Introduction by Croakey: As the number of COVID-19 cases continues to fall in Australia – for the time being at least – the Federal Government has made key changes to the delivery of care for patients with COVID.
The Government is banking on the country’s rising double vaccination rate – 79.1 percent today for people aged over 16 – to reduce the severity of illness and the need for hospitalisation.
But doctors say the $25 Medicare payment to see COVID patients in their clinics is “danger money” and, along with their patients, they have serious safety concerns.
In the article below, journalist Linda Doherty explores the reaction to Federal Health Minister Greg Hunt’s recent announcement.
Linda Doherty writes:
The move to devolve the care of COVID-19 patients from hospitals and specialised services to general practitioners has alarmed some patients and doctors concerned at the risk of infection in waiting rooms and an inadequate $25 “bonus” Medicare payment.
Federal Health Minister Greg Hunt last Friday announced the next stage of care for COVID-19 patients in light of rising vaccination rates and the lower numbers of people expected to require hospitalisation.
“As we open up, we know that there will be more cases that will be treated at home because people will be fully vaccinated. They may not require hospitalisation, and so the balance will shift from hospitalisation to community care,” Hunt said at a press conference.
The Government’s $180 million funding package for primary care to support COVID-19 patients at home and in the community includes:
- A new, temporary MBS item for $25 for general practices to cover the extra cost of treating COVID-positive patients face-to-face, including infection control measures.
- GPs supervising COVID patients will receive pulse oximeters from the national medical stockpile to assist in remote monitoring of patients’ oxygen levels at home.
- The existing GP-led respiratory clinics will be continued until June 2022.
- Home visits for COVID patients by nurse practitioners and practice nurses organised by Primary Health Networks.
Dr Anthony Brown, Executive Director of Health Consumers NSW, said the package was a good start in the transition to community management of COVID-19 but it had been designed without consultation with patients, particularly those who had contracted COVID-19.
“Of course we need to move back to people going to the GP, but there are patient safety issues here that need to be addressed,” he told Croakey.
“GPs haven’t been managing COVID at all, and local hospitals and health services have built up the expertise in caring for people with COVID. We’re concerned that GPs haven’t had enough time to receive adequate training in caring for people with COVID.
“The future of telehealth in general practice is not guaranteed after December 31. It doesn’t make sense to extend the role of GPs to manage a highly infectious disease in the community without telehealth.”
Hunt said the package was developed with the Royal Australian College of General Practitioners. RACGP President Karen Price said it represented “a new era” towards an integrated health system and was the “silver lining” of the pandemic.
The Australian Medical Association (AMA) said “more funding and support is required” for GPs.
“The AMA will continue to work with the Department of Health and the Government to ensure appropriate arrangements and supports are in place,” the AMA said in a statement.
Funding inadequate to guarantee safety
The $25 MBS item for GPs treating COVID patients was described by Hunt as “a face-to-face bonus for GPs that are treating COVID-positive or suspected COVID-positive patients in the clinic”.
But some GPs and consumer groups said patient and staff safety in waiting rooms would be compromised and the MBS payment would not cover the costs of infection control procedures such as personal protective equipment (PPE), cleaning and the potential need for separate waiting rooms.
Melbourne GP Dr Mukesh Haikerwal, a former federal president of the AMA, told Australian Doctor News: “GPs are worried about COVID-19, but it has just got scarier because the Federal Minister for Health has told millions of people they can visit a general practice if they test positive.”
Haikerwal has been operating a GP respiratory clinic in Melbourne next to his main practice but he said it was funded by the Commonwealth and “geared up with staffing, negative pressure ventilation and all sorts of protocols and equipment”.
“So it’s not just a room in the clinic and it isn’t something that every practice in the country is set up to do,” he said.
A Sydney GP, who did not want to be named, said: “The $25 danger money is so far beyond insulting. The reality is all our clinical staff would have to be in full PPE and we’d need a waiting room separate to other patients.
“I spend a day a week in PPE, which is suffocating. Patients can’t hear you and then you have to wipe down all surfaces, door handles and change the PPE,” she told Croakey.
“Obviously you need to factor in the time and the equipment to do this but more concerning is the risk to staff and other patients and then needing to shut down, deep clean or isolate staff. It’s ridiculous.”
Returning to community care
RACGP President Dr Karen Price said community care of COVID-19 patients would free up beds in hospitals for other patients with acute injuries or medical conditions.
“So this is about returning to community-based care because basically the Australian community have stepped up and got vaccinated, and that means that we’re only really going to experience, we hope, mild disease in the community. But it does need to be watched,” she said at Minister Hunt’s press conference.
NSW Health said it was working with the Federal Government, primary care clinicians, and the RACGP and AMA “to share the knowledge gained from the recent Delta outbreak and design the future models for COVID-19 care in the community”.
“This includes collaborating on the clinical and virtual care skills that will be required in the primary care networks to deliver high quality, safe and reliable care to patients with COVID-19 being cared for in the community,” a spokeswoman told Croakey.
The Consumers Health Forum CEO Leanne Wells said “significant challenges for both hospitals and primary care doctors and nurses in the community will continue” with the easing of lockdown restrictions and the opening of borders.
“Consumers need to play their part in avoiding infection by continuing with sensible anti-COVID precautions,” Wells said.
But she said the extension of COVID care to GPs and allied health professionals was a positive step towards more comprehensive healthcare.
“CHF has long advocated for Medicare to cover more coordinated and integrated care involving GPs working with allied health professionals because it is the logical and effective step towards better healthcare,” Wells said.
Health Consumers NSW this week released a survey asking people who have been diagnosed with COVID-19 to share their experiences.
See Croakey’s extensive archive of stories about COVID-19