Principles of care: unvaccinated patients

Published 1 December 2021

The Royal New Zealand College of General Practitioners position on the management of unvaccinated patients (which includes all children under the age of 12) is that these patients should have access to face-to-face consultations when required. 

Caring for unvaccinated patients 
Where possible patients should be triaged before they arrive in the practice and their vaccination status determined. If the patient is unvaccinated or refuses to say, then they should be:

  • Offered a teleconsult in the first instance to manage their medical problems remotely.
  • If a face-to-face consultation is considered clinically necessary, then the practice needs to arrange for the patient to be seen face-to-face by a clinician. This clinician may or may not be the patient’s regular GP.'
  • The patient should be treated as a ‘red’ stream patient according to practice procedures and appropriate precautions taken including:
    • separation in the waiting room, or waiting outside the practice (e.g., in the carpark).
    • the use of appropriate PPE by clinical staff interacting with the patient.

Caring for yourself, your team, and other patients
It is also reasonable for clinicians to take appropriate precautions to ensure these patients do not pose a risk to clinical staff or other patients (who may be vaccinated), be immunocompromised, elderly or have multiple co-morbidities that put them at risk of poorer COVID-19 outcomes (although this risk is significantly reduced). 

However, this risk mitigation must not include the clinician being placed at increased risk themselves.  It is also not acceptable to put an asymptomatic unvaccinated patient into the same area as “red stream” symptomatic patients.

  • In developing this advice, we have made the following assumptions:
  • All clinical staff and most patients will be vaccinated.
  • General practices will be seeing patients with COVID-19, and they will need to take precautions above that of other public-facing organisations and businesses.
  • Overseas experience suggests that although some patients do like virtual consultations, many still value or require face to face contact.
  • For patient safety, general practice will need to get back to a “new normal” as soon as possible. However, the reality is that practices will be at increased risk because of close contact with COVID-19 positive patients.
  • COVID-19 will be endemic in New Zealand for the foreseeable future. The actual degree of COVID-19 in the community cannot be predicted at present.
  • Some form of triage will be normal and red/green streaming will continue into the foreseeable future.