Executive summary for Series 9: 11-19 November 2020

This is the ninth of the national surveys of New Zealand general practice experience with COVID-19 and its aftermath. It was launched when the whole country was back down to Alert level 1. Surveys are now monthly. 

There was a significant drop in response rate, possibly attributable to faulty survey links we distributed to some organisations (apologies), but probably also represents survey fatigue. We will field another survey in mid-December, and then take a break over the summer. In February we will focus on possible issues practices may face regarding COVID-19 vaccination. 

Policy recommendations based on responses

Acknowledging the small numbers of respondents, it is still evident that issues regarding PPE supply and testing payments remain for some. Ministry of Health directives need to reach and consistently be actioned by PHBs and PHOs in a timely fashion.

Effects of COVID-19 on practices

3% still report significant to severe impact from COVID-19, but we acknowledge potential bias of those choosing to participate having ongoing issues. For a few, the strain has become intolerable.

“I am leaving clinical medicine due to the poor manner this govt has treated the primary care sector and public statement made by MPs that were dishonest and created huge unpaid workload for GPs” [GP, Canterbury DHB]

“I’m going to sell out if my partnership after 27 years; the pressure running these businesses with lack of understanding & support from the Ministry of Health & media is untenable in the short term.” [GP, Capital & Coast DHB]

Financial impacts

A few respondents report ongoing financial stresses, including 13% reporting lack of payment for testing.

“Payments for COVID swabs are very slow from WDHB. Most recent payment was for 11th Sep (as at 11/11) ☹️” [GP, Waitemata DHB]

“Still gutted about Labour reneging on emergency funding. and the fact they won’t come to the table with nurses strike is disgraceful” [GP, Capital & Coast DHB]

“We have been treated poorly by the Government and financially took a hit despite being frontline” [GP, Northland DHB]

Testing and PPE issues

Despite recent Ministry of Health assurances, 22% still report challenges in getting PPE, 8% are reusing or relying on homemade options and only 5% also report finance as a barrier.

“Primary care staff are furious at MOH PPE management. We still cannot get ANY N95 masks for any reason, and no PPE at all in level 1 even though we are a testing station.” [GP, Southern DHB] 

Triage systems are working for some:

“Phone triage and know what’s coming in, has put extra workload on our receptionists, but maintains strict access into practice, we can tell those with cold or flu like symptoms to remain in their cars and phone when here, a clinician there has time to PPE gear up and handle the patient via our red pod” [PM, Southern DHB]

“We are lucky that we have a garage downstairs, which we are using for COVID testing away from reception and the other patients” [PM, Counties Manukau DHB]

 For others, continued COVID-19 testing is becoming a strain.

“I am a nurse who has been assisting the COVID swabbing we provide each afternoon for our patients, this has been going on for months and months now, us nurses get No recompense for this, the Drs say they take months to get paid for it I’m sick of doing it!!!” [PN, Waitemata DHB]

“Continuing to maintain the “Red Stream” for all fever/respiratory patients (including those presenting for other problems) puts a significant strain and expense on the practice.” [GP, Waitemata DHB]

“The red stream is an inefficient use of GP time.” [GP, Waitemata DHB]

Workload and patient issues

29% still report the effects of COVID-19 limiting chronic care consultations. Practice continue to deal with the accumulated demand and increased health burden.

“The elderly have described increase stress not knowing what to do when sick, also increase in loneliness. Many described the 2nd Auckland lockdown was worse than the 1^st“ [PN, Counties Manukau DHB]

“Pent-up demand to see us in-person is tiring now” [GP, Waitemata DHB]

“Busier with catch up from lockdowns plus time for swabbing” [GP, Counties Manukau DHB]

“Extra time for cleaning (room/ remove PPE) after consult, in between patients” [GP, Waikato DHB]

“We are being swamped with work. We can’t get staff and we can’t keep up” [GP, Canterbury DHB]

“Struggling with patients with “shopping lists” – possible saved them up over the lockdowns or financial barriers to coming more often” [GP, Auckland DHB]

“More complex consultations. Bigger mental health work load. Paperwork exponentially grown with more pushed onto us from secondary care” [GP, Waitemata DHB]

“We are seeing a lot more cancer than we would expect at the moment, and often later presentations. We are very short of appointments” [GP, Tairāwhiti DHB]

Telehealth consultations

48% report they have patients who struggle with telehealth. 43% are still using some video-consults (but not often), whereas almost all (97%) are doing some phone, and 52% other forms of e-consultation.

This survey had a particular focus on which patients are considered suitable or unsuitable for telehealth consultations. Consultations suitable for telehealth include those for follow up and discussion about investigation results or a previous consult, patients seeking advice only, well-known patients who regularly attend in-person consults especially for repeat prescriptions, advice for very minor injuries, referral for screening procedures such as colonoscopy, and certifications (eg ACC, WINZ, off-work) especially for stable renewals. Other comments were for contraceptive advice, mental health review and hypertension medical reviews where patients are self-monitoring. Patients having good health and English literacy and being “tech savvy” were also cited factors.

Commonly mentioned as unsuitable for telehealth are consultations requiring physical examination (unless the patient can send a photo or video) and poor access to, or ability to use, the technology. A variety of conditions and presentations were cited as requiring in-person visits including chest or abdominal pain, asthma or COPD exacerbation, pneumonia, stroke symptoms, new onset palpitations, prolonged vomiting and diarrhoea. One response was “bottoms and bellies”. Several think that all babies should have in-person consultations, and others the elderly. Other reasons for in-person visits include new patients or those not well known to the practice, complex presentations, and where there is a mental health component.

Again in this survey, some respondents identified efficiency gains with IT solutions such as e-prescribing, and value the introduction of telephone triage.

Method

On Wednesday 11^th November, the ninth of the Quick COVID-19 NZ Primary Care Survey was launched. An invitation to participate was distributed to general practice GPs, nurses and managers across the country, disseminated by the RNZCGP, RNZCUC, GPNZ, PMAANZ, RGPN, and NZMA. The survey closed on 19 November.

Sample

There were 62 respondents: 49 doctors (GPs or urgent care doctors), 7 practice nurses [PN], and 6 practice managers [PM]. 69% of practices were GP-owned; 66% had more than 3 GPs; 24% independent and part of a larger group, 6% owned by a community trust, 16% as urgent care / after hours. 14% identified as rural.