General Practice and the COVID-19 Alert Levels


Last updated 7 September 2021

You can read the Government's Alert Level descriptions here, but the following principles relate specifically to general practice. 

The principles of Level 4

  • The target during Level 4 is for general practice to reduce face-to-face consultations by 70%.That means the majority of your consultations will be phone or video based and you will do phone triage for every patient.
  • If, having done a phone triage assessment, it is clear that the patient needs to see a GP, then a normal GP consult can be arranged.
  • You need to continue to reassure patients that they can get healthcare from their general practice but that they might do that differently. General practice is safe and careful, and we’ve done this before.
  • Use your PPE.
  • Continue high risk yearly cervical screening and it is recommended you continue with childhood immunisation. Appropriate screening needs to be carried out for respiratory infection as per practice protocols. 
  • Maintain scrupulous hand hygiene
  • Mask wearing by patients and clinical staff recommended. 
  • Maintain physical distancing practices in the surgery, within reason, – at Level 4 that is two metres.
  • Please check our risk matrix, which is designed to allow primary care clinicians to assess their own and their colleagues’ risk within the clinical setting.

The principles of Level 3

  • We need to continue to reassure patients that general practice is open for business.
  • The first service to contact for community medical care is your general practice.  
  • Offer virtual consultations to patients as first choice: telephone, video and patient portal.
  • In-person consultations should be available as required.
  • In-person visits should be preceded by virtual triage or assessment. 
  • Maintain physical distancing procedures within the surgery. 
  • Scrupulous hand hygiene. 
  • Maintain the use of PPE as appropriate. 
  • Investigations should be provided if there is a strong suspicion of pathology.
  • Proactive care is important for patients with chronic disease. 
  • Long term management is important for our patients. 
  • Increase focus on elderly, children, chronic conditions and mental health. 
  • Business as usual services need to continue including preventive services, immunisations, contraception services and acute care. 
  • Equity is central to care with a focus on Maori, Pasifika and vulnerable populations.
  • Medicolegally any deviation from your standard practice as a result of COVID-19 should be documented in the patient’s notes.

The principles of Level 2 - Offer in person consultations as required

In moving to Level 2 there will be a further loosening of the restrictions that have been in place up until this point.

What does that mean for general practice? Vaccinating and physical distancing is still the mainstay of controlling COVID. We have a duty of care to our patients and communities.

  • We need to continue to reassure patients general practice is open for business.
  • In-person visits should be preceded by screening for respiratory illness by reception/nurse or GP
  • Continue to offer virtual consultations to patients: telephone, video or portal.
  • Offer in person consultations as required. 
  • All patients and patient facing clinic staff need to wear masks within the clinic.
  • Maintain physical distancing procedures within the surgery. 
  • Maintain separation in waiting rooms.
  • In particular, patients with respiratory symptoms need to be separated from non-respiratory within the practice - red/green streaming.
  • Scrupulous hand hygiene is required.
  • Maintain the use of PPE as appropriate. 
  • Investigations should be provided for acute and chronic medical care.
  • Proactive care is important for patients with chronic disease.
  • Continue to increase the focus on long term management for those patients with chronic conditions.
  • Continue to increase focus on elderly, children, and mental health.
  • Core services should be established including preventive screening, immunisations, contraception services and acute care.
  • Planning should be underway to undertake any deferred care that has occurred during other alert levels.
  • Equity is central to care with a focus on Maori, Pacific and vulnerable populations.
  • Medicolegally any deviation from your standard practice as a result of COVID-19 should be documented in the patient’s note

In level 2, consider tele-consults for patients with acute respiratory symptoms and ensure red/green streaming is happening within the surgery.

The principles of Level 1

  • General practice is open for business, and full acute and chronic services should be offered.
  • The first service to contact for community medical care is your general practice.
  • Equity is central to care with a focus on Māori, Pasifika and vulnerable populations.
  • In-person visits should be preceded by assessment at reception for any symptoms of respiratory illness, and risks according to Ministry of Health guidance. 
  • Maintain physical distancing procedures within the surgery. In particular, patients with respiratory symptoms need to be separated from other patients within the practice, provided with a surgical mask and must maintain a two metre distance from others in waiting rooms.
  • Scrupulous hand hygiene before and after each patient examination is essential.
  • PPE should be used according to Ministry of Health guidance for patients with respiratory illness. 
  • Proactive care and long-term management is key for patients with chronic disease.
  • Full preventative services should be offered including screening, immunisations and contraception services.
  • Continue to manage deferred care from the lockdown period. 
  • Medicolegally, any deviation from your standard practice as a result of COVID should be documented in the patient’s notes.

In Level 1, we anticipate that practices will continue to offer telephone, video or other virtual consultations as required. We anticipate 80 percent of consultations will be in-person, while 20 percent will be virtual. It is important we give patients flexibility in how they interact with their GP, and to maintain our ability to move back up a level if required as a result of a breach in boarder control. 

General practice needs to lead the ongoing fight against COVID-19 and demonstrate that general practice clinics are a safe environment for patients and staff.

Maintaining Green and Red Streams in general practice 

Patients with symptoms suggestive of respiratory infection must continue to be separated from non-respiratory patients within the practice. Red streaming of all undifferentiated respiratory illness is necessary.

Ideally your Red Stream includes:

  • Separate workforce
  • Separate entry/exit
  • Separate bathroom and break /kitchen facilities
  • Good ventilation
  • For many practices this means the Red Stream assessment and swabbing will be occurring outside.
  • When the patient is in a car, ensure ask they open the opposite window to create air flow before opening the window towards you.

Signage for patients is essential, and some practices will find it necessary to have their doors locked - allowing only restricted access for the safety of patients and staff. It is essential that we continue to provide the environment and the assurance to patients and our staff that our practices are safe for them and their families.