GPs are angry and now is the time to listen

IT is an unusual f-word to be offended by, but say “frontline” health care worker to a GP and the hair on the back of their neck will stand up.

“Frontline” has been a loaded term since Monday 22 February 2021 when the first COVID-19 vaccine was administered in Australia and along with it came a feeling of hope that better days were ahead.

That sense of hope quickly evaporated for GPs like myself, who discovered that they were not eligible to be vaccinated as they did not qualify as a “frontline” health care worker. It was a defining moment for general practice and set a precedent that saw GPs being sidelined in a pandemic response that staggered as a result of not appropriately recognising and incorporating primary care.

In often small consulting rooms with poor ventilation, wearing inadequate personal protective equipment (PPE), GPs across the country sat opposite unwell patients who did not realise or had not disclosed before their appointment that they had symptoms suggestive of COVID-19. Behind poorly fitted masks we wondered, “in what universe is this not the frontline?”

Anxious about the obvious, catching COVID-19 – or worse, bringing it home to vulnerable family members – there were many other pressures that weighed heavily on our minds. If a confirmed case was to walk through the clinic doors, a 2-week closure would follow. As most GPs work as contractors and run clinics that are private businesses, this had significant implications for the viability of clinics and the financial security of staff.

While hospital doctors reflected on the pandemic as being “an extraordinary and privileged time to be on the frontline,” GPs had a vastly different experience, lamenting that “we are all smashed … smashed more because the state government had no real scheme to involve general practice”. It was poetic injustice that despite being “smashed”, GPs have gone on to administer over 26 000 000 doses of COVID-19 vaccines, saving innumerable lives and preventing catastrophic numbers of hospital presentations and admissions.

This is just one of many examples that have caused GPs to feel angry, unseen and unheard as the profession was cloaked in an invisibility jacket, provided with minimal PPE, denied early access to vaccination and starved of funding for much of the past 2 years.

Access to funding for telehealth and vaccine administration has been inconsistent and unpredictable, undoubtably contributing to the spread of COVID-19. A pitiful price tag of $25 was slapped on the incredibly high risk venture of reviewing a patient with confirmed COVID-19 in person, something that would be very unlikely to result in a change in management – with no training on how, and more importantly why, this should be done. This prompted the Royal Australian College of General Practitioners (RACGP) to release a guideline on COVID-19 community care that was perhaps more bizarre than it was helpful, with instructions to steam clean soft furnishings after each consultation – this alone would cost far more than $25.

When GPs have been the focus of public health announcements, it has often been ambiguous, confusing or deeply problematic. It is clear that many leaders, and presumably some health advisors, don’t actually understand what the job of a GP involves.

In a typical day, a GP will have back-to-back consultations, some by phone and some in person, with patients who present with complex issues, undifferentiated illnesses, mental health crises and medical emergencies. Coupled with overflowing vaccination appointments and the need to keep up with ever-changing advice and guidelines, there is barely enough time in the day to eat, let alone field calls from thousands of patients who were told by the Prime Minister to phone their GP if they had a positive rapid antigen test result (which would require a proper risk assessment so that appropriate and safe medical advice could be provided).

As we enter a period of relative COVID-19 stability and collectively catch our breath, now is the time to reassess the role of GPs before we once again find ourselves in the thick of the pandemic. If it is not the next variant that brings the health system back to its knees, it will be the winter, when we will also see a resurgence of influenza cases.

Aside from the obvious – ensuring occupational safety and providing adequate funding for GPs – it is time to recognise the valuable contribution general practice can make in managing COVID-19 in the community. This would allow us to support our hospital colleagues by doing what we do best: preventing hospital admissions, coordinating care, optimising underlying health conditions, and providing patients with education and reassurance.

First and foremost, GPs must have their voices heard. The advocates for general practice are few and far between. While the media appearances of RACGP President Dr Karen Price and former Australian Medical Association President Dr Mukesh Haikerwal have been vital, we need more practising GPs at the table when public health decisions are made. It is a bare minimum that we are part of conversations that directly impact us; GPs are done with being blindsided by public health announcements.

Furthermore, the work of a GP needs to be understood in order for it to be valued. GPs are proudly specialists in whole-person care. We know our patients well, especially those with chronic illness. This knowledge is unique to primary care, and should be appropriately utilised during a public health crisis. GPs can tell you from a name alone who is likely to call in need of reassurance after being diagnosed with COVID-19, who will only call when they are severely unwell, and who won’t call at all and needs a friendly reminder that their doctor is there if needed.

GPs know who declined vaccination and who postponed vaccination and are not yet eligible for their booster dose. If case notification can be integrated with general practice, this will allow GPs to ensure high risk individuals have access to the care they need while monitoring low risk patients. That will avoid unnecessary emergency presentations and calls to emergency services that put undue pressure on an already strained health system. If referral pathways for inpatient care for the high risk are streamlined, we can also arrange timely treatment for those who need it.

GPs will continue to promote vaccine uptake of not only COVID-19 but of all vaccine-preventable illnesses. We will also continue to support our patients as they navigate a world that will remain unpredictable for some time to come. We will educate them on how and when to isolate and get tested, and we will read the latest research and guidance on long COVID to ensure those patients are properly supported.

If GPs can be recognised and involved in COVID-19 care, this will lead to better health outcomes for patients and also restore a sense of satisfaction and worthiness within the GP network. This is something that has been missing from the profession for too long and is contributing to colleagues showing signs of burnout.

What the remainder of 2022 will bring is unknown, and we have experienced first-hand that complacency and lack of forward planning during a pandemic leads to chaos with disastrous consequences. It is time for GPs to be properly integrated into pandemic response plans so that all frontline health care workers can deliver quality care that will not only save lives, but also save our strained health system.

Dr Alisha Dorrigan is a Sydney-based GP and deputy medical editor for the Medical Journal of Australia.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.