General practitioner management of notifiable diseases is central to communicable disease control.

to the editor: Public health units routinely carry out investigations into cases of notifiable diseases, specified by state and territory Public Health Acts, because of the potential impact on the health of the public. Investigations involve contacting individuals and their contacts, and providing advice for follow up and treatment. This may include seeing a general practitioner for further testing, treatment, or prophylaxis of contacts. To assess the extent of input from GPs in managing notifiable diseases we documented GP encounters related to public health unit communicable disease control activity in inner‐western and south‐western Sydney.

Data on routine communicable disease activity in Sydney and Sydney South West Local Health Districts were collected over 2 months from 1 June to 31 July 2014. For all investigations into suspected and confirmed cases of notifiable disease, data were collected on the type of condition, visits to GPs and tests specifically requested as part of routine public health follow‐up. The study was approved by Sydney Local Health District Ethics Review Committee. There were 220 investigations associated with suspected or confirmed cases of 34 notifiable conditions during the study period, requiring 212 GP visits and 286 tests. The Box lists conditions according to their required level of GP input (those involving GP encounters more than 50% of the time were considered to require high‐level GP input). Influenza and gastroenteritis outbreaks, typhoid, rubella, hepatitis E and measles were the conditions requiring the highest level of GP input per investigation. Measles, arbovirus, pertussis and gastroenteritis outbreaks were conditions with the highest frequency of suspected or confirmed cases that also required high‐level GP input. Based on population size, we estimated that, if extrapolated to state level, communicable disease control activities would have resulted in about 1047 GP visits across New South Wales in the same time period.

Our findings indicate that GP encounters are central to communicable disease control and shed light on which conditions require the most input from GPs. Influenza outbreaks, measles and gastroenteritis outbreaks are of particular concern. Influenza outbreaks require particularly high‐intensity input from GPs, while measles and gastroenteritis outbreaks are frequently investigated conditions that require high‐level GP input. Influenza and measles are serious conditions, often involving vulnerable populations (nursing home residents and children). , Our results indicate that primary care plays an important role in protecting the public from conditions with potentially serious consequences. This finding should be considered in policy discussions about access to primary care.

Acknowledgements

We thank communicable disease nurses Leng Boonwaat, Beth Cullen, Essi Huhtinen, Andrew Ingleton, and Claire Pearson for their assistance in data collection.

Competing Interests

No relevant disclosures.

Visits to general practitioners and tests associated with communicable disease investigations

Condition or infection investigated (suspected and confirmed cases)	No. of investigations	Average no. of visits per investigation	Average no. of tests per investigation
High‐level GP input
Influenza outbreak*	5	14.8	20.2
Typhoid	1	9.0	17.0
Gastroenteritis outbreak†	17	2.1	3.7
Rubella	2	1.5	1.0
Hepatitis E	8	1.4	1.4
Measles	24	1.0	1.6
Varicella	1	1.0	1.0
Arbovirus	19	0.9	0.8
Pertussis	18	0.9	0.7
Legionella	9	0.8	0.9
Intermittent GP input
Hepatitis A	4	0.5	0.5
Q fever	2	0.5	1.0
MERS Co‐V	2	0.5	1.0
Hepatitis B	7	0.4	0.4
Malaria	3	0.3	0.3
Shigella	11	0.2	0.3
< 16 Chlamydia‡	6	0.2	0.0
Salmonella	9	0.1	0.1
Cryptosporidiosis	11	0.1	0.0
No GP input
Rotavirus	5	0.0	0.0
Mumps	5	0.0	0.2
Meningococcal	7	0.0	0.0
Lymphogranuloma venereum	1	0.0	0.0
Invasive pneumoccocal disease	22	0.0	0.0
Hepatitis D	3	0.0	0.0
Hepatitis C	2	0.0	0.0
Haemophilis influenzae B	1	0.0	0.0
Diphtheria	4	0.0	0.5
Creutzfeldt–Jacob disease	1	0.0	0.0
Brucellosis	2	0.0	0.0
< 16 Gonorrhoea‡	1	0.0	0.0

MERS Co V =  Middle East Respiratory syndrome (MERS) coronavirus.
 * Three or more epidemiologically linked cases of Influenza‐like Illness in residents or staff of child care or aged care facilities within 72 hours PLUS at least one case with a positive laboratory test result OR at least two cases with a positive point‐of‐care test. † Two or more cases of vomiting or diarrhoea in an institution are followed up as a possible outbreak. ‡ Conditions followed up in children aged under 16 years only to ensure they are not at risk.