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Chapter 1: Current and emerging issues

1.4 An issue in focus: pandemic response

The Australian governments’ combined response to the COVID-19 pandemic has yielded mostly positive results to date. Australia performed well in comparison to other similar countries around the world, successfully limiting the spread of COVID-19 and flattening the infection curve early in the pandemic. A combination of early case identification, physical distancing, public health measures and a reduction in international travel slowed the spread of the disease in Australia.16

GPs rapidly shifted care away from face-to-face visits and embraced telehealth, demonstrating the adaptability of general practice in the face of challenging situations. Telehealth helped to ensure the safety of patients and general practice staff and undoubtedly saved many lives. Australia’s confirmed deaths due to COVID-19 is just 35 per million population, compared to other developed countries with rates of 100–600 per million population, or higher.§,,17

While the governments’ actions allowed time for health services to prepare and build capacity, later outbreaks in Victoria and the aged care sector revealed faults and limitations in the response.

The Royal Commission into Aged Care Quality and Safety hearing was told on 10 August 2020 that Australia’s coronavirus aged care death rate is among the highest in the world, with 68% of COVID-related deaths in Australia occurring in nursing homes.18

The response to COVID-19 in the Aboriginal and Torres Strait Islander health sector was successful. More than four in 10 Aboriginal and Torres Strait Islander people have at least one chronic health condition which poses a significant health problem.19 High rates of chronic health issues are a risk factor for COVID-19 mortality.20 Aboriginal and Torres Strait Islander people are also 16 times more likely to be living in an overcrowded house than non-Indigenous Australians,21 making physical distancing measures difficult to implement.

Decisive action was taken to reduce the impact of COVID-19 on remote Aboriginal communities, including community closures and designated biosecurity (travel restricted) areas across Australia. Aboriginal-led health services ensured that public health messages were communicated to communities in their local languages and in a culturally appropriate way. These actions resulted in this part of the population avoiding significant impact of COVID-19, with only 148 confirmed cases. Only one case among Aboriginal and Torres Strait Islander people was notified from remote or very remote areas of Australia.,22

These outcomes contrast with Indigenous communities in other countries; for example, the Navajo nation had the highest infection rate per capita in the United States at 2304.41 cases of COVID-19 per 100,000 people in June 2020.23

1.4.1 GP views of government responses

Survey responses showed a range of opinions among GPs about the Australian governments’ responses to the pandemic. Many GPs are supportive of the federal government’s response, with one in two ranking the response as ‘good’ or ‘very good’ for ensuring the safety of GPs and general practice teams (Figure 6).

Free text responses highlight that GPs are grateful to have the option to bill a Medicare item for phone and video consultations, work which had previously been unpaid, and that the increased bulk-billing incentive had been instrumental in allowing them to continue to provide care to patients during the pandemic.24 In the midst of a pandemic, the need for telehealth was recognised quickly, and the government provided funding to support this model of care.

In the midst of a pandemic, the need for telehealth was recognised quickly, and the government
provided funding to support this model of care

Figure 6. GPs view the federal government’s COVID-19 response favourably for ensuring the safety of general practice teams*

GPs view the federal government’s COVID-19 response favourably for ensuring the safety of general practice teams

*Due to rounding, figures do not add up to 100%
Measure: GP responses to the question ‘How would you rate the federal government’s pandemic response for ensuring the safety of GPs and general practice teams?’
Base: Responses to survey question, n = 1782
Source: EY Sweeney, RACGP GP Survey, May 2020.

However, the pandemic has had a significant impact on the viability of general practices and the ability of GPs to provide holistic care to their patients. GPs report that more could have been done – both in the early stages of the pandemic and as it progressed – to involve GPs in pandemic planning and to support GPs in their role as frontline healthcare workers.

One of the greatest challenges GPs report during the pandemic is access to PPE

One of the greatest challenges facing general practice during the pandemic is access to appropriate personal protective equipment (PPE) (Figure 8).

Eight out of 10 GPs thought both the federal and state governments needed to do more to provide practices with PPE (Figure 7).

Figure 7. GPs want government help to source personal protective equipment during the pandemic*

GPs want the governments’ help to source personal protective equipment during the pandemic

*Due to rounding, figures do not add up to 100%
Measure: GP responses to the question ‘Below is a list of groups who can be seen to be responsible for providing practices with personal protective equipment (PPE) during a public health emergency. For each group please indicate how you feel they are currently acting in ensuring PPE is available to practices.’
Base: Responses to survey question, n = 1782
Source: EY Sweeney, RACGP GP Survey, May 2020.

1.4.2 Challenges faced by GPs during the pandemic

COVID-19 created many challenges for GPs and the delivery of general practice services, from changes in patient presentation patterns; impacts on GPs’ personal wellbeing; financial, employment and business impacts; to the need to rapidly adapt to new models of care. These matters are discussed throughout the report.

Inability to provide usual care to patients

The most cited challenge for GPs during the COVID-19 pandemic is their inability to provide usual care to patients, with one in two (52%) indicating this as one of their top three challenges (Figure 8). This is likely due to a combination of the challenges inherent in a non–face-to-face model of care (discussed further in section 2.3), combined with the decreased number of patients presenting for usual care when they were being encouraged to isolate at home (Figure 9).

In 2019–20, 87.4% of Australians visited a GP – the lowest rate since 2014–15.1

GPs who work in Aboriginal Medical Services are more likely to cite inability to provide usual care to patients as one of their top three challenges (67%).5

Total MBS claims for chronic disease management items, such as care plans, fell dramatically at the start of the pandemic, despite the creation of telehealth equivalents (refer to section 2.3 for further discussion).

GP chronic disease management items (provided both face-to-face and via telehealth) claimed in April 2020 fell by 15% from the previous month, and by 4% from the same period in 2019 (Figure 9).

Figure 8. An inability to provide usual care, and access to personal protective equipment, are the top challenges for GPs during COVID-19*

An inability to provide usual care, and access to personal protective equipment, are the top challenges for GPs during COVID-1

*Where data labels are not included, data represents less than 5%
Measure: GP responses to the question ‘What challenges are you experiencing which impact your ability to provide care to patients as a result of COVID-19?’
Base: Responses to survey question, n = 1782
Source: EY Sweeney, RACGP GP Survey, May 2020.

Consultation types that did not have telehealth equivalents saw the most dramatic decreases at the start of the pandemic. Claims for GP health assessments in April fell by 46% from the previous month, and by 43% compared to the same period in 2019. Minor procedure items fell by 29% from the previous month, and by 25% compared to the same period in 2019 (Figure 9).

The picture began to normalise from May 2020. Chronic disease management items, women’s health, and health assessments all saw increases, although the number of presentations across all categories remained lower than in the same month in 2019. Minor procedure items saw the smallest recovery in number of presentations (Figure 9).

Figure 9. MBS data shows the impact of the pandemic on GPs’ ability to provide usual care

MBS data shows the impact of the pandemic on GPs’ ability to provide usual care
Measure: GP chronic disease management items (MBS items 721, 723, 732, 729, 731, along with their COVID-19 telephone and video equivalents)
GP health assessment items (MBS items 701, 703, 705, 707, 715 and 699)
Minor procedure items (MBS items 30071, 30072, 30192, 30196, 30202, 30064, 30061, 30219, 41500, 30026, 30032, 30029, 30035, 47904, 47915, 47916, 32147, 32072 and 30003)
Women’s health items (MBS items 73806, 16500, 16591, 14206, 30062 and 35503)
Billed in April 2019, May 2019, June 2019, March 2020, April 2020, May 2020, June 2020
Data source: Services Australia. MBS item statistics reports [Accessed 15 August 2020].

More than one in two patients surveyed by the Continuity of Care Collaboration reported that they had delayed or avoided a medical appointment in the three months leading up to May 2020.25 Reasons for avoiding regular health checks included concerns about taking public transport to the practice, difficulty using telehealth, and concerns they might be breaking lockdown rules.25 Patients also reported that they were worried about their own safety (90%), ie through coming into contact with people with COVID-19 when visiting their doctor, and that they thought health services might be too busy to see them for routine care (36%).25

Access to personal protective equipment

The second most commonly cited challenge, by 48% of GPs, is difficulty accessing adequate PPE including masks, gloves, eye protection and gowns (Figure 8).

Healthcare workers rely on PPE to protect themselves and their patients from being infected and infecting others. Supply chain disruptions caused by increased global demand for PPE, and some instances of panic buying or misuse, meant GPs were not always able to obtain adequate supplies of PPE through normal distribution channels. Prices surged to privately purchase PPE, causing increased financial pressure on practices.26 Although masks were distributed to practices through Primary Health Networks, supplies were initially sporadic, and gowns and other PPE were not supplied.

One study indicated that 30% of healthcare workers resorted to using non-traditional or non-vetted forms of PPE, and 70% of healthcare workers needed to ration their use of PPE.27

In Victoria during the month of August, an average number of 33.7 new cases among healthcare workers were diagnosed each day. At least 69% of all healthcare workers who were infected with COVID-19 acquired it in the workplace, including hospitals, aged care services, and general practice.28

Other challenges

By the end of July, there had been seven waves of Medicare reform related to telehealth item numbers. One in three GPs report that constantly changing messaging around new Medicare telehealth item number usage (33%), and COVID-19 testing criteria (29%), were significant stressors at the start of the pandemic. Financial pressure, complying with social distancing rules, and own wellbeing are ranked similarly highly as challenges which impact on GPs’ ability to provide care (Figure 8).

GPs who work in Aboriginal Medical Services are more likely to cite difficulty complying with social distancing rules as one of their top three challenges (43%) compared to GPs working in other locations (29%).5

GPs also report that obtaining enough stock to supply flu vaccinations for their patients was a significant challenge, despite advice issued to the public that it was imperative to get vaccinated earlier this year. In a poll of over 1000 RACGP members in late April 2020, 54% reported they were unable to access enough stock to provide influenza vaccinations to their patients.29

It is more important than ever that GPs are able to provide continuity of care for patients with
chronic diseases

© 2021 The Royal Australian College of General Practitioners (RACGP) ABN 34 000 223 807