Covid-19

Going to the doctor has changed

Primary healthcare providers are making a rapid change to care for people over the phone, video or by email if face-to-face consultations can be avoided

GPs are still open for business, but they are changing the way they work by reducing face-to-face appointments.

Doctors scrambled over the weekend to put systems in place. The new normal is telephone, or email triage and can result in car park consultations. The goal is to keep people safe from infection.

“We’ve asked all our GPs to immediately switch to doing a virtual consult before an ‘in-person’ one,” said Royal New Zealand College of General Practitioners president Dr Samantha Murton.

Asked how the first morning of the new approach was panning out, she said it was “mayhem” in her practice as kinks were ironed out.

“When everything has changed so dramatically, it’s tricky to get things running smoothly.”

The decision was made on Saturday and the GPs have been working to find the best system. People who need to be seen face-to-face are still being seen.

“In our practice, have put aside places where people can come in and be seen in person.”

These appointments are made at “strategic” times of the day.

At-risk people who are a priority for flu shots can still get them. Murton said individual practices are handling this differently depending on what suits their situation.  

“Some are putting it at a particular part of the day, some of them are putting it into the part of the building which is separated from everyone else, others putting it into a local building, or occasionally some people have been doing them in the car pack so that people don't need to come into the building.”

All DHBs have set up testing locations for Covid-19 which has relieved some of the pressure of surgeries. However, Murton said it’s likely in some situations GPs might still need to test a patient.

“It can't be all done in the testing stations and some people won't be able to get to one. So most practices will probably still be doing a few tests in a day just to keep up with their own patients.”

She asks for patients to be patient as doctors adjust to a way of working which will help keep everybody safe.

Part of Monday’s teething problems include telecommunication issues where phone calls failed to connect today due to congestion. Telecommunication companies said these issues were being worked on.

West Auckland GP Dr Tony Moyle said his surgery was making use of video calls to do consultation. He said his surgery had been trialling the approach for a month and spent Sunday improving the website to make it easy for patients to access. 

“We had a chat with our staff about the various things we could do to reduce our face-to-face consults by 70 percent, that’s the goal apparently from the Ministry of Health.”

He said people were told to wait in their cars unless they’ve come via bus. Bills were also being sent later so no physical transaction needs to take place. 

“It’s trying to reduce contact and keep our reception staff safe as well.”

For people with chronic conditions, who have regular appointments, he said it was likely the approach would be tailored by the doctor, depending on patient needs. 

Unless they’re sick, he thinks people with routine check-ups won’t be needed to be seen in person for a while. 

“The people we worry about are our patients on chemotherapy or on medicines for rheumatoid arthritis which make them immunocompromised. We'll take them becoming unwell much more seriously.”

Flu shots are still being dispensed, he said. A clinic on Saturday will immunise priority people in their cars. They will need to have someone with them, a cell phone and will need to wait to ensure there’s no adverse reaction.

In Hamilton, Te Kōhao Health managing director Lady Tureiti Moxon said her organisation was making use of a marae to give flu vaccinations. The organisation offers health, education and social services. 

“We’re very blessed here. The marae has stopped having groups there, so we’ve got a facility.”

Sick people are being separated from those who are well and just want a flu shot.

Measures are also being taken to make sure vulnerable people don’t fall through the cracks. With winter approaching, she said the approach needed to be proactive. Part of the approach is to ensure people who do need medications are receiving them. 

“The staff are looking at who their priority whanau are, vulnerable whanau, people who are living on their own, people who don't have family support.”

Community members are also looking into whether masks can be sewn if there’s a need for them. 

She said her organisation has supplies such as hand sanitiser for now, and if they ran out, would make use of soap.

Other issues shared by surgeries are related to PPE - personal protective equipment.

Rangiora Southside Health co-owner and practice manager Anne Rogers said suspected Covid-19 cases were being triaged and told to go to a Christchurch testing centre that opened last Wednesday. 

Those with a sore throat or cold are assessed in the car park, but supplies of protective gear are limited.

“We’ve taken our own measures. There are very few of the proper goggles available.”

Face shields were purchased from a hardware store.

“They’re the sort of thing you would use out in the field if you were using a chainsaw. There’s a proper hat that fits on the head and a glass shield that goes right around your face and down below your chin. We bought half a dozen of these.”

Despite some equipment shortages, Rogers is upbeat. She urges the public to focus on positives, to use media for education and try not to overload on alarming messages. 

“We're in a really good place at the moment. New Zealand is one of the best places to be right now.”

One doctor and entrepreneur, Dr Sam Hazledine, is also focusing on shortages and is investigating reusable masks, as well as trying to mobilise a back-up workforce.

He’s behind the call to arms of medical staff who are retired, or have let their registration lapse, and has been working with the medical and nursing council to fast track registration.

“I believe we’re in the calm before the storm,” he said shortly before Monday’s announcement of the impending level four shutdown.

“We’re moving into an unprecedented demand for healthcare services.”

He said over 1000 nurses and doctors had been in touch wanting to help. 

“We had a 70-year-old retired GP, come forward and say, ‘Look, I've got lung issues, but I want to help’. Now obviously, we're not going to send that person to the front line. That would be crazy. But we are looking at a telehealth option.”

Run on prescriptions

West Auckland’s Dr Tony Moyle said there has been a rush on prescriptions as people try to stockpile medication. 

“The receptionist held up - it was like a book - a thick 500-page book of prescriptions she had been faxed from Friday to this morning. It was the best part of a ream of paper.”

Pharmac director of operations Lisa Williams said she was aware of the issues GPs are facing with prescription requests and the anxiety people might be facing, which is driving attempts to stockpile.

Strategies to stockpile medicines the drug-buying agency is aware of include requesting a fresh-three month prescription shortly after receiving one, asking for early dispensing of outstanding prescriptions or asking for medicines usually dispensed monthly to be dispensed all at once. 

“We want to reassure people that Pharmac, pharmacies and suppliers are working closely together to maintain continuous medicines supply, and to put in place measures to minimise and fairly distribute any medicines in short supply.”

She said stockpiling could lead to other people missing out.

“We all have a role to play in keeping medicines available for our community - people on regular medicines should always have enough for one to two weeks treatment … Patient illness or self-isolation are not barriers for people getting the medicines they need; people should phone their general practice and regular pharmacy to discuss options for getting fresh prescriptions and medicines dispensed when they need them.”

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