Massive response from primary care to help beat Delta

Primary teams across New Zealand have swung into action with incredible commitment and resilience to carry out tens of thousands of COVID-19 vaccines and tests while also delivering ongoing care to their patients remotely over the past week, GP leaders say.

A snapshot of the work that’s been initiated in Level 4 ranges from redeploying staff overnight to standing up full testing centres in a few hours, from establishing a paperless testing system to administering vaccines to homeless people and in cars, marae and churches.

Dr Jeff Lowe, Chair of General Practice New Zealand (GPNZ) and Karori GP, says some practices are estimating that workload has more than doubled as they manage strict infection control and keep up to date with changing clinical advice on top of testing, administering vaccines and the usual work of general practice.

‘I was impressed by how well we adapted to delivering care during previous lockdowns, but in this Delta outbreak our people really have gone above and beyond.

‘Past experience clearly helped us prepare, but to be able to ramp up our vaccine rollout on top of the huge surge in swabbing while providing regular care to our patients by phone, video and in person has been truly exceptional.’

Practices are splitting their staff into completely separate ‘red’ and ‘green’ streams with red teams focusing on work with patients who may be COVID positive, including testing, while green teams manage the remainder of the work. Staff in separate teams don’t mix at any time and staff remain in their team throughout a shift to avoid the risk of spreading the virus.

Whangamatā GP and Chair of the New Zealand Rural General Practice Network, Dr Fiona Bolden, said rural practices have been outstanding in responding to the needs of their communities, despite many having limited staff. Her practice has been conducting COVID-19 tests and delivering vaccinations over the weekend in order to manage their busy day to day running of the practice

‘We divided our team into two instantly when we went into Alert level 4. This leaves our practice and other rural practices very thin on the ground,’ she says. ‘We have limited staff and so much business as usual, and we want to avoid cross-contamination. Our priority right now is to get as much of the population here vaccinated at least with one vaccination if possible.’

President of The Royal New Zealand College of General Practitioners and Wellington GP, Dr Samantha Murton, said: ‘We’re so impressed - but not at all surprised - at the way primary care has stepped up to protect the community, and with the change in timings between doses extended to six weeks, the College has been advocating for priority vaccines for Māori and Pasifika.

‘It is a fundamental equity issue to vaccinate these communities now because the effects of COVID-19 will be more damaging for them than for other groups. Even one dose of the vaccine gives a better chance at fighting COVID-19 and will also mean we’re preventing the possible overwhelm of the health system.’

In Auckland, at the centre of the current cluster, there is a particular focus on meeting the needs of the Pacific community, including a major push to get vaccines out to all those who are eligible.

‘The important thing is to go to where people are and to work in partnership with community leaders,’ according to Dr Allan Moffitt, GP at The Fono and Clinical Director of ProCare Health. ‘What we’re seeing right now is all the parts of our health system come together with local services and local people to give us the best chance of beating this outbreak.’

Snapshot of week one Level 4 in primary care

Broadway Health in Northland has five clinics in the mid to far north with more than 50 staff split into separate bubbles to support safe service delivery while also administering vaccines and swabbing for rural communities. The team has morning ‘huddles’ via zoom with each clinic giving feedback, celebrating wins and sharing learning on how systems and care can be improved. Consultations are available face to face as well as by phone and through the practice portal.

CEO Jessie Hoskins says: ‘It’s a wonderful time to be part of this team and to see people in genuine need like the whānau living in the back blocks of Kaikohe or rurality of Kaitaia humbly apologise for needing us at this time, or genuinely ask us if our family is OK and give us warm heartfelt messages of support for being here! It’s our job but it’s a bloody great one and I am privileged to be here supporting them.’

Across the Coromandel Peninsula the response to the Delta outbreak from primary care and from the community has been phenomenal, Riana Manuel, CEO of Hauraki PHO points out. On day one following confirmation of the outbreak 400 people in Coromandel township turned out to be tested. More than 1200 people have been tested in the area over the past week. and more than 500 vaccinated who wouldn’t have been otherwise.

With so many remote communities and with many people not having access to transport, a mobile vaccination service has been operating across the peninsula, taking the Pfizer vaccine to people from Paeroa to north of Colville. Practices and other health providers, the local PHOs and the DHB have been working together in what Riana describes as the perfect example of the locality model planned under the health reforms.

‘We work so much better when all those “my population” narratives go out the window, when we look at what the data is telling us and what we need to do together for our community. Now we also need to take stock and look at how we can prepare that community for any future health emergency.’

But Riana stresses that a health crisis is more likely to amplify existing inequalities and she is calling for everyone, and for Māori in particular to continue to access healthcare through lockdown.

‘More Māori will die of diabetes this year than will die of Delta. It’s so important that people continue to get their blood tests, to continue their medications. We are still there for people. And Māori vaccine rates are still lower than other groups. That goes for other vaccines too. We need to ensure that our babies are protected with their childhood immunisations even in times like these.’

Dr Bryan MacLeod, a GP at Coromandel Family Health Centre, said the team have been under the pump to swab as many people as possible and to continue delivering vaccines on top of their day-to-day work.

“We started by swabbing 230 people on the first day of lockdown. Since then, we have been continuing with vaccinations, about 80 a day. We’re doing this in addition to seeing urgent cases, being on call and providing virtual consultations as well as lots and lots and lots of phone calls,” he says.

Dr MacLeod says there has been huge support for the practice including from its PHO, Pinnacle Health who arranged a local school nurse from Cooks Beach to assist in the practice for a few days. The practice has also partnered with local iwi-based health provider Te Korowai Hauora o Hauraki.

Extra PPE, swabs, and other supplies have been delivered to the practice to support the surge in swabbing and vaccinating and they’ve also had support from the local community, which has helped keep morale in the practice high

Northcare medical centre in Hamilton, on hearing the prioritisation of essential workers for vaccines, contacted their local Countdown and New World stores and put on a specific vaccination clinic last Sunday to vaccinate as many of their staff as possible. Seventy extremely grateful staff were vaccinated.

Huntly West medical centre is putting on extra vaccination clinics aimed specifically at Māori patients. Staff are rapidly ringing any unvaccinated Māori patients and inviting them and their whānau into these specific clinics held at the weekend.

‘Regular’ GP care continues throughout Level 4 with most face-to-face appointments switched to phone or video. Dr Giles Turner, Taupō Medical Centre points out that video consults are particularly useful for managing paediatric care, where the child can be observed with the parent in the home setting. ‘One mother rang concerned about a lethargic toddler. I could ask questions and see the child and was soon able provide reassurance to the mother that no additional care was required.’

Bulls Medical, close to one of the early locations of interest for the outbreak, rapidly stepped up to support a COVID vaccination and swabbing service, as well as providing access to general practice for their rural population, alongside Taihape Health and Ruapehu Health teams providing care for their isolated communities. CEO of Whanganui Health Network, Jude MacDonald says: ‘The rural health teams in our district have been outstanding in being responsive to their communities and they have some of the smallest workforces. Working alongside their iwi and DHB partners to get the mahi done is something we are all very proud to see.’

Kim Hurst, GP at Silverstream Health Centre Upper Hutt says that last year’s lockdown had provided a strong base for providing telehealth services that many patients have adapted well to.

Even at level 1 around 25% of our consultations were virtual, which has been really beneficial for some people, including those with mental health issues who may be more comfortable talking in their own environment. As GPs, with our knowledge of our patients, we can triage them and give them advice because we know when there are warning signs of something serious.

But GPs are always available for face-to-face consultations with doctors onsite for urgent appointments: ‘The urgent health problems don’t ever go away and new disease keeps emerging, regardless of COVID. This week that has included a new diagnosis of breast cancer, someone making decisions about managing a terminal illness and pregnancy complications.’

She says that the experience of last year and the lessons learned has meant that stepping into providing care at Level 4 has been easier this time, but not without its challenges.

‘It simplifies and complicates at the same time. I’m working from home providing telehealth with a partner who’s also an essential health worker and two children under three.

‘Our staff have been working extra shifts testing and we are two GPs down because the number of locums coming into New Zealand has dropped off. It’s stripped back, but you’re also isolated from your usual support network.’

Tū Ora Compass Health in Wellington is working with local iwi groups and Wellington 10ths Trust and using Pipitea Marae as its main vaccination space in central Wellington, prioritising whānau vaccinations for Pipitea iwi.

A partnership with Kahungunu Whānau Services, serving Wellington’s homeless population and people in emergency housing, has included ‘train the trainer’ sessions to enable the Kahungunu Whanau Services workforce to raise awareness of testing and boost vaccination rates. An outreach vaccination service serving the local homeless population has been set up in Ballance Street. A series of vaccination events at Downtown City Mission and The Home of Compassion Soup Kitchen has also enabled the vulnerable inner-city population to have access to vaccinations in a safe place.

Partnership with Capital and Coast DHB and local Pacific churches has led to a vaccination rate of 30% among the local Pacific population.

Despite being a small practice, Eastfield Health in Ashburton mobilised quickly to provide testing and increase vaccination capacity while maintaining care for its population.

The practice had been administering vaccines for a month but realised that it wouldn’t be possible to keep on vaccinating at the practice premises under level 4 conditions, as well as ensuring face-to-face appointments were available for people who need to see a GP in person. At the same time the practice received an urgent request from the local hospital to vaccinate an extra 300 people to make sure the essential workers in town have at least their first dose.

Business manager, Tony Dann, says: ‘We decided to take our vaccinations clinics offsite and we managed to secure the pavilion at Ashburton Racecourse which has given us plenty of space to ensure everyone in our waiting and observation spaces can keep at least two metres from each other. The extra bonus is that the racecourse has an amazing view of the Southern Alps and we can watch horses being trained first thing in the morning.

The vaccination clinics are intense, primarily because the observation time creates some more logistical challenges and we are very conscientious about making sure we’re not wasting any vaccines. The team have really stepped up and I think they get a great sense of satisfaction about doing something constructive for the community. The Canterbury Primary Response Group have been super responsive - I call them about ten times a day – they quickly set up our mobile site, re-organised the booking system and helped with the increased vaccine delivery to Ashburton.’

Tuapeka Community Health in Lawrence ran a very successful drive through clinic which delivered 200 vaccinations in half a day with the help of volunteers. Among local people receiving the vaccine were a number who had previously been anti-vaccine.

Dunedin-based practice, Te Kaika is running drive through events at the Edgar Centre, administering thousands of vaccines.