Significant measures to keep health professionals on the coronavirus frontline

The opt-out sub-register will likely be established by 6 April, with the aim of fast-tracking the return of non-practicing doctors, nurses, midwives and pharmacists to the workforce, according to the Australian Health Practitioner Regulation Agency (AHPRA) and national boards.
 
The register will run for 12 months and apply to healthcare workers who left the register or moved to non-practising registration in the past three years.
 
Only personnel who are properly qualified and suitable will return to the register, and they will not need to fill in forms or pay fees, nor meet the usual return-to-practice requirements. There is no obligation for anyone added to the sub-register to practise or remain on it and AHPRA has said they can opt out at any time, for any reason.
 
Associate Professor John Kramer told newsGP there are ‘plenty’ of areas where non-practising GPs and other healthcare workers can contribute, but that it would be irresponsible to ‘just throw them in’ to working on the frontlines.
 
‘It doesn’t have to involve clinical duties,’ he said. ‘[For example] medical students need teaching, GP registrars need teaching – it’s something I’m grappling with at the moment.
 
‘We’re having trouble doing anything more than corridor consultations and chats at lunchtime because we’re so busy dealing with the clinical lab.
 
‘A retired GP would be very useful, coming in and just having a weekly hour or two [session] with the registrars. That would mean I knew they were still getting taught and I can get on with doing what I need to do.’
 
AHPRA Chief Executive Martin Fletcher said the new measure is designed to get more practitioners into the health system quickly and safely.
 
‘We want more of our critical health practitioners available to work as part of the health system in responding to the pandemic,’ he said. ‘Patient safety remains an important focus and registered practitioners who were subject to regulatory action in the past three years will not be re-registered.
 
‘Employers and health departments will also play an important role by undertaking employment and probity checks, and providing any induction and training which may be needed.’
 
Practitioners who choose to stay on the pandemic sub-register and go back to work will need to comply with their profession’s code of conduct, professional indemnity insurance requirements, and work within the scope of their practice.
 
They will be removed from the sub-register after 12 months, or sooner if the pandemic subsides. If they wish to continue practising after the emergency they will be able to apply for ongoing registration through the standard process.
 
Victoria has also moved to try to consolidate the number of available healthcare workers and other essential workers it has at its disposal by expanding the testing criteria it applies to determine suspected coronavirus cases.
 
With modelling used by the Victorian Government indicating the coronavirus infection will peak in June, Health Minister Jenny Mikakos warned people not to be complacent as the state faces a calm before the storm.
 
RACGP Victoria Chair Dr Cameron Loy told newsGP that criteria for healthcare workers had already expanded previously to allow for more testing, but the latest update would bring the state into line with national guidelines.
 
‘Our problem arises when we have two different sets of guidelines to apply. The thing that we actually need is consistency across the nation,’ he said.
 
‘If there are going to be differences between state and federal guidelines, for whatever reason, [we need] that to be clearly articulated to us as a profession.
 
‘They don’t need to be scared of us. They can actually be honest with us.
 
‘We’re in this together.’
 
The new guidelines also direct doctors to clearly mark pathology slips with ‘HCW’ to ensure swabs can be easily identified for priority testing. However, while there are fewer epidemiological barriers to testing, suspected cases are now required to have a temperature of 38°C, up from 37.5°C included in previous guidelines.
 
The clinical criteria have been tightened despite Victoria lagging behind many other states with regard to testing, as well as having healthcare workers comprise 10% of all coronavirus cases in the state.
 
Dr Loy said healthcare workers representing such a high proportion of positive cases is ‘distressing’, but noted that the Victorian Department of Health and Human Services (DHHS) had indicated most did not contract the virus within healthcare settings.
 
‘That being said, we all know what happened overseas,’ he said.
 
‘We watched doctors die in China. We are watching as doctors die in Italy. We watch doctors die in Spain. We’re watching doctors die in England.
 
‘We are incredibly concerned and fearful that that’s going to be replicated here.
 
‘I don’t want to be in a position where I’m writing condolence letters to 30, 40, 60 of my colleagues’ families throughout this year. That is an active concern of ours.
 
‘We just need to do everything we can to work through those issues.’
 
Aside from the physical threat of coronavirus, Dr Loy said it has also been exacting a considerable mental toll on doctors.
 
‘This is an incredibly anxious time for all of us in the community and for us doing our job,’ he said.
 
‘We know that we’ve got targets on our heads and it’s very difficult to deal with that significant cognitive load that sits on top of us with regards to this.
 
‘When you start to see positive cases in friends, families, in your community and, in some cases, in your clinics, it gets incredibly real, very quickly.’
 
The RACGP has more information on coronavirus available on its website.
 
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