Executive Summary for Series 10: 9 – 17 December 2020

This is the tenth of the national surveys of New Zealand general practice experience with COVID-19 and its aftermath and the last for 2020. It was launched when the whole country was back down to Alert level 1. Surveys will resume in 2021 and focus on issues around COVID-19 vaccination.

Policy recommendations based on responses

There appears to be ongoing issues with some DHBs regarding difficulties and delays with non-COVID-19 referrals, and lack of prompt payment for COVID-19 testing, which need to be addressed. Assessment is needed for the MoH to provide guidance and resourcing to practices to support an onogoing move to telehealth.

Effects of COVID-19 on practices

11% still report significant to severe impact from COVID-19. For a few, the strain has become intolerable.

“I am going to sell my practice over the next tax year (I am not at retirement age). We have stopped all evening surgeries (worried we will get resp patients and assessing them outside in the dark is not good plus we don’t have enough staff to manage the extra work around these patients at night). We have stopped offering care to rest-home patients and have handed their care to the in-house docs reluctantly (don’t know about each home’s pandemic plan, where their PPE is etc, plus safer not to come & go from many sites to reduce spread of resp illness to vulnerable elderly plus our own practice patients and our valuable staff” [GP, Capital & Coast DHB]

Others are still feeling tired from the strain:

“We are tired, looking forward to the vaccine – though that could be a logistical nightmare” [PM, Hutt Valley DHB]

Telehealth consultations

64% report they have patients who struggle with telehealth. Only 33% are still using some video-consults (but not often), whereas almost all (97%) are doing some phone, and 41% other forms of e-consultation. Respondents were asked to rank the additional external resources or assistance that might help them overcome barriers to telehealth. Top-ranking overall was guidance for triage (mean 3.5), then increase in co-payment for telehealth consultations (2.9) followed by money for extra administrative support involved in telehealth; ways to increase patients’ access to technology; and ways to increase patients’ IT literacy (all 2.8).

Some indicated that a triage system at booking was needed:

 “Main issue is patients book a telehealth appointment when they need to be seen so have a short phone consult then have to be booked again for inpatient appointment. We only get paid once & lose an appointment slot for the day”

Another commented ”actually patients want to come in so they can bring their lists of 500 problems and take up more time than allocated”.

The added costs to practices from telehealth featured in comments, although some have been assisted by their DHB:

“We have actually been given some extra funding to assist with telehealth investment – it came via the PHO with in the last 3 months” [GP, Capital & Coast DHB]”

“The cost to set up our hardware and software for video consults is currently prohibitive and our patients cannot afford to pay more to cover the cost” [GP, Waikato DHB]

“The increased costs to the practice for telehealth is more than expected and impacts the bottom line quite severely” [PM, Southern DHB]

“Patients often view telephone consultations as a lesser consultation. This results in a reluctance to pay from some patients”

Regarding increasing patient access to telehealth, one commented “Rural community here: it would be good just for patients to have reception, even in the centre of town, to start with” [GP, Taranaki DHB]

Safe to open up our country

73% think it is safe to allow unrestricted domestic travel, 42% for Pacific islands travel, 27% for trans-Tasman travel, and no-one thinks we should freely open our borders for international travel.

Some thought we should still “take care with domestic travel”, that “the virus is still there. Patients are declining tests when have symptoms”.

Some had caveats about opening to our Pacific island neighbours – that we “need to choose carefully which Pacific Islands” and only open “to islands without COVID” such as “Niue and the Cooks”, “not like Taihiti that actually have COVID cases”. Some thought that “Pacific islands may not be ready” and “the risk to them is too great currently”.

It was acknowledged that it will be good to open to Australia but not safe to do so yet:

“Would be good to get the trans-Tasman bubble soon as so many of our patients have family there”

There is awareness of the dangers of opening borders internationally, but perhaps there could be more exemptions:

“Need ongoing border protections otherwise will be swamped by covid19 – however, it would be good allow in non residents/citizens who have a genuine reason to be here eg international students, close relatives of residents”

Another thinks it is “outrageous that sports teams and film crews are being allowed in and families are not”.

Staffing

17% report that layoffs or leave arrangements of clinicians or staff due to COVID-19 are an ongoing stress. One is feeling the impact of lack of medical staff availability:

“Really impacting on a availability of international medical graduate GPs” [GP, Whanganui DHB]

In another practice, a nurse has lost her job due to dropping patient numbers:

“I have been laid off from my practice nurse job due to a decrease in patient volume and thus a decrease in income for the practice. I am considering going into another area of community nursing that is not general practice now” [PM, Auckland DHB] 

Testing and PPE issues

13% still report lack of financial recompense for testing is an issue, and 6% indicated financial barriers in obtaining PPE. Swabbing is still a major stressor for some practices:

“The red stream is putting a huge strain on our staffing resources in the surgery, but I can’t see a quick end to it”

“Difficulty deciding whether to send every URTI related case for testing particularly in children”

“We swab anyone with flu symptoms. Currently have a surge of pre-schoolers with temps over 40 and no other localising signs”

“Reluctance from patients to comply with testing/red stream when community cases low”

“Patients decline tests mainly due to time off that may be unpaid”

“Huge delays in COVID-related payments by the DHB – 8-9 weeks!” [GP, Waitemata DHB]  

Workload and patient issues

30% still report the effects of COVID-19 limiting chronic care consultations, and practices still continue to deal with the accumulated demand and increased health burden. Some are still feeling overworked:

“We are much busier now than usual catching up from quiet period earlier in the year. Doing a lot of unpaid administration for DHB” [GP, Nelson-Marlborough DHB]

“More to health than COVID. Mental health / cancer / chronic care are suffering, for a contagion that is all but absent from NZ”

“Secondary care push back to GP due to back log in secondary care from cancellations over COVID and then thresholds changing meaning pts not seen at all or having to re-refer back again adding to already huge paperwork burden” [GP, Waitemata DHB]

On the other hand, 14% report an ongoing large decrease in patient volumes, with concurrent financial concerns.

For one, “the situation has nearly returned to pre-COVID situation in my own practice”.

Method

On Wednesday 9th December, the tenth of the Quick COVID-19 NZ Primary Care Survey was launched, the final for 2020. 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 17 Dec.

Sample

There were 64 respondents: 50 doctors (GPs or urgent care doctors), 7 practice nurses [PN], and 7 practice managers [PM]. 81% of practices were GP-owned; 66% had more than 3 GPs; 19% independent and part of a larger group, 11% owned by a community trust, 9% as urgent care / after hours. 16% identified as rural.