The system is yet to fully recover from the pandemic, especially in the behind-the-scenes roles that did not gain nearly as much public attention in the years of PPE shortages, overwhelmed medical staff and anti-vax conspiracies.

Too many GP practice administrators are burnt-out, Associate Professor Belinda O'Sullivan, of the Murray Primary Health Network (Murray PHN), says.

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"Now we have significant, ongoing workforce shortages, and we've had practice manager turnover as well," she said.

"People are exhausted.

"My suggestion for a future pandemic event would be for thought to be given to surge capacity for rural practices, reducing admin burden wherever possible, and providing staff enough time off."

The insight is one of many Professor O'Sullivan has gleaned during research on ways rural GP practices handled the COVID-19 pandemic.

Professor O'Sullivan interviewed GPs and GP managers from 11 rural, community based practices for research published recently in the International Journal of Health Planning and Management.

The interviews became time capsules detailing the myriad challenges rural GPs and their teams faced in an extraordinary situation that spread across years.

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They showed the work-arounds and innovations that practices brought in to deal with three phases of the pandemic, starting in June 2020 during statewide lockdowns, when GPs were scrambling to full telehealth models, initially without funding, among other gargantuan headaches.

Associate Professor O'Sullivan contacted each interviewee again six months later when lockdown orders had eased slightly. She found practices were starting to see more patients with mental health issues and new tree-changers.

Another half a year after that, they were dealing with vaccination issues and more patients who had delayed treatments and consultations over chronic conditions.

"The strength of the rural health system - and this paper shows it - is just how adaptable people can be to new pressures," Associate Professor O'Sullivan said.

Rural practices constantly worked out how to overcome major issues, an environment that was already struggling with GP and other worker shortages before COVID-19 arrived in Australia.

Innovations came thick and fast, from driveway consultations to new systems to get paperwork to isolating doctors, along with trial and error on telehealth and phone consultations.

Insights from research like Professor O'Sullivan's could prove to be food for thought for policymakers who helped shepherd GP practices through 2019-20's Black Summer bushfires, 2020-22's pandemic and last spring's catastrophic flood events.

They have already moved to shore up areas of weakness exposed in the pandemic years including more emergency coordinators, she said.

It will also come in handy for the Murray PHN itself.

"These emergency situations are really important for us to understand as an agency involved in brokering access to coordinated primary care services," Associate Professor O'Sullivan said.

The research was funded by the Murray PHN and done in collaboration with Monash University's Rural Health School.

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