Letter re Pathways Support

19 August 2021 Dr Ashley Bloomfield, Director General By email: Ashley.Bloomfield@health.govt.nz Bridget White, Deputy CE of COVID Response By email: Bridget.white@health.govt.nz Dr Andrew Connolly, CMO By email: Andrew.Connolly@helath.govt.nz Dr Don Matheson, Deputy DG Public Health and Primary care Transition By email: Don.Matheson@health.govt.nz Clare Perry, Deputy Director HSII By email: Clare.Perry@health.govt.nz Shayne Hunter, Deputy Director Data and Digital By email: Shayne.Hunter@health.govt.nz

Tēnā Koutou Managing People who are Covid+ in the Community We are writing to you on behalf of General Practice NZ, the Primary Care Clinical Leaders Group, and the Royal New Zealand College of General Practitioners. We would like to start by thanking you and your teams for your work over the past few days.

We are conscious that should there be a significant outbreak of Covid-19 in the community there is likely to be a need for mild to moderate cases to be managed by their primary care team in the community. Primary care is preparing for the effective management of these cases.

There are a number of things we believe are essential to the effective and consistent management of people in their own homes. This is based on evidence from other places where management of Covid in the community has been achieved in large volumes.

Consistent Primary Care Pathways In 2020 the Ministry of Health funded the development of and access to Covid-19 related pathways that were nationally consistent. We applaud this approach, and HealthPathways would be the ideal vehicle. The sector needs this information quickly, and Healthpathways has the writing expertise, trust across the sector, and the capability to turn this around in a relatively short time frame. This system also links to current PMSs. We are requesting that resources be allocated to the development of and access to a number of consistent primary care pathways for managing patients in the community. These pathways might cover pathways such as: • • • • • • •

Remote assessment and assessment of severity, referral Interim guidance for health staff implementing home care of people not requiring hospitalisation Remote monitoring and follow up When to discharge from isolation Long-Covid, management of post-acute Covid Symptoms Management of Covid positive patients with specific pre-existing complexities (e.g.

Paediatric assessment and referral

We recognise that the development of accessible and funded pathways for all primary care clinicians will require resource and we request your support with making this happen as a priority.

Supporting General Practice Networks and Teams

Pathway associated patient resources Recognising some resources may already exist for patients who are currently managed in MIQ, we would like to see a number of patient focused resources developed alongside the pathways. These might include: • • • • •

Treating Symptoms at Home How to use a pulse Oximeter Long Covid / Post Covid Condition advice Covid recovery - including advice for coming home from hospital, managing daily tasks Advice on Caring for someone else

These would need to be produced in a number of formats and a number of languages to ensure equitable access.

We would like to highlight that there are excellent resources available already that might be localised, so this work would not need to be done from scratch. These include: • • •

McMaster University and Hamilton Family Medicine in Canada: https://hfam.ca/clinical-pathwaysand-evidence/covid/assessment-diagnosis-and-management-of-covidand https://hfam.ca/patientresources/ NHS South Tyneside (just one example of UK resources) – user name: South Password: Tyneside https://southtyneside.communityhealthpathways.org/741255.htm World Health organisation (particularly episodes 36 and 47): https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/news

Additional Resources There are a number of tools that will also support management of patients in the community. These include: • Pulse Oximeters which can be made available to individuals to monitor in their own home environment. Modelling from Canada suggests 3 per 1000 population would be adequate • A robust online symptom checker such as this from the Centre for Disease Control and prevention: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

The teams at General Practice NZ, RNZCGP and the Primary Care Clinical Leaders group are happy to support this work.

Noho ora mai,

Dr Jeff Lowe, Chair GPNZ and GP Karori Medical Centre

Dr Jo Scott-Jones, Clinical Lead Pinnacle, Chair Primary Care Leaders Group and GP Opotiki Medical

Supporting General Practice Networks and Teams

Dr Sam Murton President, RNZCGP and GP Capital Care Health Centre