8 April 2021

Learning from the great GP COVID vaccine swindle

COVID-19

Over the Easter weekend GPs were treated to what must have felt like the last straw as far as the government’s “no really, GPs are front and centre of this vaccine rollout” and “don’t we love them, they’re the beating heart of our healthcare community” positioning.

The NSW government reached out to the federal government to start the ball rolling on state-run mass vaccination centres, and the feds immediately accepted.

In doing so, they not only ignored that the underlying problem is one of supply, not logistics in getting vaccines out to GPs, but they wholly abandoned months of spruiking, marketing and promising the GP sector the starring role in the national COVID vaccination program.

It was that politically easy. Apparently the PM didn’t even need to few hours to think about it. Something twigged politically and out the window went months of worry, planning, effort and investment by a lot of GP practices around the country.

The worst hit were those that had decided to innovate early and lead the charge with significant up front plans and investment.

In one prominent newspaper report over the weekend, a Bondi GP practice, which had bought new hardware, employed new staff and trained their entire existing staff so they could vaccinate up to 2000 patients per week, was allocated 50 doses per week but wasn’t confident enough in actual supply to take bookings until the doses arrived on site.

How much sunk cost and loss has this thoughtful and well-meaning group suffered at the hands of a federal government that put all its political marketing eggs in the GP basket – even though it knew it wasn’t paying them enough to vaccinate financially as small businesses?

Given the NSW government’s likely escalation of mass vaccination hubs, and the likelihood of other states following, how much tangible immediate loss is the GP sector going to cop nationally?

How many more illogical, financially draining, thoughtless, but politically expedient about-turns will it take by the federal government for GPs to actually reach a tipping point here?

Is there a limit to how badly the GP sector can be treated, before it reacts with one voice in Canberra that says ‘enough’?

You suspect as things stand there might not be a limit. And that might be the only lesson individual GPs and practice owners can take from the whole episode. No one has their backs in the end in Canberra. No one is organised enough, smart enough and tough enough to threaten Canberra in a way that Canberra feels genuine political pressure and fear, and isn’t able to twist the narrative to the “greedy doctor syndrome”, which is what they do if the lobbying is disorganised enough, as it has been now for years.

Here’s a quick timeline reminder of the journey the government has taken GPs on through the politically hot issue of getting the nation vaccinated:

  • Rhetoric started before Xmas on how important GPs would be to the entire process. Federal Health Minister Greg Hunt repeated the terms “front and centre” and “centrepiece of the program” too many times to count.
  • The government announced in late January that they wouldn’t be paying GPs enough to vaccinate unless they industrialised the process and managed to get very high throughput. A lot of practices started gearing up for that – the one mentioned above included, but something like 500 bigger set ups around the country.
  • The RACGP and the government gave every indication that only 1000 to 1200 practices would be capable of doing what was needed (which made sense if you were going for speed and volume) but at one minute to midnight the government did an about face and approved 4600 GP practices’ EOIs. The government spun the increase in terms of “front and centre” rhetoric, but something didn’t add up. Suddenly nearly quadrupling the numbers threw all the logistics planning out the window, and a lot of financials for those that had taken government signals and invested in big set ups.
  • The government spruiked its vaccine credentials, numbers and timetable to the nation, despite knowing that Europe and the US was in crisis, and had in Europe already invoked legislation that would withhold supply from that region if things got bad. But things were already bad. There was never going to be stock to feed 4600 GP surgeries when phase 1b began. There was never going to be stock full stop. But the government kept the rhetoric up and many GP practices started preparing.
  • When practices got their detailed logistics and planning advice from the government, many went into shock. Fifty doses per week was the norm, and even then, practices coming online would be staged.
  • Despite this the government went ahead with a big announcement around GP practices one week before the first practices were due to come online, and then with not enough stock. Mayhem ensued, as surely some must have predicted. GPs were inundated, patients were angry and disappointed, and the government came out with a “nothing to see here” type response, although going early was a clear stuff up for which they should have apologised and even compensated some GPs.
  • The government had initially promised a “centralised booking and logistics system”. It paid out millions to big C consultants to get a logistics system up centrally out of Canberra, but once they decided to distribute to 4600 GP practices not 1200, the game was up in terms of realistically being able to manage the logistics. There was no booking system, the government hastily retreated to the existing booking system infrastructure, but because the government could not set up single ID now, multiple bookings were inevitable, and the madness that came with that.
  • Bookings officially became a mess for the entire GP sector and still are.
  • So there is currently no vaccine, and no logistics to manage supply accurately to GPs, either. From this point on, the program could not succeed. And although the government was copping more flack than individual GP practices, GP practices were copping flack, and losing time and money trying to explain what was actually going on to patients who had not been communicated to properly by the government.
  • The last straw? On Saturday the NSW government (which says it doesn’t want to play COVID politics, but has been masters of it since dipping out of any blame for the Ruby Princess debacle) made an approach to the federal government to help with the  supposed issue of the vaccination program running late. But while the program is running late, it is nothing to do with the the federal government using GPs to vaccinate. It is to do with supply of vaccine, which will eventually be sorted out by local manufacturer of the AZ vaccine by CSL.
  • Too late. The federal government ignored what was really going on, ran with the NSW Health narrative that they are the service providers and know how to do it and are set up (which they aren’t entirely yet either), ignored that GPs are the  hub of most vaccination programs including flu, and decided to take the political fig leaf offered by the NSW government and run with the idea that the problem will get solved now because state governments are going to go early and hard with mass vaccination hubs.
  • Game over. GPs entirely left in the cold.

This isn’t to say that going mass vaccination hub isn’t a good idea. It’s logical, economical and will help with speed, no question.

But that isn’t the point.

The point is the federal government rightly or wrongly (probably wrongly) made GPs the “centrepiece” of the national COVID vaccination program, then treated them appallingly to the point where this last weekend, surely the most optimistic and well thinking GP can see that their cynical treatment by the government has been near unethical.

There are no silver linings if you were one of the unlucky practices that spent time and money organising to go big early: you are out of pocket by quite a margin almost certainly, and patients aren’t thinking any better of you. Many of these groups had figured that if they went to the expense of setting up for very high volume, they would not make money on the project but might add clients to their roster.

For those small to mid range practices, most of whom were told they would only get 50 doses per week, in some ways, the economic issues can be handled much better now.

A lot or patients will go to a mass vax set up going forward. You can take the ones who are the rare in betweeners who still want you to do it, and you will have less issue fitting them in. You can also take all the ones who freak out with symptoms or need a medical certificate to get through the few days of symptoms.

GPs can settle back to being badly treated in Canberra by the government, and, sorry to keep harping on about it, but being badly represented by the RACGP at every turn.

I haven’t said much here deliberately but if you want a timeline of what the RACGP did and said which supported the government at nearly every turn in what is now very clearly a lot of push and pull deception, it’s very easy to put that together. Google department of health press conferences and count how many times senior leadership of the college stood hand in hand with the government and attempted to take credit for things the government had already decided to do.

And then in this last week they’ve come out with “GPs are struggling with supply and its not their fault”.

Well, derr.

We knew this was going to happen six weeks ago when you were being polite and getting photo ops with the Minister and DoH in Canberra at a big table, like you were making some sort of difference.

Do we have a lesson, or just another giant straw on the back of the GP camel in its relationship with the government?

GPs had a pay freeze for five years and in that time the AMA and the RACGP attempted to spruik that they’d done some sort of accord, like Bob Hawke in the 80s. It was the opposite of course. It was people in Canberra being seduced by Canberra and selling out their peers.

No lesson really in that.

The RACGP does a lot of good but anyone still willing it to be a great lobby group is a dose short of a vial. It is structurally incapable, as we’ve outlined a lot now, so don’t expect it to be changing anything from a political perspective, don’t exert too much effort in thinking about it, and work on some other solution to this issue, if indeed there is one.

The giant straw is just how badly GPs got dumped this last weekend after being used as the key point of the government’s vaccination marketing for so long.

That straw goes up there on to that back with a lot of other straws.

When that back does eventually break, GPs are going to need to be better organised from a lobbying and marketing perspective than they are now.