The role of general practitioners in disasters and emergencies


1.Position

GPs play a vital role in supporting communities before, during and after significant disasters and emergencies and must be involved in disaster management at all levels, including planning, mitigation, response, and recovery. The RACGP is calling on Australian Federal and state/territory governments to implement a number of recommendations to recognise and support general practice in this role. The RACGP is advocating for:

  • formal inclusion and representation in national, state/territory and local government disaster and emergency planning groups and committees including the National Emergency Management Agency

  • dedicated funding directly allocated to general practices for preparation, response and recovery from emergencies and disasters

  • prioritisation of general practice as an essential service during disaster events

  • minimising administrative red-tape for general practitioners who are willing and able to contribute as part of disaster response

  • GPs working in areas impacted by disasters being exempted from Medicare compliance activities

  • investment in research to ensure the capabilities GPs can bring to disaster planning, response and recovery are fully understood

  • increased support for GPs and their practice team’s wellbeing following a disaster.

Background

The World Health Organisation (WHO) predicts 250,000 additional deaths globally from climate sensitive diseases (such as heat stress, malnutrition, vector borne diseases and injury) from 2030 onward.1 Australia is particularly vulnerable to the impacts of natural disasters, emergencies, and climate change, including floods, heatwaves, drought, storms, bushfires, and risk of zoonoses. These impacts are increasing in frequency and in significance across the nation.2

It is clear natural disasters and emergencies have a significant health impact on people and their communities. Disasters cause significant environmental and social health issues and exacerbate existing health conditions. GPs in disaster affected areas will see an increase in people presenting with health issues immediately after a disaster event and in the weeks, months and years following on from the disaster.
Most significantly, disasters can have short, medium and long term effects on people’s mental health or exacerbate pre-existing psychological and mental health conditions. Most people experiencing mental health issues because of a disaster will initially present to a GP.

GPs are, therefore, essential in supporting individuals and communities before, during and in the recovery phase of natural disasters and emergencies. The RACGP has integrated disaster health into the RACGP curriculum and produces a suite of resources for its members. 
GPs must be involved in national natural disaster management at all levels, including planning, training, mitigation, response, and recovery. However, this commonly does not occur, resulting in underutilisation of GP expertise and capabilities, inadequate communication in times of disaster, and a lack of support for general practice across all levels of disaster preparedness and response.  
For the purpose of this document, the terms ‘emergency’ and ‘disaster’ are used interchangeably. 

2. Issues and recommendations

2.1 GP representation and inclusion

GP representation on national and state/territory disaster management committees is crucial in preparedness efforts and to ensure decisions involving or affecting general practice are feasible, appropriate and actionable.

Inclusion in preparedness activities also equips GPs with the knowledge and resources required to support their community during and after a disaster or large emergency event.3

The integration of GPs and general practice more broadly into formal systems of disaster response is variable across each region. This results in GPs not having a clearly defined role in emergency response plans and creates a systematic barrier impacting their ability to assist efficiently.

During larger or more prolonged incidents, local and state health emergency operation centres would benefit from GP representation to assist in liaison with frontline GPs and, support general practice maintain health services during the disaster.

2.2 Funding

General practice financial viability is a national issue4, which is exacerbated for general practices located in emergency and disaster-prone areas. Without adequate support, it may not be viable for general practices to remain open following a major disaster, or for GPs to stay in high-risk areas.

The RACGPs Health of the Nation Report 2022 found the proportion of GPs considering imminent retirement is increasing in part due to the added pressure of pandemics and natural disasters.4 The report found 62% of practice owner respondents identified sustaining practice during and following a disaster or pandemic as a major business challenge.4

The loss of general practice in a community is a devastating outcome and puts additional and significant strain on the hospital system as non-emergency and routine care is diverted to the acute care sector or left untreated in the community.5

Without the necessary funding, general practice faces challenges to support response efforts in an emergency or disaster.5 A commitment to financially supporting general practice in times of crisis has the potential to retain and attract GPs into disaster prone areas.
General practice must be financially supported to prepare, respond, and recover from disasters to keep their practice doors open to deliver high quality patient centred care across the short and medium to long term periods following a disaster, and into the next event.

This includes:

  • support for GPs living in disaster prone areas to undertake GP appropriate disaster planning education and training

  • support to participate in Federal/state/regional planning meetings.

  • recognition as an essential service in order to access support funding (see 2.3 below)

  • dedicated funding to general practices to allow for disaster planning and to develop disaster management plans

  • increased or expanded bulk billing incentive payments in areas under formal disaster declarations.


2.3 Prioritising general practice as an essential service

Disaster response includes the protection of community infrastructure to support resilience and recovery. Most local disaster plans will usually identify which infrastructure and community assets are priorities for protection and restoration during a disaster event.
General practice must be prioritised as an essential healthcare service to support resilience in the aftermath of disasters. It needs to be able to access essential services including ongoing electricity supply during outages with access to diesel powered generators and be prioritised for power restoration. General practices affected by the 2019-20 bushfires reported numerous days of power outages leading to difficulties running practices and vaccination waste.

Prioritising general practice as an essential service can support access to:

  • personal protective equipment (PPE)

  • other supplies and medicines to support disaster healthcare, in particular to support GPs and their teams’ providing services in emergency evacuation centres

  • infrastructure repairs to restore health services

  • emergency funding to ensure practices can remain operational, reopen promptly, support staff where practices need to close for long periods of time to recover and employ additional locum GPs to respond to an increased workload during the recovery phase


2.4 Service coordination and support

GPs are a constant healthcare service present before, during, and after any disaster. Pre-planning for disaster response to secure ongoing access to GPs and other general practice services can help keep patients away from often overwhelmed hospital emergency departments and provide better outcomes for the community.

Minimising administrative red-tape for general practitioners who are willing and able to contribute as part of disaster response, is important to free up resources and enable GPs to respond to the needs of their community without fear of falling foul of regulations. For example, allowing the portability of provider numbers for as long as required, particularly where GPs are displaced, rather than just for the current two-week period before an emergency provider number needs to be obtained. This will minimise the administrative burden for providers who need to relocate for extended periods and enable them to still provide Medicare eligible services to patients.

There may be a need for longer consultations and increased use of telehealth to facilitate access to healthcare for displaced populations. This may result in Medicare billings that fall outside of normal practice. GPs should be exempted from Medicare compliance activities while a disaster declaration is in place to ensure the healthcare needs of local populations can be met.

Many patients will face financial hardship in the wake of a disaster and may postpone seeking healthcare due to cost concerns. GPs will also face financial pressures in the aftermath of disasters. Increased or expanded bulk billing incentive payments in areas under formal disaster declarations could alleviate some financial burdens for both patients and GPs by supporting GPs to bulk bill patients financially impacted by disaster.

2.5 Research into GP disaster response

There is currently a lack of research into the role of GPs which exacerbates the lack of integration of GPs in disaster planning and response. There is a lack of understanding from other first responders on the role of GPs and their capacity to contribute to the disaster response.

Ongoing investment in research is required to ensure the capabilities GPs can bring to disaster planning, response and recovery are documented and understood. This will support GPs and their teams to build community resilience, improve health outcomes through all stages of disasters s from prevention, preparedness, response and recovery.

2.6 GP wellbeing and support after a disaster

Local healthcare responders, including GPs, face immense pressure during and after a disaster, providing care to their communities while also being affected as a community member themselves. The importance of health support is duly recognised for emergency services workers at a Federal level5, and this same consideration should be extended to GPs and general practice staff on the frontline of disaster response.  

GPs affected by disasters are more likely to feel burnout6, more likely to retire early, or close practice earlier than intended.5 GPs need to be supported to seek care and take time away from work when needed and disaster areas need to be appropriately resourced with locum support to avoid local GPs working extraordinary hours.

Consideration needs to be given to the financial and emotional toll disasters will have on GPs and there needs to be clear pathways for GPs and their practice teams to access timely physical and mental health support following a disaster 


Conclusion

The RACGP recognises the exceptional efforts of GPs and their teams during the many disasters and emergencies Australia has experienced despite a lack of integration into broader disaster response systems, however, the current approach to GP involvement in disaster response is not sustainable. The RACGP calls on the Federal, state/territory and local governments to consider and implement our recommendations to ensure Australia has prepared, strong, and resilient general practice ready to deliver high quality care to affected communities and support them through recovery efforts for years to come.

Author:                   Practice Technology and Management
Contact:                 practicemanagement@racgp.org.au
Review date:         2026


RACGP Mission statement

The RACGP's mission is to improve the health and wellbeing of all people in Australia by supporting GPs, general practice registrars and medical students through its principal activities of education, training and research and by assessing doctors' skills and knowledge, supplying ongoing professional development activities, developing resources and guidelines, helping GPs with issues that affect their practice, and developing standards that general practices use to ensure high quality healthcare.

  1. World Health Organization. Climate change overview. Geneva: WHO [date unknown]. Available at www.who.int/health‑topics/ climate‑change#tab=tab_1 [Accessed 17 May 2022]
  2. Zhang Y, Workman A, Russell MA, Williamson M, Pan H, Reifels L. The long-term impact of bushfires on the mental health of Australians: a systematic review and meta-analysis. Eur J Psychotraumatol. 2022;13(1):2087980. doi:10.1080/20008198.2022.2087980 
  3. Burns PL, Aitken PJ, Raphael B. Where are general practitioners when disaster strikes? Med J Aust 2015;202(7):356-358
  4. Royal Australian College of General Practitioners. General Practice Health of the Nation. East Melbourne, Vic: RACGP; 2022
  5. The Royal Australian College of General Practitioners. Vision for general practice and a sustainable healthcare system. East Melbourne, Vic: RACGP, 2019
  6. Johal S, Mounsey Z, Tuohy R, Johnston D. Coping with disaster: general practitioners' perspectives on the impact of the canterbury earthquakes. PLoS Curr. 2014;6: ecurrents.dis.cf4c8fa61b9f4535b878c48eca87ed5d. doi: 10.1371/currents.dis.cf4c8fa61b9f4535b878c48eca87ed5d

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