Table 3

Key pandemic-generated modifications to safety, clinical, workflow and practice management routines

Workflow routine	Definition	Description of changes
1 Keeping staff and patients safe	Procedures to reduce infectious disease transmission.	Increased PPE use; enhanced cleaning practices by external cleaners and practice staff. Patient waiting routines, for example, changed waiting room layout; wait in their car/outside until appointment times. Booking processes: all practices paused patient ability to make appointments online. Receptionists began to check respiratory symptoms and travel/contact history during patient booking for appointments by telephone and on arrival. Staff-to-staff contact reduced greatly, such as closed lunch rooms, lunch to be eaten in rooms, and in some practices the wearing of surgical scrubs. (Impacts on routine 3)
2 Realigned clinical work
2.1 Telehealth	Procedures for conducting consultations via phone or video, rather than face to face.	All practices began using telehealth for many consultations—enabled by changed MBS funding for telehealth (previously limited to rural and remote areas). All practices remained open for face-to-face consultations (usually with almost all GPs on-site). Most GPs provided telehealth from the practice, but some worked from home when isolating or unwell or if they had personal risk factors such as advanced age or chronic disease: Difficulties due to lack of required technology at home; providing access to patient database, printing, faxing and billing. At CHC, all but two GPs worked from home; management provided home technology. GPs overwhelmingly used phone rather than video: Reluctance to use video due to difficulties with logistics, practice technology and perceived ability for patients and/or GP to access and use technology. Receptionists needed to be aware of significantly modified billing schedule.
2.2 Case management chronic illness/care continuity	Procedures for management of patients’ ongoing health conditions.	All practices initially paused: chronic disease management recalls; cervical cancer screening; health checks for 45–49 and 75+ years old: Major concerns about missed diagnosis with telehealth and patient reluctance to attend GP and/or hospital. Different approaches and timing for resuming chronic disease management follow-ups—often financially driven in view of falling practice income: Primarily conducted via phone or video with the assistance of the practice nurse.
3 Practice management	Procedures for coordination between practice staff.	Staff meetings: pre-existing large variation between practices in frequency and attendance: Shift to online meetings: excludes some but includes others. Some practices increased meetings, others decreased them. Major loss in collegiality: Infection control obstructs social interaction and makes it more difficult to gain second opinions from practice colleagues. Especially where many staff work from home (as in the CHC). Online forums, meetings and phone calls assist but exclude non-GPs in some practices.

CHC, community health centre; GP, general practitioner; MBS, Medical Benefits Schedule; PPE, personal protective equipment.