This article is referenced in the Medical Republic’s article Making the COVID vaccination pay 23/2/2021

 

Make it safe: a sustainable and socially responsible solution.

A five point checklist for patients and providers on why you can trust your local GP. 

Our Prime Minister has had a hilarious start with an Aussie bird when announcing Australia’s vaccination arms race!

 

Source: ABC News, 21st February 2021

David Dahm our CEO and Founder was recently interviewed for this article in the Medical Republic called Making COVID Vaccination Pay.

 

While Australia begins its ambitious mass COVID-19 program, a recent ANU study confirms one in five Australians are unwilling to receive a jab. The Federal Government wants all eligible GP’s to not just contact their regular patients who may want the vaccination.

We need to start a “Go and see your regular GP” COVID campaign. If a patient does not have one encourage them to nominate a regular GP practice. Offering a patient continuity of care should make them feel safer. 

A few weeks ago I wrote an article called New GP vaccination items don’t add up on 23rd January 2021.


I have spent much of my time working on a viable, safe model. I even offered $500 nationally to my network for anyone who could make the Government offer work without cutting corners. Patient safety is paramount.

I have had no takers to date. To reduce practice losses, the most promising model is hiring the local football oval, inviting local GP’s to send their patients to these GP cooperative mass COVAX clinics. Throw in a sausage sizzle and I think we are cooking with gas. Great work, Dr Mukesh Haikerwal and friends.

1. A personal context


I am not an anti-vaxxer. I am not a doctor. I am also not naive to appreciate when something new comes up in medicine, never be the first unless you have to. Where possible without my consent, I do not take kindly to needles or anything else placed in my body. I believe in freedom of choice, which also includes the freedom to move. 

While vaccination is not mandatory, at some point you may feel this is no longer the case for you. Your employer may require it, or a government or country may not allow you to travel without an immunisation certificate. The Government has form restricting government handouts with it’s no jab no pay program in 2015.

I am a patient and provider advocate. I have a family member overseas in the UK affected by the virus. I am feeling forced to take a vaccine I am not sure of. I share similar concerns about the vaccine and adverse reactions like many people around the world. I feel I must talk to a GP who has completed vaccine training on the drug I am about to receive.

How can I be sure the new COVID vaccination is safe for me and the people who I care for?

Australia is about to roll out the AstraZeneca vaccine

The last thing we need is another preventable medical or healthcare error. The third biggest killer of human life. 

We know there are no globally commonly agreed on healthcare standards. This can only breed further confusion and fear in people’s minds. Let’s face it we are living in a state of confusion in a sea of conflicting expert opinions.

Today, you have no choice but to actively engage on this issue.

To jab or not to jab, that is the question! 

It will not go away until you do your bit, or should you?

Can you really trust healthcare workers? 

If they are open and transparent, tick all the boxes and remain viable, then the answer is yes. Does it have to be a doctor? The Government advice is no. If you are not a patient that may have complications, the local pharmacist should be fine. 

My problem is, how am I meant to know what I don’t know when it comes to this new vaccine? Will an approved random pharmacist or mass immunisation clinic have a better idea? To be safe, a better alternative is to talk to your regular GP first. 

Things can easily go wrong due to rapid rollout. We are all still learning on the go. 

Be aware. The Government standards of care are higher for your local GP than your local pharmacists.

What can you do now?

2. For patients

If you are at risk such as the elderly, now would be a good time to update your will and financial affairs. Here are some things you can do.


  • Wait to see your leaders roll up their sleeves

The ultimate pub test and the first step is when the Prime Minister and all high profiled Premiers and Ministers and their health officials roll up their sleeves for the national media. 

  • Book an appointment with your regular doctor or get one now.

If you have any hint of concern, the best advice is to book a long appointment with your doctor and make sure you receive a thorough check-up. If they cannot provide the vaccination, then by all means consider your next best available option such as your local pharmacist under close supervision.

Experiencing permanent lung damage is not a lot of fun! It only takes one moment if you experience an adverse drug reaction. While many may not be life-threatening, it is interesting to note Pfizer vaccine has a 70%+ systemic reaction rate however it appears to be more effective. Give this article to your doctor to check the latest.

If you do not have one, now is the time to find and settle on a regular GP and practice. Continuity is king. Most airline crashes occur because of multiple problems. Rarely is it due to a single problem. Visiting multiple practices is asking for trouble. Fragmented patient histories mean it may be inevitable something will be missed. 

Do not worry if your regular practice/GP will not participate in the national mass vaccine rollout, many are likely to initially miss out. You should use them to centralise all your healthcare information, as this is not possible with your local hospital or pharmacist.

Make sure you know when you are eligible. Use this checker. Personally prepare properly before the jab. Then book a return visit to ensure all documentation and any other matters are covered.

  • Get in early. Plan for multiple visits to your GP over several months and years

I am planning a pre-immunisation visit as I need to update my records, two immunisation shots and a post review. Throughout the year, I expect to be called back for additional booster visits. This will now become a regular part of my life. This could take up to 6 years until there are no more cases.

  • 5 minute immunisation clinics are they safe?

Despite being in good health, I do not feel safe to just visit a traditional pharmacy-led immunisation clinic. I would like to be safely monitored for this new drug. This is not a traditional vaccine clinic. Doctors are dealing with a new virus and vaccine. There may be many unknowns. Daily there are many shifting goalposts. The key is to carefully monitor your care with your regular GP, especially if you feel you may be at risk. 

  • Low patient COVID-19 Medicare vaccination rebates may mean lower than expected quality of care

The Government has low balled the patient rebate. Do not blame the clinic if you feel you are being rushed. It may feel like a hit-run job. The Government is pushing for high throughput clinics. They are not encouraging or discouraging a pre-consult.

I feel safer if I am visiting healthcare workers who are familiar with me and my family history.

Do not take unnecessary chances. Ensure you have no doubts about how your body may react to a vaccine. Book a full check-up before receiving the vaccine. Allow the practice to fully document and or update your clinical history. Take the time to ask good questions specific to your health needs. Get it in writing if you have to. Do not rely on well-intended generic public health messages. Seek specific advice. Tailor your first session with your GP for the long haul and plan accordingly. Remember, it could be up to 6 years. Play the long game. Use this opportunity for a full check-up if you have not had one recently.

Avoid the queues, avoid the rush, do the preparation work now. It is a quieter time in general practice. You do not want to rush your doctor or practice staff.

3. For practices 


  • Plan and implement a COVID pre and post clinic now

Our Kicking COVID-19 101 Practice Survival Guide may be of assistance.

Map workflows from advertising, website notices, registering patients, consents, taking down patient history, telemedicine and face to face consults, documentation and external government reporting and timely follow up all year round and providing ongoing patient information and monitoring adverse events. 

Make sure you update any employment, service or contractor agreements and administration systems. 

  • Check your pricing and practice viability against safety requirements

Mass immunisation clinics practices are being forced to bulk bill i.e. make it for free to patients. 

Many doctors are happy to do their ethical duty and be in a position due to nearing retirement to provide their services for free. For others who own or work at the practice they may have personal family commitments like a home loan, they may not be in a position to be as generous. Providing quality means making sure they are running a viable, safe service. 

Doctors may need to be charging a higher 50% service or management fee of gross billings or take a pay cut. I understand the Government is reviewing the current Medicare rebates on offer. This will be required to cover nearly double additional administration, nursing and documentation overheads compared to a traditional vaccination clinic. Ideally, nurses or allied health should bear the brunt of this workload under the keen supervision of a doctor for more complex cases.

  • Consider optimal arrangements

Run clinics dedicated so it will not impact current services. After-hour clinics look a little more attractive to run. Offer concerned patients before and after their immunisations a longer consultation on other healthcare matters (preferably not on the same day, although this is allowed). These consults can be privately billed to address more complicated patients.

    4 . Encourage patients to book in now if they feel they are at risk

The TGA will be providing promotional COVID19 brochures. Remember there are some rules to observe. 
 
Clinics offering COVID-19 vaccines face hefty fines for any legal breaches” and “Individuals can be given on-the-spot fines fines of up to $25,520 for non-compliant advertising, rising to $12,600 for organisations”.
For approved advertising and social media templates for your practice click here
 
What is not allowed
“A COVID-19 vaccine is the best way to protect you and your family from falling seriously ill!”
“You can now get your COVID-19 vaccination at the Downtown Medical Centre. Available Monday to Friday from 9am-9pm. Just walk in and enjoy a free cappuccino while you wait.”
Video of patient receiving a vaccine and saying: ‘Wow that didn’t hurt at all!’
What is allowed
“You can now get vaccinated against COVID-19 at the Downtown Medical Centre. Available Monday to Friday from 9am – 9pm. Call 9999 9999 for an appointment.”

Source: Dos and Don’ts of Promoting the COVID19 Jab, 23.2.2021

It does not matter if you will be running a mass immunisation clinic. Test your workflows and when you are confident begin to recall and set up reminders to your regular patients and attract new patients on what services you can offer in relation to their general and COVID vaccination care.

Where possible automate the patient registration service using mobile and website forms and SMS text where clinically relevant. Ensure the waiting room, on-hold messages and advertising clearly explain the benefits to patients who do not have a regular doctor why they should enrol with your practice. The main point being the continuity of care should anything go wrong. Many patients do not appreciate how important this is. See the section below on ideas on how to encourage patient engagement called “Why you can trust your regular GP”.

This may be the only viable option for general practice to offer a mass immunisation service. Do not expect every clinic to be in a position to administer the vaccine. Many will not participate or miss out or have some alternative arrangement at the local footy park. Check with your practice what their plans are.

If you do not have time to convince patients on what they need to think about, simply share this article with them to nudge them your way.

    5. Ongoing Monitoring

Continue to monitor patients and your new systems to ensure they are working.

Why can you trust your regular GP?


The global context

The deadliest strain countdown is on. We started with Wuhan, then the UK, South Africa and now Brazil! Monthly new strains are being added and even named after your local suburb

This unprecedented global biological invasion has landed in everyone’s backyard. It’s a real BBQ stopper. When it comes to health, it certainly has everyone’s attention.

Moving forward, doing nothing does not seem to be an option. 

Whether you are planning a flight interstate because your job relies on it or you are feeling at risk, you may feel forced to vaccinate. Vaccination will be about your freedom to move. Do not think the Government will make it any easier. This is no longer about you it is about the greater good. This is not a bad thing.

Ideally, every government would love to see 100% of their population vaccinated in the next 9 to 12 months. This would certainly be an achievement.

The Government’s bleak alternative is to face managing nationwide lockdowns, blowouts in budget deficits while they nurse their zombie economy back to health. This could take decades. Destroying business and consumer confidence will lead to higher unemployment and this will magnify post-pandemic preventable illness such as depression, regular cancer and heart screening clinics and non-urgent quality of life care. 

The thought is overwhelming, to be living in constant fear. We cannot be on serial lockdown ready mode, face masking, hand washing, elbow greeting for the rest of our lives. 

Regardless of how careful you are, the real enemy of the State is that one person who decides not to do the right thing. They instantly spoil it for the rest.  

What is hurting all of us is you playing Russian roulette with a mutating highly infectious virus. We are living in an unhealthy state of paranoia.

The good news is it appears the vaccines are making a positive dent. Israel is leading the way, but it may be harder to replicate in larger populations, although all countries with an active immunisation program are showing a notable decrease compared to the peak of the pandemic.

We can only thank the generosity of countries like India for offering free vaccines to third world countries. 

Understandably a new post-war arms race has begun. This time it is for your own arm!  Every Government around the world is rolling out a mass grab and jab program in your local neighbourhood. Many Prime Ministers and Presidents have said this is the biggest logistical effort since World War II. No country and no person are immune to this pandemic.

Nobody really knows the long-term effects of these vaccinations other than some side effects. How effective is vaccination? The information continues to improve each day. 

The only set back appears to be more announcements of a new and more deadly strain by country or suburb of origin every few months. In June last year, I had lost count at the 84th strain.

This is a long-term game. It may take up to 6 years to eliminate. Be prepared for annual or regular flu-like shots called interim booster shots to attack new strains.

A national context

Can we really trust our Prime Minister and their Medical Advisers? 

Your local politician up to the Prime Minister has next to no idea what is your exact health status. They have no idea how the vaccination is going to affect you. Will you lose time off work, suddenly become permanently ill? There are many things to discuss with your GP to know if you are at risk or not.

Be on guard with any general advice being provided by them and the health authorities. At times they may conflict with basic issues like the wearing of masks to more complex issues such as vaccine suitability.

Seek out specific advice relevant to your needs.

As mentioned earlier, the last thing we need is another preventable medical or healthcare error. The third biggest killer of human life. 

We know there are no globally commonly agreed on healthcare standards. This can only breed further confusion and fear in people’s minds. We are living in a state of confusion in a sea of conflicting expert opinions.

Recently in Australia, the damning Federal Senate Inquiry into the Therapeutic Goods Act (TGA) poor handling of the dodgy transvaginal mesh implants should be a national scandal. It serves as a clear warning to all. 


Despite the makers setting long-running $8billion dollar lawsuits, our under-resourced TGA remained impotent when it came to protecting the public. 

They had left this responsibility to suppliers. They lacked independent post-market testing and effective compliance. 

Today the same agency is in charge of the vetting of the vaccination and personal protective equipment. The last thing we want to hear is another Government scandal and cover-up about a dodgy healthcare company. Unsurprisingly, the Government has gone to extreme lengths to assure the public you will be safe.

Government credibility starting from the PM downplays a crucial role in matters of public health.

Do not be surprised you have signed off on a skydiving waiver of all care, but no responsibility when you take the plunge. 

If a problem arises, many poorly resourced patients may have limited recourse or energy to fight a global multi-national billion-dollar company. Hopefully, the Government has learned from its past, nobody wins from a systemic failure. 

Unlike other countries, Australia has not led with the mass immunisation of its community. We have had the luxury to learn from overseas. We should have some confidence in what we know from the countries that have gone before us. 

While on a good wicket the Government is keen for the fastest (“less than perfect”) roll out in the world starting next week to conclude by October 2021.

It remains to be seen if these numbers are sufficient for another outbreak/lockdown to occur, especially as Australia is rolling out the less effective Astrazeneca vaccination. 

Avoid rhetoric and herd mentality, remain vigilant. Stick to the facts. It can feel like a game of roulette, Anything can change at a moment’s notice. Your local GP can put the odds in your favour.

No amount of money will replace the harmful effects of COVID-19. Regardless of whether you are vaccinated or not, you only have one life, so look after it. 

About me: David Dahm

After a serious work-related car accident in 1989, and nine operations later I continue to be a patient and provider advocate. I enter my third decade as a national Chartered Accountant for Medical and Healthcare practices in Australia. I am a former 10-year Australian General Practice Accreditation surveyor, I come from a medico family. I have served on the AAPM National Board and was the inaugural national Chair of the Certified Practice Manager CPM post-nominal.  I continue to provide accounting tax and practice management advice to many practices all over Australia. 

You know who you are and I thank you for this real honour and privilege to serve you and your community through you. Note I am not a lawyer please seek appropriate legal and accounting advice. This information is for general information and discussion only.

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