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Australia GPs brace for COVID-19 case surge as Melbourne exits lockdown

13:27  21 october  2021
13:27  21 october  2021 Source:   abc.net.au

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With cases continuing to peak ahead of Melbourne's reopening at midnight, general practitioners like Simon Benson are about to become even busier.

The vast majority of COVID-19 patients who are not sick enough for hospital will end up being assessed and cared for by GPs like him.

"80 per cent of COVID-positive patients will be managed in the community by their GP," said Dr Benson, whose clinic is based in Sunshine, which is considered a COVID-19 hotspot area.

"I think that's appropriate because hospitals really should be reserved for those cases that can't be managed in the community, where patients are either high risk or they're having a very serious episode."

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Sunshine City Medical Centre is being inundated with calls from COVID and non-COVID patients, with its 15 phone lines ringing off the hook each day.

"I worry about the number of positive [COVID-19] notifications that I'm going to receive as soon as I walk through the door," he said.

"It's important that we preserve capacity within the healthcare system, but for that, general practice needs support and needs guidance, as well as resources to take on this extra workload."

The Victorian government is predicting cases to peak at about 4,000 a day in December.

However, revised modelling by the Burnet Institute has shown that due to an increase in vaccination, the chance of hospitals being overwhelmed has fallen significantly, from 63 per cent down to 23 per cent.

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While that is welcome news for hospital workers, any increase in cases will still mean more people needing medical care — even if they are only mild cases of COVID-19 — and GPs will help to fill that gap.

GPs call for funding overhaul

A report released on Thursday by industry body the Royal Australian College of General Practitioners (RACGP) reflects the concerns of GPs across the country, and calls for a change to the structure of government funding for primary care, including extra funding.

"Only when the fundamental role of general practice is properly recognised and greater support and resources are given to our hardworking GPs, can government honestly say it is committed to improving the health of the nation," Karen Price, the president of RACGP, said.

In terms of COVID-19 costs, the federal government has already agreed to a 50:50 split with state governments when it comes to funding hospitals.

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GPs, however, are mostly funded through the federal Medicare system.

Funding for GPs is less than 8 per cent of total health expenditure, according to the RACGP report, yet they provide more than twice the number of episodes of care a year than hospitals, and at one-sixth of the cost.

"The fundamental problem, I think, is that GPs are managed by the federal government, and the pandemic response in the rest of the healthcare system is managed by the state government," Dr Benson said.

"It is really important that these two branches of government and healthcare systems work together to improve patient health outcomes, both in a pandemic and in other issues.

"Every day on the television, the Chief Health Officers are directing patients with COVID questions or vaccination questions to their GP.

"I don't think that GPs have been at the very front of mind in terms of the planning response."

In a statement, a spokesperson for the federal Department of Health said: "Primary care has been at the forefront of our planning and investment since the beginning of the pandemic."

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"In fact, there has been an increase in the number of GP services funded under Medicare, and in the total number of services funded under Medicare, since the pandemic started," the spokesperson said.

"The government is engaging with general practices and their peak bodies about the safe management of general practice patients as lockdowns are lifted and Australia moves to living with COVID through phases B and C of the National Plan."

Mental health appointments not available until 2022

Aside from managing the bulk of COVID-19 patients, GPs are also picking up the slack from hospital delays in elective surgery, as well as dealing with a huge jump in the number of people with mental health problems.

"I've worked here for almost a decade and I've never known a time longer than a couple of weeks for a patient to get in to see a psychologist. And right now, the earliest appointment is well into next year," Dr Benson said.

According to the RACGP report, four out of five GPs say they have patients with mental health conditions that are mostly managed within general practice.

"Ask any GP and they will likely report more and more patients presenting with mental health concerns," Ms Price said.

"This aligns with data showing that GPs provide the majority of Medicare-subsidised mental health services.

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"This is part of a longer-term trend. For the fifth consecutive year, psychological conditions, including sleep disturbance and depression, were the most reported reasons for patient presentations."

'I'm asked for a vaccine exemption every single day'

Primary care services such as GPs also administered more than half of all COVID-19 vaccine doses during the first five months of the rollout.

On top of this, they are the first point of call for anyone seeking an exemption to getting a jab.

"I'm asked for a vaccine exemption at least every single day," Dr Benson said.

"The criteria for exemptions are extremely strict and GPs don't have any discretion.

"One of my colleagues here has been offered $2,000 to provide a vaccine exemption, and I know of a GP in a nearby clinic who was offered $5,000 to falsify an immunisation certificate."

Dr Benson said he used conversations with patients about exemptions to explore their concerns and anxieties about vaccination, which more often than not led to them rolling up their sleeves.

Steve McGloughlin, the director of intensive care at The Alfred Hospital in Melbourne, which is also Victoria's biggest COVID-19 ICU – said increased vaccination would take pressure off of GPs and hospitals.

"It's been amazing to see how the community has embraced vaccination," he said.

"It's made such a big difference but it needs to get higher.

"The worldwide experience is that the need for intensive care goes down as vaccines go up, so that's what we'd be hoping happens in Australia."

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