The Medical Association (NZMA) is warning all doctors that the impact of Covid-19 on general practice is at crisis point.
(File image) Photo: 123RF
The association has sent out what is called a 'red letter', which is only rarely used to communicate matters of importance to its members.
The letter said the NZMA had serious concerns about government expectations of general practice over the management of Covid-19 in the community.
The letter reminded GPs they could decline non-emergency care for people in the community with Covid-19 if they if they did not have the staff and resources, and if they could refer them elsewhere.
"With the impending increase in the number of people who will need care in the community we thought it was important that we reminded them they do need to keep their ordinary general practice going," Medical Association chair Alistair Humphrey told Morning Report.
"They should not sacrifice that for the sake of an under-resourced Covid response."
Insufficient consideration had been given of the impact on frontline workers, the letter said.
Significant and growing demands have come with little or no engagement or effort to agree on details or terms of the services implemented, it said.
The association is concerned that expectations of general practice ignore matters of capacity, which is already stretched, matters of workforce, which is already stressed, matters of sustainability, which is already at crisis point and the health of other patients who may be impacted.
NZMA said doctors should think about their already stressed out staff and the impact on other patients, before committing to caring for Covid-19 cases, over and above normal GP services.
It is telling GPs that if they believe they do not have the capacity to safely offer this service, then they should inform their primary health organisation (PHO) and/or their district health board (DHB) in writing with their concerns and ask them to urgently consider alternative pathways.
The letter reminds doctors that if they have been asked to provide Covid-19 community care for a particular patient referred to them or someone seeking help, doctors are ethically bound to provide care if it is an emergency situation.
If not, doctors can decline care as long as an alternative source of care is available and the appropriate avenue for securing help is known to the patient.
The NZMA acknowledged access to alternative care may be limited, particularly in rural areas. It believed the Ministry of Health and DHBs should urgently establish alternative care pathways.
"It's an ethical issue about making sure you care for all of your patient community as a GP and not sacrificing the vast majority of the care that you are contracted for," Humphrey said.
That was especially so when many DHBs had Covid-19 community hubs and appropriately-resourced facilities where people could be referred, he said.
"GPs in Auckland have already been told that they are not obliged to take on the contract that the government has arranged with them.
"Many of them already feel that they are getting overwhelmed and by taking on these extra expectations of the government - which are under-resourced."
The government appeared to be "penny pinching" in its contract such as not reimbursing GPs' travel at the IRD standard rate, Humphrey said.
"The government should listen to the GPs when they explain to them what it costs to run a service," he said.
Minister of Health's office responds
A response from Minister of Health Andrew Little's office said the government "acknowledged the important role that GPs and other community healthcare workers had to play in treating as many people as possible at home so that hospitals were kept free for those who really need them, and that for many of them, this is the first time they have had to deal with Covid".
"The government has provided nearly $1 billion to support community healthcare for Covid patients. The government is fully funding treatment by GPs, and most assessments are expected to be done remotely by phone or online.
"This includes $395 million for the provision of primary-care services, including Kaupapa Māori and Pacific Health services; $25m for community pharmacy services, including virtual advice and management and delivery of medicines to those isolating; and $5m of translation services to support primary care.
"GPs and their representative bodies have been involved in the design and roll-out of the Care In the Community model at every stage, including agreeing contracts about levels of funding.
"The Covid Care in the Community work stream sits within the Ministry of Health's Health System Preparedness Programme. The chair of General Practice New Zealand sits on the Ministry's advisory group and the president of Royal New Zealand College of General Practitioners is on the assurance group.
"The email from the New Zealand Medical Association (NZMA) was sent yesterday after a meeting with the Director General of Health. The NZMA did not raise the issues in the email with the Director-General."