Executive summary for Series 4: 24 July to 6 August 2020

This is the fourth 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 1. While the only NZ cases are from incoming travellers, practices are required to triage and COVID-19 swab patients with respiratory symptoms

Policy recommendations based on responses

Practices have been demoralised by inconsistent messages around COVID-19 testing, and feeling unfairly blamed in the media for low surveillance. Clear messages, adequate resourcing and payment is required going forward.

Effects of COVID-19 on practices

The strain on the practices from COVID-19 continues, with 69% still reporting significant to severe impact, and only 6% no ongoing effect. 20% report ongoing effects of COVID-19 leading to staff layoff or affecting leave arrangements, with no change from S3.

Testing

The biggest concern raised in this survey is around testing. 20% still report concerns about lack of financial recompense for testing. Less testing is taking place – 80% were conducting tests, with 32% having tested 11 to 39 in the previous fortnight, and only 7% 40 or more (compare 28% in S3). 8% had triaged and referred 40 or more for testing (down from 22% in S3).

Ongoing confusion regarding testing – understandably constantly needs review however still a disconnect between what we actually do vs what the Minister thinks we don’t do! We need more accessible/walk in CBACs if they want to increase swabbing and for us to continue BAU general practice – example – having to do a COVID swab unexpectedly on my first pt of the day with waiting room of mothers and kids looking at my PPE in fear and needing reassurance they were not being exposed (not to mention that subsequently ran late for the morning)[GP]

While most were able to get patients tested, 16% had been unable to do this for a few or more (14% in S3).

My notifications and swab referrals have been declined on multiple occasions at local CBAC and designated practices, despite it being my clinical judgment that they should be swabbed. [GP]

Many commented on the inconsistencies around surveillance testing strategies communicated by the Ministry of Health, with low rates reported in the media but practices unable to test due to restrictive criteria or lack of supplies.

Still being tossed around between the MOH and DHBs over covid surveillance both in funding and definition. MOH continue to state that testing should be free knowing that DHBs are not paying us enough to allow the service to be “free” leaving us to run the service at a loss ie GPs are subsidising the service not government. [GP]

What was said in stand up daily press conferences didn’t necessarily reflect reality. Ie when the prime minister was telling everyone to get a test but we couldn’t do them due to criteria or funding or lack of equipment. This made us look incompetent when we were trying our hardest. [GP]

No appreciation from DHB, PHO, MOH, broken promises to support us financially, kept in the dark, constantly changing rules for testing, now gov is blaming us for not testing enough when it is their problem. [GP]

Often media were reporting what was not yet known / confirmed at a practice level. For example telling NZ population to be tested at GP but not given general practice enough supplies to do so. Patients think you are lying to them as have been told to go and get tested. [GP]

Good advice and direction from those higher up is required eg 3 weeks ago “stop testing” and then 2 weeks ago “test more”. [GP]

There is also an issue with patients refusing to have swabs taken.

Has been harder to get people to take swabs. We have tried pushing the public health message and this has increased uptake a little but not nearly the same volumes we were doing prior to most recent criteria change for testing. [PN]

Effects on patient care

Large decrease in patient volume is down to 10% (down from 20% in S3), with 20% reporting that well and chronic care visits are still limited for COVID-19-related reasons (35% in S3). Mental health issues are featuring significantly, with 73% of practices reporting increase in mental health presentations since the advent of COVID-19.

There is a base level of anxiety in both patients and staff, due to the uncertainty of COVID prevalence. [PM]

One GP insightfully commented:

From having to be agile and flexible through lockdown we have developed practice relationships and areas of expertise, team work has improved, having faced extreme difficulty we are coming out this side stronger and better, we are still dealing with angry/ aggressive members of the public on a daily basis – we have stopped recording these as incidents for reflection, as it has become our new normal and most of their fear/ anger is not about our service but about the situation in general.

Telehealth consultations

Only 31% practices are still conducting video consultations, and at less than 20% of consultations. However, almost all (97%) are still conducting telephone consultations, and for 21% this is for more 20% of consultations or more. 37% are also conducting other types of e-consultations such as via email or patient portal. 83% report consultations are now being reimbursed. However, some practices value the new technology and the ability to conduct business electronically.

E prescriptions were, and are, fantastic We learnt to become creative. Telehealth is a fantastic tool and we shouldn’t let it go. It should be another tool in our “toolbox”.

Emailing prescriptions is great!

Morale

Many mention the positive effects on teamwork in addressing COVID-19.

Very positive with regard to bringing out team together, bringing out everyone’s creativity and helping us realize our potential in quickly adjusting to challenges successfully.

However low morale and burnout still feature.

Overall mentally burned out and will quit in the very near future, no hope that there is a future for GPs [GP]

Many GPs complaining of patients having long lists to attend to within the 15 minute consultation time. [PM]

Extremely tiring, constant phone triage, daily changes [PN]

My own anxiety levels have increased manifesting in poor sleep, poor motivation and higher self assessed burnout
score. [GP]

Financial considerations

While some DHBs and PHOs have provided good prompt financial support for testing, this support has been severely lacking by others.

Our DHB (x) have been poor at supporting primary care (esp financially with significant delays in POAC payments) leaving GPs to carry all of the cash flow issues. We have not received a single note of thanks from the DHB. For a health care system and its managers to not appreciate the effort and sacrifice made by all those in primary care is shameful. [GP]

We are really happy the Govt handled it well. It’s been good to get more in the flow of doing virtual consults (and charging for them). … We appreciate the funding we have been given for swabbing. [GP]

Method

On Friday 24 July, the fourth 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 6 August.

Sample

There were 182 respondents: 121 GPs, 13 practice nurses [PN], and 48 practice managers [PM]. 76% of practices were GP-owned; 72% had more than 3 GPs; 29% independent and part of a larger group, 2% were DHB-owned, and 11% owned by a community trust. 18% as urgent care/after hours. There was greater rural representation this survey, with 24% identifying as rural.