Australian general practitioners’ experiences delivering essential care services during the 2020 and 2021 coronavirus-related lockdowns

Problem

During the peak of the coronavirus pandemic (COVID-19), aggressive mitigation strategies were implemented across Australia. These included city-wide lockdowns, which, combined with scarcity of personal protective equipment, and occupational health risks, negatively impacted the delivery of essential care services by GPs. The UK RCGP provided clear guidance to UK GPs to help safely deliver care during this time. Similar guidance was not available in Australia, and Australian GPs largely made autonomous decisions on how to triage patients based on acuity and urgency of medical conditions, and risk of COVID-19 transmission to staff. Therefore, the aim of this study was to describe Australian GPs’ experiences and approaches to delivering essential care services during the COVID-19 pandemic and to explore if GP service delivery in Australia was in line with RCGP guidance.

Approach

291 GPs who were actively involved in patient care during the March 2020 to December 2021 COVID-19 lockdowns in Melbourne and Sydney undertook an electronic deidentified survey which explored their perceptions of essential care service delivery during this period. The 45 multiple choice question survey collected data relating to the change in delivery of GP care during COVID-19, as well the participants experience of delivering care. The survey was modelled on the UK RCGP traffic light system of patient care: Green (continue regardless of outbreak scale), Amber (continue if capacity allowed), and Red (postpone, with aim to revisit).

Findings

274 completed surveys were received. Approximately 65% of participants were from Melbourne, 53% female, 49.5% over the age of 46 years, and 85.6% Fellows of the RACGP. Five key findings were identified: (1) There was a shift towards telehealth provision across the board from diagnosis (95% of participants reported increased use) to follow up (96.6%). (2) Preventative care that had definite health outcomes (e.g. immunisations) overwhelmingly continued regardless, but did not if they had possible health outcome (e.g. health assessments). (3) Many women’s health services continued regardless, including high risk cervical screening (68.7%), postnatal checks (63.3.%) and abortion services (62.3%). (4) High acuity and urgent conditions continued regardless (e.g. 91.1-93.6% of cancer/red flag symptoms). (5) Care for low acuity conditions varied depending on telehealth suitability (e.g. routine ECGs were postponed by 66.2% of GPs). Overall, Australian GPs reported consistent practices for 17 out of the 30 essential care services outlined in the UK RCGP guidance.

Consequences

Despite a lack of national guidance, Australian GPs appropriately triaged the provision of essential care services during COVID-19. Where discordant with RCGP guidelines, Australian practices tended to continue care regardless while RCGP recommended more restrictive practice. Australian guidelines should be developed to ensure appropriate prioritisation of delivering essential services for future pandemics that considers local contextual factors and these experiences of providers during the COVID-19 pandemic.