The Royal Australian College of General Practitioners (RACGP) is recommending that more must be done to help GPs care for patients with long COVID.
It comes following the college's response to the House Standing Committee on Health, Aged Care and Sport inquiry into long COVID and repeated COVID infections.
Long COVID is a broad term referring to a range of symptoms that can last for weeks or months after the initial illness. At this stage the ongoing effects remain relatively unknown, and prolonged illness could potentially last for years. The symptoms can be very serious and include fatigue, breathlessness, anxiety and depression, chest pain, "brain fog" and changes to taste and smell.
The RACGP recommends:
- GPs are acknowledged as being best placed to provide coordinated care for patients with long COVID
- current inadequacies in the Medicare Benefits Schedule to support patients with long COVID must be addressed
- an agreed definition of long COVID be established as an essential component of a plan to support appropriate assessment, diagnosis, and management
- that inequities be addressed to ensure all patients, irrespective of location or social factors, have access to best-practice medical care and support
- long COVID data is captured in primary care to understand the breadth and impact of this chronic condition in Australia and standards are implemented to create consistent clinical coding to support consistent data capture in electronic medical records
- funding is directed to general practice research into long COVID, with GPs leading this research and the interpretation of primary care data.
RACGP President Adj. Professor Karen Price said that long COVID must be taken seriously.
"Long COVID is hitting many patients hard and we must do more to help them," she said.
"That includes providing immediate support to patients with this condition and putting the right systems in place to ensure that in the years to come we are better prepared to tackle long COVID and the impacts on our healthcare system and communities more broadly. To start, we need a formal agreed definition of long COVID because right now there is uncertainty for patients and healthcare workers. We also need up-to-date evidence-based guidelines developed and maintained, something that could be achieved through ongoing funding of the National Clinical Evidence Taskforce.
"One of the challenges we face is poor patient awareness of long COVID and lack of access to medical and allied heath appointments, not to mention the possibility of substantial out-of-pocket fees in accessing multidisciplinary care. Patients are reporting problems navigating the health system to get proper long COVID assessment, diagnosis, and appropriate treatment and that must change. There are not enough specialist long COVID clinics, especially in rural and remote areas, and those clinics that are up and running can't meet demand. There are also long wait times for review and input by other medical specialists and allied health professionals.
"We need to educate the general public about long COVID and make sure all patients, regardless of their postcode or any social factors, have access to best-practice medical care and support. That can only occur through a mix of access via appropriately funded and resourced practices and dedicated long COVID clinics, with extended access to Medicare Benefits Schedule-funded allied health sessions. Until we have those supports in place, people will not be able to get the help they need and their ability to live their lives to the full won't be realised.
"GPs coordinating care in the community will greatly assist the health literacy of patients when it comes to long COVID. The last thing we want to do is fragment care and ignore the expertise of specialist GPs."
Adj. Professor Price said that reforming the Medicare system would also allow GPs to better manage long COVID patients.
"The Medicare Benefits Schedule is not fit for purpose for managing long COVID patients," she said.
"GPs are reporting confusion on the use of different Medicare items including GP Chronic Disease Management items in the context of long COVID as well as Team Care Arrangements. Yet again the fiendishly complex Medicare system is making the job of GPs that much harder than it needs to be. Let's give GPs a break and let them do what they do best – getting on with the job of helping patients in need. The unique circumstance of this complex condition requires further clarity on the use of the relevant Medicare item numbers so that GPs have certainty in what they are doing.
"Consider also that the problems inherent in the Medicare system are impacting patient care for those with long COVID. The current Medicare rebate structure disincentivises GPs spending longer amounts of time with patients with multiple, complex conditions. Long COVID patients with other chronic illnesses fall squarely into that category of patient and this further highlights the need to reform the system by increasing rebates for longer consultations so that GPs can take the time to really get to the bottom of what is going on.
"We must make sure to learn lessons from this pandemic, including the longstanding need for improved funding to support general practice care. GPs are needed by their patients more than ever before and if government doesn't increase funding for GP care some patients will be left behind, including those with serious long COVID symptoms."
The RACGP President said that a long-term plan was also needed.
"Whilst it's vital we do everything possible to help long COVID patients in the here and now, we must also look ahead because this public health problem is not going away anytime soon," she said.
"We must better define long COVID to enable accurate data collection and the development of best-practice guidelines. It's vital that data is gathered from the entire health system, not just hospitals, and that GPs are included in interpreting all primary care data. Let's also make sure to investigate factors such as the correlation between different variants and long COVID, the impact of vaccination and antiviral treatments, and how best to manage this condition.
"If we continue to learn and share information, we can tackle long COVID head on rather than playing catch up as patients suffer. In short, Australia needs a data driven plan to manage this pandemic and long COVID for the years ahead and accurate data allows us to set targets and measure outcomes.
"The RACGP also believes a renewed focus on supporting and funding research in general practice will assist in the fight against long COVID. Unfortunately, general practice research is not always prioritised by government, and this must change because we are the cornerstone of the health system that provides care to the vast bulk of the population.
"So, research funding into long COVID should be directed to general practice where much of the patient care is being undertaken. Only then can we get a more accurate snapshot of this condition and how to help affected patients."
An RACGP resource on caring for adult patients with post-COVID-19 conditions can be found here.
