GP Communique – July 2020

Updates from Dr Roger Halliwell (Chair of GCPHN) and Dr Kat Mclean (Acting Chair of GPGC Board).

Dr Roger Halliwell Gold Coast Primary Health Network (GCPHN) Board Chair I have asked what GCPHN has done for primary health care through this challenging time. An early Board decision in February was to walk beside local primary care providers supporting the critical work needed in a time of crisis. This has been a significant piece of work and the team have been in contact with every general practice, every retail pharmacy, every residential aged care facility and and many allied health providers as all pivoted to  meet the new challenge. Some of this has been directly COVID-19 related including regular updates on the guidelines that sometimes changed daily, and the distribution of some personalised protective equipment (PPE). We have also provided direct support to individuals who have sometimes needed a more personalised approach.

The core business of GCPHN in coordinating clinical services for disadvantaged patients has also continued. With the office being closed and all staff working from home, it is reassuring to know that this has continued albeit with different modes of contact including telehealth.

The non-COVID-19 health care activities have been significantly disrupted through this time. And this has had an economic impact on small businesses that has challenged many. A deliberate strategy of messaging around the importance of “health care as usual” has been under way for several weeks now. We have engaged actively with the media to remind patients that primary care is still there, still committed to providing patient support, is a safe environment, and ultimately to get the non-COVID-19 health process back into gear.

We have also gone directly to patients with the distribution of a flyer to all households via a mail box drop, and supplies have been sent to all general practices and retail pharmacies. One side is about COVID-19, the other side is to remind patients that GPs are providing a
safe environment for ongoing care of their chronic diseases, their mental health, vaccination, cancer screening and proactive wellbeing advice. I was delighted to see a patient arrive at a respiratory clinic holding one of these, and she was planning to re-engage with her GP after the result of her test came through.

One of the big issues that we have faced is the prolonged shutdown of Outpatient Referrals for Cat 3 being returned to the referring doctor unprocessed. This was raised at our weekly SHECC (State Health Emergency Co-ordination Centre) Primary Care meeting and taken “up
the line” by Dr Carl de Wet. A series of meetings convened by Queensland Health quickly followed. Our concerns were acknowledged, action promised, and we have all seen the letter last week from John Wakefield on this subject. Further work is needed within our hospital and health service and we are told that all referrals were in fact retained on file and will process all into the system by the end of July.

Of course this does not automatically convert into an appointment, but we can be somewhat reassured that the management of these patients is shared in the mean time. It is estimated that it will take 12 months to “catch up” with out patient appointments. It will require some innovation around maintaining physical distancing, safe contact with patients, and a process that is robust in our new environment. The work with Queensland Health is ongoing in this space.

Where to from here? With our colleagues across many organisations we will continue to support primary care, to support individual health care professionals, to advocate for better outcomes for patients, and to strive for an improved World Class Health Care System. We will continue to walk with health professionals, and we hope the collaborative approach we have seen continues to best outcome.

Kind regards,
Dr Roger Halliwell

Dr Kat Mclean General Practice Gold Coast (GPGC) Acting Board Chair As I write this, worldwide COVID-19 cases continue to escalate, the interval between millions now less than a week. Locally however we have seen a coordinated response that has seen incredible collaboration and integration across our professional organisations. We are all in this together, and one of the silver linings is the ‘new’ way of our local professional organisations are working together. Behind the scenes representatives from GPGC, Gold Coast Primary Health Network (GCPHN), the Gold Coast Medical Association GCMA, the Gold Coast Hospital and Health Service and the Queensland State Health Emergency Coordination Centre have been meeting regularly. Twice weekly initially when cases were rising and information was rapidly changing, and fortnightly now as we enter a phase where it has been some time since we have seen community spread.

The feedback and questions from all of you as we have navigated this brave new world has been invaluable, and those in representative roles have been able to be fed issues back in a prompt manner, at both a regional and state level. It has been a privilege getting to know and working alongside all involved. Hard questions are sometimes asked however with shared values and a common goal navigating the way forward has been done in a respectful and collaborative way.

Being able to understand the ‘why’ behind some of the decisions has helped us all to understand the reasons behind decisions. It has also allowed the opportunity for constructive feedback to come directly from General Practice and be incorporated into the response. It is so important that General Practice is ‘at the table’ with any disaster management response. This is something the GPGC board continues to advocate for.

Communication can however always be improved and we are keen to hear back from GPs. What has worked? What can we do better?

To complement the Facebook group, the GPGC board are working on a new website. The aim being to create a resource that both local GPs and our hospital Doctors can use, and value. Specifically, we want to build a site that facilitates ‘horizontal’ referrals from GPs, to other local GPs. We have such a broad skillset within our Gold Coast and Tweed community and on many occasions we have GPs who have the skills to assist each other in managing patients. Areas we are looking to incorporate include; vasectomies, IUD insertions, antenatal shared care, breastfeeding support, iron infusions, medicinal cannabis prescribing, and skin cancer procedures. Horizontal referrals will enable a greater number of patients to be managed in the community. They will also facilitate the building of relationships between GPs and support the financial sustainability of practices. Covid19 will be with us for some time and our patients really are safer in the community.

As COVID-19 restrictions ease GPGC is looking to run some ‘in person’ events. Keep an eye out for the invitations.

Finally I would like to share the following poem with you all, it was recently written by Kylie Gibson (a practice manager). I know that many of you will relate to it.

Today, I watched a GP cry.
I stood at the doorway. Silent, watchful.
Waiting for my moment.
I saw the phone go down, the mumbled thank yous.
I watched.
Tears well. Frustrations spluttered.
Emotions swell like a flood.
Are you OK? I ask redundantly.
Not really.
Doors slammed. Patients lost.
Helplessness.
Hours lost. Sleep lost.
Frustration.
I’m sorry. I say. But I need you.
I watched.
They swallow their pain. Their anger. Fear of the inevitable.
What do you need, they ask.
More, I say. Always more.
I watched.
They gather their crumpled emotions.
They give.
Another patient. Another crisis. Another door-slam.
Another lifeline. Another hour. Another piece of them.
Thank you. I say.
What can I do? I say.
I know there is nothing.
Please eat. I say.
Just two more phone calls. They say.
I watched.
Amazed. Humbled. Grateful.
Today, I watched a GP at work.

Kind regards,
Dr Kat Mclean

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