Coronavirus (COVID-19) information for GPs

National webinars

Podcasts

Your colleagues from Generally Speaking, Just a GP, The Good GP and Practice THAT! podcasts are producing regular COVID-19 update episodes, designed specifically for GPs and practice managers.

Australian Journal of General Practice

The Australian Journal of General Practice (AJGP) has developed a dedicated coronavirus (COVID-19) webpage. Important, relevant and timely articles will be published as they become available in addition to the scheduled monthly release of AJGP.

Read AJGP articles

Subscribe to receive the COVID-19 newsletter for GPs from the Chief/Deputy 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
• Current situation and case numbers
• 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 confirmed, probable and suspected cases as:

Confirmed case

A person who:
i. tests positive to a validated specific SARS-CoV-2 nucleic acid test;
OR
ii. has the virus isolated in cell culture, with PCR confirmation using a validated method;
OR
iii. undergoes a seroconversion to or has a significant rise in SARS-CoV-2 neutralising or IgG antibody level (e.g. four-fold or greater rise in titre).¹
 

Probable case

A person who has detection of SARS-CoV-2 neutralising or IgG antibody1 AND has had a compatible clinical illness AND meets one or more of the epidemiological criteria outlined in the suspect case definition (see below).

Suspect case

Clinical and public health judgement should be used in assessing if hospitalised patients with nonspecific signs of infection and patients who do not meet the clinical or epidemiological criteria should be considered suspect cases.​

A person who meets the following clinical AND epidemiological criteria:

Clinical Criteria:
Fever (≥38°C)² or history of fever (e.g. night sweats, chills) OR acute respiratory infection (e.g. cough, shortness of breath, sore throat)⁴ OR loss of smell or loss of taste.

Epidemiological criteria:
 
In the 14 days prior to illness onset:

• Close contact^5,6 (see Contact definition below) with a confirmed or probable case
• International 
• Passengers or crew who have travelled on a cruise ship
• Healthcare, aged or residential care workers and staff with direct patient contact
• People who have lived in or travelled through a geographically localised area with elevated risk of community transmission, as defined by public health authorities⁴

Notes:
¹ Antibody detection must be by a validated assay and included in an external quality assurance program.
² It is recommended that temperature is measured using a tympanic, oral or other thermometer proven to consistently and accurately represent peripheral body temperature.
³ If the person is a close contact of a probable case, at least one person in the chain of transmission must be a confirmed case.
⁴ Other reported symptoms of COVID-19 include: fatigue, loss of smell, loss of taste, runny nose, muscle pain, joint pain, diarrhoea, nausea/vomiting and loss of appetite. Clinical and public health judgement should be used to determine if individuals with sudden and unexplained onset of one or more of these other symptoms should be considered suspect cases.
⁵ 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’ (refer to definition above).
⁶ In certain high risk outbreak settings, PHU may consider testing asymptomatic contacts to inform management of the outbreak. For further information, refer to outbreak investigation and management in high-risk settings section of the guidelines
⁷ For further information on geographically localised areas with elevated risk of community transmission, refer to the Department of Health website.

A close contact is defined as requiring:

• face-to-face contact in any setting with a confirmed or probable case, for greater than 15 minutes cumulative over the course of a week, in the period extending from 48 hours before onset of symptoms in the confirmed or probable case, or
• sharing of a closed space with a confirmed or probable case for a prolonged period (e.g. more than 2 hours) in the period extending from 48 hours before onset of symptoms in the confirmed or probable 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 and Appendix D of the guidelines 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. A case by case risk assessment should be conducted to identify which passengers and crew members should be managed as close contacts. See Special situations and Appendix D of the guidelines for further information.
• 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 48 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).

If the case is asymptomatic, see PCR positive tests in asymptomatic or pre-symptomatic persons section in the guidelines for information on determining the asymptomatic (or pre-symptomatic) case’s infectious period and to inform identification of contacts.

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 treat and test suspected COVID-19 patients in line with the advice from their local public health unit.  
Practices should not conduct consultations or carry out testing on suspected patients if they do not have the appropriate PPE.  These 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.

Initial assessment

Consider initial screening of patients via a phone or video consultation using the National COVID-19 Clinical Evidence Taskforce flowchart: Assessment for suspected COVID-19 (V2.5 Published 25 June 2020).   

Only follow up with a face-to-face assessment if a diagnosis of moderate or severe illness cannot be confidently excluded via telehealth assessment. Patients who meet the criteria and who require a face-to-face consultation, should be asked not to enter the practice until precautions are put in place. NB: Patients with severe symptoms suggestive of pneumonia should be managed in hospital. For patients meeting this criteria, the collection of respiratory specimens must be performed using contact and airborne precautions

Further assessment

• Apply standard precautions, cough etiquette/respiratory hygiene and physical distancing, as above.
• Immediately give the patient a surgical mask and ensure they put it on correctly.
• Direct them to a single room, whether or not respiratory symptoms are present.
  •  If a single room is unavailable, an area separate from other patient areas should be designated for assessment of suspected COVID-19 patients.
• The patient should be tested for COVID-19 (if this has not been done already).

Contact and droplet precautions should be used for assessment of, and specimen collection from, patients suspected or confirmed of having COVID-19. See the RACGP COVID-19 infection control principles and current advice from the DoH for specific information on gown use when conducting specimen collection ONLY without clinical consultation. 

Specimen collection

• To collect upper respiratory swabs, stand slightly to the side of the patient to avoid exposure to respiratory secretions, should the patient cough or sneeze.
• Encourage the patient to maintain a slow breathing pattern and not hold the breath as this reduces the likelihood of gagging.
• Self-collection of a nasal swab is acceptable, with appropriate supervision.
• To collect a sputum sample from a patient with a productive cough:
  • Ask the patient to stand approximately 2 metres away and turn aside before coughing into the specimen container. OR
  • Ask the patient to go outside or into another room to produce the specimen.

For a detailed description of methods of specimen collection for diagnosis of COVID-19 see: Public Health Laboratory Network guidance on laboratory testing for SARS-CoV-2 (the virus that causes COVID-19)

At the conclusion of the consultation

• Remove PPE and perform hand hygiene
• Room 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.

See the RACGP COVID-19 infection control principles for further information, including preparing your consultation room and subsequent environmental cleaning.

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. 
 

The National COVID-19 Clinical Evidence Taskforce, of which the RACGP is a collaborating partner, has living guidelines on the management of adults with mild COVID-19. 

Access the guidelines (V6 Published 9 July 2020) (most recent change to flowchart reflects new recommendations on use of chloroquine and colchicine)

COVID-19 infection control princples

The new RACGP COVID-19 infection control princples resource has been developed to support GPs and practice teams when consulting with suspected cases of COVID-19. 

The resource provides concise information on: 

• Preparing your consultation room for a suspected COVID-19 case 
• Consultations with a suspected COVID-19 case when swabbing is performed 
• Environmental cleaning after assessment and/or testing of a suspected COVID-19 case 

• Guidance on use of personal protective equipment (PPE) in non-inpatient health care settings, during the COVID-19 outbreak
• Coronavirus (COVID-19) environmental cleaning and disinfection principles for health and residential care facilities 

Responding to a COVID-19 case in the practice team

• managing possible exposure to other staff and patients
• self-isolation
• consulting via telehealth during self-isolation
• practice cleaning
• communicating with patients.

Infection-control training

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

Videos and posters: Using PPE and sanitising hands

During outbreaks like COVID-19 or influenza, appropriate hand hygiene and use of personal protective equipment (PPE) are critical to protecting yourself, your practice team and your patients, and to preventing further spread of the virus.
Watch these short videos on how to apply, remove and dispose of PPE safely, and how to sanitise your hands.

• Full version – How to use personal protective equipment (PPE)
• Part 1 – How to sanitise your hands
• Part 2 – How to don personal protective equipment (PPE)
• Part 3 – How to fit a P2/N95 mask
• Part 4 – How to remove and dispose of personal protective equipment (PPE)

Access all videos 

See the RACGP New items for COVID-19 telehealth and phone services webpage for summary information on MBS items available to GPs when providing telehealth and phone consultations. 

Telehealth resources

• Guide to providing telephone and video consultations in general practice 
• Telephone and video consultations in general practice: Flowcharts​
• Video consultations with patients suspected to have COVID-19 
• ​Consultations in the practice with patients suspected of having COVID-19 
• Having a phone or video consultation with your regular GP: Information and support for patients - patient information sheet
• Telehealth consultations with patients requiring an interpreter - NEW!

In addition, a new guide Telehealth and supervision: A guide for GPs in training and their supervisors has been developed to provide guidance on supervision of GPs in training when using telehealth.

Telehealth webinar

• an overview of the new items
• tips on implementing telehealth in your practice
• practicalities of delivering a consultation over the phone or video
• hardware and software requirements
• steps to ensure your practice has a smooth transition into telehealth

MBS enquiries

COVID-19 telehealth services for veterans

Temporary Department of Veterans’ Affairs (DVA) telehealth items are now available.

The Veterans’ Access Payment (VAP) is payable with the telehealth items but DVA is aware the system has not been making these payments. To overcome the issue, DVA has created two new VAP items: MT88 (claimed instead of 10991) and MT89 (claimed instead of 10990).

You can claim the VAP retrospectively for telephone and video conferencing services provided to DVA patients from 13 March 2020. DVA anticipates that practice management software won’t automatically pick up these new items in the immediate term, so you will need to separately and manually claim these VAP items.

The DVA VAP fee has doubled for both face-to-face and telehealth services effective 30 March 2020 for the duration of the COVID-19 response. The DVA Fee Schedules for Medical Services has been updated to mirror the temporary Medicare Benefits Schedule arrangements. You can find more details on the new items, including patient and provider eligibility, at MBS Online.
 

‘chronic health condition’ and ‘immune compromised’ eligibility defined

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 'prescriptions via telehealth' 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 the patients 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, and you have conducted the consultation via telehealth, 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.

See summary changes for 'prescriptions via telehealth' in your state/territory and the DoH fact sheet A guide for prescribers. 
 

Electronic prescribing

Legislation has been changed to recognise electronic prescriptions as legal documents. Electronic prescribing enables the prescribing and dispensing of medicines without the need for a paper prescription, which can improve efficiency and medicines safety.
 
The electronic prescribing initiative is part of the National Health Plan, and it was originally due to be rolled out next year. However, it has been progressed to support telehealth consultations and help protect healthcare providers and patients from infectious disease (in this case, COVID-19) by removing the need to present to your GP in person to get a prescription. 

See the RACGP website for further information and resources. 
 

The RACGP has compiled a summary of links to information and resources to support people with disability during the COVID-19 pandemic.
 

COVID-19 Health Professionals National Disability Advisory Service

National Disability Insurance Scheme (NDIS)

• Coronavirus (COVID-19) information and support

• Latest advice from the NDIS

• Information for NDIS participants - This page includes information about changes announced on 27 April 2020 to support NDIS participants during the COVID-19 pandemic. These include increased flexibility to purchase low cost assistive technology, two new support items for participants in Supported Independent Living arrangements, and online access to the Access Request Form and Supporting Evidence Form.

• Information for NDIS providers

• NDIS Quality and Safeguards Commission

Australian Government information/resources

• Australian Government – Information about COVID-19 including the COVIDSafe app

• Department of Health – Coronavirus (COVID-19) advice for people with disability

• Management and Operational Plan for COVID-19 for People with Disability

• Department of Social Services – Information and referrals for people with disability and their supporters about coronavirus (COVID-19) - This page includes information about the Disability Information Helpline.

• Services Australia – People with disability

Disability organisations

• People with Disability Australia

• National Disability Services

• Australian Federation of Disability Organisations

• Council for Intellectual Disability

• First Peoples Disability Network Australia
   

Disability service providers

• Yooralla

• Scope

National Aboriginal Community Controlled Health Organisation (NACCHO) resources

Recommendations for healthcare teams supporting prevention and management of COVID-19 for Aboriginal and Torres Strait Islander people

The RACGP, National Aboriginal Community Controlled Health Organisation (NACCHO), Lowitja Institute and Australian National University (ANU) are working together to develop a series of rolling, evidence-based recommendations to assist healthcare teams with the prevention and management of COVID-19 in Aboriginal Community Controlled Health Services and other primary care settings.

The guidance is available now through NACCHO’s online COVID-19 information hub.

Australian Indigenous Doctors Association (AIDA) resources

Access to information and resources from the Australian Indigenous Doctors Association (AIDA) from the AIDA website.   

AIDA are conducting twice-weekly peer support forums for Aboriginal and Torres Strait Islander doctors. Please contact communications@aida.org.au for log-in details. 

Department of health resources

The Department of Health have released Coronavirus (COVID-19) resources for Aboriginal and Torres Strait Islander people and remote communities.
 

Management Plan for Aboriginal and Torres Strait Islander Populations

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.
 

The Essential Network (TEN) for frontline workers

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.
 

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).
 

RACGP Wellbeing support calendar

The RACGP has developed a Wellbeing support calendar. This July, the calendar highlights how you can focus on incorporating the things that bring you joy each day.
 

COVID-19 mental health resources

• Beyond Blue Coronavirus Mental Wellbeing Support Service​
• MindSpot 10 Psychological Tips for Coping with Coronavirus (COVID-19) and other resources
• Head to Health COVID-19 Support
• Pheonix Australia Coronavirus (COVID-19) mental health resources

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

• 27 July to 30 October 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 application form to register and submit to the GPMHSC.
 
Equivalent telehealth item numbers can be found on the GPMHSC website: Telehealth consultations

The RACGP acknowledges the significant impact and disruption that the COVID-19 pandemic will have on GPs working in rural and remote communities. Access up-to-date information via RACGP’s COVID-19 information for rural GPs webpage.

Translated COVID-19 resources for culturally and linguistically diverse communities

• The Department of Home Affairs website has a range of COVID-19 resources translated into 63 languages. 
• Other translated resources, including posters which can be displayed in the practice, are available on the Department of Health website.  
• SBS Radio is also broadcasting translated COVID-19 news and information.  

COVID-19 and family violence

The impacts of COVID-19 and self-isolation on stress, job losses, financial strain and health concerns will increase the cases of family violence. GPs play an important role in being the first point of contact for people who are experiencing family abuse or violence. The RACGP has created a COVID-19 and family violence support resource to help GPs manage their patients during the pandemic. 

 View the resource  
 

Maintaining safe immunisation services during COVID-19 

The Australian Technical Advisory Group on Immunisation (ATAGI) has released guiding principles to support the maintenance and continuation of immunisation services during the COVID-19 pandemic.  

To minimise COVID-19 exposure risk for you and your patients, ATAGI has also released a statement on the duration of observation after vaccination. 
 

COVIDSafe fact sheet 

The RACGP has developed a COVIDSafe fact sheet to help answer questions about the new COVID-19 contact-tracing app. This fact sheet can be shared with patients. 
 

Resuscitation during COVID-19

The Australian Resuscitation Council has released updated FAQs about resuscitation during COVID-19, addressing requirements for personal protective equipment for responders.
 

NPS MedicineWise COVID-19 information hub

NPS MedicineWise is regularly reviewing the latest evidence regarding medicines, tests and treatments for COVID-19.
Summaries for health professionals and consumers are published to the hub regularly.
The hub also contains useful information about prescribing and taking medicines during this pandemic, as well as a new podcast for health professionals.
Access the hub
 

Managing diabetes during COVID-19

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.
 

Financial assistance for practices 

The RACGP Financial Assistance for Practices webpage provides a high-level summary of the Australian government’s stimulus package, Australian Tax Office administrative concessions, and changes to the Practice Incentives Program and Workforce Incentive Program in response to COVID-19. Some elements of this stimulus package will apply to general practices as small to medium businesses.
 

Patient alert posters 

• Patient alert poster - Coronavirus - A3 (v9 - Updated 15 April 2020)
• Patient alert poster - Coronavirus - A4 (v9 - Updated 15 April 2020)

Letter template for GPs crossing borders

Many GPs currently need to cross state/territory and regional borders to deliver essential healthcare services.

Use this letter template* to show evidence of your purpose of travel, to be exempt from current restrictions. GPs may complete and amend this template as necessary.
*Note: Accessing the template requires member login.

 

Letter for employers seeking staff medical clearances 

A number of employers are asking employees to provide medical clearances from COVID-19. An updated letter template is available to respond to such requests. Practices may amend this template to suit their situation. Please note there may be some exceptions as directed by your state/territory department of health.

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

Preparation and response resources

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