COVID-19 Medical Director update

7 April 2020

Three issues have dominated the last few days for me, and Sam, and I’ll make some comments about each of them. My thoughts are drawn from daily conversations and meetings with the Ministry, contact with the Government and many media interviews.

Change of the case definitions and priority groups creates disconnection between messaging and practice 

Changing case definitions has caused some concern amongst GPs. There’s no doubt we need to increase swabbing, but I believe there’s been a disconnect between some of the public statements, which have increased public expectation that everyone will get a swab, and the reality. There are issues around lab capacity, swabs and PPE and so there needs to be a de-escalation of public statements in favour of work around how the new definitions and priority groups translate to front-line care. I’ve conveyed these views, and your experiences, directly to the National Co-ordination Centre at the Ministry, TAG Group (National Advisory Group), and Deputy Director General. We are expecting to be able to provide you with some definitive guidance on who and when to test in the next couple of days.

Significant concern that priority groups may not be vaccinated 

The distribution system and lack of control over where vaccines went has shown up structural flaws in the system. 1.8 million vaccines are on order, but they may run short, especially when opened to the general population.

Sam and I have spoken directly to the Director General of Public Health, Manager of Immunisations, and the Ministry who are all now aware of the issues. Fluvax issues are also going to the primary care sub-group of TAG and to TAG itself; the system needs to be changed and to ask for an extension for vaccinating priority groups. We are particularly concerned that vulnerable communities – particularly Māori, Pasifika and the elderly – may not be able to access the vaccine. We would encourage members to develops plans to contact and encourage these patients to get the vaccine.

Practice sustainability is a major stressor for GPs

Practice sustainability is a rapidly emerging issue and something the College did media work on last week. We have been active with the Ministry and politicians, including the Minister of Health, on this issue. We have been absolutely firm that GPs need to keep their employment and that the viability of practices is essential for now, when patients need to be seen, but also at the end of lockdown when a significant amount of work will have built up.

General practice is an essential service at the front line of the COVID-19 crisis. Sam and I have spoken to many media outlets advocating this point, and now the Government needs to step in. They are very aware of the issue and have been left in no doubt of its urgency and the limited amount of time left to address it. The Ministry has given assurances the Government is working toward an announcement this week and we're waiting to see what that will be.

Sam spoke to the Chair of CMC and I spoke to ASMS Executive Director Sarah Dalton about the message that was put out about specialists and the MECA. They were frank conversations and made it clear that the timing ASMS’ bulletin regarding specialist working conditions during the COVID-19 crisis was poor, especially when GPs are doing it tough.

Amongst this work I also sent a letter to Hon Andrew Little about lack of payment for coroners’ letters.

Stay strong and keep smiling!

Dr Bryan Betty
Medical Director, The Royal New Zealand College of General Practitioners