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The issuing of a “Red Letter” is the traditional method for the New Zealand Medical Association (NZMA) to notify its members, the wider profession, and the community about serious issues affecting the profession and/or the health of New Zealanders.  This letter is intended to advise you of the NZMA’s very serious concerns about Government’s expectations of General Practice regarding the management of COVID in the community.
While we continue to support the Government’s approach to manage COVID and minimise the impact on health and hospital services, there has been insufficient consideration of how these strategies will impact General Practice and the workforce that has been at the frontline of this pandemic. 

In recent weeks we have seen the emergence of significant and growing demands and expectations of General Practice with little or no engagement or effort to agree the details and terms of the services implemented.  We are concerned that these expectations ignore matters of capacity which is already stretched, matters of workforce which is already stressed, matters of sustainability which is already at crisis point, and the health of other patients who may be impacted due to these pressures. 

It is our belief, and a belief shared by many members, that attempting to provide Covid in the Community services - where such services are under-funded and under-resourced - is highly likely to compromise the ability of a general practice to provide the full array of contracted services as specified in the contract. 
While we and other sector organisations continue advocate strongly on your behalf with Government, members need to be aware that you are not compelled to agree to undertake services beyond what is required by contract (your back-to-back contract with your PHO) or what is required legislatively.  In the case of COVID care in the community we believe that some of these services may fall outside those contracted providers must deliver as specified in the PHO agreement. 
Our advice therefore is that members give full consideration to capacity, workforce, sustainability and the impact on other patients before committing to the delivery of COVID care in the community or other COVID related services that are over and above normal General Practice services. If you believe you do not have the capacity to safely offer this service, you should inform your PHO/DHB in writing of your concerns and ask them to urgently consider alternative care pathways. 
Please note however that if you have been asked to provide COVID community care for a particular patient that is referred to you, or who seeks your care, you are ethically bound to provide care if it is an emergency situation.  If it is not an emergency, you can decline care as long as an alternative source of care is available and the appropriate avenue for securing this is known to the patient.  
Here is a link to our Code of Ethics.

We acknowledge access to alternative sources of care may be limited, particularly in rural areas, and believe the Ministry and DHBs should urgently establish alternative care pathways.
We will keep you informed of any progress with Government of these matters, but we are also very interested in hearing your views.  Please feel free to contact the National office, or either of us.  We also encourage you to pass this letter to any colleagues who are not NZMA members.

Dr Alistair Humphrey & Dr Vanessa Weenink