Physiotherapists are well placed to treat Long Covid patients and ease the pressure on the primary care sector, but the lack of government funding is proving to be a handbrake, argues Dr Sarah Rhodes.
The New Zealand health reforms are designed to put a greater emphasis on primary health care and improve equity of access to healthcare for all New Zealanders, regardless of ethnicity, disability, or geographical location.
However, in the newly released 2022 Royal New Zealand College of General Practitioners Workforce Survey, 48 per cent of GPs rated themselves as high on the burnout scale. Data from the same survey shows 55 percent of GPs intend to retire in the next 10 years.
There is no capacity to cope with a potentially high numbers of patients presenting with Long Covid symptoms in primary care.
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The lack of progress from the Government on funding services for those with Long Covid could be interpreted as a lack of regard for the longer-term consequences of the pandemic and for those disabled by the effects of Long Covid.
Funding physiotherapists and other health professionals in primary care to support those with Long Covid back into their lives and jobs makes sense on many levels.
Physiotherapists are already managing patients with long-term conditions; they are already seeing Long Covid patients ad hoc in individualised pockets of care provision available randomly around New Zealand. It makes sense to collaborate and provide a coordinated service to better utilise these skills in the primary care sector.
Long Covid affects one in ten people who contract the Covid-19 virus, and its symptoms commonly include breathlessness, chronic fatigue and dysautonomia. These are all symptoms that can be managed with the support of a physiotherapist but, at present, there is no coordinated health response and people do not know where to go for help.
In the absence of government funding, some private practitioners are setting up Long Covid services to meet patient need. Whilst this is great news for those patients who can afford it, it further exacerbates health inequities by promoting a user pays approach to accessing care.
Importantly, as modelled by overseas researched cohorts, the impact of Long Covid extends beyond the collective health burden. Economic productivity will be affected as many with persistent symptoms are unable to return to work.
At an individual level, people living with Long Covid may experience despair associated with their inability to perform their usual roles, both at work, and in their whanau/family and community, and this can be associated with a profound sense of loss.
This loss can have a marked effect on mental health which Aotearoa New Zealand can ill afford, given the current state of our mental health services. The World Health Organisation stresses the need to step up mental health services in response to their findings published last year, which indicate a 25 per cent increase in anxiety and depression worldwide following the first year of the pandemic.
Funding physiotherapists – alongside other members of a multi-disciplinary team – to provide Long Covid services would ensure more equitable access to support. Additionally, it would allow people to be seen earlier in their Long Covid journey, thereby potentially reducing the economic and mental health consequences.
Physiotherapy already exists in primary care, predominantly in the form of private practice, with a primary focus on musculoskeletal issues. To the average person in the street, physiotherapy is synonymous with sports injuries.
Yet physiotherapy is so much more than that. As a profession, it spans the breadth of health care, from the acute hospital setting through to exercise classes and home-based rehabilitation in the community. The profession’s scope of practice is wide, including cardio-respiratory health, neurological rehabilitation, paediatrics, women’s health and much more; yet this is often unseen and underappreciated.
As a workforce physiotherapy is agile and adaptable, evidenced by the ability to rethink delivery of care with little notice. At the outset of the pandemic, physiotherapists were educating the workforce to provide appropriate advice, treatment and engage with patients safely, quickly pivoting to provide effective telehealth services to meet patient need.
Furthermore, there was early recognition that there were many likely to be impacted by post-viral symptoms of Covid-19, and physiotherapists worked hard to advocate for those with Long Covid, as well as keeping up to date with developments overseas. This three-year effort – often in unpaid time – has ensured a readiness to support those with Long Covid. However, there is a fly in the ointment: no funding.
Ignoring the collective professional voice from multiple professions calling for the same is disheartening to a workforce dedicated to providing care. If we can learn anything from our cousins across the ditch, it is that prompt action is most effective, in terms of both health and economic outcomes.
The glacial pace at which things are moving is frustrating for health professionals and a source of despair for those living with the condition. Boosting primary care and funding health professionals to support and empower those with Long Covid back to work and life should be a priority.
The health reforms highlight a shift to primary care, but words are cheap. It is time for the Government to put its money where its mouth is.