GPs need more support to manage long covid

And patients need more than a 10-minute consult and five allied health visits a year, a parliamentary inquiry has heard.

---

GPs treating people with long covid need help, including earlier access to chronic disease item numbers and a tripling of the bulk-billing incentive.

In its last scheduled public hearing today, the House Standing Committee on Health, Aged Care and Sport’s inquiry into long covid and repeated covid infections heard from Professor Mark Morgan, chair of the RACGP’s Expert Committee for Quality Care, and co-chair of the National Clinical Evidence Taskforce primary and chronic care panel.

“Long covid requires care coordination, it requires time with the patient, it requires time to understand the local resources, and it requires time for follow-up,” Professor Morgan said.

“Current rebates are not adequate, additional resources are needed, and five allied health appointments per year is clearly insufficient.”

Professor Morgan told the committee that in the short term the ability to use chronic disease MBS item numbers earlier in the case of patients suspected of having long covid would “make sense”. Currently, those item numbers (721, 723, 729, 731 and 732) can only be used “for a patient who suffers from at least one medical condition that has been present (or is likely to be present) for at least six months or is terminal”.

“Adjusting item numbers to allow asynchronous meetings would allow case coordination and remove some barriers to accessing multidisciplinary care,” said Professor Morgan.

In the medium term he said a rethink of the way the MBS supports chronic diseases was needed.

“[At the moment] the system is designed for episodic care, with time-based funding that drives doctors towards shorter consultations,” he told the committee.

Over the long term, Professor Morgan said a “tripling” of the bulk-billing incentive was needed: “That will encourage practitioners to provide services to vulnerable people without charging a gap.”

Professor Brendan Crabb, AC, CEO of the Burnet Institute, also gave evidence today, telling the committee that governments needed to publicly acknowledge the seriousness of the long covid situation.

“We have a very substantial problem here,” he said. “The likelihood is there are 500,000 people with long covid and that needs to be acknowledged. The days of talking about acute covid without also talking about long covid should be over.”

That acknowledgement would “help enormously” in persuading Australians to lift the vaccination uptake.

“What increases vaccination rates is having a true sense of the risk out there,” Professor Crabb said.

“I believe Australians are not aware of the true risk: there is a disconnect, the message is not getting through.

“Life expectancy in Australia is going to go down for the first time in 50 to 70 years – and that is driven by covid.

“When you take your child to the emergency department and you are told there’s no room – that is because of covid.

“We have to get a clear message to Australians, without panic.”

Professor Crabb was also clear on two other issues – PCR testing for covid must be improved, and eligibility for antivirals must be widened.

“If you are sick and you want to protect those around you, you have to find out if you’re positive,” he told the committee.

“Testing in this country is now ambiguous at best. You can’t get treated if you don’t know you’re positive.”

While acknowledging that research about antivirals needed to continue, Professor Crabb said that “we can walk and chew gum at the same time”.

“It’s very important that we widen availability of excellent treatments like Paxlovid.”

Other witnesses at the hearing today included Robyn Schofield, Associate Professor of Atmospheric Chemistry at the University of Melbourne, Professor Lidia Morawska from Queensland University of Technology, and Professor Geoff Hanmer, a director of advisory group OzSAGE.

All three emphasised the urgent need for a national indoor air quality standard.

Professor Hanmer, Professor Architecture at the University of Adelaide, said natural ventilation in schools and aged care facilities was “the biggest risk” in terms of mitigating transmission of covid.

“Schools have openable windows and so do residential aged care facilities, but nobody opens them,” he told the committee. “That’s because of thermal comfort factors. Until we can control thermal comfort we’re nowhere [with natural ventilation].

“Mechanically ventilated buildings perform pretty well, but over time filters don’t get changed often enough and fresh air is reduced to reduce costs.

“With no indoor air standard we can’t rectify poor ventilation except by casual use of air filters, which are better than nothing. But over the medium to long term we need a strategy to move from temporary measures to permanent ones.”

Submissions to the inquiry are now closed.