An old Australian colloquialism which I’ve only just discovered – it basically means “we’re here to do a job, lets stop wasting time” (see the Urban Dictionary explanation).
I think this is the sort of language primary care may have to start using with the Government, particularly at the time of the pandemic response and the slow roll out of immunisations.
By way of background, I felt like a lone Cassandra back in the H1N1 days, when I was reviewing the State-based pandemic response plan. My frustration at that time was focussed on a phrase which suggested “GPs will staff dedicated influenza clinics”
All well and good, but I don’t recall any actual discussion around this prior. The document smacked of motherhood statements by State health departments (public sector) about what would be expected of primary care (private practice).
The analogy would be in the case of a major power failure, the State plan might as well state “we’ll ask all local electricians to report for duty”
Nice idea – but it’s not necessarily going to happen….unless you engage with the workforce and find out what they can do/can’t do. Not make magical statements.
How about during COVID?
So fast forward a decade, and since then we’ve had Medicare Locals and the new Primary Care Networks – organisations which one assumes are designed to bring systems to primary care and help incorporate primary care into State systems such as pandemics, bushfires or just bog-standard chronic disease management. to bridge the gulf between State health services and private primary care services.
So the past year has been marred by COVID-19. We’re now well into 2021 and Australia remains remarkably untouched…sure, we have some wobbles around hotel quarantine and returned travellers, as well as slowly dawning realisation that the gig economy of low paid security guards also working as Uber drivers, combined with likelihood that COVID-19 is airport, not just droplet and aerosol spread. But we’re doing quite well. Better than many of us imagined.
Most amazingly of all, we now have promising vaccines and are in a position to roll out a mass immunisation program across Australia and indeed the world. We’ll need to get to about 80% of the population immunised for this to work, and it’s going to take years, not weeks.
Now, one would like to think that there was a plan around this. That it would have been nutted out in the decade since H1N1 and that someone might have paid attention to the concerns from primary care that they would be asked to provide an important public health role, despite being private contractors.
The sort of model might be based on a conversation along these lines:
Govt “Hey, we’ve finally got a vaccine – who’d have thought? But we need to get this out to as many Australians as possible. That means over 20 million doses, repeated a few weeks later. At a time when we will be delivering usual influenza immunisations to the population. Now we realise this is going to be a massive task. So what we propose is this – we’ll manage the logistics – the vaccine supply, the cold-chain and refrigeration.
Now this is going to be a massive task – rather than cram people into private clinics, we’re going to use well-ventilated spaces like sports arenas, convention centres, churches, school halls, car parks even.
We’ll also supply the administrative support to register new patients, check for allergies and also ensure everyone gets an immunisation certificate.
Now we realise that you guys already have private clinics and a significant patient load to attend to. But we really want your help to make this happen – and that of your practice nurses – in fact anyone who can safely immunise. So we’re wondering if you could rotate through providing services on a sessional basis – such as booking off an afternoon or morning session to immunise? And also provide services after hours or at weekends. For this we suggest. sessional rate of X and an after hours or weekend rate of Y.
Again, we’ll provide the location, the administration and the rest – you just need to immunise.
There ARE a couple of things that you’ll need to be confident with – the use of a multi-dose vial without cross-contamination or wastage. And you’ll need to be sure to manage anaphylaxis.
OK, that’s it – got any questions? Let’s DO THIS THING”
Instead, what have we got?
Govt “Hey primary care, we want you to immunise the population. We’re going to ask you to complete an EOI application. We want you to do this in your clinics – not in the car park or local sports ground. You’ll need to ensure your staff enter all admin details, monitor the patient for at least 15 mins and also update their records to show they’ve been immunised – otherwise there’s a $6000 fine. Oh and you’ll need to get the patients email to make sure they can be emailed an immunisation certificate at a later date.
Now we won’t be paying you to do this – you’ll have to provide the service under mandatory bulk-billed Medicare – and the doctor will need to see every patient in order to claim. The bulk-billed rebate is set at a level A consult – the shortest time – even if the patient has questions, suffers a reaction or if it takes considerable time to upload their data and patient registration.
Oh – and there’s one more thing – we’ll need you guys to undertake a mandatory 3-4 hour online training module in order to be able to administer the vaccine. Without that you won’t be eligible. What’s that? You already administer immunisations routinely and jab needles into multiple parts of the body…..never mind, you’ll still need to undertake four hours of mandatory training”
In short, primary care is ready to get this job done. Sadly the Govt seem to want us to fuck spiders.