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COVID, telehealth, rural Australia, the future: Health of the Nation

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Each year, RACGP members select a topic of focus for General Practice: Health of the Nation.
 
The 2020 report focuses on the unique environment created by the COVID-19 pandemic and the 2019–20 summer bushfires.
 
The challenges of adapting processes and responding to crises is reflected in survey findings throughout the report from almost 1800 GPs across Australia.
 
‘Our fourth annual [Health of the Nation] report could not come at a more important time,’ RACGP Acting President Associate Professor Ayman Shenouda said in his video address at Friday’s launch.
 
‘The last 12 months have tested our health system like no other time in living memory. We had the devastating summer bushfires and then, before we could draw breath, the emergence of a once-in-a-lifetime pandemic.
 
‘These twin health crises have made clear how vital primary care is when disaster strikes.
 
‘GPs on the frontline of these health crises worked tirelessly to help their communities. It is the DNA of general practice to do so.’
 
Federal Health Minister Greg Hunt was on hand for the launch of the report. He opened his speech by acknowledging healthcare professionals and their work during the pandemic.
 
‘I am delighted to officially launch the General Practice: Health of the Nation report for 2020,’ he said.
 
‘I would like to acknowledge all RACGP members in what has been perhaps the most significant and difficult year for Australia’s medical workforce since the Second World War.’
 
Shadow Health Minister Chris Bowen also said he was honoured to help launch the report, thanking GPs for their ‘tireless efforts throughout this annus horribilis’ and acknowledging the impact 2020 has had on GPs and their practices.
 
‘A lesson from this report is this: the challenges that general practice faces didn’t begin, and won’t end, with the pandemic,’ Minister Bowen said.
 
‘This report again highlights the funding pressure that general practice faces – and the burdens that imposes on both GPs and patients, who face record out-of-pocket costs.’
 
Minister Bowen welcomed the focus on Aboriginal and Torres Strait Islander GPs in training.
 
‘As the report notes, Aboriginal and Torres Strait Islander people remain significantly under‑represented in the health workforce, which contributes to reduced access to health services for the broader Aboriginal and Torres Strait Islander population,’ he said.
 
‘In that context, it’s good news that First Nations medical graduates are more likely to choose general practice than any other specialty – but, of course, we have much work to do, on workforce issues and more broadly.’
 
All presenters paid tribute to Immediate Past President, the late Dr Harry Nespolon.
 
In the context of an unprecedented pandemic, the 2020 Health of the Nation provides an insight into the advances and challenges faced by GPs.
 
Twenty-two million Australians visit a GP each year, and GPs see an average of 102 patients each week, spending 16 minutes with each patient.
 
However, 2019–20 saw the lowest rate of GP visits since 2014–15 (87.4%).
 
It is not yet known what long-term impacts COVID-19, or the temporary decrease in patients presenting for usual care, will have on the health of the population, but the reports indicates it is more important than ever that GPs are supported to provide continuity of care for patients with chronic diseases.
 
GPs reported the most common patient presentations types during COVID-19 were:

• psychological (eg depression, sleep disturbance)
• preventive (eg immunisation/vaccination, diet)
• respiratory (eg cough, asthma, sinusitis, suspected COVID-19)
• musculoskeletal (eg back/neck pain, arthritis).

Mental health
Perhaps unsurprisingly, mental health issues remain the most common presentation reported by GPs for the fourth year running.
 
And these issues are not limited to the patients they see, but include GPs themselves.
 
Of GPs surveyed for Health of the Nation, 27% report a deterioration in their mental health due to COVID-19, and one in three GPs rank their own wellbeing as one of the top three challenges that affects their ability to provide care to patients during the pandemic.
 
Rates of burnout can be almost twice as high among GPs caring for the highest number of patients with multimorbidity, compared with those caring for the lowest number.
 
Minister Hunt highlighted the toll recent crises have taken on the nation’s mental health and efforts to support both healthcare professionals and the broader community.
 
‘The Government is committed to providing support and funding for the health of our doctors across Australia, and we want to work with the RACGP going forward on strengthening that role.’
 
‘We have also invested additional funds for mental health through the course of the pandemic. In particular, [we] doubled the MBS psychological services under the Better Access Program, which many of you [GPs] have made the case and argued for that – you’ve recognised the importance.’
 
Pandemic response
The majority of GPs are supportive of the Federal Government’s response to the pandemic, according to the report, with one in two ranking the response as ‘good’ or ‘very good’ for ensuring the safety of GPs and general practice teams.

However, GPs cited challenges during the pandemic, including:
 

• the inability to provide usual care to patients – particularly with a decreased number of patients presenting for usual care when they were being encouraged to isolate at home
• access to appropriate personal protective equipment (PPE) – eight out of 10 GPs thought federal and state governments needed to do more to provide practices with PPE
• keeping up to date with MBS changes and financial pressures – seven in 10 GPs report that their income or revenue in April–May 2020 was lower than in the same period in 2019, with six in 10 GP owners concerned about the viability of their practice.

Associate Professor Shenouda said increased support for GPs is vital so they can continue helping their communities.
 
‘The role of GPs must be formally recognised in disaster and health crisis preparation, mitigation, response and recovery, at both state and national levels,’ he said.
 
‘We know our communities and will be there for patients during and after this pandemic, so we should be front and centre. We are also the ones helping communities hit by bushfires to heal.’
 
Telehealth
GPs have embraced rapid change and quickly adapted to telehealth to ensure the safety of patients and practice staff, and ongoing access to quality care.
 
Health of the Nation reveals that while 97% of GPs report they are using telehealth, about 65% of consultations in April and May 2020 were provided in person.
 
Two-thirds (67%) of GPs report a positive change in attitude toward using telehealth as the result of the pandemic – the most common reason is that MBS items now support use of telehealth.
 
GPs indicated that their patients like the convenience of telehealth, it supports GP safety in the workplace, and patient access to care has been improved. Patients also report positive experiences of telehealth, with two in three of those surveyed saying they would be open to continuing to use telehealth after the pandemic.
 
Seven in 10 GPs think continuing telehealth after the pandemic would support patient access to high-quality care in general practice.


RACGP Acting President Associate Professor Ayman Shenouda is pleased on the progress being made in​ rural health.

Rural health
Associate Professor Shenouda, himself a rural GP, said encouraging news for rural general practice had emerged from this year’s report. He is pleased on the progress being made in this area.
 
‘We do not focus nearly enough on the many positive and rewarding aspects of working as a rural or remote GP,’ he said.
 
‘I can personally vouch that it is an incredibly rewarding career, where you can see the impact of your work on people in your community every day.’
 
However, Associate Professor Shenouda said rural general practice still faces some challenges.
 
‘Progress is being made, but we must do more to encourage GPs to pursue a rewarding career in the bush so that we can increase the rural workforce and boost accessibility for patients,’ he said.
 
‘The RACGP worked closely with the Department of Health to change the Australian General Practice Training Rural Generalist policy, giving registrars more flexibility to choose the right training pathway.
 
‘As a result, we saw a 40% increase in junior doctors choosing the rural generalism pathway for our 2021 training, compared to applications for 2020. That shows that with the right policy settings we can encourage more future doctors to opt for a career in these communities.’
 
Minister Hunt said the National Rural Health Workforce Strategy is a key investment for the Government, also noting the report’s findings of a 55% increase of Aboriginal and Torres Strait Islander students studying medicine.
 
‘This is a strong pathway for overseas-trained doctors into rural generalism … and to attract and retain GPs in rural Australia,’ he said.
 
‘We are putting in place integrated primary care models and working together with Aboriginal Community Controlled Health Organisations and working together on our National Rural Health strategy.
 
‘It’s an exciting time – general practice is being transformed.’
 
Issues requiring policy action
Linking with the RACGP’s Vision for general practice and a sustainable healthcare system, which outlines a model of care that addresses many of the nation’s healthcare challenges, the 2020 Health of the Nation report highlights policy issues in need of government action.
 
GPs identify Medicare rebates as the highest policy priority area, followed by mental health, telehealth and ePrescribing, and creating new funding models for primary care.
 
Associate Professor Shenouda said there is room for improvement – and GPs need to be involved.
 
‘More could have been done, both in the early stages of the pandemic and as the pandemic escalated, to involve GPs in pandemic planning and to support GPs in their role as vital frontline healthcare workers,’ he said.
 
‘When we look at the patients hardest hit by the pandemic … it becomes clear once again how vital continuity of care is. It improves patient health outcomes and reduce hospitalisations.’
 
Echoing the sentiments of GPs surveyed for Health of the Nation, Associate Professor Shenouda said more investment in primary healthcare funding is needed.
 
‘Given the workload general practice is shouldering in the wake of the twin health crises, it is clear that change is needed,’ he said.
 
‘The last 12 months have shown us that primary care is fundamental to the health of our community and must be properly resourced.
 
‘Sometimes it takes a crisis to take stock of what is working and what needs improvement.’
 
The 2020 General Practice: Health of the Nation report is available on the RACGP website.
 
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COVID-19 Health of the Nation mental health telehealth

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