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.


GPs must be integrated into pandemic response plans
  • Strongly agree (92%, 238 Votes)
  • Agree (6%, 15 Votes)
  • Neutral (1%, 2 Votes)
  • Strongly disagree (1%, 2 Votes)
  • Disagree (0%, 1 Votes)

Total Voters: 258

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10 thoughts on “GPs are angry and now is the time to listen

  1. Colin Masters says:

    Can’t even prescribe roaccutane as a Specialist GP – that says it all to me.

  2. Dr Wolfe Rakusin says:

    I was a GP for 4 years and an ophthalmologist and lecturer for over 40 years and I feel that the most unappreciated and undervalued role is that of the GP. They are the backbone of the medical profession and deserve the highest praise and recognition for the work they do. Many of the best and most compassionate doctors I know are GP.s and they are constantly on the “frontline ” .

  3. Brian Morton says:

    Well stated Alisha. That State vs Federal gameplay disadvantages GP repeatedly. That GP provided greater than 50% of vaccinations for a pittance and continued to provide usual care demonstrates true ethical standards and care. We do also need to question the super specialty inputs that failed us and undermined vaccine coverage eg Pfizer vs AZ risks. The failure to cover carers in aged care was similar to the failure to cover General Practice and staff. These impediments add to the loss of attraction of GP to new graduates.

  4. Sue Ieraci says:

    I feel the well-motivated emotion here, and I empathise with the author – but what have employers and Occupational Health and Safety professionals been doing all this time?

    “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 ….”

    These have NEVER been acceptable working conditions. GPs and EDs have always been “front line” for any infectious disease – whether this is influenza, gastroenteritis or any other easily transmissible not non-vaccine-preventable pathogen.

    We have traditionally accepted that people working in health care, in schools and in aged care will just “get sick” every winter. Everyone recalls the gastro they got during their paediatric rotation as a student or junior doctor.

    Why haven’t we thought to protect ourselves before?

    I’m very well protected – I now work in emergency telemedicine, well protected by my screen. However, I think back to all those times in ED when a child coughed in my face, or the community and health system were crippled by flu outbreaks – we didn’t employ even the most basic measures, and we expected sick staff to “keep soldiering on”!

    So, yes, national systems run by government should be rational, but it’s also up to all of us to demand better, whatever workplaces we inhabit. “I’m not working in a small room with no ventilation, an inadequate mask and a potentially infected person” would be a good start.

  5. Anonymous says:

    Well expressed, an excellent and accurate reflection on what has happened in GP land in the last 2 years.
    Politicians, and health departments re State and Federal planning have woefully ignored general practice, and shown their ignorance. In addition Qld ex-Chief Health officer and Premier, unfortunately undermined Astra Zenica Vaccination programs by their actions and words.
    Fortunately our depyuty Chief Medical Officer, Michael Kidd has kept GPs in the loop, and provided useful information on a regular basis.
    Vaccinations and Telehealth made Covid infected patients’ care much easier to provide, so I did not need to refer one patient to the virtual hospital, only one needed admission to real hospital.
    Many RACGP GPs have been active advocating in Queensland, but there are none so deaf as those that will not hear.
    Like everyone, GPs need acknoweldgement for the vital role they have played, despite the delays in vaccine supply, PPE supply, RAT tests, and the lack of financial support.

  6. Mark Santamaria says:

    I agree completely. As an Emergency Physician working in a tertiary ED I am acutely aware of the importance of Primary Care in patient assessment and management, and the lack of recognition by governement. It is clear Australia has been lagging behind other countries in pandemic preparation and response to the current pandemic in all aspects of healthcare. It is also clear that traditional models of healthcare require rethinking especially the use of telemedicine and the structure of support services to assist patients to manage healcare problems in their own environment with assistance by apprpariate healthcare professionals. Unfortunately the lack of coordination between federal and state health authorities creates huge barriers to solving these big problems in healthcare.

  7. Peter Duffy says:

    Alisha: well put.
    I’m an old radiologist but have family GP members for decades and part experience myself.

  8. Alisdair Barnes says:

    Thank you so much for writing my thoughts. As a retired GP I have felt angry, despairing, frustrated and sad for my working colleagues shouldering these increased burdens, as always without the recognition and celebration they deserve

  9. Anonymous says:

    A fair and heartfelt critique. Unfortunately, the Federal Government chose to keep very tight control of the pandemic response even at the operational level, largely sidelining not only GPs (poor) but also state and territory health Departments when it came to the initial vaccine roll-out.
    Doctors have long memories, and the Government may come to regret their approach over these past two years.

  10. Anonymous says:

    Now that oral Covid-19 antiviral therapies are available, GPs should also be afforded the central role in identifying their highest risk patients, providing them with the knowledge and tools for rapid diagnosis, and then prescribing potentially lifesaving therapy within the narrow available timeframe for maximal efficacy so as to prevent deterioration and hospital admission. Unfortunately primary care has (once again) been almost totally excluded from involvement in state-based planning processes for antiviral delivery, the responsibility for which has been handed almost exclusively to public hospital specialist services with little if any direct knowledge of the few referred patients, the inevitable and foreseeable consequence being an inefficient and almost totally ad hoc and opportunistic process whereby most of the highest risk vulnerable patients with early covid-19!will be denied timely access. The usual excuses prevail at the bureaucratic planning level, centrally that’s”primary care is a federal government responsibility” – not much good when we have a federal govt that demonstrates over and over again that it really doesn’t hold a hose ever when it comes to planning and coordinating an urgent response to any crisis, be it global heating, natural disaster or the pandemic.

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