Providing safe general practice services for unvaccinated patients

Answer: I am not aware of any 'standards' around an 'amber stream' for unvaccinated patients, but I agree on principle it is a valuable thing to do to protect those people that are unvaccinated for whatever reason. 

The rationale being: 

1. unvaccinated people have a higher risk of contracting COVID-19 when in the community
2. unvaccinated people have a higher risk of passing on COVID-19 to others during the asymptomatic phase. 

The highest risk environment for someone who is not vaccinated would be in close contact with patients with known or suspected COVID-19 (in the red stream). Particular consideration is given to the airborne nature of the virus. 

Identifying the patients and risk stratifying them at the outset is key. If it is possible, given the other pressures on your practice team and building, it makes sense to have a:

• “green stream” for vaccinated asymptomatic patients
• “amber stream” for unvaccinated asymptomatic patients
• “red stream” for symptomatic patients. 

In the green stream patients are masked, maintain social distancing, and use the QR code. Staff are masked, wash and sanitise their hands regularly, and maintain social distancing.

In the amber stream, in addition to the above, patients are kept physically separated from other patients, including other unvaccinated patients. This could be done by seeing them at a different time of day, using a different entrance and waiting area, or keeping patients in their car or outside until their appointment time. Practices will have other ideas which it would be good to share. 

The red stream process has within it infection protection and control which helps to prevent transmission from one patient to another (good ventilation, PPE use, surface wipe down, and avoiding shared waiting spaces) but if possible further separation of unvaccinated people from vaccinated people will provide them with further protection. It may be possible, for example, to see patients at different times of the day. If not, practices should be confident that their IPC measures keep patients in the “red stream” protected from each other. 

It is really important all patients feel safe and welcome when they come into a practice, whether they are vaccinated or not. 

There are more than enough barriers in place for people needing to access care without us adding more. This also demonstrates to everyone that practices are safe places where in-person care happens because it adds extra value over and above a telehealth consultation. 

It will increase whānau confidence to see the environment is clean and well ventilated, and that people are protected from contact with respiratory illness from other patients and staff. 

Vaccination is very likely to be recommended for 5-12 year olds, and next year for 6 months-5yr olds. Boosters are very likely to be recommended before Christmas. But until this happens, children will be the largest unvaccinated patient group, keeping them safe and providing parents with the confidence they are safe and that care is still accessible, is vital.

It may not be viable to set up an “amber stream” for unvaccinated patients in your practice. I would see this as fine tuning your infection control policies as the risks they are exposed to, and pose to others if they have to be managed in a well-managed “green stream”, will be quite small. But clearly keeping them away from the “red stream” patients is vital.