as is offered to those working in hospitals and emergency departments, but that did not happen in many countries.
 
As a result, we had many people in primary care putting their own health at risk by continuing to provide services. It also put their family’s health at risk, and, of course, before the availability of vaccines, COVID-19 was a very serious illness that often resulted in many people becoming severely unwell, hospitalised, and at risk of death.
 
So, this was a major concern. And I think one of the central messages that has emerged is the importance of making sure that we are protecting all of our health workforce in all of our countries, and that we’re prepared for future national emergencies, epidemics and pandemics and that we don’t experience that again.
 
I think the community’s respect for the healthcare workforce – including people working in primary care, family doctors, primary care nurses and others – has also grown as a consequence of the contributions made during the pandemic.
 
We know that in a country like Australia, GPs, nurses and pharmacists are already right at the top of the list of the most trusted people in society, but the contributions that people made during the COVID-19 pandemic has only enhanced their standing.
 
Are there any other major lessons that primary care can learn as a result of the pandemic?
One of the areas that I like to focus on is the contribution towards looking after the people who are most vulnerable in our societies.
 
In general practice, in family medicine, we are responsible for the care of many of the most vulnerable people – including the frail elderly, those with chronic diseases, people who are immune compromised, and many people with disability.
 
We look after everybody in our communities, which includes families on low incomes, refugees, new arrivals to our country, and people who don’t speak the national language of our country.
 
We are responsible for everybody in society, and what we know is that COVID-19 disproportionately impacted some of those priority populations, especially older people living in aged care facilities.
 
Very early on, we saw the impact that COVID-19 had in those settings in countries all around the world and it’s a really important lesson coming out from COVID-19.  The OECD has done an assessment in OECD nations which showed that in the first two years of the pandemic more than a third of deaths from COVID-19 occurred in people living in long-term care facilities or nursing homes. These people experienced a hugely disproportionate burden of morbidity and mortality. When we’re planning for future emergencies and pandemics and epidemics, in the very front of our minds, we have to consider how we protect the most vulnerable people in our communities, which includes older people living in these settings.
 
We now have antivirals, vaccines and other ways of treating and preventing illness compared to what it was like when COVID-19 first emerged. But what do you think are some of the main challenges going forward? Because the pandemic is still happening.
We’re now learning how to live with COVID-19. And what that means for many countries is opening back up and life getting back to normal for many people. But there is a continued need to provide additional support and protection for people who are at particularly high risk if they become infected.
 
That means continuing the vaccine rollouts and continuing to provide booster vaccines to provide a high level of protection.
 
It also means people remaining very wary if they have symptoms, or have been exposed to someone with COVID-19, and staying away from older family members, loved ones and friends to not risk passing it on.  
 
The appropriate use of masks when we have significant community levels of community transmission is also important. We know that COVID-19 transmission is likely to keep happening in waves in countries all around the world, so we need to respect the wishes of people who wish to protect themselves through wearing a mask when they’re going out into public and in crowded settings, for example public transport.
 
These measures may result in actual improvements in the health of everybody.
 
For example, if we change our approach to what people do when they have symptoms of a viral respiratory disease, to where people stay home and work remotely if they can and reduce the risk of transmission to other people, it might have an impact every winter on what happens with outbreaks of viral respiratory infections and we may see a reduction in the preventable deaths that we see each year from influenza and other viruses.
 
Again, with influenza, we’ve got vaccines but not everyone gets vaccinated, and even if they are vaccinated, if a person is frail or elderly they are still at risk of becoming seriously unwell and at risk of hospitalisation and death.
 
There are changes from the impact of the COVID-19 pandemic that will likely be enduring in all of our countries, no matter how much we’d all like to put it behind us.
 
Moving on from COVID, let’s focus on the WONCA conference. What are you most looking forward to about WONCA?
I attended my first World WONCA conference in 1989 in Jerusalem. I was a young recent graduate, having just finished my postgraduate general practice training with the RACGP.
 
What I found extraordinary, firstly, was people from all different parts of the world coming together and discovering that what we might think is special about general practice in Australia exists in so many other countries around the world.
 
There are doctors, there are primary care nurses, there are people working in general practices in countries all around the world who share the same values and the same commitment that I have and that doctors have in this country.
 
The other thing which I found wonderful was that whatever special area of general practice you are particularly interested in, you can find a group of like-minded colleagues from countries all over the world who share that interest as well.
 
My interests back in 1989 – and still today – were the use of new technologies in general practice, particularly digital health, and also the general practice-based management of HIV and other blood-borne viruses and sexually transmissible infections. I found my home with groups of like-minded family doctors in each of those two areas, who over the intervening 35 years have been longstanding and enduring colleagues and friends.
 
It’s a wonderful conference and I hope that as many GPs in Australia as are able will take the opportunity to come to Sydney and join in. I especially hope that many of our registrars and new Fellows will take the opportunity to come to the conference and gain the sort of rich experiences that I did at that stage in my own career.
 
The engagement with WONCA – and obviously I’m a big fan because I ended up being elected the President of the organisation [from 2013–16] – has been a really important, enriching and rewarding part of my professional career in so many ways.
 
Aside from what you just mentioned, are there any other reasons people should register to attend this year’s conference?
Well, of course, it’s combined with the RACGP annual conference as well, so you get all the benefits of GP23; attending and linking in with colleagues from right across Australia; the great education opportunities that the conference offers; and also the opportunities to look at the impacts of national policy on the important work that we do through general practice.
 
You can reflect on your practice and how it runs, and get tips and hints from colleagues from around the country.
 
So there’s the national focus through the regular RACGP conference and then this amazing added bonus of linking in with colleagues from all around the world. One of the things I really love about the WONCA conferences is that you can walk in there, not knowing anybody, and at the end of the conference, you’ve got this whole group of people who you’ve met, new friends and colleagues who you will engage with in the future.
 
Is this the first in-person WONCA World Conference to be held since the arrival of COVID?
The last conference was based in Abu Dhabi in the United Arab Emirates right in the middle of the COVID-19 pandemic in 2021, and that was largely a virtual conference.
 
This is the first big face-to-face conference since the COVID-19 pandemic began, but of course, it’s not the first time the WONCA World Conference has been held in Australia, because the very first conference was in Melbourne back in 1972.
 
So this is the 50 year anniversary conference (delayed a year due to the pandemic) and hopefully there’ll be a few of our colleagues who attended that conference who will be coming to this one too.
 
Is there anything else that you wanted to add?
Just one final point. One of the important things that WONCA does is it represents general practice at a global level, particularly at the World Health Organization [WHO].
 
What that means is that through WONCA, we have the opportunity to influence the development of global health policy and the rollout of global health programs – not only in high-income countries like Australia, but in low- and middle-income countries all around the world.
 
And part of the focus of the WHO and the United Nations at the moment is a strong renewed commitment to universal health coverage – ensuring that every single person on the planet gets access to basic health services as a fundamental human right.
 
The way the WHO sees being able to achieve this is through strengthening primary care and enhancing the role of doctors, nurses and other people working in primary care in every single country in the world.
 
So, one of the fascinating aspects of WONCA’s work is being involved with the WHO and the United Nations and other global health organisations in strengthening primary care in every country in the world and working with colleagues and governments in countries from around the world.
 
So again, part of what people experience at the WONCA conference is finding out what’s happening at the global level. Being able to put into perspective the work that we each do on a day-to-day basis with our own patients in our own communities in our own country, and comparing that to what’s happening in every other country on the planet.
 
The insights can be really fascinating and, through WONCA, there’s an opportunity for people to get involved with working parties and special interest groups and actually be part of influencing global health policy and the rollout of national health programs.
 
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COVID-19 Professor Michael Kidd WONCA World Conference