Coronavirus (COVID-19) information for GPs

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.  Refer these patients to a local GP-led respiratory clinic or testing centre. Or ask your local public health unit 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 (V3 Published 10 September 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

Upon presentation of a person who is under quarantine or investigation, is a suspected or confirmed case of COVID-19 or has respiratory symptoms, current advice from the Department of Health (DoH) is to: 

• 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

As per advice from the Department of Health and as per swab collection infographic:

• 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 clinical flowcharts for:

• Management of adults with mild COVID-19 [Updated 24 September 2020]
• Management of adults with moderate to severe COVID-19 [Updated 24 September 2020]
• Management of people with COVID-19 who are older and living with frailty and/or cognitive impairment [Updated 10 September 2020]
• Management of people with COVID-19 who are receiving palliative care [Published 10 September 2020]

See all living guidelines.

The RACGP has develoved Home-care guidelines for adult patients with mild COVID-19 to help you support patients who test positive for COVID-19 in their home. A guide, action plan and symptom diary is available to share with patients.

Telehealth consultations requiring an interpreter:

The RACGP has released a guide to support GPs conduct telehealth consultations with patients requiring an interpreter. 

The Australian Government’s Translation and Interpreting Service (TIS) has a Doctor’s Priority Line, and as a GP you are eligible for a free TIS code. If not already registered, general practices can register by calling 1300 131 450 or by visiting the TIS website. 
 

Resources for GPs:

• Australian refugee health practice guide
• Guide for clinicians working with interpreters in healthcare settings
• Australian guidelines for the prevention and treatment of acute stress disorder, post-traumatic stress disorder and complex PTSD – chapter on the psychological care of traumatised refugees and asylum seekers
• Guide for clinicians working with interpreters in healthcare settings
• Generally Speaking podcast ­– episode on refugee and asylum seeker health

 

National multilingual resources:

 

• **NEW** Maridulu Budyari Gumal SPHERE – 36 multilingual fact sheets containing medical advice and instructions during COVID-19 covering Arthritis, Asthma, Cardiovascular Health, Diabetes and Stroke translated into Arabic, Chinese, Chinese (Standard and Simplified), Greek, Italian and Vietnamese
• Etholink Information in your language - translated information from federal, state, territory and local government and the World Health Organization
• SBS Coronavirus information in your language – news and information about COVID-19 in 63 languages
• Department of Home Affairs COVID-19 in your language – information on the current outbreak in multiple languages
• Department of Health Translated resources – fact sheets and posters on the current outbreak in multiple languages
• MyAus COVID-19 App – a multilingual resource for CALD communities on COVID-19 and available supports

 

State and territory multilingual resources:

New South Wales:

• Transcultural Mental Health Centre
• NSW Health

Queensland:

• Refugee Health Network Queensland
• Queensland Government

Victoria:

• Health Translations 
• Department of Health and Human Services (DHHS) 
• CoHealth

 

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

New guidelines for the rights of people with disability during COVID-19

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

 

NSW and Victoria NDIS participants can now claim for personal protective equipment (PPE)

Victoria and NSW NDIS participants can now recover the cost of purchasing PPE items if they receive an average of at least one hour a day of face-to-face daily living support. Previously, only participants who used PPE as a regular part of their support arrangements were able to access PPE through their NDIS funds.
Further information
 

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

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.

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 and includes:

• What needs to be considered to support someone to meet requirements of isolation and quarantine?
• What social and emotional wellbeing and mental health care/support is needed for health care workers (HCWs) in the context of COVID-19?
• How do health care workers minimise their risk of acquiring infection and of spreading infection between patients while physically examining a patient with respiratory symptoms?
• COVID-19 in Aboriginal and Torres Strait Islander children with chronic suppurative lung disease (CSLD) - Guidance for primary care
• What quarantine measures are required for healthcare workers travelling to remote communities?
• What quarantine measures are required for healthcare workers travelling from higher prevalence areas to low prevalence areas?
• What is best practice when transporting patients who do not have confirmed or probable SARS-CoV-2:
  • without fever or respiratory symptoms?
  • with fever or respiratory symptoms?

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

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.
 

 

 

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

This new online e-mental health hub, developed by the Black Dog Institute, connects frontline healthcare workers with services to cope with the stress of the ongoing pandemic.   
 

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).
 

Immediate 24/7 supports

Beyond Blue Support Service - 1300 22 4636
Lifeline Crisis Support - 13 11 14
 

 

Providing mental health and wellbeing support to your patients

 

GPs play a critical role in the ongoing mental health and wellness of their patients. 

The General Practice Mental Health Standards Collaboration (GPMHSC) has collated important information to help you support and care for the mental health and wellbeing of your patients during the COVID-19 pandemic.

This includes:
Mental health resources - resources, factsheets and guides. 
Telehealth consultations - information on the new MBS item numbers for the provision of telehealth (videoconferencing and phone) consultations by GPs with and without mental health training.

New MBS items for additional psychological therapy sessions

Thirty-six new temporary mental health treatment Medicare Benefits Schedule (MBS) items have been introduced, which provide 10 additional Medicare-subsidised psychological therapy sessions for people affected by COVID-19.
The new items are available under the ‘Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS’ initiative and will apply from 7 August 2020 to 31 March 2021. The additional sessions will allow eligible patients to continue to receive mental healthcare from their GP, psychologist or other eligible allied health worker.

The 10 additional sessions are available to:

• patients in areas with public health orders that restrict movement within the state or territory at any time from 1 July 2020 to 31 March 2021 (eg lockdown or stay-at-home orders)

• patients required to self-isolate or quarantine under public health orders for at least 14 days.

Find more information on the RACGP website, including descriptors and rebates for the six new items that support mental healthcare provided by GPs.
 

Completing Mental Health Skills Training (MHST)

Accredited MHST activities provide GPs with the skills and knowledge to assess, treat, plan and review mental health issues commonly presenting in general practice. Upon successful completion of MHST, GPs should be able to develop and review a GP Mental Health Treatment Plan (MHTP).

GPs can complete MHST by completing one of the following pathways:

• MHST primary pathway, or;
• MHST modular pathway.

The MHST primary pathway is a six-hour (at minimum) activity that can be completed online or face-to-face. It is designed for general practice registrars and other medical practitioners entering Australian general practice.

To satisfy the requirements of the MHST modular pathway, GPs must complete one Core Module (usually three hours) and one Clinical Enhancement Module (usually four hours). The MHST modular pathway is designed for more experienced GPs who assess, treat and manage complex mental health issues in their practices.

For additional information on the specific requirements for MHST pathways, download the Mental health training standards 2020–22: A guide for GPs.

View accredited MHST (primary pathway) courses
View accredited MHST (modular pathway) courses

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.

Completing Focussed Psychological Strategies Skills Training (FSS ST)

Completing an accredited FPS ST course and registering with Medicare as a GP provider of FPS, allows GPs to deliver evidence-based psychological interventions to their communities and important where shortages or lack of access to psychologists and psychiatrists exist, particularly in rural and remote settings.

1. Complete an accredited MHST course
2. Complete an accredited FPS ST course
3. Complete application to register as a GP provider of FPS with Medicare Australia and attach certificate of completion to gpmhsc@racgp.org.au.

The GPMHSC Secretariat will forward your application to Medicare Australia. Medicare will confirm your eligibility to access MBS items 2721–2727 (or non-VR equivalent; 283–287). Please note: you cannot claim against these item numbers until you receive this letter. 

 

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.

RACGP COVID-19 resources

You can now find all RACGP COVID-19 resources in one centralised location on the RACGP website. These resources cover:

• Telehealth 
• ​Infection control
• Resources for patients
• ​Clinical care
• Advocacy and finance 

 

National webinars

The RACGP, along with a number of other organisations, are delivering webinars to support you in responding to COVID-19 and the transition to new workflows. See your local RACGP Faculty webpage for additional webinars specific to your state/territory.
 

Webinar	Date	Time	Host	Registration
COVID-19 and child mental health	Available on demand now	Available on demand now	RACGP Specific Interests	View now
Business resilience and continuity during COVID-19	Available on demand now	Available on demand now	RACGP National	View now
GP Practice Owners: Managing your workforce in a changing environment	Available on demand now	Available on demand now	RACGP National	View now
GP Practice owners: Understanding a pathology rental reduction request	Available on demand now	Available on demand now	RACGP WA	View now
Practice owner’s webinar: Navigating a rent reduction –  does ScoMo’s Code apply to me?	Available on demand now	Available on demand now	RACGP WA	View now
Phone and video consultations: a how-to presentation	Available on demand now	Available on demand now	RACGP Practice Technology and Management	View now

 

The John Murtagh Library: COVID-19 evidence and research resources

The John Murtagh Library has curated some resources on COVID-19 to help you find reliable evidence and research literature. These resources include evidence summaries, updated ebooks and texts, ‘live’ literature search links, research portals, and more.  

Access the library's COVID-19 subject portal

Infection-control training

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

See RACGP COVID-19 infection control resources. 
 

Prescribing and dispensing medicines using telehealth

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. 
 

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. 
 

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
 

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.