While the Covid-19 virus has caused major disruption for general practices, it has also forced them to embrace long-contemplated innovations.
Some of these new methods were introduced speedily within 48 hours in late March, after the Government announced a nationwide quarantining of households to try to contain the sometimes-deadly virus.
“It’s extraordinary really what can be done when you’re forced to,” says Dr Nina Molteno, a part-time General Practitioner (GP) at the Meridian Medical Centre in Dunedin.
Innovations include nurses phone-triaging patients to establish who needs to speak with a doctor. GPs phone those people for a remote consultation and then only patients who need an examination will visit the clinic.
Another innovation is “almost a military-operation flu vaccine clinic”, which has proven highly efficient.
This means that patients can receive the vaccine without being exposed to other people or the general practice environment.
Dr Molteno describes how at a set time, batches of cars are allowed into the clinic car park where they are spaced apart. A GP or nurse in personal protective equipment hands an information sheet through the car window and asks screening questions.
We approach with a needle and they have to bare an arm through the window of the car.”
The vaccine recipient waits to ensure there is no reaction, then drives off in convoy with the other vehicles.
With telephone triaging and remote consultations, Dr Molteno says that a proportion of people are stable on their medication, have undergone recent blood pressure checks at a pharmacy and don’t need to visit their GP for repeat prescriptions.
The Meridian is an urban city practice and the majority of its patients speak good English and have moderate health literacy, so the innovations work quite well, she says.
However, phone consultations do have a higher risk of missing something serious, so such changes wouldn’t work for everybody.
She notes that triaging and remote consultations don’t particularly save time because sometimes, for example, it would be quicker just to check a patient’s blood pressure than carry out an extensive check
For the future, beyond the Covid-19 crisis, a combination of these innovations and people visiting their doctor could work well.
“Probably a combination…is going to be more of the sweet spot.”
Dr Molteno explains why such innovations have long been contemplated.
Overcoming health pressure points
For some time, general practices have been under pressure because of their ageing workforce and the increasing complexity of problems in the community.
Older people are living longer and so have more health problems. Hospitals are also under pressure, so are referring more patients back to GPs.
In order for the same number of GPs to handle increased workloads, general practices have wanted to become more efficient and more like a one-stop shop, she says.
Proposals have included utilising nurse practitioners more and using different ways to decide who needs to go to a clinic to visit their doctor.
A Health Care Home scheme was being phased in, however the Covid-19 crisis has put this on hold. Under this scheme, patients would be triaged by telephone.
“That’s kind of happened because of Covid-19, because we’re phoning everyone,” she says.
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