Vaccine rollout ‘relied on GP goodwill’: Study

General practices barely broke even in the vaccine rollout – with many losing money as a result, according to a new report published in the Australian Health Review journal.
 
Its authors, who include Dr Michael Wright, Chair of RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), write that general practice’s contribution to the vaccine rollout was largely based on the community-minded spirit of GPs.
 
The involvement of primary care – with general practice having delivered 31,594,390 doses at the latest count – helped more than 95% of the population receive at least two doses and led to Australia being one of the most vaccinated nations in the world.
 
‘The success of Australia’s COVID-19 vaccine rollout relied on the goodwill of general practices,’ the researchers concluded.
 
‘Participation in the COVID-19 vaccine rollout resulted in increased stress, increased administration workload, and reduced financial viability for many practices.’
 
The study was designed to evaluate the rollout’s impact on general practice finances and workforce, and was based on 18 interviews with general practice owners and managers in Greater Sydney from June to August 2021.  
 
Most interviewees were practice managers, while the majority of the general practices involved are described as ‘clinician-owned, well established, and medium to large in size’.
 
At the time of the interviews, most were operating under lockdown restrictions.
 
While many suspected they would make a loss by taking part, they still wanted to contribute to fighting the pandemic.
 
‘We knew that if we were going to do COVID vaccinations in the practice, that we would probably have a drop in revenue because of it,’ one interviewee said.
 
‘But we were all very keen to do what’s good for the community.’ 
 
‘Very accurate’ report
Two GPs and a spokesperson for some of the biggest GP clinic operators in the country, said they strongly supported the findings of the report when approached by newsGP.
 
Dr Yee-Shing Kan, Chair of RACGP Specific Interests Business of General Practice, said the research resonated with her and would do with many GPs around the country.
 
‘Our practice in Perth signed up to be a COVID vaccination clinic mainly for the patients’ benefit, [out of] goodwill and hoping it will end the lockdown and the pandemic,’ she told newsGP.
 
Dr Kan said the practice ‘just’ broke even due to having to purchase an extra vaccine fridge as well as a back-up generator to take part.
 
As well as the financial investment, she highlights the extra time involved, such as training spent on vaccination courses. However, the personal toll on staff proved to be the greatest cost Dr Kan said, with the practice having to adapt to a resignation caused by burnout, as well as arguments stemming from the stress of having to organise the clinics and vaccines.
 
‘That had never happened since the clinic was established more than 10 years ago,’ Dr Kan said.
 
Jeremy Stones is the former CEO of Better Medical, a group of 80 general practices, and the current spokesperson for the Primary Care Business Council, which represents Australia’s seven largest GP clinic operators.
 
He describes the study as ‘very accurate’.
 
‘Even though financially it was generally detrimental to practice profitability, we did this for the community and our patients as a key pathway out of the restrictions endured during COVID,’ he told newsGP.
 
Mr Stones, however, says participation has had an ongoing impact on patient care.
 
‘With many GPs, nurses and admin staff [being] absent with COVID isolation, it was a choice between dealing with the urgent versus managing longer-term health issues as the system did not have workforce capacity to deal with both simultaneously,’ he said.
 
‘Many of the longer-term health issues not dealt with during COVID are now emerging.’
 
‘Lack of understanding of general practice’
The study says the initial enthusiasm for participation was eroded by the way the rollout was handled.
 
‘There was a strong sense from all interviewees that the goodwill shown by general practice was not reciprocated by the Federal Government in the development or communication of COVID-19 vaccine policy,’ the authors wrote.
 
‘This lack of communication compromised vaccine rollout efficiency.’
 
They indicate many employees interpreted this as stemming from a lack of understanding of general practice.
 
Mr Stones says the satisfaction many felt at being involved in the ‘heavy lifting’ for the vaccine program was undermined by the Government approach.
 
‘[It] was combined with fatigue, burnout and frustration at the stop/start nature, and seemingly ad hoc approach to communication via TV news that created major operational headaches the next day,’ he said.
 
‘For practice operators, we felt very disconnected to what was happening at times and were constantly left scrambling and reacting.’


Sydney GP and Chair of REC–FHSR Dr Michael Wright co-authored the research.
 
The study’s assessment also strikes a chord with Dr Michael Tam, a GP academic at the University of New South Wales as well as a member of the RACGP Expert Committee – Quality Care (REC–QC).
 
‘We are members of the communities in which we serve,’ he told newsGP.
 
‘However, this goodwill was not reciprocated by the Government with the rollout being made more difficult than necessary, with poor funding for the emergency public health initiative. 
 
‘Some serious questions need to be asked why “nickel-and-diming” this vital part of the public health response was ever considered appropriate or strategic.’
 
Another clear issue was the timeliness of vaccine supply – a concern reflected in the interviews when there was a lack of Pfizer at many practices.
 
‘The financial viability of vaccine clinics relied on practices receiving an adequate and predictable supply of vaccines to match demand,’ the report says. ‘This did not happen for many practices.
 
‘Vaccine deliveries were unpredictable, with staff spending hours rescheduling appointments when expected shipments did not arrive.
 
‘This mismatch between vaccine demand and supply created multiple challenges and added costs.’
 
The study does allude to some positive aspects to the vaccine rollout, particularly when looking beyond the immediate impact.
 
Participants said longer-term gains could be possible through the changes made to deliver the vaccines, including investment in online and telephone systems and new processes brought in to facilitate high-volume vaccinations.
 
‘This may have long-term benefits for viability and efficiency of primary care, but in the short-term, has increased financial and workforce pressure on practices,’ the paper states.
 
The authors acknowledge that the interviews took place at a relatively early stage of the vaccine rollout, and that results may have showed different results if they had taken place later.
 
However, the study reflects the early findings of an Australian National Audit Office (ANAO) report published last month, which was highly critical of the planning and communication for the initial phases of the rollout.
 
General practices ‘proud’ of role
Despite the financial and personal challenges involved, all those approached by newsGP say general practice’s participation in the rollout was worthwhile, albeit not necessarily in a financial sense.
 
‘I think most GPs and their teams who participated in the vaccination rollout are rightly proud of their efforts and service to the community,’ Dr Tam said. ‘And this, of course, makes it worthwhile.’
 
Dr Kan added that while there was a lack of Government acknowledgement, patients were ‘very grateful’.
 
‘I still think it was worth it because look at the results we obtained,’ she said. ‘Now we are able to be free, back almost to normal.’
 
Mr Stones also said staff at GP clinics were ‘proud to serve our communities’ but warned it would not be easy to be involved in a similar campaign in the future.
 
‘Can the primary care sector do it again? We would be very willing, but we could not do it with the funding and resources received during the COVID pandemic,’ he said.
 
‘For example, the MBS rebates were not adequate to cover all the costs, direct and indirect, of that unprecedented program and we could not afford a repeat of that.’
 
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