Coronavirus (COVID-19) information for GPs

Subscribe to receive the bi-weekly COVID-19 newsletter for GPs from the Chief Medical Officer. 

The DoH website provides up to date information for health professionals and patients on the evolving COVID-19 situation.

Check their website for:

• Daily health alerts
• Resources for health professionals, including aged care providers, pathology providers and healthcare managers
• Resources for the general public and industry

Please note that some states and territories have implemented different criteria. Please see your state of territory department of health guidance for further confirmation.

The Communicable Diseases Network Australia (CDNA) National Guidelines for Public Health Units define probable and suspected cases as:

Probable case

A person with fever (≥38°C)¹ or history of fever (e.g. night sweats, chills) OR acute respiratory infection (e.g. cough, shortness of breath, sore throat) AND who is a household contact of a confirmed or probable case of COVID-19, where testing has not been conducted.

Suspect case

A person who meets the following epidemiological and clinical criteria:

Epidemiological criteria	Clinical criteria	Action
Very high risk Close contact* in the 14 days prior to illness onset with a confirmed or probable case International travel in the 14 days prior to illness onset Cruise ship passengers and crew who have travelled in the 14 days prior to illness onset	Fever (≥38°C)1 or history of fever OR acute respiratory infection (e.g. cough, shortness of breath, sore throat)	Test2
High risk setting Two or more cases of illness clinically consistent with COVID-19 (see clinical criteria) in the following settings: Aged care and other residential care facilities Military operational settings Boarding schools Correctional facilities Detention centres Aboriginal rural and remote communities, in consultation with the local PHU Settings where COVID-19 outbreaks have occurred, in consultation with the local PHU Individual patients with illness clinically consistent with COVID-19 (see clinical criteria) in a geographically localised area with elevated risk of community transmission, as defined by PHUs	Fever (≥38°C)1 or history of fever (e.g. night sweats, chills) OR acute respiratory infection (e.g. cough, shortness of breath, sore throat)	Test (on site for aged care residents, where feasible)
Moderate risk Healthcare workers, aged or residential care workers	Fever (≥38°C)1 or history of fever (e.g. night sweats, chills) OR acute respiratory infection (e.g. cough, shortness of breath, sore throat)	Test
Background risk (No epidemiological risk factors)	Hospitalised patients with fever (≥38°C)1 AND acute respiratory symptoms (e.g. cough, shortness of breath, sore throat)3 of an unknown cause	Test

¹ It is recommended that temperature is measured using a tympanic, oral or other thermometer proven to consistently and accurately represent core body temperature.

² Testing household contacts of confirmed or probable cases of COVID-19 may not be indicated where resources are constrained. These cases would be considered ‘probable cases’ (see definition above).

³ Clinical judgement should be exercised in testing hospitalised patients. All patients should attend an emergency department if clinical deterioration occurs.

A close contact is defined as requiring:

• greater than 15 minutes face-to-face contact in any setting with a confirmed case in the period extending from 24 hours before onset of symptoms in the confirmed case, or
• sharing of a closed space with a confirmed case for a prolonged period (e.g. more than 2 hours) in the period extending from 24 hours before onset of symptoms in the confirmed case.

For the purposes of surveillance, a close contact includes a person meeting any of the following criteria:

• Living in the same household or household-like setting (e.g. in a boarding school or hostel).
• Direct contact with the body fluids or laboratory specimens of a case without recommended PPE or failure of PPE.
• A person who spent 2 hours or longer in the same room (such as a GP or ED waiting room; a school classroom; communal room in an aged care facility). See Special situations for further information specific to aged care facilities and schools.
• A person in the same hospital room when an aerosol generating procedure is undertaken on the case, without recommended PPE.
• Aircraft passengers who were seated in the same row as the case, or in the two rows in front or two rows behind a confirmed COVID-19 case. Contact tracing of people who may have had close contact on long bus or train trips should also be attempted where possible, using similar seating/proximity criteria.
• For aircraft crew exposed to a confirmed case, a case-by-case risk assessment should be conducted by the airline to identify which crew member(s) should be managed as close contacts. See Special situations for further information.
• If an aircraft crew member is the COVID-19 case, contact tracing efforts should concentrate on passengers seated in the area where the crew member was working during the flight and all of the other members of the crew.
• Close contacts on cruise ships can be difficult to identify, and a case-by-case risk assessment should be conducted to identify which passengers and crew should be managed as close contacts. See Special situations for further information.

Contact needs to have occurred within the period extending 24 hours before onset of symptoms in the case until the case is classified as no longer infectious by the treating team (usually 24 hours after the resolution of symptoms).

Note that:

• Healthcare workers and other contacts who have taken recommended infection control precautions, including the use of full PPE, while caring for a symptomatic confirmed COVID-19 case are not considered to be close contacts.
• Contact tracing is not required for close contacts arriving on international flights on or after 16 March 2020.

GPs should not treat or carry out testing on suspected coronavirus patients if they do not have the correct PPE equipment. Practices should seek advice from their local public health unit on where to send the patient for treatment or testing and how to minimise the risk of infection while the patient is being transported.

Patients who notify of symptoms before attending a practice and who have epidemiological evidence, should be asked not to enter the practice until precautions are put in place.

In probable and suspected cases, current advice from the DoH for clinicians is:

• Place a surgical mask on the patient

• Place patient in isolated room

• Contact and follow advice from their local public health unit on the exact specimens required for specialised testing, the approved collection methods and equipment for collecting specimens and the protocols for handling, storage and transport to correct laboratory

• Practice staff in contact with any patients suspected of having coronavirus ie at reception, should wear a surgical face mask when dealing with these patients.

The requirements for PPE differ based on the patients respiratory symptoms. Current advice from the DoH is:

• For most patients with mild or no respiratory symptoms in the community, collection of respiratory specimens is a low risk procedure and can be performed using contact and droplet precautions

• Patients with severe symptoms suggestive of pneumonia should be managed in hospital. For patients meeting this criteria, the collection of respiratory specimens can be performed using contact and airborne precautions

• For droplet precautions the room the room does not need to be left empty after sample collection.

• At completion of the consultation, remove PPE and place in a biohazard container, perform hand hygiene, wipe any contacted/contaminated surfaces with detergent/disinfectant

See DoH fact sheet Interim advice on non-inpatient care of persons with suspected or confirmed Coronavirus Disease 2019 (COVID-19), including use of personal protective equipment (PPE)​ and the RACGP poster Correct use of Personal Protective Equipment (PPE)

If GPs and practice staff have worn PPE when dealing with a patient who is then confirmed as having the virus this is not considered a close contact so self isolation for 14 days is not required. 

For up-to-the-minute information, visit the Australian Federal Government Department of Health website.  

The DoH advice, available in the fact sheet Interim advice on non-inpatient care of persons with suspected or confirmed Coronavirus disease (COVID19), including use of personal protective equipment (PPE), is that:

• After the consultation, remove PPE and perform hand hygiene.
• Any contacted/contaminated surfaces should be wiped with detergent/disinfectant by a person wearing gloves, surgical mask and eye protection.
• Note that, for droplet precautions, a negative pressure room is not required and the room does not need to be left empty after sample collection.

Specific advice on product selection is available in state/territory guidance materials, such as the NSW Health fact sheet Infection Prevention and Control Novel Coronavirus 2019 (2019-nCoV) – Primary and Community Care

Self-isolation requirements

Like others, staff need to stay at home for 14 days after returning from overseas or being in close contact with someone confirmed to have COVID-19.

If GPs and practice staff have worn personal protective equipment (PPE) when dealing with a patient who is then confirmed as having the virus, this is not considered a close contact and therefore self-isolation for 14 days is not required.

See the DoH fact sheet Coronavirus (COVID-19) information for health care and residential care workers
 

Staff who test positive for COVID-19

In the event that a GP or practice team member tests positive for COVID-19, contact your Public Health Unit who will advise what actions need to be taken by the practice.

Required actions will be dependent on a number of variables including when the staff member last worked, the nature of their work performed by that individual and possible exposure to others in the practice.

 
Washing clothes and practice linen

Immediately remove and wash clothes or linen that have blood, body fluids and/or secretions or excretions on them.

Daily washing of workplace attire is advised.

In general, wash and dry with the warmest temperatures recommended on the clothing label with a disinfectant the manufacturer claims antiviral activity. Chlorine bleach is effective but note that is not an appropriate laundry additive for all fabrics.

Mechanical drying in a tumble dryer is the preferred method because of the effects of thermal disinfection. 

Further information can be found in the RACGP Infection prevention and control standards (5^th edition). 

Temporary MBS item numbers now allow bulk-billed telehealth (phone or video) consultations by GPs for all Australians, where it is safe and clinically appropriate to do so.

Summary information on these changes, including an overview of new items and descriptors is now available via the RACGP website. 

The RACGP has been developed to support GPs in consulting remotely via phone and video during COVID-19. These resources are available via the RACGP website, with further to follow shortly.

• Guide to providing telephone and video consultations in general practice 
• Telephone and video consultations in general practice: Flowcharts

If you have a query relating to the COVID-19 telehealth MBS items you can now email a new dedicated address, COVIDResponse@health.gov.au. For all other queries relating to all other items in the Schedule, continue to email askMBS@health.gov.au.

Further information on the new item numbers is available from the DoH website. See the COVID-19 Bulk Billed MBS Telehealth Services GPs and Other Medical Practitioners fact sheet for specific item numbers and Provider Frequently Asked Questions. 

The Department of Health has put in place a Special Arrangement that makes it easier for patients to access prescription medicines while self-isolating. The Special Arrangement commenced on 26 March 2020 to temporarily allow Image Based Supply of PBS Medicines, and also temporarily allow patients to receive PBS medicines without needing to sign for it.

This means that prescribers can provide a pharmacy with a digital image of their prescription via fax, email or text message. The pharmacist can dispense from the image of the prescription*, and can deliver or post the medicines to the patient. NB: *does not apply for a Schedule 8 or Schedule 4(D) medicine

If your patient prefers to receive the legal paper prescription you will need to mail it to them.

If able, you should send the pharmacy the paper prescription as soon as possible. If you are unable to send on the paper prescription, you will be required to retain the paper prescription for a period of 2 years for audit and compliance purposes.

The COVID-19 Home Medicines Service enables vulnerable patients to have their PBS medicines delivered to their home. The Home Medicines Service complements the expanded use of telehealth under Medicare and the fast-tracking of electronic prescribing.

GPs can now request an authority using Online PBS Authorities in HPOS.

During this time patients may still present to general practice with flu like symptoms who do not fit the criteria for a COVID-19 suspected case.

When treating patients with suspected influenza, droplet and contact precautions, as with COVID-19, are recommended.

Therefore it is recommended that when consulting with any patient with flu like symptoms, droplet and contact precautions should be applied.

For further information, see the RACGP resource Managing pandemic influenza in general practice.  

The National Aboriginal Community Controlled Health Organisation (NACCHO) are leading a COVID-19 Taskforce (the Taskforce) which includes government and member representatives.
 
It is recommended that members monitor the NACCHO Coronavirus site for updates and subscribe to the NACCHO Communique for the latest Aboriginal and Torres Strait Islander health sector news and information on COVID-19.
 

Management Plan for Aboriginal and Torres Strait Islander Populations

The ‘Management Plan for Aboriginal and Torres Strait Islander Populations’ has been developed by the Aboriginal and Torres Strait Advisory Group on COVID-19 and endorsed by the Australian Health Protection Principal Committee (AHPPC).

The Management Plan outlines key issues and considerations in planning, response and management of COVID-19 that need to be addressed at all levels of governance, in collaboration with key partners and stakeholders, including impacted communities.
 

 

Access up to date information via RACGP COVID-19 information for GPs in training webpage.

 

Caring for yourself

During events such as the current coronavirus situation, additional pressure may be placed on GPs and practice staff as frontline workers through increased patient attendance to the practice, responding to fear and anxiety amidst the community and staying up to date as the situation evolves.

It is important during such times that GPs and practice staff take time to care for themselves and take the opportunity to debrief with colleagues. If you require additional support, services are available, specifically developed for doctors.

RACGP GP Support Program

Should you need support, don't hesitate to contact the RACGP GP Support Program. This is a free and confidential psychological support service available to all members, delivered by LifeWorks by Morneau Shepell. Access the service by calling 1300 361 008 (24 hours/7 days).

DRS4DRS

You can also access support via the DRS4DRS website and state/territory based helplines. DRS4DRS is an independent program providing confidential support and resources to doctors and medical students across Australia, by doctors. Confidential phone advice is available 24/7 for any doctor or medical student in Australia via each state/territory helpline and referral service.
 

COVID-19 mental health resources

• Beyond Blue Looking after your mental health during the coronavirus outbreak
• MindSpot 10 Psychological Tips for Coping with Coronavirus (COVID-19)
• Head to Health COVID-19 Support

Providing psychological support to your patients

Completing Mental Health Skills Training online

Currently the only available activities to complete this education are by completing a modular pathway. This means you must complete both a Core Module, and a Clinical Enhancement Module.
You can choose to complete the Core Module through two options:

• Activity 193879 - Mental health skills training pathway core module - RACGP gplearning
• Activity 187267 - Mental Health Skills Training: Core module  - ThinkGP

The only Clinical Enhancement Module available is through Think GP

• Activity 187157 - Clinical Enhancement Module Youth Mental Health - ThinkGP

Once both these activities are completed, please contact the General Practice Mental Health Standards Collaboration (GPMHSC) on 03 8699 0556 to ensure your Provider number is on file. This will enable the report of your completion to Medicare. Medicare advise four to six weeks processing time. Completion of these activities will make you eligible to access the higher rebate numbers 2715 and 2715 (and equivalent non-VR and telehealth numbers) for the preparation of a Mental Health Treatment Plan.

Other Training Providers are working to deliver their activities through distance learning.
 

Completing Focussed Psychological Strategies Skills Training online

Completing Focussed Psychological Strategies Skills Training and registering with Medicare will enable GPs the eligibility to deliver treatment to patients themselves, rather than referring to another health professional. It provides eligibility to access the equivalent item number 2721, 2725, 2727, 2729.

Currently RACGP Rural runs education in batch enrolment, the next available dates are:
Activity 183518 - Accessible Focussed Psychological Strategies Skills Training

• 13 April to 17 July 2020
• 22 June to 25 September 2020
• 31 August 2020 to 4 December 2020

For more information contact: Chantelle Vonarx, T: 07 3456 8967, E: chantelle.vonarx@racgp.org.au. Following this you should complete the Form to register and submit to the GPMHSC.
 
Equivalent telehealth item numbers can be found on the GPMHSC website: Telehealth consultations

National COVID-19 Clinical Evidence Taskforce 'living guidelines' 

The National COVID-19 Clinical Evidence Taskforce, of which the RACGP is a collaborating partner, has launched new ‘living guidelines' that will provide the latest, evidence-based recommendations to clinicians caring for patients with COVID-19. The Taskforce is constantly updating the ‘living guidelines’ to ensure clinicians have access to reliable, up-to-date guidance during this unprecedented health crisis.

Other resources developed by the Taskforce include decision flowcharts and 'evidence under review'. 
 

Infection-control training

Access the Department of Health’s (DoH) new online Infection Control Training for healthcare workers.

 

Letter for employers seeking staff medical clearances 

A number of employers are asking employees to provide medical clearances from COVID-19. A letter template is available to respond to such requests. Practices may amend this template to suit their situation.

• General Practice letter to employers template (DOCX 18KB)
• General Practice letter to employers template (PDF 51KB)

 

Guidance for certifying COVID-19 deaths

The Australian Bureau of Statistics has released Guidance for Certifying Deaths due to COVID-19 detailing how you should record COVID-19 on the Medical Certificate of Cause of Death.

Preparation and response resources

• RACGP Infection prevention and control standards (5^th edition)
• RACGP Managing pandemic influenza in general practice
• Emergency Response Planning Tool

 

Financial assistance for practices 

Information on the RACGP Financial Assistance for Practices webpage has been updated with the Federal Government’s tranche three stimulus package, detailing the Job Keeper payments.
 

Patient alert posters 

• Patient alert poster - Coronavirus - A3 (v8 - Updated 13 March 2020)
• Patient alert poster - Coronavirus - A4 (v8 - Updated 13 march 2020