COVID clinic closures frustrating Victorian GPs

COVID clinic closures frustrating Victorian GPs

October 4, 2021

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Victorian GPs say a policy requiring them to shut their clinics following coronavirus exposure is delaying medical treatment and COVID-19 vaccinations for thousands of people.

As coronavirus cases continue to grow in four-figure daily increments, frustrated doctors are demanding an immediate overhaul of the state’s guidelines for handling COVID-19 exposures at GP clinics. The guidelines have not been updated since the start of the year.

Spotswood doctor Todd Cameron said it took nine days for Victoria’s department of health to contact him after a pre-symptomatic patient with COVID visited one of his clinics.Credit:Jason South

“It is getting ridiculous,” said western suburbs GP Simon Benson.

“There is a real risk our healthcare system is going to burst at the seams. What happens to all these patients who need care when we are continually shut down? They end up in the overrun emergency departments.”

The doctors argue the current policy is a “complete overkill”, requiring fully vaccinated staff who unwittingly come in contact with a COVID-19 patient to isolate, even when the risk of transmission was minimal.

Dr Benson was forced to close his Sunshine clinic twice in recent weeks, including for several days after an asymptomatic patient tested positive about a week after visiting his practice.

He warned the policy was becoming unsustainable, saying there was “a real danger patients will come to harm”.

Dr Benson said he knew of several medical clinics that had temporarily paused routine medical procedures, such as Pap smears and childhood immunisations, until there was clarity on the guidelines.

There are more than 12,000 active coronavirus patients in Victoria. Dr Benson said general practitioners provided healthcare in the home to about 80 per cent of them to ensure hospital beds were free for the most critically ill.

“If GPs continue to be taken out of action it’s going to have huge impact,” Dr Benson said.

Spotswood doctor Todd Cameron said it took nine days for Victoria’s Health Department to contact him after a pre-symptomatic patient with COVID-19 visited one of his clinics.

Dr Cameron, who runs several medical clinics and has implemented hospital-grade protocols to protect staff and patients, immediately enacted tier-2 exposure protocols, shutting the clinic while staff were tested and waited for their results.

The following day, the department declared the clinic a tier-1 site. Fully vaccinated staff, who had worn hospital-ward-standard protective gear – including N-95 masks, goggles, gloves and gowns during a 10-minute socially distanced consultation – were sent into isolation.

The department also requested a deep clean of the clinic before it was allowed to reopen.

“It’s just colossal diaster at the moment,” said Dr Cameron, who wants a dedicated Health Department contact for GPs to assess clinic exposures on a case-by-case basis.

“To request a deep clean nine days later, for an airborne virus is just absolute stupidity. We’re running the same standard as you’d expect in a COVID ward, and everyone is double vaccinated.”

Last month, Dr Umber Rind’s practice, located in the COVID-19 epicentre of Melbourne’s northern suburbs, was shut for two weeks after a visit from an infected patient made it a tier-1 exposure site.

This was despite the fact all staff who came in contact with the infected woman had been fully vaccinated and wearing protective equipment, including highly protective N95 face masks.

Dr Rind estimated up to 600 medical consults were cancelled, including appointments for patients having breast cancer checks and those requiring treatment or medication for chronic illness, while a further 300 people had coronavirus vaccinations postponed.

“My concern is that if this continues, it’s going to put immense pressure on surrounding GPs, and increased pressure emergency departments, which are already under huge strain,” she said.

“A person seriously ill with coronavirus, who is relying on their GP for care, could also fall through the cracks.”

Dozens of medical clinics have been shut across the state in recent months as COVID-19 infections swell beyond 1000 new cases each day. A practice in Tarneit was forced to close for four weeks after two separate COVID-19 exposures.

Dr Benson said despite the highly infectious nature of the Delta variant, many staff at GP clinics were still using surgical masks, unable to source N95 masks.

The doctors want Victoria to adopt the same model used by NSW Health for GP clinics, where exposure risk is measured on an individual basis, allowing most clinics to keep their doors open.

“The risk matrix needs to be reviewed and brought into line with NSW, which is tried and tested, and has not resulted in a case explosion of outbreaks in GP clinics,” Dr Benson said.

The NSW Health matrix considers the nature and length of an appointment and the protective equipment worn by those taking part to evaluate the level of risk. If a masked and fully vaccinated GP conducted a standard 10-minute, socially distanced appointment with a masked patient who later tested positive to coronavirus, that meeting would be deemed a “low to moderate” risk. Staff who came in direct contact with the patient would be required to be tested twice for the virus in the next five days, and allowed to return once cleared of the virus. The practice would not be automatically closed.

If the same scenario occurred in Victoria, the medical practice would automatically be deemed “high risk” and staff would be quarantined for two weeks.

Royal Australian College of General Practitioners Victorian chair Anita Munoz said, until recently, concerns about the mandatory two-week furloughing of healthcare workers was centred on hospital outbreaks.

But following repeated closures of GP clinics, she said the medical college requested the state government urgently update its advice.

“They have treated those concerns very seriously, and they are looking at new guidance to help general practice better mange exposures,” she said.

A Victorian Department of Health spokeswoman said the government was working with the medical college to refine policies around medical practice closures.

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