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Common practices involved in Australia’s COVID-19 vaccination program are hardly making ends meet, researchers say.
General practice has administered more than 31.5 million COVID vaccines during the outbreak so far.
Common practices barely broke even when the vaccine was introduced – with many losing money as a result, according to a new report published in Australian Health Review diary.
Its authors, including Dr Michael Wright, Chair of the RACGP Expert Committee – Health Funding and Reform (REC–FHSR), write that the contribution of general practice to vaccine dissemination is largely based on the ethos of GPs doctors.
The involvement of primary care – with general practice delivering 31,594,390 doses at the last count – helped more than 95% of the population receive at least two doses and led to Australia being one of the most vaccinated nations in the world.
“The success of the launch of a COVID-19 vaccine in Australia relied on the goodwill of general practices,” the researchers concluded.
“Participating in the launch of a vaccine against COVID-19 has resulted in increased stress, increased administrative workload and reduced financial viability for many practices.”
The study is designed to assess the impact of the introduction on general practice finances and workforce and is based on 18 interviews with general practice owners and managers in Greater Sydney from June to August 2021.
Most interviewees were practice managers, while the majority of participating general practices were described as “clinician-owned, well-established and medium to large in size”.
At the time of the interviews, most were operating under lockdown restrictions.
Although many suspected that they would make a loss by participating, they still wanted to contribute to the fight against the pandemic.
“We knew that if we were going to do COVID vaccinations in the practice, we would probably have a drop in revenue because of that,” said one interviewee.
“But we were all very passionate about doing what was good for the community.”
A “very accurate” report
Two GPs and a spokesman for some of the country’s largest GP clinic operators said they strongly supported the report’s findings when contacted newsGP.
Dr Yee-Shing Kan, chair of the RACGP Specific Interests Business of General Practice, said the research resonated with her and would appeal to many GPs across the country.
“Our Perth practice has registered as a COVID vaccination clinic primarily for the benefit of patients, [out of] goodwill and hope that this will end the lockdown and the pandemic,” she said newsGP.
Dr Kahn said the practice had “just” failed due to having to buy an extra vaccine fridge as well as a spare generator to run.
Apart from the financial investment, she highlights the additional time required, such as training spent on vaccination courses. However, the personal toll on staff proved to be the biggest cost, Dr Kahn said, with the practice having to adapt to resignations caused by burnout, as well as arguments stemming from the stress of having to organize clinics and vaccines.
“This has never happened since the clinic was established more than 10 years ago,” said Dr. Kahn.
Jeremy Stones is the former CEO of Better Medical, a group of 80 general practices, and the current spokesperson for the Primary Care Business Council, which represents the seven largest GP clinic operators in Australia.
He described the research as “very accurate.”
“Although financially overall it was detrimental to the profitability of the practice, we did this for the community and our patients as a key way out of the restrictions suffered during COVID,” he said newsGP.
However, Mr Stones says the involvement has had an ongoing impact on patient care.
“With lots of GPs, nurses and administrative staff [being] lack of isolation from COVID, it was a choice between dealing with the urgent versus managing long-term health issues because the system did not have the manpower capacity to deal with both at the same time,” he said.
“Many of the long-term health issues that were not addressed during COVID are emerging now.”
“Lack of understanding of common practice”
The study says that the initial enthusiasm for participation was eroded by the way the implementation was handled.
“There was a strong sense from all interviewees that the goodwill shown by general practice was not reciprocated by the federal government in developing or communicating COVID-19 vaccine policy,” the authors wrote.
“This lack of communication compromises the effectiveness of vaccine deployment.”
They show that many staff interpret this as arising from a lack of understanding of general practice.
Mr Stones says the satisfaction many feel from taking part in the “hard work” of the vaccine program has been undermined by the Government’s approach.
‘[It] it was coupled with fatigue, burnout and frustration with the stop/go nature and seemingly ad hoc approach to communication via TV news that created major operational headaches the next day,” he said.
“For practicing operators, we felt very disconnected from what was going on at times and were constantly left to fumble and react.”
Sydney GP and Chair of REC–FHSR Dr Michael Wright co-authored the study.
The study’s assessment also struck a chord with Dr Michael Tam, a GP academic at the University of New South Wales and a member of the RACGP Expert Committee – Quality Care (REC–QC).
“We are members of the communities we serve,” he said newsGP.
“However, this goodwill was not reciprocated by the government as roll-out was more difficult than necessary, with poor funding for the public health emergency initiative.
“Some serious questions need to be asked as to why ‘nickel-and-dim’ this vital part of the public health response was ever considered appropriate or strategic.”
Another clear problem was the timeliness of vaccine supply – a problem reflected in the interviews when there was a lack of Pfizer in many practices.
“The financial viability of vaccine clinics relied on practices obtaining adequate and predictable supplies of vaccines to meet demand,” the report said. “That didn’t happen in many practices.
“Vaccine supplies were unpredictable, with staff spending hours rescheduling appointments when expected shipments did not arrive.
“This mismatch between vaccine demand and supply has created numerous challenges and additional costs.”
The study does hint at some positive aspects of the vaccine rollout, especially when looking beyond the immediate impact.
Participants said longer-term benefits could be possible through changes made to vaccine delivery, including investments in online and telephone systems and new processes put in place to facilitate high-volume vaccinations.
“This may have long-term benefits for the viability and effectiveness of primary care, but in the short term it has increased financial and workforce pressures on practices,” the paper said.
The authors acknowledge that the interviews were conducted relatively early in the vaccine launch and that the results may have shown different results if conducted later.
However, the study echoes the early findings of an Australian National Audit Office (ANAO) report released last month, which was highly critical of planning and communication for the initial phases of the rollout.
General practices “proud” of the role
Despite the financial and personal challenges involved, all those approached newsGP say that the involvement of general practice in the implementation has been worthwhile, although not necessarily in a financial sense.
“I think most GPs and their teams who have been involved in the introduction of vaccinations are rightly proud of their efforts and service to the community,” Dr Tam said. “And that, of course, makes it useful.”
Dr Kahn added that despite the lack of recognition from the government, patients were “very grateful”.
“I still think it was worth it because look at the results we got,” she said. “Now we are able to be free, back almost to normal.”
Mr Stones also said staff at GP clinics were “proud to serve our communities”, but warned it would not be easy to take part in a similar campaign in the future.
“Can the primary care sector do it again? We would have been very willing, but we were unable to do so with the funding and resources received during the COVID pandemic,” he said.
“For example, the MBS rebates were not enough to cover all the costs, direct and indirect, of this unprecedented program, and we could not afford a repeat of that.”
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