Executive summary for Series 1: 23-29 May 2020
This is the first of fortnightly national surveys of New Zealand general practice experience with COVID-19. This first survey was conducted after NZ had been in lockdown (Alert 4) for over 4 weeks (25 March to 27 April), with some restrictions lifted under level 3 (28 April to 12 May) and was now under level 2 (no restrictions except physical distancing). Respondents reported that dealing with COVID-19 under these restrictions in the past two months has severely impacted and on their practices including staffing and financial viability, and affecting patient care.
Affects of COVID-19 on practice
- 60% report COVID-19 is putting strain on practice
- In 50% of practices GPs are off work due to illness or self-isolation
- In 60% of practices nurses are off work due to illness or self-isolation
- In 45% of practices receptionists are off work due to illness or self-isolation
- In 37% of practices staff are taking leave or being laid off
- 98% report they have the staff to stay open, and 89% think it likely that they would have the patient volume to stay open
- 2% did not think they had the financial reserve to stay open, and 21% were unsure
- 11% think it likely they will ask for financial assistance in the next 4 weeks, with a further 37% unsure
- 3% are likely to apply for a loan and 35% unsure
Affects on patient care
- 84% report large decreases in patient volume
- 84% report limiting well / chronic care visits in the past two weeks
- 88% think they have addressed preventive needs of patients less frequently or very little
- 84% have been able to address their chronic care needs less frequently or very little
- 70% have been able to maintain continuity of care with their patients less frequently or very little
- 71% think that they are less able to coordinate care across service settings
- 74% of respondents indicate that they have patients who struggle with virtual consultations (either internet or technical difficulties)
- Video consultations are being conducted a little by 52%, some by 12%, a lot by only 2%, and 34% were not doing these at all
- In contrast, 58% are conducting a lot of telephone consultations, 34% some, and the rest (8%) a little
- Most report they have provided a lot (25%) or some (54%) face-to-face care over the past two weeks
On Friday 23 May, the first of the fortnightly 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 and GPNZ. The survey closed on 29 May.
- There were 170 respondents: 120 GPs, 21 practice nurses, 2 nurse practitioners and 16 practice managers.
- 73% of practices were GP-owned; 71% had more than 3 GPs; 31% independent and part of a larger group, 1% was DHB owned, and 14% owned by a community trust. 15% identified as rural practices, and 12% as urgent care or after-hours practice.
Policy recommendations based on responses
The primary care sector is stressed with staff shortages and financial hardships resulting from the extra workload, move to remote consultations and lack of recognition from the government of the role they have played. There is frustration that the initial financial promises were not fulfilled, and increased recognition and funding allocation is required to ensure all general practices remain viable and open.
Open up the country
12% think we should open up the country, 42% do not, and 40% think that this depends. They would like to see slow and careful easing of domestic travel restrictions. Clinicians in support of opening the country cite reasons such as avoiding an economic crisis, the currently low number of COVID-19+ and low levels of community transmission.
“Within the country, yes. To overseas visitors and travel – no”
“So few cases active there is no reason to further cripple the economy more than has already occurred”
“COVID will be back, despite our best efforts, but the economy has to be balanced against lives lost through COVID”
Quarantine: Almost all would like a mandatory and enforceable quarantine in place for travellers, especially those coming internationally from countries with active COVID-19 cases.
“The borders need to be well controlled if opened and should only be to Australia.”
“Open up the country but keep borders closed. When reopening quarantining and self-isolation will be critical”
“No new covid-19 cases in NZ. BUT 5 million + covid-19 cases overseas I think borders should remain closed”
Those that do not support opening the country cite reasons such as the risk of a “second wave”, a lack of knowledge and understanding of COVID-19, and public complacency surrounding distancing and hygiene measures. Some are open to the idea of a trans-Tasman travel with Australia due to the low number of cases and similar public distancing and hygiene measures already implemented.
“Because the risk of a second wave is too high when people aren’t following guidelines already.”
“People breach and lie — risk to others. “High–trust environment’ is not adequate plan”
Travel restrictions: Clinicians would like to see staged and careful easing of travel restrictions. Clinicians specifically suggest strict quarantine and management plans for flight crew, widespread quick and easy access to testing combined with public contact tracing, and close monitoring and evaluation.
“to re-open the country safely, we need to ensure that the public has easy and quick access to testing when the need arises i.e. when a patient has respiratory symptoms”
“Need to continue to protect borders and quarantine new arrivals. Concerns re long cluster tails and exemptions from quarantine, such as flight crew, triggering new spread.”
119 provided additional comments about their experiences dealing with the pandemic. Overall, they have found work during the COVID-19 pandemic stressful in relation to their health, the health of their patients, business viability and loss of income. Most felt devalued; some even questioning their continued vocation.
“The lack of recognition and appreciation for the work we do has affected morale so much so that I have started thinking about my future in general practice.”
“It bought home to me as a GP who loves her job not a viable option going forward unless large uplift in capitation…Ministry and Government has not adequately valued or supported general practice.”
They feel unsupported and underappreciated by the NZ government and are frustrated by conflicting information, compounded by uneven distribution of patients, funding, and resources between primary & secondary care.
“DHB referrals have been sent back saying “re-refer after COVID” essentially doubling GP workload”
“Really under supported and under recognized for primary health’s effort in managing the pandemic. Feels like DHB’s got all the praise and $$, yet they saw very, very few actual cases. Demoralising that funding for PHC was largely ignored, yet DHB’s could keep their consultants on full pay yet only working 1 in 3 weeks! Need guarantee from government that we will continue to be paid for the work we are doing managing this pandemic.”
“Primary care’s contribution to stopping the spread of COVID19 was not, and is not, being mentioned enough in media and government communications. And most importantly, in funds allocation. The hospitals won’t be (and haven’t been, COVID-wise) overwhelmed with a more robust primary care sector.”
“The communication to the working GP has terrible – Facebook and the 1pm briefings have been the most informative. Public health tell us very little, even when we have swabbed a condiment case or if there are local clusters. Please give us some respect and tell us what is going on and include us in the pandemic planning”
Despite a strong focus on stress and hardship, many primary care clinicians took an opportunity to commend their teams.
“Very fluctuating situation which our team have brilliantly handled”
“Great support from our practice team and owners.”
“Very proud of our healthcare sector”