The role of general practitioners in disasters and emergencies

2.1 GP representation and inclusion

Issues

The integration of GPs and general practice more broadly into formal systems of disaster response is variable across each region. This results in GPs not having a clearly defined role in emergency response plans and creates a systematic barrier impacting their ability to assist efficiently.

General practice has not historically, nor consistently, been well integrated into federal, state and territory and local emergency planning and scenario training, with the role of GPs unclear in command-and-control structures.  

Recommendations

The RACGP recommends:

1. GP representation is established, via a mechanism or pathway for regular input into national, state/territory and local health disaster management and other relevant committees and groups, including but not limited to:

• (AHPPC)
• (NHEMS) (a subcommittee of the AHPPC)
• the

This will ensure decisions involving or affecting general practice are consistent, feasible, appropriate and actionable.
 

2. general practice is included in federal, state and territory and local emergency planning and scenario training, with clear command-and-control structures in place.

Inclusion in preparedness activities equips GPs and their practice teams with the knowledge and resources required to support their community during and after a disaster or large emergency event and leverages the unique, trusted role GPs play in our community structures.³
 

3. GP participation should be appropriately remunerated for time and expertise.

2.2 Funding

Issues

General practice financial viability is a national issue⁴, which is exacerbated for general practices located in emergency and disaster-prone areas. General practice is critical health infrastructure, however without adequate support and prioritisation before, during and after a disaster event, it may not be viable for practices to remain open, or for GPs to operate in high-risk areas.

The RACGPs Health of the Nation Report 2022 found the proportion of GPs considering imminent retirement is increasing in part due to the added pressure of pandemics and natural disasters.⁴ The report found 62% of practice owner respondents identified sustaining practice during and following a disaster or pandemic as a major business challenge, with burnout a key issue identified.⁴

The loss of general practice in a community following a disaster is a devastating outcome and puts additional and significant strain on the hospital system. This poses a risk to the vulnerable community members within the population who rely on GPs for their continuity of care.  The absence of GP services following a disaster exacerbates the load on hospitals to manage acute patients, as non-emergency, chronic illness management and routine care is diverted to emergency departments, or patients are left untreated in the community with significant risk to health outcomes.⁵

Ensuring practices are supported to continue operating in the wake of a disaster event is critical. Without dedicated funding for disaster and emergency preparations, general practice faces challenges to support response efforts in an emergency or disaster. ⁵ A commitment to financially supporting general practice before and in times of crisis events will improve health outcomes and has the potential to retain and attract GPs into disaster prone areas to support the additional load on services.

General practice must be financially supported to prevent, prepare, respond, and recover from disasters to keep their practice doors open to deliver high quality patient centred care across the short and medium to long term periods following a disaster, and into the next event.

Recommendations

The RACGP recommends:

1. direct financial support for GPs and their practice teams to:

• invest in infrastructure support (where a practice operates in a high-risk area), for example procurement of diesel generators or modifications to a building to minimise flooding, to support business continuity following a disaster event (see also 2.3)
• undertake GP appropriate disaster planning education and training
• develop, implement, test and train an emergency/disaster management plan for their practice
• participate in disaster specific mental health training, in order to provide counselling care to patients who may have experienced disaster.

Direct financial support for practices could be via a program similar to the , with funding allocated based on practice location, accreditation status and the GP full time equivalent (FTE) per practice.

2. broader financial support from the Federal government for the general practice profession to:

• support general practice access to state and local emergency management training and exercises to prepare for disaster events, including upskilling a cohort of GP disaster managers, providing national representation 
• support the RACGP to develop further resources, training and education on general practice disaster management
• ensure Primary Health Networks (PHNs) receive ongoing funding to support locally tailored disaster prevention, preparedness, response and recovery activities within their catchment.

2.3 Prioritising general practice as an essential service

Issues

Effective disaster planning and management includes the protection of community infrastructure to support resilience and recovery. Most local disaster plans will usually identify which infrastructure and community assets are priorities for protection and restoration during a disaster event.

General practice must be prioritised as an essential and critical healthcare service to support resilience in the aftermath of disasters. It needs to be able to access essential services including ongoing electricity supply during outages, with access to diesel powered generators and be prioritised for power restoration.

Extended power outages are an identified major risk of concern for many general practices. Lack of power results in significant difficulties running practices, therefore limiting community access to essential healthcare at a time of crisis, as well as vaccine wastage, which have both health and financial impacts for the community and practice.

Recommendations

The RACGP recommends:

1. prioritising general practice for protection and restoration before, during and after a disaster event to support access to:

• priority infrastructure repairs to restore health services
• emergency funding to ensure practices can:
  • remain operational, or reopen promptly
  • support staff where practices need to close for long periods of time to recover
  • engage additional locum GPs to respond to an increased workload during the recovery phase
• two-way communication channels with decision makers and relevant information to support an appropriate response to the event and their ability to continue operating
• supplies and medicines to support disaster healthcare, including support for GPs and their teams providing services in emergency evacuation centres
• additional personal protective equipment (PPE) from the National Medical Stockpile, where required.

2.4 Creating efficiencies for GPs interacting with government services

Issues

GPs are a constant healthcare service present before, during, and after any disaster. Pre-planning for disaster response to secure ongoing access to GPs and other general practice services can help keep patients away from often overwhelmed hospital emergency departments and provide better outcomes for the community.

Creating efficiencies for GPs and practices contributing as part of disaster response, when they are interacting with government services (such as Services Australia), will enable them to efficiently and effectively respond to the needs of their community.

Recommendations

The RACGP recommends:

1. allowing the portability of provider numbers for as long as required, particularly where GPs are displaced, rather than just for the current two-week period before an emergency provider number needs to be obtained. This should include for GPs in training

This will minimise the administrative burden for providers who need to relocate for extended periods and enable them to still provide Medicare eligible services to patients.

2. supporting longer consultations and increased use of telehealth to facilitate access to healthcare for displaced populations

This may result in Medicare billings that fall outside of normal practice and the Department of Health, Disability and Ageing should exercise discretion when undertaking compliance activities that may impact these GPs, with consideration given to the scale, timing and administrative burden placed on the GP.

3. The exemption to the currently in place for “people affected by natural disaster, defined as living in a local government area declared a natural disaster by a State or Territory Government” be retained permanently

Patients who meet this criterion can access MBS telehealth services from any GP, regardless of whether they have had a face-to-face visit in the past 12 months, ensuring continued access to healthcare during a disaster event.

2.5 Research into GP disaster response

Issues

There is currently a lack of research into the role of GPs during disasters which exacerbates the lack of integration of GPs in disaster planning and response. There is a lack of understanding from other first responders on the role of GPs and their capacity to contribute to the disaster response which must be rectified.

Recommendations

The RACGP recommends:

1. ongoing investment in research to ensure the capabilities GPs can bring to disaster prevention, planning, response and recovery are understood, documented and employed.

This will better enable integration of GPs into disaster prevention and planning, and support GPs and their teams to build community resilience and improve health outcomes through all stages of disasters.

2.6 GP wellbeing and support after a disaster

Issues

Local healthcare responders, including GPs, can face immense pressure during and after a disaster, often providing care to their communities while also being affected as a community member themselves. The importance of health support is duly recognised for emergency services workers at a Federal level⁵, and this same consideration should be extended to GPs and general practice staff on the frontline of disaster response.  

GPs affected by disasters are more likely to feel burnout⁶, more likely to retire early, or close their practice earlier than intended.⁵ GPs need to be supported to seek care and take time away from work when needed and disaster areas need to be appropriately resourced with locum support to avoid local GPs working extraordinary hours.

Recommendations

The RACGP recommends:

1. Clear pathways be established for GPs and their practice teams to access timely physical and mental health support following a disaster.  

This may be via:

• PHN funded programs
• funding for state and territory doctors’ health organisations who can provide  support for doctors who have been directly or indirectly impacted by disasters.

2.7 Contribution recognition

Issues

GPs and their practice teams often provide services, care and support during and in the wake of disasters that display exceptional commitment and surpass professional standards. These efforts must be recognised.

Recommendations

The RACGP recommends:

• GPs and their practice teams providing sustained or significant participation in disaster response and recovery activities should have their contributions formally recognised, such as through consideration for the .