COVID-19 and the changes to general practice
This information was published on 16 August 2023. This advice is updated regularly.
The Government has signalled that COVID-19 management mandates are to be removed, which unfortunately may suggest to the public that the risks associated with COVID-19 have now diminished. In reality COVID-19 and other respiratory infections remain a real threat and it is important for general practice to continue to take a lead bringing clarity in this area.
It is now three and a half years since the advent of COVID-19 and we can now look back on how it has affected general practice while allowing us to see what changes are likely to remain.
This document is an update on a College document entitled “COVID-19 and the changes to general practice” produced in February 2023.
Messages to the public
General practice will continue to warn the public that COVID-19 and related respiratory illnesses remain a real threat to both patients and to clinical staff. For that reason, general practices will continue to manage infection control carefully, particularly as we are still in the middle of winter which always brings an increase in respiratory illnesses.
General practice will continue to maintain infection control measures to ensure that:
- Patients entering a practice can feel confident that their health is a priority.
- Vulnerable patients in practice waiting areas are not unnecessarily exposed to patients with respiratory illnesses.
- Clinicians and practice staff are not unnecessarily exposed to respiratory illnesses. This reduces the consequential risk to other patients and ensures that the practice can operate in an efficient manner for other patients.
How we move forward will be influenced by a variety of factors including:
- Public perceptions
- Lessons learnt from COVID-19
- The cost of changes and the effect of funding decisions
International data has shown that poorly ventilated and overcrowded areas, particularly where sick patients congregate are a health risk in their own right. New Zealand practices have listened to that message and made changes accordingly.
To that end ensuring that consulting and waiting rooms have clean indoor air is vital. The aim should be to have at least 6 changes of air per hour, and it is likely that these changes will be part of the “new normal”.
Likewise the regular cleaning of flat surfaces and instruments which touch patients has had a greater focus in the last three years. Again, this is something which will be a continuing focus.
Te Whatu Ora (TWO) have already reduced the special funding for the management of COVID-19 which means that practices will have to consider expenditure on COVID-19 care and adjust accordingly.
Streaming of patients with respiratory infections
“Red/green streaming” was a core element of good practice in the early days of the COVID-19 epidemic; however this along with phone triage appears to be becoming less stringent.
Practices that have the luxury of two waiting rooms and spare consulting room capacity to separate infectious patients may well continue with these activities; however, for many practices this is something that has already been relaxed.
Notwithstanding it will be normal to ensure that there is adequate separation of these patients from others. This may be by maintaining adequate distancing or having one section of the waiting room devoted to these patients. In extreme situations it may mean that some patients may have to wait in their cars.
Over recent times there has been an obvious reduction in the use of masks by the public in everyday life, and the recent announcements will be interpreted by many patients that they do not have to wear a mask under any circumstances. However, there will be patients who want to wear a mask and may feel safer if the clinician does likewise, and their wishes need to be respected.
Common waiting areas
Once patients have been triaged, it is reasonable to make mask wearing by patients encouraged but optional. In the longer term there may be even more relaxing of this activity.
The College view is that patients with respiratory illness should be asked to wear a mask or stay in a stipulated area.
Where clinicians are in a high-risk environment dealing with potentially infectious patients, (those with symptoms of acute respiratory viral infections including COVID-19, or fever and undiagnosed rash), P2/N95 masks should be worn and checked regularly to ensure that they fit properly.
For waiting room staff who have a physical (Perspex) barrier between them and the patient it may be reasonable to allow them to remove a mask if they themselves are comfortable with that. However, if they prefer to wear a mask, this should be their decision.
The College suggests that in the present environment, clinicians are likely to want to wear a mask in public areas; however, in a consulting room after it has been determined that there is no risk of COVID-19 or other respiratory infection it is up to the patient and the clinician to determine whether a mask is necessary. This should however be a dialogue, as some patients may well prefer that they do wear a mask and may even want the clinician to do likewise.
Removal of masks helps to overcome the problem of wearing a mask in a hot environment and allows a more natural non-verbal interaction as well as hearing those with hearing difficulties.
Any changes to mask wearing could be explained via notices in the waiting room so that the issue is not time consuming.
PPE and handwashing
Wearing of gowns for the management of COVID-19 has not been recommended for some time and wearing a P2/N95 mask and eye protection is all that is needed when carrying out higher a risk procedure such as taking throat swabs. Specifically, a normal clinical examination of even an infectious patient should require nothing more than a P2/N95 mask.
Gloves are no longer recommended and there is evidence that wearing them increases the risk of infection! This is however predicated on scrupulous hand washing after each patient and a recent Cochrane report has confirmed that.
As noted above it is reasonable to invite a non-infectious patient to remove their masks and where there is an infection risk, a mask is all that is required by the clinician.