GPs in New South Wales have been left scrambling less than a week before Christmas after the state health department told them they will now be responsible for the management of Covid patients in the community.
On Friday NSW Health informed GPs through the state's 10 primary health networks that there is a new state-wide approach for the management of low-risk Covid-positive patients, effective immediately. It comes as NSW Covid cases spiral with a record 3,763 new infections on Wednesday.
Each region of NSW is managed by a different primary health network, which collaborate with general practitioners and other health professionals to support and manage the health workforce, and to provide care to patients in that region.
A directive sent to health workers from the Nepean Blue Mountains primary health network said low-risk Covid-19 patients "will be 'self-managed' and will receive information via SMS from NSW Health about managing any mild symptoms".
"NSW Health has announced that from today there will be a new state-wide approach for the management of low-risk Covid-19 positive patients," the statement said.
"Patients who have been identified to self-manage at home will be advised to contact their GP or a dedicated Covid-19 service for an initial assessment and continued care."
"Patients who are self-managed will require a GP to complete their de-isolation."
De-isolation means permission to leave isolation, which requires medical clearance for people with confirmed Covid-19, including for the those who are fully vaccinated.
A separate letter signed by the NSW chief health officer Dr Kerry Chant and sent to GPs, also seen by Guardian Australia, said: "We now face a significant challenge with rapidly increasing Covid-19 case numbers related to circulation of the Omicron variant".
"It is anticipated that contacting and managing all positive cases by telephone will become more difficult," Chant wrote. "I would therefore like to take this opportunity to advise you that we are making some changes to the way we manage Covid-19 cases in the community."NSW Health will still screen all Covid-19 cases for certain risk factors and escalate those with known higher risk for increased support, but cases that meet the criteria for low-risk will be advised to undertake self-care at home in the first instance, she wrote.
An urgent meeting was held on Tuesday night by the health network with GPs who are distressed about how to manage Covid patients at such short notice. One Sydney clinician told Guardian Australia that while GPs knew such a move was on the cards, they assumed the government would give them more notice before implementing it, along with additional support and resources.
"We were told the week before Christmas, when already many staff are already on leave, with no planning and no protocols in place," she said. "An urgent meeting is being held so we can be informed how the hell we are supposed to manage this."
Low-risk patients in NSW are considered to be those aged three months to 50 years old, those who have received two or more doses of an approved Covid-19 vaccine, those who are not identified as Aboriginal or Torres Strait Islanders, who are not pregnant, and do not have any specified chronic conditions are deemed at low risk of hospitalisation.
The president of the NSW branch of the Australian Medical Association, Dr Danielle McMullen, who is a GP, said most of the low-risk patients would have minimal symptoms.
McMullen said she was shocked there was no additional funding offered to GP practices. "We need more flexible funding offered to general practices so they can field the calls that will come and have them handled by the most appropriate staff member," she said.
"So that might be funding for more reception staff or clinic nurses. But those staff, and GPs, are exhausted, broken and were looking forward to trying to get a bit of a break. This additional work has come on top of ramping up boosters and managing vaccinations including for children.
"We are all feeling the pinch of these increased Covid numbers and it's not easy for anyone in health. But general practice has been thrown this at the last minute and we were not expecting it to come the week before Christmas.
GP Jane Basden told Guardian Australia that there was an expectation that GPs now hold a telehealth consult on the day the Covid patient contacts their doctor. She said doctors felt Chant understood the pressures, even if they felt premier Dominic Perrottet did not.
"What I am feeling - and what I'm hearing from many of my colleagues - is that this is a move Dr Kerry Chant and NSW health have virtually been forced into making as case numbers in NSW rise out of control," she said.
"We are so angry at the politicians who are 'letting this rip' - as if the only sign of a health system and health workers being under incredible strain is the number of ICU beds being filled.
"Every one of the thousands of new Covid cases per day is a person who needs a long, same day appointment either with already stretched 'Hospital In The Home' services, or now with already stretched GP practices. It's not like GPs have been twiddling our thumbs for the last 21 months. Just about every health and government announcement has ended with 'talk to your GP'.
The president of the Royal Australian College of General Practitioners, Dr Karen Price, said there is no need for undue alarm and that the changes "were necessary and a sensible move as cases rise.
"My message for all NSW GPs, practice managers, nurses, receptionists and admin workers is keep up the great work," she said.
"I know it's been the most trying of years and your communities have never needed your more".
