Executive summary for Series 2: 5-11 June 2020

This is the second of the national surveys of New Zealand general practice experience with COVID-19 and its aftermath. This survey was launched when NZ was in alert level 2 (moved from level 3 to level 2 on 14 May) and moved to alert level 1 on 8 June. There was still some physical distancing in place, triaging and encouragement to use virtual consultations under level 2. Under level 1 face-to-face care is not restricted except special care to be taken with people with possible COVID-19 symptoms.

Policy recommendations based on responses

Under Alert level 1, practices are mostly back to providing face-to-face care, and moving into the busy winter season. Many practices are still financially stressed, and staff morale is low, feeling that their extraordinary efforts have gone under-recognised. Support should be provided to ensure staffing or money issues do not lead to practice closures.

Future surveys will explore the post-COVID-19 consequences further – whether and how e-consultations are conducted going forward, delayed management concerns due to COVID-19, and the rise in mental health issues and social problems from unemployment in the aftermath.

Affects on patient care

65% of practices are still experiencing a large decrease in patient volume (down from 84% in S1), but others are now back to busy patient loads

Not having patients waiting in the waiting room was great. As was no appt times initially. Moving back towards “normal”, I am reinforced to the idea that the standard 15 min appt is a crappy way to provide good care and makes my life a misery. [GP]

75% still report that well and chronic care visits are limited for COVID-19-related reasons (down from 84% in S1)
Practices are still conducting telehealth consultations

75% reported patients struggling with virtual / tele-health (internet or technical limitations) (74% in S1).
63% are still conducting video-consultations, but for 50% this is only a little.
99% are still conducting telephone consultations, with 29% over half of consultations done over the telephone. This is down from S1, when 58% of practices reported conducting over half of the consultations by phone.
Correspondingly, 50% practices are now seeing more than half of patients face-to-face, up from 25% in S1.

Practices felt that some patients have unrealistic expectations of the care they receive, and sometimes are demanding and abusive.

Patient expectations have added to the stress. A large number (probably stressed themselves) have no appreciation that we are working with fast-changing and imperfect conditions and our ability to deliver care as usual (even timely flu vaccines) has been impossible through no fault of our own. This has added additional stress on the staff and the sense of injustice and frustration has taken its toll on morale. [PM]

Telehealth is awful, no non verbal cues, patients talk over you (phone delay contributing but patients becoming more demanding and rude when not face to face). [GP]

It was suggested that the media has played a part, with patients complaining about the cost of a telephone consult and refusing to pay.

RNZ reported on patients being charged for short phone consults in a negative way, then patients who were happy to pay started arguing about the value of a phone consult [GP]

A rise in mental health issues and complexity of presenting conditions was also highlighted post-lockdown.

So much mental health work with anxiety and depression. Significantly increased complexity [GP]

Respondents reported on the level of support they had received from various organisations

For all organisations, respondents indicated a range of responses from ‘none’ through to ‘couldn’t have done more’, but the proportion of those unhappy with the support varied by organisation.

They felt most supported (‘moderate’ or ‘couldn’t have done more’) by their PHOs (77%) and then the RNZCGP (53%). Less than half (43%) felt supported by the Ministry of Health, and a minority by their DHB (25%), public health (37%), or NZMA (22%).

We have felt supported quite well by our PHO and the RNZCGP have been great. But we feel let down by the government – GPs have done much of the work during this COVID situation, but we’ve not had much recognition, the media focus has been on the hospital doctors, and our reward for our hard work was reduced income during lockdown along with increased expenses. [GP]

However there was great praise for the teamwork and resilience of practice staff.

All my staff deserve giant gold stars for riding this wave, they have all shown resilience and risen to whatever has been required, sometimes with incredibly short notice [PM]

This has placed significant stress on all team members – who have coped excellently [GP]

Wishing to leave the profession and burnt-out

In this survey there are a number of GPs who are actively considering leaving the profession as a result of their COVID-19 pandemic experience. Others are feeling burnt out, taking leave for mental health reasons, or wanting a holiday which is not possible with the winter patient load.

Nationalised employee status with DHBs would be better. I am exhausted. I’m not sure I want to do GP any more. It’s too difficult to do a good job and generate an income at the same time. [GP]

Feeling ready for a break rather than a busy winter [GP]

I’ve had 2 weeks off with relapse anxiety and clinical depression. First time in 10 yrs [GP]

Half my nurses wanting to leave PHC Including myself [PN]

Affects of COVID-19 on practice

Despite now being in Alert level 2 or 1, these affects have not changed significantly since the 1st survey (S1)

48% report COVID-19 is putting strain on practice (down from 60% in S1)
In 51% of practices GPs are off work due to illness or self-isolation (50% in S1)
In 50% of practices nurses are off work due to illness or self-isolation (60% in S1)
In 46% of practices receptionists are off work due to illness or self-isolation (45% in S1)
In 31% of practices staff are taking leave or being laid off (37% in S1)

Financial considerations

The lack of government financial support is still a common theme, although one practice said they had actually done well financially.

We increased revenue compared to same period last year. Our practice did very well financially. [GP]

For many others though, the lack of financial support from the government dui=ring the lockdown period was a recurring theme.

Having the money we were offered to support us through the huge COVID demands removed by cabinet took the wind out of my sails. At worst I did 85 hour weeks and was paid for 16 hours [GP]

We were unpaid for our swabbing for more than 6 weeks. This was extremely stressful as we were the predominant practice providing swabbing in our community. This was disheartening also as our GP roles were cut back and there was a lot of uncertainty around our hours and pay.[GP]

We got just over 11 thousand which doesn’t even cover a fortnight’s wages for nurses and admin, let alone the GPs who are on guaranteed minimums and the owners pay. We couldn’t apply for the wage subsidy because we were only 28% down on revenue, yet our expenses have gone through the roof [PM]

Method

On Friday 5 June, the second 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, GPNZ and PMAANZ. The survey closed on 11 June.

Sample

There were 153 respondents: 85 GPs, 16 practice nurses and 58 practice managers. 73% of practices were GP-owned; 76% had more than 3 GPs; 34% independent and part of a larger group, 7% were DHB-owned, and 14% owned by a community trust. 21% identified as rural practices, and 17% as urgent care or after-hours practice.