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TranscriptDepartment of HealthCoronavirus (COVID-19) Response Update –General Practitioners Thursday, 7 May 2020 – 11:30amPresented by:Professor Michael Kidd AM (Host)Deputy Chief Medical Officer, Department of HealthDr James Ayres General Practitioner, Lakeview Medical Practice, CanberraDr Jenny FirmanDeputy Chief Medical Officer and Chief Health Officer, Department of Veterans’ Affairs[Opening visual of slide with text saying ‘CORONAVIRUS (COVID-19)’, ‘UPDATE FOR GPs’][The visuals during this webinar are of each speaker presenting from table and speaking to camera]Professor Michael Kidd AM:Good morning, and welcome to this weekly webinar for Australia’s general practitioners where we talk about what’s happening in our response to the COVID-19 pandemic. My name is Professor Michael Kidd, and I’m Deputy Chief Medical Officer here at the Department of Health in Canberra. I’m joined today by Dr James Ayres, who’s a general practitioner working at the Lakeview Medical Practice here in Canberra. Welcome James.Dr James Ayres:Thank you.Professor Michael Kidd AM:And also again, as always, by Dr Jenny Firman, who is also Deputy Chief Medical Officer here at the Department of Health. Welcome Jenny.Dr Jenny Firman:Thanks Michael.Professor Michael Kidd AM:I start by acknowledging the traditional owners of the lands where we are all meeting today, and pay my respects to Elders past and present, including to any Elders who may be joining us on this webinar.As always, this webinar has live captions available. If you’d like to turn on the live captions, please click on the link on the web page that you’re looking at now. As always, we welcome your comments and your questions, so please start entering your comments or your questions now, and after we’ve provided a brief update on some of the things which have been happening this week, we’ll come to your comments and your questions.First I’m very pleased to advise that the Minister of Health, the Honourable Greg Hunt, has today announced a new resource to support health care workers across Australia to support our mental health. This resource which has been developed by the Black Dog Institute in partnership with other organisations, provides phone support, online support, and also an app which will enable health care workers to get fast and easy access to specialist advice and care. Please, if you’re experiencing distress or if you feel it would be helpful to reach out and connect with a counsellor, please go to the Black Dog Institute website and have a look at the resources which are available to you from today.In addition, the government has provided funding for Smiling Mind, which is a resource for health care workers offering meditation programs and mindfulness guidance. This is a resource which is also available to our patients, but through the government, health care workers can have free access to the premium app of the Smiling Mind program.Finally, Beyond Blue continues to have its dedicated Coronavirus mental wellbeing support lines, and that’s available 24/7 to anyone in the country, including to us as health care workers. We’ve spoken many times over the past few weeks about the importance of looking after our own mental health at this very challenging time. So please, if you feel the need to, please use these resources. They are there to support you and enable you to continue to provide the great care that you’re providing to your patients every day.An update on telehealth. As of today, more than 7.7 million telehealth consultations have occurred between Australians and their chosen health care providers. And this has been since the 13th of March this year. Many of you have been asking for additional guidance on telehealth, and in particular on privacy and security aspects of using telehealth in your practice. The Department of Health has published a new checklist which is available on the MBS Online website, and a link to this page is provided in the resources section on the web page that you’re viewing now. This checklist is to assist you in making sure that you’re complying with your privacy obligations when delivering telehealth services to your patients.I want to say thank you to everybody who’s embraced telehealth. As we’ve mentioned in the past on these webinars, this is one of the biggest changes that we’ve seen in the model of delivery of care of general practice to our patients since the introduction of Medicare many years ago.The third item I want to update you on is the COVIDSafe app, which has now been downloaded by more than 5.2 million Australians, and we ask for your support in continuing to grow the number of people who are using the app. Clearly the app is going to be most effective with more and more people using it, having it downloaded on their phone and running on their phone while they’re moving around in the community. And of course that includes for each of us in the work that we’re doing in our engagement with our patients, with our staff, and with the work that we’re doing in the wider community as well.So please support the COVIDSafe app, and please encourage your patients and your staff to be downloading this as well. It helps to protect your health, the health of your loved ones, and the health of our wider community.Jenny, can you give us an update on what’s been happening with PPE access in general practice? Dr Jenny Firman:Thanks Michael. And there’s been more than ten million masks that have been dispatched in the last week, so clearly we’re getting lots more stocks in and it’s being sent out. And there’s also been a number of gloves and gowns dispatched this week as well. And of course those masks support frontline health care workers looking at working in the public hospital system, primary health, allied health and the aged care sector. And GPs, community pharmacies, Aboriginal controlled health organisations should contact the PHN if they need some masks and get supplied there.I was just going to go on and talk about testing, because that’s been changed too. In the last week, the National Cabinet agreed to expand the testing criteria to all people with any symptoms of COVID-19. So in the past, people had to have symptoms and the right exposure. Now you just have any symptoms, we’d like those people to be tested. So we’re really expanding that testing. Because as our numbers are very low, it’s really important to make sure we’re not missing anybody. So we need to test, test, test, and in particular test those people with symptoms. Because of all the people we could test, they’ll be the ones most likely to be having COVID-19.Professor Michael Kidd AM:Thanks Jenny. And I’ve noticed a number of people have been reaching out to me and saying ‘Look, I’ve got a bit of a sniffle or a bit of a sore throat. I think it’s probably just a cold. Do you think it’s worth getting a COVID-19 test?’ Dr Jenny Firman:And right now, yes please. We really want to know that there’s no COVID-19 out in the community that we’re missing. So it’s really important that everybody gets tested. Absolutely.Professor Michael Kidd AM:And please, that applies to everybody who’s watching, to your family members, as well of course as to your patients. Everyone with any symptoms, no matter how mild, please arrange a test.I also wanted to provide a brief update on what’s happening with the general practice led respiratory clinics across the country. The Australian Government has provided funding and support for, to date, 77 general practice respiratory clinics which have opened in metropolitan and rural areas right across the country. And very pleased that we’re joined today by James who has taken the role in leading and working in one of these clinics which has opened this week here in Canberra. We’ve also this week seen the opening of the first GP led respiratory clinic being run by an Aboriginal community controlled health service up in Toowoomba, and that service is providing great support to their patients who are able to attend and be tested and treated for COVID-19.And I’d like to make a call out and say thank you to all the general practitioners and all the people working in the GP respiratory clinics right across Australia for providing these targeted centres for doing testing and treatment, and also a big thanks to our primary health networks, our PHNs, who’ve been working very hard to get these clinics up and running in each of the regions that they’re responsible for across the country. It’s been very rapid, and what we’re hoping, is over the next week we’ll actually move from 77 of these clinics to 100 clinics, as I say, distributed right across the country.So James, I wonder if you can share with us firstly as a GP, how’s your work been impacted during the pandemic? Dr James Ayres:Yeah. Thank you Michael. I think the first thing to say is change has been quite uncomfortable for people, particularly patients and doctors, and what we thought might happen compared to what is actually happening is perhaps very different. So we’ve pivoted from predominantly face to face appointments to now 90-95% telehealth. So basically dealing with everything we can over the phone. It does present some problems, and what we’ve found now is as we’ve increased our infection control and developed measures to protect the staff and protect the patients, we’ve now got an environment in which we can start bringing patients back in. And I think that’s really important as well, so that the normal health care doesn’t get forgotten. Over the telephone you can do quite a lot, but there’s certain things you just need to see in person. And having that safe environment to do that has been really important. On top of that, with the respiratory clinics as well and the help from the PHN and the government, it’s allowed us a facility in which we can actually provide a service to the community both through information, testing and assessment, allowing safe management of patients, providing the data for swabbing the patients, but still running the normal general practice clinic as well. So very important. Professor Michael Kidd AM:And how are you and your staff finding this first week where you’re working in the respiratory clinic and running this new service for your community?Dr James Ayres:Yeah. It’s been interesting actually. The team’s gelled together really nicely, and we’ve found people really stepping up. We were quite lucky. The turnaround has been very quick from initiation to implementation of the respiratory clinics, and I don’t think that would have been possible without the support from the DOH and the PHN. So they’ve thought about this quite well, and so implementing it has gone very, very smoothly, and I think that’s built the confidence and helped the team to function.Now that we’re open on day three and people are seeing how things work, we’ve got quite a good flow for the patients. We’ve got a good follow up. And I think the staff are settling in really well, mainly because they feel safe and protected. We’ve got clear leadership and clear defined areas of work, and it just helps them to get on with the day to day things without having to worry too much.Professor Michael Kidd AM:And have you brought in additional staff to work with you now that you’re running both services?Dr James Ayres:So we’re quite lucky that we run over three sites, so we’ve been able to implement the staff that already work for us. We’ve utilised our casual staff, and some of the more experienced ones have stepped up to take the lead in terms of training. But so far no, but the idea is if we have to scale up – we can see up to about 250 patients a day from a COVID swabbing point of view, as well as maintaining the general practice. So we will look to implement other staff if we need to. Professor Michael Kidd AM:And some of the respiratory clinics across the country are actually swabbing now everybody who attends, not just people who we feel there may be a diagnosis of COVID-19. What’s the approach that you’re taking in your clinic?Dr James Ayres:So our approach is a little bit more in line with the ACT Department of Health. So we would only swab people that meet the criteria. We’re aware that that’s changing all the time. What we do though is provide follow up, either with the patient’s usual GP or advice at the time if needed to treat other symptoms that don’t quite meet the criteria. So although we appreciate that the more people we swab the better the quality of the data, we’re aware that there are still some limitations in place at the moment. So only people that meet the respiratory components for COVID.Professor Michael Kidd AM:Great. Well thanks. Thanks James. So we’ll go to your comments and questions now. So please keep sending your questions in. And Jenny, I think this first one might be for you, because it’s about PPE.Q:Should we as general practitioners be gowning and gloving and masking for all patients coming in during winter with non-specific viral URTI symptoms?Dr Jenny Firman:Well I think you do have to remember at the moment there’s in fact not much viral respiratory illness around, apart from COVID-19. We know from all our surveillance that in fact the rates of influenza in the community are much lower. We know that other respiratory illnesses are lower. So I think if you’re seeing someone who’s coming in with respiratory symptoms, you’ve got to think they may have COVID-19, in which case yes, you should wear the most appropriate PPE. Professor Michael Kidd AM:Thanks Jenny. And what are you doing James? What’s your practical approach?Dr James Ayres:So we’ve sort of taken it as dividing the practice into three zones, so red, amber and green. And we plan for worst case scenario. So I think as Jenny said, if you look at worst case scenario, which there is COVID present, we just don’t know about it, then the risks to the patient and the risks to the general practitioners far outweigh any benefits of say not wearing the PPE gear. So I think you have to think very, very carefully about yourselves as general practitioners and your own risk to yourself, your families and your patients. So any face to face contact that puts you next to the patient for more than 15 minutes, we’re basically setting up and telling all the other general practitioners that you need to be in full PPE gear and in the correct environment.We can always scale back, but I think if you protect yourself from the worst case scenario. Because we’ve got to remember that we won’t have real time data on the COVID. It takes at least two days to get the testing. But if you’ve set your infection control standards correctly, then you’ll always be protected and you won’t have to have that conversation again.Professor Michael Kidd AM:Thank you. The next question is about some of the fever clinics, the respiratory clinics, not the GP led ones, but ones run through the states and territories, are just a testing facility rather than assessing and managing people with respiratory symptoms. And don’t we want to keep these people out of the ED and keep our general practices safe. So your clinic, you’re assessing people, but you’re also managing them aren’t you?Dr James Ayres:That’s correct. So anybody that comes through the door will be seen by the medical team. So GP led with experienced nurse support. So we won’t just swab. We’ll actually fully assess and manage anything that’s appropriate, so your asthmas, your pneumonias, and in fact anything else. If we can’t manage at the time, we refer back to the usual GP, and if the patient doesn’t have a GP, we’ll arrange for them to be seen in one of the clinics. But really important that we don’t just swab, that we actually acknowledge what’s coming through the door and treat the patient in front of us.Professor Michael Kidd AM:And obviously not just testing means that those people are then not having to go to an emergency department or not having to go to another general practice for further management.Dr James Ayres:Yeah. Absolutely. A lot of patients can be a bit worried, either getting face to face appointments, or GPs might not be offering face to face. So rather than letting health suffer, they have to have an environment in which they can be seen and assessed. Professor Michael Kidd AM:Thank you. There’s a question around self-collection for COVID-19. So in past webinars we’ve mentioned self-collection is okay if people are instructed well and observed while they’re doing the collection. Q:Has the advice changed on this, and are there any resources or documents available to explain how this might work and guide general practitioners?I know there’s a lot of discussion around self-collection both here in Australia and overseas Jenny, and there’s some places where people are actually being posted out or delivered out the swabs. But of course it can be very difficult to do the swab appropriately on yourself rather than have someone else do it.Dr Jenny Firman:And I think that’s why in the recommendations from our public health laboratory networks, so our expert pathologists, they’ve explicitly addressed self-collection and said that can be useful, and they’ve done some validation studies to understand how accurate self-collection is versus the usual collection of the swabs. And certainly they’ve seen comparative results, but it does require medical supervision. So it requires someone to actually supervise the person while they’re doing the test, and then you get the best results. You can imagine if you’re doing it on your own and you’ve never been shown, that your self-collection may not be quite as rigorous as one would like. So absolutely, having it medically supervised is really important I think.Professor Michael Kidd AM:Thank you. The next question might be one that we’ve got to take on notice and share an answer with you, which is asking if there’s consideration for adding home medication reviews to the list of telehealth items which are available. And I think we need to check that one out. Jenny, you don’t have an answer to that one?Dr Jenny Firman:I can’t answer that one.Professor Michael Kidd AM:Off the top of your head? So we’ll look at that and check with the MBS group within the Department of Health and we’ll post a response to that question on the website.Next question is about My Health Record.Q:Are the results of testing for COVID-19 being entered into the patient’s My Health Record?And I guess that in part may depend on who is actually doing the test. So James, if you’re doing a test on a patient of your practice, would that be going in to their My Health Record if they’re registered and signed up. Dr James Ayres:If they’re registered and signed up. The results that we get are through Capital Pathology. You can use any provider. So a bit like a normal blood result. They’ll be downloaded into your practice management software, which is Best Practice for us, and then allocated to the patient. So if they are signed up, the results should automatically flow through once they’ve been acknowledged by the treating doctor.Professor Michael Kidd AM:But I guess if one of your patients goes to another testing centre, that may not necessarily flow through?Dr James Ayres:No. Correct. So there’s a universal app from the government that everybody logs on for the testing, it doesn’t yet link in with the existing software. So I think that they’d have to follow up by getting their usual GP, as we normally do, to send through a treatment plan and a result.Professor Michael Kidd AM:Great. Thank you. The next question is:Q:Could there be consensus as to the visiting arrangements to residential aged care facilities? Each residential aged care facility this doctor goes to has different guidelines for doctors, and also has different guidelines for family members being able to attend the residential aged care facility. So Jenny, this has been a challenge, and we have had reports of some residential aged care facilities actually blocking the regular GP from attending, which of course shouldn’t be happening. The GPs should be able to attend and provide care to the residents who are their regular patients. And we have seen some differences between different facilities haven’t we around the country?Dr Jenny Firman:And look, I think it would be great if we can achieve consensus. There will of course be some differences in different facilities, depending on the local epidemiology as well. If you’re a facility in the midst of an area where there’s an outbreak going on, you’re probably going to have much tighter guidance on who can visit, when and how than if you’re in an area where there’s been very low or no cases. But where possible, we’d like everybody to follow similar guidance on visiting.Professor Michael Kidd AM:James, is your practice looking after people in residential aged care?Dr James Ayres:Yeah. We do. It’s dropped off a little bit over the last month, and we’re looking how to reimplement that, I think for the reasons you mentioned, which is there’s no consensus as to how to go about it. So when the COVID cases were quite prominent, you’d rock up to a nursing home and there wasn’t really a protocol in place as to how you’d get to see a patient. So we work in with the nursing homes, but having a universal standard is quite difficult, because as you mentioned, the areas that they are in, there’s different rates of COVID. So it’s a challenge.Professor Michael Kidd AM:Well I have to say that the residential aged care facilities across the country have been doing a marvellous job looking after the very vulnerable people who are in their care, and we have had some outbreaks, but we’ve also had incredible support from residential aged care. And of course we do have many of the facilities who are facilitating the use of telehealth between GPs and the residents as well where that’s appropriate. Have you been using telehealth at all in residential aged care?Dr James Ayres:Not so much in the residential aged care, because I think you can communicate with the staff, but obviously some of the patients have different challenges where you need to be face to face. But yeah, the option is there, it’s just it hasn’t been prominent for our practice.Professor Michael Kidd AM:So Jenny, a question about more wide spread testing.Q:With significant numbers of people who are asymptomatic or presymptomatic with COVID-19 infection, what’s the thinking about widening the testing across the community?I know that over the past week we’ve seen, in the state of Victoria for example, a real focus on doing a lot more testing in community sites and some random testing of people in the community, as well as targeting testing of particular groups. Where are we going with this expanded testing? Dr Jenny Firman:And if we look at what’s happening in Victoria with their much broader testing – they were having a real testing drive for a fortnight – fortunately they’re finding very few positives in asymptomatic people, which is as we’d expect. And if you think about it, if you’re testing a very big population, you will find a few, but you might find a few false positives as well. So it’s best to think about where can your testing give you the maximum benefit. And as we said, we think people with symptoms are where the maximum benefit is for most testing, and we really want to expand that. We know from an online flu symptom tracker called Flu Tracker that about a third of people who report symptoms have been tested. So we know that there’s a gap out there of people who haven’t sought testing, so we really want to approach that.We’d like to look at people who might be at higher risk, and that might be those who are contacts of cases. So if you have a case, following up all their contacts to make sure we test them and find out if any of those indeed are positive. Health care workers particularly in the setting if they’ve got some atypical symptoms, it might be useful to increase testing there. We’d look at where there’s vulnerable populations. So if you think about in an aged care setting, one positive equals an outbreak in that setting, and we’d want to test everybody in that setting to understand what’s going on.We’re also potentially looking at some special cohorts or groups that we might want to survey, but again we try and think about where would be the most value in testing that. Are they people who are at risk because of their exposure in the workplace, or are they indeed people who are working in a setting where every one case places a really big risk to everybody else? And down the track we’ll also be looking at what we call sero-surveillance, which is where we have blood that’s been collected for other purposes, and we’ll be doing antibody testing on that as a population wide process to understand the testing.We of course always have something called sentinel surveillance. It’s syndromic surveillance. So it’s looking for respiratory illnesses. And that’s something that’s been running for years and years, looking for respiratory illness in the community. And in primary care, that’s through the Aspirin system, which it looks at patients with respiratory illnesses and reports them in, and they test a certain percentage. Aspirin in fact are finding that their case numbers are really, really low this year, because there’s not much respiratory illness going around, and cases with symptoms are being diverted to the testing clinics. But we are trying to broaden our testing, and do it in such a way that we maximise the benefits of the testing rather than doing a lot of testing for no reward.Professor Michael Kidd AM:Great. Thanks Jenny. James, there’s a question about when you said you’re doing everything you can, the changes you’ve implemented in the respiratory clinic to ensure your staff and patients feel safe. Can you specify what sort of changes you’ve actually made so people do feel safe? Dr James Ayres:Yeah. Sure. So our clinic was chosen partly based on the staffing that we have, but also the geographical location and the layout. So essentially there’s a physical barrier between what we call the clean zone and the dirty zone. So there is no transference of any staff from one zone to the other, except at the start of the day where they’ll gear up into their PPE gear and move through. The set up of the respiratory clinic itself is such that it’s very minimalistic. So in terms of infection risk and infection control, it’s very easy to clean and very hard, should there be a positive case, for the virus to be spread throughout that clinic. So physical barriers, strict cleaning and tightening the controls of the staff as they move through the practice. That’s sort of the main way we’ve approached it.Professor Michael Kidd AM:Great. Thank you. Jenny, one final tough question which is from Karen about PPE, and particularly about access to the stockpile, not just for masks, but for the full PPE that GPs need. And GPs are being asked to bulk bill many, many patients during this time with the requirements which have been put in, but with the bulk billing incentives which have been added to those arrangements, but an expectation to privately purchase much of the PPE, apart from masks, which are coming currently through the stockpile.Dr Jenny Firman:And the stockpile is there as a reserve stock, and that’s its major purpose. And as we know, we’ve been working very hard to make sure that we’ve got sufficient additional stocks there to make sure that if there is a larger outbreak or case numbers go up, we’ve got those reserves there in the situation where we may not get resupplied at the same rate. And in primary care, practitioners have a responsibility to look after themselves and their staff, and to make sure that they’ve got the PPE there to make sure their practice is safe and it’s safe for their patients.Professor Michael Kidd AM:And private providers are now having supplies. So the regular supplies which people would be ordering from are starting to flow again, which of course was not the case early in the pandemic when we were seeing the global shortages of all aspects of PPE.Dr Jenny Firman:And that’s really fortunate I think.Professor Michael Kidd AM:So James.Q:Are the GPs working in the respiratory clinics also working in their usual practice, and does that create a risk?Dr James Ayres:Yeah. So that’s an interesting question. So we run four hour shifts. So myself, I will work in the respiratory clinic in the morning, then the protocol is to doff, remove the gear, shower, change clothes, and then move to the clean zone. So it’s a completely different outfit after showering. Some of the other GPs will just do a shift in the respiratory clinic and then the next day return to their usual clinic. And I think part of the benefit of having three separate sites is you can pull from different areas. So we’re aware that that is a potential area for transmission, but I think we’ve mitigated that by having such strict standards.And just on the point of PPE, there is a personal responsibility as a private practice to support your staff and the patients. There are things that can be done. So we’ve sourced our own PPE gear, but in particular what’s called PAPR, which is the positive pressure masks. It removes the risks, it’s re-useable, and although expensive initially, it sort of takes it out of anybody else’s hands. So although we appreciate the support, I think there is an emphasis if you’re going to see patients, you’ve got to actually take a bit of personal onus and try and support yourselves and your team. Professor Michael Kidd AM:Great. Well thank you James. Thanks for joining us today. Dr James Ayres:Thank you very much.Professor Michael Kidd AM:Been great to have you with us. Jenny, thank you once again. Just once again, those resources which are available to support your mental health as a health care worker. The Black Dog Institute today has announced its support programs, which are phone support, online support and also an app to provide support for you. The government has also provided funding for Smiling Mind. Smiling Mind, giving health workers free access to their premium app. So that’s available to you as well. And finally, the hotlines and resource lines available through Beyond Blue available 24/7, 1800 512 348.Please continue to look after your own health and wellbeing, including your mental health during these challenging times. Thank you for the great work that you’re all doing, and thank you for continuing to provide us with your feedback through these webinars. We really appreciate it. Thank you everybody.[Closing visual of slide text saying ‘CORONAVIRUS’, ‘(COVID-19)’, ‘UPDATE FOR GPs’][End of Transcript] ................
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