COVID-19: Where Is the Support for General Practice?
“We have an emerging threat. We have a worried population. General practices are at the forefront of the response,” said Dr Tim Woodruff, President, Doctors Reform Society. “But we hear little to support them, either from the Federal or State Governments.”
“The WA Health Minister was reported as saying (West Australian, 5 March) that it was inappropriate that GPs were ‘rejecting’ patients who were concerned about COVID-19 and directing them to an Emergency Department”, said Dr Woodruff. “The Minister’s words sadly reflect a complete misunderstanding of first response carers in emergencies. Every surf life saver, paramedic, and emergency service worker knows that in an emergency, safety of the emergency responder is the first priority. What use is an electrocuted SES volunteer or a drowned surf life saver? What use is a GP who assesses a patient one day and dies a week later, having exposed his/her staff and family members to a potentially fatal infection?”
“General practice is the site of first responders in this emerging COVID-19 scenario. GPs, practice nurses, and reception staff need every support to help the many patients who are understandably concerned about the problem.”
“State Governments need general practice to step up to help deal with the problem”, said Dr Woodruff. “Without such help, the burden on their overstretched public hospitals will be even greater than it is. But general practices simply do not currently have the resources to do that safely. They need time, money, space, and personal protective equipment. It is not being provided.”
“The Federal Government is the funder of general practice. It has the funds to support general practice, including funding telephone consultations. It has the power to control the distribution of personal protective equipment but almost nothing has been offered. It has the capacity to recognise that support for general practices will limit the potentially disastrous consequences of the COVID-19 outbreak. But” said Dr Woodruff, “to date patients and their doctors have not been advised of any plan!”
“ It is great that the Federal Government has been working hard on the big picture regarding the spread from overseas and the containment, where possible, of local spread. It needs to do much more.”
“What is its plan for our first responders, particularly our general practices?, asked Dr Woodruff. “Is it ‘you’re on your own mate’ or will it demonstrate some leadership and announce a comprehensive support package for general practice.”
“Minister Hunt, can you tell us your plan?”
“State Health Ministers, can you request more support for general practice so your hospitals can cope?”
Below is a letter to the WA Health Minister from a Western Australian DRS member regarding Minister’s comments impugning GPs.
Dr Tim Woodruff, President, PH 0401042619
Dr Con Costa, Vice President, Ph 0418400309
Dr Brett Montgomery, author of letter below, ph 0407909840
http://www.facebook.com/DoctorsReformSociety
Dear Minister Cook,
I am a General Practitioner in Western Australia.
I write regarding the unfolding novel coronavirus situation, and specifically regarding your recent comments reported in the West Australian (5 March 2020):
Health Minister Roger Cook, below, said it was “inappropriate” that GPs were rejecting patients who were concerned they had COVID-19.
“The GPs should certainly not be rejecting patients and saying, ‘Go to ED’,” he said.
“To simply reject that patient is inappropriate and unacceptable and I think really is contrary to not only the legal obligations but certainly the moral obligations by the GP.”
I am not sure where you are sourcing your advice on the legal and moral obligations of GPs. I source mine, in part, from my medical defence organisation (MDA National), which has reassured its members, in an email this morning, that there is no legal obligation for GPs to see patients concerned about COVID-19. I will quote for you the relevant summary points from this email:
“A medical practitioner does not have any obligation to see a particular patient other than in an emergency or if subject to a workplace contractual agreement.
MDA National supports that Members should not treat or carry out testing on suspected cases of COVID-19 if they do not have the appropriate PPE or practice facilities.
Medical practitioners should remain up to date with evolving public health advice.”
Moral obligations are more complex. I feel morally bound to care for my patients with due professionalism. However, I also feel morally bound not to unnecessarily expose staff or other patients at my practice to this new coronavirus. Many older people and people with pre-existing medical conditions in my practice’s waiting room may be especially vulnerable to COVID-19. Of course, I am aware that this is also very much the case in emergency departments, where people with other significant illnesses may be unnecessarily exposed to the new coronavirus when patients with mild COVID-19 attend.
General practices are struggling to purchase personal protective equipment to enable their doctors and other staff to safely care for people with COVID-19 – masks are running out like toilet paper in supermarkets. Primary Health Networks have reportedly offered only two masks to each general practice – a frankly pathetic supply in the face of a global pandemic. We are advised, if we lack personal protective equipment, that we should not personally swab or examine our patients in whom COVID-19 is suspected.
What are we to do when neither general practice nor EDs are safe places for care? Your promised “fever clinics” at tertiary hospital sites are a reasonable step forward.
We are all frightened and stressed by this unprecedented unfolding health emergency, and the limited safe options available to us. I don’t have all the answers to the question of what an ideal response to COVID-19 would look like. However, I’m confident it would not include health ministers publicly and inaccurately impugning the professionalism of general practitioners.
I look forward to your reply, your public apology, your ongoing commitment to fever clinics, and your vigorous advocacy with national colleagues for provision of personal protective equipment for Australian GPs and for Medicare funding of safe telephone-based assessments by GPs of people concerned about COVID-19.
Yours sincerely,
Dr Brett Montgomery MBBS DCH FRACGP MMedSci
General Practitioner (East Fremantle)