COVID-19 may well be the catalyst for significant change in how general practice operates in New Zealand in future, according to University of Otago general practice experts.

The coronavirus pandemic is potentially the most significant change to primary health care services and general practice within most health care providers’ lifetimes.

General practice has been at the forefront of innovation; it has changed almost overnight, from delivering most of its patient contacts through face-to-face consultations to deliver these remotely through telephone, video and internet consultations.

“There is significant uncertainty and differences of opinion within general practice about what ‘general practice’ should look like as we move towards a ‘new normal’,” the Otago general practice leaders say. 

“How much of the new ways of working should and will be retained?” they question.

University of Otago Professors of General Practice, Tony Dowell (Wellington) Les Toop (Christchurch) and Tim Stokes (Dunedin) and their colleagues Heads of General Practice Departments, Drs Carol Atmore (Dunedin), Lynn McBain (Wellington) and Ben Hudson (Christchurch) all agree that while the pandemic has presented challenges for general practice, some positives have emerged.

“As well as the difficulties that have arisen, there is a sense that the change in how we have been delivering primary health care due to COVID-19 has provided opportunities as well,” the leaders say.

“The question is, how do we get the right balance between face-to-face and virtual means of continuing our relationships with patients and providing care that meets their needs?”

The group is unanimous that general practice and primary health care will be vital to the health sector as it moves forward.

“We will continue to need strong generalist primary health care in the new post-COVID era that will feature more telemedicine.”

General practices are currently not as busy as usual and this brings financial concerns at a time when expenses have increased.

“The challenge of managing a primary care workforce which at present sees many doctors under-employed and practice income compromised, will need to be balanced with the increased workload that may still come directly from COVID-19 with the backlog of late presentations and deferred maintenance of long-term conditions.”

The Otago experts consider it likely that the impact of COVID-19 on how general practice provides care to people will lead to a re-examination of business models and systems.

They say there is a real opportunity to debate what new system will be most beneficial to patients and one which achieves equity in health outcomes for all - particularly with the New Zealand Health and Disability System Review imminent.

They predict significant impacts on individual patients and the population.  “Many patients will be very significantly affected by the socio-economic downturn and this will have an impact on their ability to access health care as well as increasing rates of, for example, child poverty with increased childhood morbidity as a result. These burdens will be felt disproportionately by Māori, Pacific and vulnerable populations such as refugees.”

They also perceive there will be significant psychological impacts on patients presenting in general practice.  “The psychological impact of COVID is likely to be complex and an increasingly important component of COVID-19 work. 

Depending on the future pattern of the virus, then COVID anxiety will remain as a general feature of social life for some time to come.”