GPs are pushing back against pressure to care for COVID-positive patients face to face, saying they do not have sufficient financial support to ensure it is done safely.

It comes as the federal government offers general practitioners an extra $25 Medicare payment for seeing sick COVID-19 patients in their surgeries.

One GP called the proposal an insult.

"As much as we would all be very much willing to assist the government in managing COVID-positive patients, this model simply won't work," Bondi Junction GP Daria Fielder said.

"Frankly, the $25 remuneration to see an infectious patient and put yourself and your staff and other patients at risk is an insult."

Dr Fielder said even the cost of deep cleaning a surgery after seeing a COVID-19 patient was about $400-$800, far exceeding any money made.

She said the current model, in which mild to moderate COVID-19 patients were cared for via telehealth in their homes, was working.

"If they need medical care, that should be provided in hospital in specific wards," she said.

'They need to do a lot more than just pay $25'

The federal Department of Health said its proposal was part of a wider $180m package to support the primary health industry manage COVID-19 cases and to alleviate pressure on public hospitals.

That package includes supplying GPs with more PPE and pulse oximeters to measure patients' breathing and oxygen levels.

It also said that given high vaccination rates, as the country opened up it was "expected that a larger number of people will test positive to COVID who have no or mild symptoms and little underlying risk".

"It is appropriate that these patients are cared for in the community under the supervision of their usual GP wherever possible," it said.

Charlotte Hespe, the Royal Australian College of General Practitioners (RACGP) NSW&ACT chair, said there was no need for GPs to see mild to moderate COVID-19 patients face to face.

She also pointed out that specialist respiratory clinics had been set up to specifically provide that in-person care if needed.

"We can't just bring infectious COVID patients into normal general practices which are not set up to be safe places for that sort of care," Dr Hespe said.

"We know that you need appropriate ventilation, we know you need to have certain spaces, and waiting rooms set up safely … That's why respiratory clinics got extra funding to set themselves up.

"If the government is wanting standard general practice to see COVID positive patients, then they need to do a lot more than just provide $25 for a patient consultation."

How will the sector transition to 'living with COVID'?

The Australian Medical Association (AMA) says GPs should be able to see low to medium-risk COVID patients if they are properly funded.

"This $25 payment … doesn't do enough to help GP practices prepare for working in a COVID environment," Omar Khorshid, the president of the AMA, said.

“Face-to-face care is critical, telehealth has a role to play, but face-to-face care is a right of every Australian and it's important our GPs are properly supported to be able to deliver that for Australians."

The debate has raised a larger issue.

That is, how will GPs manage face-to-face care of all patients as Australia transitions to "living with COVID"?

Currently, it is very difficult to see a GP if you have any respiratory symptoms, as most practices require a negative PCR test first.

But Dr Korshid wants GPs to go back to face-to-face care for non-COVID patients who might have respiratory symptoms.

“It’s critical that the government steps in and assists GPs in setting up practices to be COVID safe,” Dr Khorshid said.

That includes infrastructure to ensure separation of potential COVID patients, and better PPE.

“That allows them to keep their doors open, to keep seeing patients regardless of whether they’ve got COVID or not, or if there is any suspicion of COVID or not,” he said.

"Without this in place … they’re going to be pushed to manage people by telehealth rather than face to face. And that's a price we don't think is reasonable for Australians to pay."

Updated guidelines to be released soon

The RACGP has updated guidelines for its members on how to manage infectious respiratory illnesses in patients, which will be released publicly soon.

The college acknowledges GPs need to have a better system than simply turning away seeing patients with cold or flu symptoms, like during the last major lockdowns.

But ultimately, GPs are going to be far more cautious about allowing anyone with respiratory symptoms into their waiting rooms and they will rely more heavily on triage via telehealth, using car parks to see patients, and rapid antigen testing.

Daria Fielder's practice used to see all patients face to face regardless of their symptoms.

But she said that was now too risky without a patient returning a negative PCR test first.

"I think the shift is the fact we're having a lot more cases and now we're living with COVID," Dr Fielder said.

"Now everyone is walking around not wearing masks, having parties, attending sporting events, so the risk of contracting COVID is much higher."

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