Practice Connect #136

 

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An update on the management of COVID-19 positive patients in WA for general practice

The WA Department of Health is finalising a model of care for the management of COVID-19 positive patients once WA borders re-open (planned for Saturday 5 February 2022). 
 
WAPHA and our partner agencies, including the RACGP WA and the AMA, continue to advocate to the WA Department of Health - for timely and comprehensive information to be made available to WA general practices - and for input from GPs into the design of COVID-19 specific Pathways and models of care.
 
Based on our current understanding of the situation, WAPHA has summarised the key points of importance for WA general practices:

• General practice will play a significant role in the management of COVID-19 positive patients in the community.
• The WA Department of Health has contracted Medibank Health Solutions and Calvary to deliver a virtual home monitoring service for COVID-19 positive patients who are assessed as having moderate to high risk of symptom exacerbation and hospitalisation.

Indicative planning assumptions from the WA Department of Health indicate:    80 per cent of COVID-19 positive patients will be low risk and able to self-care at home 15 per cent will be classified as medium risk and will require active telehealth management involving primary care, mainly through telehealth remote monitoring, potentially with pulse oximeters five per cent will require hospital care.

• Risk stratification will determine access to the home monitoring service, concentrating on identifying those at high risk and those needing acute care.
• A central referral process for patients requiring acute care is planned and GPs are expected to have fast tracked, priority access to this service for their patients.
• Rapid antigen testing will form the backbone of WA’s testing once borders re-open.

WAPHA understands that general practices need specific guidance and advice from the WA Department of Health to provide best practice care to COVID-19 positive patients and to continue to operate comprehensive general practice services once WA borders re-open. 
 

HealthPathways To support GPs and their practice teams at this challenging time, WAPHA has requested additional information from the WA Department of Health to develop Pathways encompassing a whole of system context. The Pathways will cover: COVID-19 self-care patient triage and support COVID-19 GP active case management COVID-19 PPE infection control and exposure response WAPHA is hopeful that the WA Department of Health will have the required details to finalise and endorse these Pathways within the next fortnight.

We attach, for your reference, a document you may wish to share with your at-risk patient population as you work with them to plan their care ahead of the WA borders re-opening.
 
A series of webinars designed to support general practice in the lead up to the WA borders re-opening are planned. 
 

COVID-19 Management and Model of Care webinar Thursday 27 January 2022 7.00pm-8.15pm (AWST) The webinar will provide General Practitioners with an overview of the West Australian COVID-19 Model of Care and key information regarding COVID-19 Management in Primary Care.    The session will cover: The role of GPs managing COVID positive patients. Escalation & referral pathways for COVID positive patients. The WA Department of Health Virtual Home Monitoring Service - Calvary Medibank COVID Care at Home.  Criteria and access to disease modifying treatments for patients with COVID-19. Panellists include  Dr Robyn Lawrence - Assistant Director General, Clinical Strategy and Planning, WA Department of Health Dr Richard Choong – Principal GP and Board Chair, WA Primary Health Alliance Dr Ramya Raman – GP and Chair, RACGP WA Faculty Dr Linda Kohler – GP Clinical Editor, WA Primary Health Alliance Dr Janette Randall - Senior Executive Medical Director – Homecare, Medibank Health Solutions Facilitator – Geraldine Mellet Register here

Another webinar is planned for early February (date TBC). WAPHA will send further details and registration links to WA GPs to take part.

WAPHA continues, through Practice Assist and regular communications to general practice, to provide up-to-date and reliable information on the rapidly evolving COVID-19 situation in WA.


 

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Advice on booster interval

On 24 December 2021, the ATAGI released a statement around boosters being shortened from six months to four months.

As part of this advice, ATAGI also advised that when practical, this should be shortened to three months.

The Australian Government announced boosters set 31 January as the expected date from which that would occur, allowing time for those in the four month category to be prioritsed.

It has been an option for primary care to implement this earlier if practical, in line with the ATAGI advice.

Earlier today, a number of state governments announced booster doses would be available after three months at state run clinics as they have capacity and available bookings.

All primary care vaccination sites may also provide boosters at 3 months if there are appointments available.

Please continue to prioritise high risk populations, older people, aged care residents, Aboriginal and Torres Strait Islander people, pregnant women, aged care, disability & health care workers, people with disability and those with underlying medical conditions.

Please continue with Pfizer 5-11 vaccinations as per normal, the changes to booster intervals do not change this cohort of the Program Roll-out.


 

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Have you prepared your Living with COVID-19 practice plan?  

As we see mask mandates reintroduced and small numbers of COVID-19 within our community, it is inevitable that when the borders open in February, we will see an increased level of COVID-19 in our community.  

To support General Practice and the delivery of primary care in these settings we have developed an adaptable suite of resources that can be refined to suit individual practices.  

The Living with COVID-19 Pandemic Checklist and toolkit is designed to be the first part of your planning process. It allows you to ask questions of yourself and your wider practice team to fully understand what you already have in place, as well as what you may consider introducing to your practice. The checklist component will allow you to tick off what you have already done,  consider what you haven’t got in place and providing you with the resources to support those specific areas. The toolkit is designed to expand on the checklist and provides a more extensive explanation of the different areas to consider. The toolkit also provides an extensive list of resource links that are all relevant to Western Australia.  

Once you have completed or considered the checklist and toolkit the Planned Pandemic Response Tool will provide you with the opportunity to create a tailor made plan of how you will respond within your practice to the ever changing landscape of living with COVID-19 in our community.  

These resources will continue to be reviewed and updated. Should you require any assistance with the use of these documents please contact us to arrange a suitable time with a member of our team at Practice Assist 1800 2 ASSIST (477 478). 

 

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General Practice has made a significant contribution to the vaccine roll out in WA

Over 27 million vaccines have been administered by General Practice in Australia, and almost 2.5 million of those have been administered in WA. We are so grateful for the contribution General Practice has made to the vaccine roll out in WA.

We understand that the introduction of additional vaccines, the complexity of doses, scheduling and delivery issues have brought about many challenges.

Are you looking for additional resources to assist you with managing these complexities?

WA Primary Health Alliance has created a suite of resources that may assist you to evaluate your COVID-19 vaccine rollout program.

• COVID-19 Vaccine Stock Governance Guide
• Stock Control Spreadsheet
• Vaccine Acceptance Checklist
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If you require additional support contact our team at Practice Assist 1800 2 ASSIST (277 478)

 

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MBS Telehealth Services from 16 January 2022

The Federal Government recently announced further changes to the MBS telehealth items bringing back temporary longer telephone consults for GPs (level C), as well as temporary specialist inpatient telehealth (video and telephone) and initial and complex specialist telephone consultation items. These temporary items will be available from the 16 Jan 2022 and will be available through to 30 June 2022.

These services will be available nationally rather than targeted to declared hotspots as was previously the case.

View the Expanding Medicare support in response to Omicron - GP & OMP fact sheet here
 
Also within the announcement was:

• the expansion of the MBS item for GPs caring for COVID positive patients through Face to Face consults to now include patients that have tested positive through rapid antigen testing (RAT).
• over 20 million units of PPE will be provided for primary care, including nine million p2/n95 masks for GPs and three million for pharmacists across Australia.

These are being prioritised for rural, regional and remote areas where access to PPE can be challenging.

Read the full media announcement here
 

What is the new ‘30/20 rule'?

From 1 July 2022, a new prescribed pattern of service (a ‘30/20 rule’) will apply to telephone attendances provided by consultant physicians and GPs. This was to be introduced on 1 January 2022, but will now be deferred. Under these new arrangements, a consultant physician or GP who provides 30 or more phone attendances on each of 20 or more days in a 12-month period would be referred to the Professional Services Review (PSR).

The PSR may take into account exceptional circumstances in considering the claiming practices of individual practitioners.

For further information on the changes visit here


 

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PPE for General Practice and Pharmacy

Recent changes have been made to the eligibility for both General Practice and Pharmacy to Personal Protective Equipment from the National Medical Stockpile.

These changes mean General practices who are caring for COVID-19 positive patients and Pharmacists administering COVID-19 Vaccinations, are now able to access PPE bundles specific to each setting.

For further information please see these factsheets:

PPE Bundle Factsheet for General Practice 

PPE bundle Factsheet for Pharmacy

General Practices (GPs), Aboriginal Community Controlled Health Services (ACCHS), General Practice Respiratory Clinics (GPRCs), Pharmacy and Allied Health providers who do not meet the eligibility for comprehensive bundles, and who are unable to source commercial supplies of PPE, are still eligible to order limited supply PPE as per the current PPE ordering arrangements.

To make a request for PPE click here

Please note that WA Primary Health Alliance (WAPHA) is reliant on mask allocation and supply chain distribution from the National Medical Stockpile which is subject to change based on COVID-19 prevalence across Australia.

For further information or enquiries please contact Practice Assist


 

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Resources to assist with your patients' - Frequently Asked Questions

The General Practice setting is often seen as a wealth of knowledge as well as a service provider that patients are comfortable to approach with their questions.

Below is a list of resources that you can use both within your practice and share with your patients.

WA Department of Health : Patient guide on how to put on and take off a mask

How to set up ServiceWA app: A step-by-step beginners’ guide

Australian Government Department of Health:

• Factsheet for people who test positive for COVID-19 or are close contacts  (Available in 63 different languages)
• Commonly asked questions about COVID-19 vaccine booster doses.
• Getting tested for COVID-19

Healthy WA : Preparing for COVID-19 in the WA Community

WAPHA – Get COVID Ready Kit


 

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Wellbeing support for primary health care workers during the COVID-19 pandemic

Who is looking after you? As we prepare for the WA borders to open and the evidence of COVID-19 in our community, we thank all our general practice, pharmacy and other primary health care professionals and staff for their dedication, resilience and ingenuity in adapting to the challenges of the pandemic, and challenges of the vaccine rollout which we know has been an extremely demanding time.

Most importantly, we want you to be sure to take care of yourselves. Black Dog Institute explains why self-care planning is critical during the pandemic. This includes you. So, please make time to care for yourself and to debrief regularly with colleagues.

We have also included further resources here that may be of assistance for all health care workers, GPs and medical students, nurses and midwives.

Self-care resources for health professionals

For GPs and medical students The HealthPathways WA General Practitioners’ Health pathway is available to support GPs. To further aid you during the pandemic, there is a range of support options available specifically for doctors: RACGP GP Support Program: a free and confidential 24/7 psychological support service. Call 1300 361 008. RACGP fact sheets: Self-care and mental health resources for general practitioners and Mental health in emergencies – Self-care for GPs and practice staff RACGP GP wellbeing resources GPMHSC resources and support for ongoing care of patients and self-care for GPs. DRS4DRS: Doctors and medical students can also access support 24/7 from senior GPs and counsellors via the website and the Victorian helpline: 03 9280 8712. DRS4DRS also have a series of five-minute guides on topics including compassion fatigue, burnout and many more. The Australian Medical Association Victoria’s Peer Support Service is available every day of the year from 8:00am to 10:00pm on 1300 853 338. The principle of the Peer Support Service is doctors supporting doctors and the service is available to all doctors and medical students in Victoria and Tasmania. You can remain anonymous and your call is confidential. Black Dog Institute’s Mental Health Community of Practice is running interactive online mental health sessions for GPs. Participants will have the opportunity to explore challenges faced in practice and provide peer support to others who may be experiencing similar issues. Participants must be members of the Black Dog Institute Mental Health Community of Practice but membership is free. Join here.

For nurses and midwives Nurse & Midwife Support: A 24/7 national support service for nurses and midwives that provides confidential advice and referral. Call 1800 667 877. The Nurse & Midwife Support website has numerous articles including staying healthy, mental health and managing workplace issues including dealing with violence and aggression and burnout.

For all health care workers Other mental health and wellbeing support options for primary care workers include: Black Dog Institute: TEN app and essential network for health professionals Beyond Blue: How health care workers can support themselves and each other Beyond Blue: Coronavirus Mental Wellbeing Support Service or call 1800 512 348 The Pandemic Kindness Movement: Created by clinicians across Australia and backed by Safer Care Victoria THIS WAY UP: Free practical online tools from the Department of Health Smiling Mind have released a special program for health care workers with support from the Australian Government. It provides resources to help you look after your mental health during the pandemic including tools for managing stress, improving sleep and building resilience. Access the program by downloading the Smiling Mind app for Apple or Android. Phoenix Australia has developed some useful mental health tip sheets to support health practitioners and community members.

 

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COVID-19 Test Isolation Payment

The WA Government will introduce a $320 COVID-19 Test Isolation Payment from Saturday 5 February 2022.

The Payment is a single $320 payment for workers living in WA who have been directed to quarantine while awaiting a COVID-19 test result, are unable to work from home and do not have access to paid leave or other income.

For more information on the payment, including eligibility and how to apply, visit WA.gov.au

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Why should I have a Fit Test?

Fit testing is a method for matching P2/N95 respirators with an individual’s facial shape.

A respirator fit test assesses whether a respirator mask forms an adequate seal around the wearer’s face and checks if the worker is receiving sufficient protection against biological contaminants. Fit testing is important to ensure that the expected level of protection is provided by minimizing the total amount of contaminant leakage into the facepiece through the face seal. After passing a fit test with a respirator, an individual must use the exact same make, model, style, and size respirator to ensure adequate protection.
 
In 2021, the Infection Control Expert Group (ICEG) updated its guidelines, recommending that all healthcare workers wear P2/N95 respirators instead of a surgical mask in the ‘likely high risk of transmission’, and that they be fit-tested before use.
 
Fit testing should be performed by an appropriately trained person. There are several commercial providers that provide the service - some of these will even conduct fit tests in the workplace with portable equipment.
 
Health care workers who wear P2/N95 respirators should complete fit testing before first use and perform a ‘fit check’ each time they put on a new respirator. Fit checking ensures the respirator fits the user’s face snugly and creates a seal. This minimises the number of particles that can bypass the filter through gaps between the user’s skin and the respirator seal which can be checked by gently inhaling. If the mask is not drawn in towards the face, or air leaks around the face seal, readjust the mask and repeat process or check for defects in the mask.

This video demonstrates how to put on a P2/N95 mask and do a fit check.















 

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VIDEO – Donning and Doffing in Primary Care Settings

Professor Alison McMillan, Chief Nursing and Midwifery Officer for the Australian Government Department of Health, explains how to don and doff personal protective equipment in primary care.

View video here

Further training on donning and doffing of PPE is available in the events & education section of this newsletter.

 

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Co-administration of COVID-19 vaccines and other vaccines

The Clinical recommendations for COVID-19 vaccines now include advice that seasonal influenza vaccines can be co-administered with COVID-19 vaccines and that, if required, other vaccines can also be co-administered with COVID-19 vaccines. This includes routine childhood and adolescent vaccines. The benefits of ensuring timely vaccination to protect from vaccine-preventable diseases and maintaining high vaccine uptake outweigh potential risks associated with immunogenicity, local adverse reactions or fever.

 

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COVID- 19 HealthPathways Updates

HealthPathways WA is regularly updating the suite of COVID-19 pathways. To keep updated health professionals and practices are encouraged to refer to the relevant COVID-19 pathways:

⇒   COVID-19 Practice Management
⇒   COVID-19 Assessment and Management
⇒   COVID-19 Child Assessment and Management
⇒   COVID-19 in Residential Aged Care Facilities
⇒   COVID-19 Last Days of Life
⇒   COVID-19 Mental Health

⇒   COVID-19 Vaccination
        –   COVID-19 Vaccination Information
        –   COVID-19 Vaccination Procedure
        –   COVID-19 Vaccine-associated Thrombosis and Thrombocytopenia
        –   Myocarditis and Pericarditis After mRNA COVID-19 Vaccines
        –   COVID-19 Vaccination Referrals and Advice

⇒   COVID-19 MBS Items
⇒   COVID-19 Telehealth
⇒   Electronic Prescribing
⇒   COVID-19 Information
⇒   COVID-19 Impact on Clinical Care
⇒   COVID-19 Impact on Local Services
⇒   COVID-19 Testing and Advice

To access HealthPathways please email the HealthPathways team at health.pathways@wapha.org.au

 

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Zostavax, Varivax, and ProQuad now available to order for regional providers

Message from Communicable Disease Control Directorate (CDCD), WA Department of Health:

The newly configured Sensitech TagAlerts used by Onelink have arrived and are now able to safely monitor the temperature requirements of Zostavax, ProQuad, and Varivax.
 
These vaccines are now available for you to order, effective immediately.
 
Please note: 

• All regional providers should notice that the ordering template name in Onelink has been reverted to the original template name and should no longer have the word ‘interim’ at the end of the template name.
• Providers who require a larger order of Zostavax than appears in their ‘Suggested order based on your monthly average’, should add a note in the ‘Delivery instructions’ field. This is to allow immunisation providers to deal with any backlog or waitlists for these vaccines. 
• Varivax should continue to be ordered only on an as needs basis and in small quantities.

We appreciate your patience during this time, and thank you for your ongoing commitment to the immunisation of Western Australians.
 

 

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Renew your NASH to maintain access to Electronic Prescribing and My Health Record

To keep access to digital health tools such as Electronic Prescribing and My Health Record, you must have a current NASH Certificate installed. NASH Certificates may be expiring in March 2022 for many organisations.

The Australian Digital Health Agency (ADHA) is hosting multiple webinar session dates that will step you through the process of requesting and renewing a NASH certificate for your organisation.

The staff member who is the Organisation Maintenance Officer (OMO) needs to attend as they are responsible for renewing NASH certificates. OMOs are also encouraged to check they can log into PRODA prior to attending, to ensure the demonstrated steps can be easily completed following the session.

Webinar details: (14 dates to choose from)
Choose a date and register

The ADHA have also released the Renewing your NASH PKI Certificate quick guide to assist you with this process for your practice.

For further support and information on renewing your NASH Certificate please contact Practice Assist. 

 

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NPS MedicineWise COVID-19 Hub

NPS MedicineWise are funded by the Commonwealth to promote evidence based health information to support informed health decisions and the quality use of medicines.

The NPS MedicineWise Covid-19 hub is a central webpage offering the latest evidence-based information for healthcare professionals and for consumers, with links to the current state and territory health department information.

The NPS MedicineWise website also includes:

• translated resources - links to reliable information about COVID-19 translated into 63 different community languages
• information on how to report and discuss possible side effects following a COVID-19 vaccination
• podcast Episode 33: Talking to parents about the COVID vaccine in which NPS MedicineWise medical advisor Dr Caroline West interview with Professor Julie Leask to discuss the COVID 19 vaccination and it’s availability to children over the age of 12. They discuss the hesitancy some parents have toward the vaccines and how to address the questions parents have.  View the podcast here

 

 

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Additional orders for COVID-19 vaccines 

The Australian Department of Health would like to remind practices of the method for requesting additional orders of COVID-19 vaccines.

• Contact WA Primary Health Alliance (WAPHA) via the stock redistribution form
• WAPHA will collate this information and notify the National COVID Vaccine Taskforce for consideration.
• Requests are collated and considered by the Taskforce.

The Taskforce consider current vaccine doses within the LGA to cover the population, among other considerations.

Practices with an urgent need for stock should fill out the stock redistribution form or reach out to nearby vaccination sites that may have excess doses to share.

Practices should avoid booking appointments and clinics unless there is a confirmed vaccine supply.

 

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WA Primary Health Alliance stock redistribution

Supply of COVID-19 vaccine stock is controlled by the Australian Department of Health.

Practices that are unable to source COVID-19 vaccine supplies through local networks, including general practices and pharmacies, should complete the survey.  

WAPHA is working with stakeholders to source large quantities of vaccine stock for practices with an urgent need to fulfil upcoming booked appointments.

For other requests, please contact the Vaccine Operations Centre (VOC) for further assistance on 1800 318 208 or via email


 

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Healthdirect Video Call COVID- 19 GP Program Extension

Learnings from colleagues on the east coast have indicated that using telehealth services during the pandemic has been critical for the health care of their patients, and the survival of their practice. If you are not telehealth enabled please contact our Digital Health Team or see the Digital Health resources below.

Healthdirect Australia is pleased to announce that the Department of Health has extended the healthdirect Video Call COVID- 19 GP Program to 30 June 2022.

This provides free Video Call access for general practitioners working in private practice and/or Aboriginal Community Controlled Health Organisations (ACCHOs).

• We encourage you to continue using this secure video consulting platform which has been purpose-built for primary care settings. 
• For GPs in private practice wanting to start using the service, please register your practice. For GPs in ACCHOs wanting to start using the service, please register for access.
• RACGP CPD accredited training in healthdirect Video Call is available for your practice (see below).

RACGP Accredited Training

In collaboration with the RACGP, Healthdirect Australia is offering CPD courses that support GPs and Practice Managers to use Video Call more confidently and effectively. The following free courses are run by Healthdirect’s RACGP Education Activity Representatives:

• Essential Video Call training 1 hour 2 CPD points for RACGP or 1 hour ACCRM credit

This module is for GPs new to Video Call and covers the basic functionality of the platform. The course will also suit Practice Managers who may be implementing telehealth into their practice workflows. Register here for essential training

• Advanced Video Call training 1 hour 2 CPD points for RACGP or 1 hour ACCRM credit

This module covers more advanced use of the platform. The course will also suit Practice Managers and anyone interested in how Video Call can reshape the provision of services to patients or clients. Register here for advanced training

Please contact the healthdirect Video Call team if you have any questions.