Safe practice during the Omicron outbreak

As COVID-19 numbers rise we know practices will find it more and more difficult to contact all patients they know are COVID positive, while maintaining ‘business as usual.

Your duty of care to your enrolled population is to provide access to 24/7 care 365 days a year, and in a pandemic this duty remains in place. 

In the current phase of the Omicron outbreak, with relatively low case numbers, the goal is to contain the virus spread as much as possible. 

Managing high COVID-19 numbers in your practice

• All patients with COVID-19 are expected to have an initial health assessment and following this regular (daily or alternate daily) health checks from a health care team following the Ministry of Health guidelines published via Healthpathways.
• At this phase in the pandemic it is expected that all practices will be able to provide this level of care. 
• If your practice cannot manage this for your enrolled patients you need to have a clear hand over process to an alternative provider who can do this. 

We know it is difficult, but it is important that you document carefully if your ability to meet the expected standard of care is compromised by your lack of resources. 

Pinnacle and our DHB partners will provide as much help as we can, and whilst no issue is ever due to a single part of the system your practice will need to assess the individual risk to a patient of not making the initial health assessment and follow up calls if you decide not to provide these services. 

Future phases of Omicron outbreak

As the case numbers grow and the system shifts to an increased dependency on self-diagnosis, rapid antigen testing and self-care it is expected practices will stratify patients they know or suspect are COVID positive into two groups:

1. those who can self-manage
2. those who need supervised care.   

Guidance on who fits into which group is available from the Ministry on Healthpathways.

In summary those patients who are not elderly or pregnant, who do not have multiple comorbidities, and who have reasonable levels of health literacy and access to technology are expected to self-manage.  

Those who are likely to need supervised care for medical reasons can be identified by looking at the “tier 3” patient list in the COVID clinical dashboard. Please let your practice development facilitator know if you require support to access or use the dashboard.

Those who need supervised care will need to be assigned to daily, alternate daily, or less frequent contacts according to whatever guidance the Ministry provides when we get to this stage. 

This phase is expected to last 4-8 weeks. 

This is going to be very difficult, and during this phase practices are likely to have to step back from some aspects of routine care that can be safely deferred.

This will vary from practice to practice, and again it is important to document carefully how services have changed due to the pandemic response. 

If you have not already had the chance to read the Medical Council of New Zealand’s guidance: safe practice in an environment of resource limitation I encourage you to do so now.

We expect practices to minimise risk to patients by continuing to provide comprehensive care to the most ‘at risk’ populations (Māori, Pacific, Dep 9-10). 

Childhood immunisation is a vital service, along with cancer screening and management of patients with high cardiovascular risk especially those with diabetes. Failure of these services represents the highest level of system breakdown, and this is not expected during the Omicrom wave. 

You have done an amazing job managing the pandemic thus far. Our vaccination rates, mask use, red and green streaming, social distancing, hand washing and wiping of surfaces and other public health measures mean we have the best chance of all health systems to manage this phase and not see excessive deaths from a collapse of our great health prevention and chronic disease management systems.