Executive summary for Series 3: 19-25 June 2020

This is the third 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 are still facing workload and financial pressures. The requirement to triage and test all patients with respiratory or COVID-19 symptoms is significantly adding to the workload and incurred costs including PPE. Ministry of Health needs to assess how patients are informed and practices funded to provide this service.

Effects on patient care

The strain on the practices from COVID-19 has actually increased from the period in lock-down (69%, increased from 60% in S1) This is particularly due to the requirements to triage and swab everyone with respiratory symptoms.  

We are struggling to manage the large ‘red’ stream especially children sick from daycare / school as they need to be assessed by phone then seen in PPE in separate part of building and then possibly COVID swab in full PPE by red team. Time consuming, stressful, clunky, inefficient. Parents not keen on swabs sometimes. We don’t have full capacity to do swabs. We are short of nurses and docs [GP]

Covid has put a huge amount of pressure on people. Patients have found testing traumatic and communication very difficult in PPE/on the phone for these other things especially when they don’t think there’s covid around[GP]

Getting patients to understand that if they have respiratory symptoms that we need to manage how they access care differently. Also that if they have COVID symptoms they should get tested – this would be very helpful if this came from MOH or Government Level e.g. during press-conference…not just a simple “contact your GP”[GP]

The amount of COVID-19 testing taking place varies, as some community-based centres are still operating. 11% had tested no patients in the previous 2 weeks, whereas 28% had tested 40 or more and 22% had triaged and referred 40 or more for testing. Most were able to get patients tested, but 14% they had been unable to do this for a few or some.

Staff are still being laid off or taking leave due to COVID-19 in 21% of practices (down from 37% in S1)

Effects on patient care

We are now very busy doing medical cases that were not seen in lockdown plus cancer screening, drivers licences, home visits [GP]

2-3 weeks after lockdown a predictable surge in RTIs has led to unprecedented demand for Covid swabs limiting our ability to offer chronic care consultations, which were already behind due to lockdown limitations [GP]

Noticing more anxious people….and I already seeing lots of mental health issues [GP]

Lots of need for counselling. High barrier to secondary care assessments means we are having to support patients with very fragile mental health. Most can’t afford to pay. Multiple large problems stored up to deal with and can’t afford to return [GP]

Telehealth consultations

Practices are still conducting telehealth consultations

• 48% reported patients struggling with virtual / tele-health (internet or technical limitations) (75% in S2).
• 43% are still conducting video-consultations, but only 11% are doing this for more than 20% of consultations.
• 98% are still conducting telephone consultations, but for 61% this is less than 20% of consultations.
• Correspondingly, 90% practices are now seeing most patients face-to-face (up from 25% in S1).

The majority are equipped to conduct remote consultations: 65% have equipment needed to conduct video-consults, 95% to conduct telephone consults, 90% have adequate internet and phone conductivity, 86% adequate administrative support, 82% adequate technical support, 65% have had adequate training to provide care over video or phone, and 73% feel confident to provide safe and effective care by video or phone. However this does mean that there is a sizable minority who are struggling to provide telehealth services. Only 5% had conducted no phone or video consults.

86% are confident to decide when phone, video or face-to-face consults are appropriate. However only 27% report that patients book themselves appropriately, and 57% that reception staff appropriately book patients. 90% reported that patients’ lack of equipment, poor connectivity, language, or insufficient technical, physical or intellectual capability were barriers on some occasions.   

However, some practices welcomed the new technology and ability to conduct business electronically.

Good incentive to get on board with new technology. at level 1 patients more complacent and wanting things to go back to normal [PM]

Positive- email scripts to pharmacy Virtual ACC extension, work and income cert, off work cert [GP]

Morale

Financial considerations

For some practices, financial considerations are still a major concern.

The financial hit we have taken ourselves as practice owners is sustaining and continuing to sustain the practice / team and support struggling patients let alone catchup and extra work that is unfunded [GP]

80% drop in income [GP]

Drs at our practice took pay cuts and are working the same or more hours. We are still being paid less than precovid. [GP]

Method

On Friday 19 June, the third 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 25 June.

Sample

There were 150 respondents: 96 GPs, 8 practice nurses [PN], and 46 practice managers [PM]. 77% of practices were GP-owned; 76% had more than 3 GPs; 28% independent and part of a larger group, 0.7% were DHB-owned, and 8% owned by a community trust. 18% identified as rural practices, and 16% as urgent care / after hours.