Without change vaccine roll-out will stress practices

By the AGPA Web Team

It appears that Australian general practices will face quite a deal of stress, financial and otherwise, in the roll-out of the Covid vaccination program.

Nearly 5000 general practices have applied to take part in what is to be one of the nation’s largest logistical exercise – the vaccination of everyone in the nation over 16 by the end of October.

General practices want to be on the frontline of the roll-out, but many questions remain unanswered.

The vaccination of people categorised as 1A (mainly people in health care and essential services with potential exposure to people with Covid) is already under way.

General practices will do nearly all of the vaccinations when Category 1B (older Australians not in aged care facilities, other healthcare workers, Indigenous Australians over the age of 55, and adults with underlying medical conditions) begins.

Pharmacies will only join the task with Category 2A (people over 55) and 2B the rest.

The Federal Department of Health’s First Assistant Secretary of the COVID-19 Primary Care Response, Dr Lucas De Toca, pictured, is urging GPs to undertake the online vaccination training as soon as possible.

The course is free, but the time to do it is unpaid. Moreover, a GP-specific course is still under development.

Dr De Toca admits that the some of the training is a bit long because it does not presume the knowledge and skills of a GP. So GPs will waste a lot of time doing the training.

Also, practices will have to meet a list of requirements before being in the roll-out. Most practices would already have these (toilets etc) but some of the requirements may require juggling of space or even extra space and the practice would have to meet the cost.

These requirements are:

Have adequate space for patients waiting to be vaccinated that observes physical distancing requirements, and is sheltered from weather elements. (So long as this meets these requirements this does not need to be separate from the usual waiting room)

Have a private and sound-proof space for consultation with patients and vaccinator (including obtaining informed consent, answering patient questions and assessment of any conditions that may preclude vaccination or require further assessment and administration of vaccine).

Have a dedicated area, separate from areas that provide other clinical services at the same time, where vaccines from multi-dose vials may be drawn up, labelled, and prepared for administration.

Have a dedicated, clean, well-lit space for administration of the vaccine to patients, including a desk and chairs for patients, parents/carers and vaccinator(s). 

Of perhaps greater importance is the fact that one major financial question remains unanswered. Does the practice get a Medicare rebate for each vaccination covered?

Dr De Toca said the department is still working to finalise the descriptor.

But as it stands, the items are classed as “professional attendance”.

“They do require some degree of interaction of the GP in the conduct of the consultation,” he said. “‘Of course, primary care functions in a multidisciplinary team and registered nurses, Aboriginal health practitioners or other authorised immunisers, according to the scope of practice and jurisdiction regulations, can provide the immunisation in itself.

“But again, pending the finalisation of the MBS descriptor, these items are professional attendance items.”

It now appears that the GP will not have to administer or be present at the administration of the vaccine for each patient which could have been a deal breaker for many practices.

Further clarity on this would be helpful. 

To meet the October target, practices would have to average 50 vaccinations (including screening and record keeping) a day seven days a week for six months. And that is in addition to their existing workload.

Practices will be able to access 1000 doses a week once the roll-out is in full swing, but inititially each practice will get a smaller amount.

At present it seems that funding is being based upon high-volume mass vaccination centres which does not apply to smaller regional or even city practices. Yet these are the very practices upon which the government must rely if it is to attain its very laudable target of total adult vaccination by October 2021.

Dr Maria Boulton, who runs a Brisbane GP clinic and is a director of the Australian General Practitioners’ Alliance, raises concerns about the cost of providing ancillaries beyond the mere provision of the vaccine, particularly needle and syringe supply.

She has argued that governments have buying power and should use it and then supply practices rather than practices buying supplies individually. That argument appears to be winning the day with the Government agreeing (week ending Mar 5) to supply consumables

Some practices are concerned about the blame game after two elderly people were erroneously given four times the proper dose and 125 Pfizer doses thrown out due to incorrect storage.

Indeed, Dr Boulton sums up the position well when she describes the altruism of general practice contrasting with the ill-thought-out financial under-pinning of the vaccine roll-out. However, as time goes on the Government appears to be listening to the well-founded concerns of peak bodies, including the AGPA.

“We will do it, but we will do it at a loss, because we believe it’s something we need to do,” she said. “But let’s not forget that it’s not just the government that’s funding this, it’s the general practice owners.”

The ACT Minister for Health, Rachel Stephen-Smith has expressed concerns about supplies of the specialised syringes that can mop up all of the vaccine in a vial to provide the full six vaccines. If that does not happen there will be wastage and blame.

“Without a specially designed ‘low dead space’ syringe, it is not possible to retrieve six doses from each vial,” Ms Stephen-Smith said.

Again, practices are waiting.

In all, there are a lot of willing GPs to help with the roll-out but there are a lot of concerns about finances and logistics that have not been addressed. 

And underlying that is the issue of individual GP stress as the roll-out is grafted on to a system of primary care that in many places is already stressed. Covid will like stress individual GPs and the practice businesses they work in the eyeballs

No doubt the Government will get through and the population will be immunised resulting in major health and economic benefits to us all, but it also looks certain that without changes an unnecessary and disproportionate burden might fall on GPs and practice owners upon whose altruism the government should not take take advantage.

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