A paramedic outside St Vincent's Hospital, Melbourne (Image: AAP/Luis Ascui)

The next wave of COVID is upon us. As of yesterday, there were almost 320,000 cases and more than 4500 hospital admissions. GPs are booked out, paramedics are run off their feet, and emergency departments are bursting.

Crikey spoke with doctors, nurses and ambulance personnel in Victoria and NSW about the chaos engulfing the industry. They were willing to share their experiences on condition of anonymity.

Pressure points differ from hospital to hospital and state to state, but there are widespread concerns that the nation’s health system is not fit for purpose — and not fit for COVID.

The general practitioner

As the health system’s first line of defence, GPs are booked out and burnt out. A GP from regional NSW put it bluntly: “Working in general practice with a pandemic has not been easy, and not a day goes by that I wish I was doing something else.”

They detailed severe staff shortages, a scarcity of trainee doctors, a growing burden of chronic disease, and the compounding factor of COVID-19. “It really is a shambles,” they said.

GPs are booking out weeks in advance, unable to keep pace with growing demand, and yet the system is simultaneously being squeezed. Rising healthcare costs paired with falling funding and stagnant Medicare rebates are cordoning off general medicine to those without deep pockets. As the GP said: “Soon only people who can afford it will be accessing GPs.”

Add to this the juggling act of telehealth, face-to-face consultations and a carousel of public health advice. “We find out about the latest COVID news via social media, or with patients coming in saying ‘I heard on the news I am now eligible for my booster’,” the GP explained. “You’re scrambling to stay on top of the latest set of rules and guidelines. Daily dizzying levels of information overload we are expected to stay up with in our own time.”

And God forbid we mention the health of the doctor themselves. In a statement to Crikey, Professor Karen Price, president adjunct of the Royal Australian College of General Practitioners (RACGP), said patients should “not just turn up at the [GP] practice” should they have respiratory symptoms but must call in advance, reiterating that failure to do so was “putting other patients, as well as practice staff, at risk”.

But despite their best efforts, GPs are regularly exposed to the full suite of coughs and colds. “I’ve had my own respiratory illness about every second week,” the GP said.

The paramedic

Delays in ambulance response times are not as straightforward as a pithy “code red”. Pressure on paramedics comes hand in hand with stretched GPs and hospital systems. People are more inclined to call an ambulance if they can’t access healthcare through other means. “There are large numbers of people out there frustrated because they can’t see a doctor or a registered nurse, so the only option is to call an ambulance,” a paramedic operating in metropolitan Victoria told Crikey. “The logic is, if I do, I’ll get into the hospital quicker. If I go by ambulance, I get seen. But that then clogs the system too.”

Although the volume of callouts had increased, the paramedic was clear that their ability to respond was not due to staff and vehicle shortages (although these have been hard hit), but rather hospitals being at capacity. “Bed block has created a situation where it doesn’t matter how many paramedics or resources we throw at the system, if you can’t clear hospitals, then we can’t do our job in the community,” they said. “We can take people into hospital, but we can’t get them off our stretchers because there are no beds. So, we have paramedics stuck in hospitals looking after paramedic patients.”

Staff and resources on standby have triggered a series of ambulance code reds in Victoria and record wait times in NSW. The Victorian paramedic blames no one but the system for emergency services being unable to keep pace. “The paramedics out there, when they rock up six hours after a call has been made, that’s not their fault. It’s not the patient’s fault. It’s not the fault of the doctors or nurses. It’s the system.”

The emergency department doctor

All of this is creating mayhem for emergency departments. Doctors have reported big spikes in non-urgent presentations, as patients are forced to bypass pre-hospital advice and care.

One emergency physician from a NSW metropolitan hospital maintained too many people were presenting with the sniffles and a sore throat. “We have whole families turning up with the flu. Mum, dad, four kids. There’s a lot of inappropriate use of the emergency department, but we can’t turn people down. We just have to say sorry about the wait,” they said.

While emergency department wait times vary according to the geography, public-private status, and size of the hospital, the bottleneck is building. According to the physician, it was not uncommon for 50 people to be huddled together in the waiting room. “The triage looks like the third world,” they said. “One nurse is looking after 50 people in the waiting room. Everyone’s coughing and spluttering. There’s no sitting room for sick patients. You’ve got a respiratory illness next to a cancer patient. It’s bedlam. And yet we have a clinical responsibility to everyone who presents at emergency. Everyone suffers as a result.”