24th January 2021, Dr Chee L Khoo
PERSONAL OPINION
Is it deliberate that we are given 10 days lead time to submit an expression of interest (EOI) to participate in the national Covid-19 vaccine Phase 1b roll-out? 18 pages of information released on a Friday afternoon in the hope that we might skim over the details and sign up without reading the fine print? Maybe I have become more cynical in my old age but I was initially all enthusiastic about being part of the whole national campaign. We all have to do our bit to achieve herd immunity via mass vaccination. It’s not about protecting me and my family but do our bit for the community we serve to get to that 70% coverage. After reading the document, I am not so sure anymore. Please read on before you commit.
Phase 1a involves frontline workers (not the usual GP) including hospital staff looking after Covid-19 patients and hotel quarantine staff. Most of them will be getting the Pfizer vaccine because of the difficulty with storage. In Phase 1b, the AstraZeneca/Oxford vaccine will be provided to general practices who sign up and to General Practitioner-led Respiratory Clinics (GPRCs) and Aboriginal and Community Controlled Health Services (ACCHS). The target groups are:
- People aged 70 years and over;
- Aboriginal and Torres Strait Islander adults;
- Critical and high-risk workers including defence, police, fire, emergency services and meat processing;
- Health care workers other than those prioritised in Phase 1a, including (but not limited to) hospitals, general practices, pharmacists, allied health, and other healthcare services in the community; and
- People at increased risk of severe disease
Just in case you have not kept up to date, the program is a two dose vaccine given 3-4 weeks or more apart. The vaccine is just your normal run of the mill vaccine that we are all used to. It just need to be kept at 2-8 degrees Celsius and come in a multi-dose vial (hey, did they not learn from the Eastern Suburbs HIV saga?).
So far so good. But look at what we undertake to provide if we sign up for Phase 1b:
- Practices who sign up are supposed “to have designated vaccine clinics” to “maximise rapid vaccine uptake”. So, they are not interested in your average GP practice.
- Utilised appropriately qualified and authorised workforce to administer the vaccine. Your staff will need to complete “a COVID-19 vaccine specific training which the Commonwealth Department of Health. This training will be available online and is planned to be available by the end of January 2021”. Why the special training? Have your nurse not given vaccines before? Do GPs need Covid-19 vaccine specific training? Who knows.
- The site requirements is so laughable. Amongst any things, you need to have toilets available for patients and staff, a dedicated well-lit space to vaccinate patients (including desk and a chair), reliable electricity and water supply and access to a telephone, computer and internet. They must think general practice operate out of a public toilet or someone’s disused garage!
- In addition to your usual vaccine fridge, you will need more storage space for the new vaccines. This means additional cost of $2,500 – $3000 to meet with that requirement. (see below how much we will be paid for the privilege)
- You are expected to provide “clear and accessible information at the general practices for patients before, during, and after vaccination. This includes leveraging Commonwealth Department of Health communications”.
- Record keeping all sounds very onerous: You need to check that whether patient had previous Covid-19 vaccine (given dose one somewhere else?), you need to obtain and record patient consent which is likely to include discussion of potential adverse events and what the vaccine actually do, record full details of batch of vaccine given (utilising a bar code scanner?), update the Australian Immunisation Register within 24 hours, record any adverse events and record and report vaccines used and stock on hand and those discarded, including reasons for discarding, and vaccine wastage.
- You are also expected to utilise the National Booking System (NBS) which has not been developed yet but when it is available, it will be integrated with your practice software. I am not sure whether that means you have no control over who makes an appointment to have the vaccine at your practice. It appears that the NBS is a centralised system to facilitate “a single point of entry to people who require vaccination“. That’s a worry. Does the NBS check that the patient is eligible for the Phase 1b or are you supposed to check that when they arrive and then if they are not, you turn them away. Oh, if they are a non-eligible overseas person, you have to direct them to the state run clinics. There goes your appointment system.
- Practices are also expected to have “the willingness and scope to scale-up vaccination workforce and site with potentially short lead times”. Another worry here. You have just lost control of your practice’s workflow and by the way, your family life with it.
The remuneration
You MUST bulkbill all covid-19 vaccination. 18 new item numbers have been created for this roll out. We can only claim an Item 3 equivalent plus a bulk bill incentive (item 10990) for all the work including explaining the pros and cons of the vaccine, observed patient for 15 mins and adhere to the record keeping. Obviously, your professional opinion on the vaccine which is what our patients is seeking for is worth zilch! For dose 1, we get paid $30.75 and wait, for dose two, we only get $27.55 plus a $10 PIP incentive per patient when they complete the 2 doses. What happens if the patient goes to another GP for the second dose? Who gets the incentive? The much advertised $68 we are supposed to get is for the two jabs over 2 consultations.
The issues
This is how you disenfranchise GPs in one single swoop. I feel insulted, angry, cheesed off, betrayed and disappointed (run out of other polite adjectives). Somehow, my application has to be vetted by someone including the PHN!
The government knows they can’t run the roll-out without GPs. They know GPs can’t do all the vaccinations. This is an underhanded way of threatening GPs that if you don’t do this our way, we have already contracted non-GP providers to do your job. In fact, it’s cheaper to get non-GPs to do the vaccination and we will politely say we are supporting GPs so that the GPs feel special. I don’t think they really want GPs to be part of the Phase 1b.
They are assuming that 100% of the patients will want to have the vaccine. They forget that on any good day, the non-vaxers probably number about 15% of the population and with conspiracy theories abound, the willing participant rate may be as low as 50%. As Prof Raina MacIntyre mentioned, you need 70% coverage for a vaccine with 90% efficacy rate and an R number of 2.7. The government is pushing their luck here to marginalise a large chunk of GPs who will likely find it all too hard and not register. I am no longer sure after looking at the document that I actually want to be part of this nonsense.
I don’t need the additional income that they are throwing at us if it means my practice and my patients will be stressed for the next 6-8 months in ways outside my control. Imagine someone else controls your appointment system. I still have a hoard of patients I have look after with their urgent chronic illness. If you sign up for Phase 1b under these conditions, you will either lose income or you compromise your care of your other patients or both.
Many of our patients look up to us when it comes to new treatments. If there is a significant number of GPs who are not registered to the Covid-19 roll-out programme, what does it say about perception of trust amongst our patients. “Even my doctor is not recommending the vaccine”. “Why else is he not involved in the roll-out”. “Even my doctor is waiting for the second trance. I think I will just wait too.”
I think I will just sit this one out.
Read the whole 18 page document here.