The lowdown on Omicron for general practice

Tena koutou katoa,

As we move into the now inevitable Omicron phase of the pandemic, we can only hope this is the last act in our three-year COVID-19 journey. The challenge that lies before us this year is how we, as general practitioners, step up and provide for our patients while riding the waves of outbreaks.

These will be testing times for a workforce, and a whole sector, that is already stretched and there are many other sectors in similar situations. We see the most patients, have the most uncertainty of workload, and are relied upon by the public and other parts of the health system. Our strength is that we are highly skilled at medical care, have committed teams around us in our practices and communities, have a membership that supports each other, have information and pathways to follow, and have close involvement at the centre of managing the outbreak.

As we have noted overseas for individual cases, with Omicron we are seeing a reduction in hospitalisation rates, admission time is approximately half that of Delta, there is less chance of ending up in ICU, and lower mortality rates. Most people will experience mild to moderate cold symptoms and there will also be COVID-19 positive people who have no symptoms.

Looking at the bigger picture and the impact on the health system, Omicron is dangerous. Its infectious nature means we are seeing a huge surge in the volume of cases around the world. New South Wales went from 34,000 cases in the week of 25 December, to a staggering 215,000 cases only two weeks later, with 80 percent being Omicron. General practice, as with any respiratory illness outbreak, will endure the most of both patient anxiety and the need for physical assessment.

The communication to patients needs to rapidly change over the coming weeks to let patients know that in the majority of cases, and especially for those who are vaccinated, they will have mild cold-like symptoms. They can safely manage and isolate at home using simple analgesia such as paracetamol and ibuprofen, keeping hydrated and resting.

The present advice is for those with Omicron to self-isolate for 14 days, and close family contacts to self-isolate for a further 10 days after the COVID-19 case has been cleared. For many, this will be the biggest issue they will face – both in terms of not being able to work and ensuring they have the support so that food and other essentials can be delivered.

For general practitioners and their teams, spending time preparing as much as possible will help to make this journey easier. We recognise that this will be different for each region and for each practice so have kept our comments at a high level.

If we break down the issues we are facing as general practitioners, they fall into five areas:

Communication: Clear communication about how to self-manage with COVID-19. The virus will be a mild respiratory illness that in most cases can be managed successfully at home. This needs to be both at a national level and individual practice level.

We have seen the information both Ministry of Health and Government have been producing on self-management and we should support and encourage this as much as possible.

Anxiety amongst our patients: over the last two years there has been a high degree of anxiety and fear amongst the community around COVID-19. The reality is this will, at times, lead to unmanageable demand on general practice with patients wanting information or reassurance about COVID-19. This has been the experience overseas and there is no reason to think that will not happen here.

• Be proactive about how you will message and contact people and be clear about what they can expect from their practice team. That will help allay this fear and help to manage the workload.

At risk patients: The reality is there will be at risk patients within our practices who will require monitoring to ensure they do not need further intervention. We need to maintain the ability to keep a focus on these patients.

• Identify your at-risk population and work with them on a strategy if COVID-19 does turn up. This will help to make their care manageable and streamlined.

Workforce: Our workforce will be affected by both COVID-19 disease as well as contact with COVID-19. This will cause service disruption across the whole general practice team.

• Consider increasing the amount of telehealth-based care to cope with demand.
• Discuss within your practice about how to manage possible disruptions, and how to work from home if self-isolating (we are not expecting unwell people to be working).
• Consider redeployment of other health care staff as well as working with other local practices to support each other if possible.

Business as Usual: While it is critically important to keep business as usual going, based on overseas experience this can be compromised at times due to patient demand secondary to Omicron.

• Consider at what point you will reduce or restrict some business-as-usual activities and how will you communicate this to your patients.

With any changes we make to our service there are key principles to bear in mind:

1. We have a duty of care to all our patients including those with COVID-19.
2. Any changes we make to service delivery must be appropriate for the situation and documented:
   a. Consider at what point telehealth, phone, and patient portal contact will be stepped up to cope with increased demand and a potential reduced workforce.
3. Infection control is paramount:
   a. Appropriate use of red and green streaming to continue. (Where Omicron cases are high you may need to consider red streaming for all).
   b. Masks must be worn by all patients, at all times.
   c. Front desk triage is essential to mitigate the risk of COVID-19 in the practice.
   d. Appropriate use of PPE.

You are part of the whole health system and connection with your local COVID-19 response hub, PHO, hospital services are essential for sustaining both your service and the wider health system in your community.

We have the tools of phone triage, telehealth, patient portals and texts at our disposal to maintain capacity. We need to use these wisely to maintain service, cope with demand and inform our patients.

You can review the updated version (24 January) of the traffic light system guidance here.

We are the forefront of the COVID-19 pandemic and are essential to the wider health service. Alongside many others we have worked hard to be as prepared as we can be. While we still face uncertainty of how this is going to play out, we can be reassured that our preparation will stand us in good stead, our systems are set up to cope, our teams are nimble, cohesive and supportive, and of all the health services we have always mastered uncertainty.

We will continue to work on your behalf as you work hard for your patients. We can do this.

You can find more information on the College’s COVID-19 response webpage.

Stay strong,

Dr Samantha Murton

President

Dr Bryan Betty

Medical Director