COVID-19

COVID-19 is a possibility in the community, physical distancing and handwashing is still the mainstay of controlling COVID-19.

We have a duty of care to our communities, in particular the most vulnerable people like the elderly and those living with co-morbidity and in deprivation.

The principles of Alert Level 2 are the same as Alert Level 3.

1. Reassure patients general practice is open for business. "The first service to contact for community medical care is your general practice."
2. Offer telehealth consultations to patients.
3. Ask yourself whether you will add significant value to the patient by an in-person consultation compared to a telehealth consultation.
4. In-person visits should be preceded by telehealth triage or assessment.
5. Maintain physical distancing procedures within the surgery. In particular, patients with respiratory symptoms need to be separated from non-respiratory within the practice, maintain 2 metre separation in waiting rooms.
6. Scrupulous hand hygiene required.
7. Use PPE as appropriate (mask for clinician, mask for patient with symptoms - droplet PPE taking a swab).
8. Equity is central to care with a focus on M?ori, Pacific and vulnerable populations.
9. Investigations should be provided for acute and chronic medical care.
10. Proactive care is important for patients with chronic disease.
11. Continue to increase the focus on long-term management for those patients with chronic conditions.
12. Continue to increase focus on elderly, children, and mental health.
13. Core services should be provided - preventive screening, immunisations, contraception services and acute care.
14. Medicolegally any deviation from your standard practice as a result of COVID-19 should be documented in the patient's notes.

As a guide in Alert Level 2 we anticipate that around 50 per cent of consultations will be "in-person" and 50 per cent will be through telephone, video or other telehealth means.

An update from Dr Jo Scott-Jones, Pinnacle MHN medical director

The community response levels that we are all now too familiar with are designed to inform the public and businesses about how to behave to reduce transmission of the virus. These response levels have an impact on the way we do business, but they are NOT designed to respond or direct the way specific HEALTH SERVICES work. You will recall that as the community response level dropped from Alert Level 4 to Level 3 there was no significant change in the advice for health service delivery.

This can cause confusion for our general practice teams. In all alert levels general practice is an essential service and practices will be open. However, appointments will be conducted online or by phone where possible. Patients can see a doctor or nurse face-to-face if required.

During the lockdown we know there was a significant drop in core activity such as immunisation and cancer screening that is likely to have caused additional morbidity, and mortality. If and when the community response Alert Levels change we need to learn from the lesson of the past few months and ensure that we continue to deliver the most important services as safely as possible.

The basic principles

1. Keep yourself, your staff and your patients safe.

• Telephone first all patients and direct them to "green / amber / red" streams of care.
• Provide for physical distancing for people using the waiting room.
• Wear a mask if the patient has respiratory symptoms, have the patient wear a mask.
• Use droplet PPE if you are taking a respiratory swab.
• If staff cannot maintain social distancing at work - wear a mask / face covering.

2. Keep providing core services for as long as you can within principle 1.

• Immunisation, cancer screening, minor surgery for suspected cancer, contraception services as safely as you can for all patients.
• If you have to reduce access to any service keep it going for the highest need populations for as long as possible, such as Māori, Pacific, Deprivation 9-10 and those at highest risk, for example previous cervical cancer needing follow up.

3. Make contact tracing easy

• Have the Ministry of Health QR code available for patients and staff. (All businesses must display a NZ COVID Tracer QR code from 11:59am on Wednesday 19 August, get your QR poster.)
• Have a system to help contact tracing for people in your waiting room (CCTV / a written list).
• Ensure staff are keeping records of their close contacts.

4. Help identify cases

• Swab people according to the criteria - offer swabs to everyone with symptoms, especially if they meet HIS criteria, don't do asymptomatic swabs unless you are told to by public health units.
• Gear up and provide swabbing in your clinics if you aren't already.
• If to meet principle 1 you can't provide swabs yourself then support the alternative swabbing services (if you bake a cake - mine's a chocolate one.)

If the prevalence of the disease increases in your community then you may not be able to differentiate between the "amber" and the "red" patients - the amber stream may need to be closed down.

If services get overwhelmed you may need to reduce access to core services - If this happens please let us know and we will support you to find help for your patients if we can.

I currently am working with the Ministry of Health and the College on the community health response framework and will keep you up to date with all developments.

If you have to close the practice (on advice from Medical Officer of Health) after a confirmed case

• Inform the PHO CEO (phone 021 925 812 / email helen.parker@pinnacle.health.nz) as soon as you know this is a necessary step, let us know the potential length of closure and re-opening protocol.
• Instigate your business continuity plan (please see our page on planning for pandemics and emergencies for more guidance).
• Inform staff of pending closure and process to follow.
• Inform patients of impending closure.
• Notify neighbouring practices / services of impending closure and agree process for practice patients during closure period.
• Continue to provide virtual services wherever possible.
• Arrange thorough cleaning of practice.

If you have to close the practice due to workforce issues

• Inform the PHO CEO (phone 021 925 812 / email helen.parker@pinnacle.health.nz) as soon as you think this may be necessary.
• Inform staff of pending closure and process to follow.
• Inform patients of impending closure.
• Notify neighbouring practices / services of impending closure and agree process for practice patients during closure period.
• Continue to provide virtual services wherever possible.

Our local leads are available for questions, concerns and advice. Please also contact one of the team if you have any issues with PPE stock - all our leads are working closely with the DHB in their region.

• Waikato - Justin Butcher, phone 021 679 407, justin.butcher@pinnacle.health.nz
• Taranaki - Tony Mottershead, phone 027 218 6524, tony.mottershead@pinnacle.health.nz
• Lakes - Pen Blackmore, phone 021 413 760, pen.blackmore@pinnacle.health.nz
• Tairāwhiti - Matt Tong, phone 027 616 4817, matt.tong@pinnacle.health.nz