Executive Summary for Series 11: 11 – 18 February 2021

This is the eleventh of the national surveys of New Zealand general practice experience with COVID-19 and its aftermath and the first for 2021. Surveys now focus on issues around COVID-19 vaccination.

Policy recommendations based on responses

General practices need clear, comprehensive and timely information about their role in the vaccine roll-out and reassurance that they will be adequately funded. Dedicated drive-in clinics may be an effective strategy, but the electronic register needs to be robust to ensure practices can know who has been vaccinated and who is responsible for 2nd dose follow-up.

Some practices considered they have capacity to deliver vaccines based on their ‘flu vaccine experience: “we do every flu season so have a well worn protocol” [GP] and “we opened on Sat to do flu vaccine , could do same for covid” [GP]. Running drive-through clinics as previously conducted for ‘flu vaccine during lockdown were seen as effective: “Drive-through clinics… worked really well for our GP group for flu vaccines during covid. We were able to book at 2 minute intervals towards the end” [GP].
One GP suggested “huge drive-in clinics would be best eg at sports parks with ambulance on site. Barcode scanning to identify patients rather than paper-based systems, ideally linked to covid tracer app. Need to be mix of traffic management, administration and clinical personnel on site”.
Many practices however do not think they can do the vaccinations: “we are too small” [GP]; “I dont think general practice should deliver vaccines” [PM]; “should be in dedicated clinics at a variety of times” [GP]; “can’t work and do vaccines. Is additional to current workload- and significant workload too” [GP]; “general practice will not be able to do their business as usual for months if they are having to do covid vaccines. Worse effect than lockdown” [GP] and “should be in designated vaccinating centres not in general practice” [GP].

“Provided they all do the Covid-19 vaccine training” [GP]. Other ideas were “health care assistants under standing orders and supervision” [PM]; “community trained vaccinators under supervision” [GP]; “train laypeople to vaccinate but have professional staff there in case of medical issues” [GP] and one GP suggested medical students.

A number are concerned about reimbursement: “if done after hours or weekends needs to be extra payments to general practice to cover staff hours” [GP] and “there is general nervousness that GP will be undervalued and overlooked with the vax roll out as we were with flu last year” [GP].

Other vaccine issues

Vaccine storage and maintaining the cold chain is a significant concern for a number of respondents: “how the supply will be delivered, frequency of deliveries, package size to plan fridge space” [PN]; “the key is the storage of vaccine” [GP] and “provided the correct cold chain is maintained and the appropriate vaccine fridge is easily and readily available” [PN].
Another issue is maintaining good record-keeping: “GP being fully informed via NIR of who is vaccinated” [GP]; “difficult part will be keeping track of subsequent doses. My concern with widespread vaccine providers is who would be responsibility for chasing the stragglers” [GP]; and “that our PMS links with immunisation register, having a separate web based one will slow us down” [GP]. One GP requests “an IT system with simple interface that is fast and live updated and links to patient’s NHI, showing eligibility category and vaccination status (or declined), and GP”.

What needs to be known to deliver vaccine safely and effectively

There were a range of responses about educational needs. A number related to storage and cold chain. A PM wants to know about “supply – when they will be delivered/available and with enough notice so that dedicated clinics can be arranged for efficient delivery”. GPs want to know about “contra-indications and pre-cautions”, “main side effects”, “logistics of delivery”, “vaccine safety and data”, “timing of booster” and “who can’t safely receive it?”
Patient education is seen as important: “all the answers that the public will ask about the vaccine” [PM], “education re vaccine hesitancy” [GP], “a simplified explanation about the vaccine for patients” [PN], “small flyer re the vaccine to give to patients receiving the vaccine” [GP] and “information to give to patients which is clear and easy to read” [PN].
Practice managers are concerned about the logistics and want “timely information about when the vaccine will be arriving in our area and the amounts” and “time frames and expectations of the roll out and the effect on also delivering flu vaccine on time to our patients”. Several respondents mentioned that they do not want a repeat of the poor communication about vaccine availability that happened last year: “clear informing the public re the availability of the vaccine once it is properly set up in general practice (unlike the flu vaccine debacle over lockdown)”.

Affects of COVID-19 on practice

Only 6% report no current capacity to test for COVID-19, and 64% have capacity based on clinical judgement. 28% report that COVID-19 continues to put quite severe to severe impact on their practice, but 40% no report no or only mild impact. Ongoing impact relates to issues such as “masks, covid triage, red green streaming… all takes a lot of time on top of already busy load, also a lot pushed out to us from hospital and chasing things missed from hospital” [GP] Issues with secondary care referrals is a common the me (“increased workload is ongoing. A number of referrals to secondary care being sent back due to capacity issues. Having to refer a patient several times for some specialties has become the norm, but is no less frustrating. Lack of communication from secondary services about what they are doing to address these issues” [PM] and “DHBs are dumping a lot of work on general practice because we can’t say no” [GP, Canterbury DHB].
Some are still frustrated about lack of funded PPE “need funded N95 fit testing and supplies or will need to refuse to see respiratory illness patients during outbreaks” [GP, Taranaki DHB] and “ongoing frustration with lack of acknowledgment that covid is aerosol and therefore not providing the correct PPE – need N95 masks for staff doing swabbing” [GP, Auckland DHB].

Method

On Thursday 11th February, the 11th Quick COVID-19 NZ Primary Care Survey was launched, the 1st for 2021. 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 18th Feb.

Sample

There were 96 respondents: 81 doctors (GPs or urgent care doctors), 6 practice nurses [PN], and 9 practice managers [PM]. 77% of practices were GP-owned; 69% had more than 3 GPs; 28% independent and part of a larger group, 9% owned by a community trust, 13% as urgent care / after hours. 19% identified as rural.

This project is funded by an MBIE COVID-19 Innovation Acceleration Grant