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Preference: Administration and Health Services

2

Health policy in play as Coalition licks wounds

AMA President Dr Michael Gannon has intensified the pressure on the Coalition to dump its Medicare rebate freeze policy following an admission from Prime Minister Malcolm Turnbull that health policy concerns swayed many voters away from his party.

“The Prime Minister, the Coalition, have had the scare of their life,” Dr Gannon said. “If they do survive, it’s time for them to listen about how elements of their health policy could be improved and let’s start with number one – unfreezing the rebate.”

As the shockwaves from the extremely tight Federal election result continue to reverberate, Mr Turnbull said it was clear that Labor’s message that the Coalition posed a threat to Medicare had fallen on “some fertile ground”.

“What we have to recognise is that many Australians were troubled by it. They believed it, or at least had anxieties raised with it. It is very clear – it is very, very clear – that Barnaby [Joyce] and I and our colleagues have to work harder to rebuild or strengthen the trust of the Australian people in our side of politics when it comes to health. There is no question about that,” Mr Turnbull said.

“Barnaby [Joyce] and I and my colleagues are as committed to Medicare as any other Member in the Parliament. That’s a fact.

“However, there was some fertile ground in which that grotesque lie could be sown. There is no doubt about that. It was a grotesque lie. Very cynical, very dishonest, but very effective.”

In comments that raise the prospect the Coalition will re-visit its health policies, the Prime Minister flagged that he and his colleagues would need to address perceptions they were not committed to Medicare.

“We have to recognise that there is a real issue for us if people voted Labor because they genuinely believed or they feared that we were not committed to Medicare, because that is not the case. So that is why Barnaby and I, as we reflect on this and our colleagues reflect on this, that is something that is an issue we have to address,” Mr Turnbull said.

Dr Gannon told ABC radio the election result had shown just how important health policy was for voters, and it was clear that the Medicare rebate freeze, combined with earlier polices such as the GP co-payment, meant Labor’s scare campaign on Medicare had resonated with voters.

“If we go back to the first co-payment model in 2014, which came out of the much-maligned Budget that year, if we look at Co-payment Mark II which came out later that year, it possibly showed that health policy was being run out of Treasury,” Dr Gannon said. “The Coalition has realised maybe too late…that people do worry about their health, they do vote on it, they do regard it as one of the major issues when they decide how to vote.”

Dr Gannon said the AMA had been campaigning hard on convincing the Coalition to join Labor and the Greens in committing to reinstate Medicare rebate indexation: “That was number one in the AMA’s campaign. We repeatedly asked the Coalition to unwind the freeze. Other elements of Coalition policy leant themselves to the scare and I think they’ve paid for it at the polling booth”.

Health has been a highly politically charged area of policy since the Coalition, led at the time by Tony Abbott, twice attempted to introduce a co-payment for GP visits. A backlash led by the AMA forced it to abandon the idea, and instead the Coalition reinstated a freeze of Medicare rebates first initiated by Labor, and has sought to make savings in other areas of health, including big cuts to public hospital funding and the abolition and reduction of bulk billing incentives for pathology and diagnostic imaging services.

During the election, Labor campaigned heavily on health care, and claimed that a proposal to outsource Medicare payments to the private sector was part of a broader but hidden agenda of the Coalition to privatise Medicare.

At the time, Dr Gannon publicly rebutted the claim, arguing that there was “never any suggestion that anyone was even remotely looking at privatising Medicare”, and Mr Turnbull tried to shut the issue down by declaring the Coalition would not look to outsource the Medicare payments system.

Reflecting on the election, Mr Turnbull blamed the issue for much of the plunge in Coalition support at the ballot box.

“This was a shocking lie,” Mr Turnbull said. “But the fact that significant numbers of people believed it or at least believed it enough to change their vote, tells us that we have work to do…That is a very clear lesson.

“We have to do more to reaffirm the faith of the Australian people in our commitment to health and to Medicare. Now, that commitment is there, but plainly there were concerns.”

Dr Gannon said that, whatever the outcome of the election, the AMA stood ready to work with all sides of politics to deliver better health policy.

“The Prime Minister has had the scare of his life and, if he is returned, I think he’ll be looking to hear ways that he can come up with an improved health policy. The Australian people have shown how dearly they hold it,” he told ABC News Radio. “The AMA is prepared to work with the Coalition, with the Labor Party, with the crossbench, to try and come up with health policy that’s good over the next three years. And we’re particularly determined to come up with health policy that will serve this nation for 10, 15 years into the future.”

Adrian Rollins

 

Pharmacy vaccinations in Queensland and the slippery slope of health services in community pharmacies

New legislation in Queensland supports pharmacy-based health care services on the basis of pilots of feasibility, embellished as evidence of effectiveness. Family doctors are concerned and disappointed that, despite lack of independent analysis, these pilots have resulted in new legislation with little consideration given to the broader health impacts. This move is paving the way for an expansion into other pharmacy-based health services, which have been successfully delivered in general practice for decades. It is also threatening the medical home model, which the federal government ostensibly supports.

When doctors speak about concerns with pharmacy vaccination programs, they talk about evidence, quality, patient safety and fragmentation of care. However, these messages are heard as ‘self interest’.

Pharmacists on the other hand talk about better access, availability, and gaps in healthcare delivery due to excessive GP waiting times. Pharmacists are not heard as being self-interested, rather as providing a beneficial service for the community. Public health arguments are also intuitively compelling; to a public health advocate it doesn’t matter where vaccinations are delivered.

However, these arguments need to be examined further. We have to look at the bigger picture and take into account adverse effects on our proven Australian general practice model, costs to the consumer, conflicts of interest of the pharmacy industry and issues with the Queensland vaccination trials.

Proven general practice model

Australia’s large network of general practitioners and their teams have been very successful in keeping Australians healthy at a low cost, compared to international standards.

National surveillance data on vaccine-preventable diseases in Australia documents a remarkable success story for vaccinations delivered by general practice, which have caused extraordinary declines in child and adult morbidity, mortality and hospitalisations over the years.

“Vaccinations delivered by general practice have caused extraordinary declines in morbidity, mortality and hospitalisations.”

Major changes to our primary care model must be based on evidence and not just sound like ‘a good idea’. There is little evidence that delivering vaccinations and other health services via pharmacists will improve efficiency, safety or quality of care for patients. Although there is a convenience factor, people need to ask how commercial interests have been allowed to be placed before health benefits to the Queensland population.

Issues with the trials

In 2014 the Queensland Department of Health approved an application by the Queensland branches of the Pharmacy Guild Australia and the Pharmaceutical Society of Australia, which led to the start of two trials to vaccinate adults over the age of 18 at community pharmacies against influenza, dTPa (diphtheria, tetanus and whooping cough) and MMR (measles, mumps, rubella).

Interestingly, no independent analysis of the trials seems to have been performed. The data that has been reported is superficial, selective and shows elements of observer bias. No analysis was undertaken to establish the clinical need for the vaccinations. No analysis was undertaken to determine what proportion of these vaccinations were high risk.

The trials did not reveal evidence about the impact on vaccine-preventable disease outbreaks. There was no comparison with alternatives such as walk-in vaccination clinics in general practice. General practitioners frequently conduct opportunistic screening and preventive healthcare during consultations for vaccinations, but the impact of missed opportunities for screening and other preventative care in general practice was not looked at, and neither did the trials focus on much-needed better integration of care delivery.

It seems no independent analysis was undertaken to determine whether the standard elements of privacy, documentation or GP notification were met. Further, no mention of commercial add-on practices was monitored, for example, using vaccinations as a means to on-sell other products. As we know the pharmacy business model relies heavily on upselling products to consumers.

The argument seems to be to improve vaccination coverage with claims of managing people ‘who have not been vaccinated’ – these claims are neither verified, nor explained; for example, are these new patients or inappropriate patients? It is a reasonable question as to why these claims have not been subject to closer scrutiny.

The stakeholders’ evaluation contained leading questions, such as: “The results of the trials show that there is increased uptake of influenza vaccination among adults who have never previously been vaccinated or who were not regularly vaccinated. Do you consider this an important public health function?” This raises questions about the objectivity of the process.

Conflicts of interest

There is an inherent conflict of interest in pharmacists delivering general practice services including vaccinations. One of the great strengths of medication prescribing in Australia is the high degree of separation between the prescriber and the medication dispenser. This enables more objective prescribing, free of pecuniary interests and leads to better allocation of resources. This is a strong argument against moving more health services into the pharmacy environment.

“One of the great strengths of medication prescribing in Australia is the separation between prescriber and medication dispenser”

The core role of pharmacy is to dispense medication safely and effectively, but the financial viability of pharmacies depends on operating successfully as small retail businesses. Concerns have been raised regarding the environment of pharmacy being more conducive to medication sales than primary care services. The pharmacy sector is seeking new ways to broaden its health services to provide new income streams, sometimes in conjunction with pharmaceutical companies with the prime purpose of profit.

Commercialisation of pharmacy vaccinations has occurred overseas and here in Australia. For example, a pharmaceutical company which produced vaccines involved in the trials, provided financial support to a pharmacy chain for their vaccination training. This illustrates the problem with delivering health services in pharmacies – but this was not reported in the evaluation of the trials.

If it ain’t broke…

There is ample evidence that increasing general practice comprehensiveness of care is associated with decreasing costs and hospitalisations. However, each time a task is given to other providers, the effectiveness and safety of our current proven GP-model is eroded and this will ultimately have consequences for the care delivered to Australian communities.

Despite concerns from doctors’ groups, the Queensland government announced in April 2016 that an amendment to the legislation now allows registered pharmacists to administer influenza vaccinations, diphtheria-tetanus-acellular pertussis vaccinations, measles-mumps-rubella vaccinations to adults.

“We should avoid a trade-off between our values and creating monetary value.”

Pharmacists are ready to roll out more ‘enhanced pharmacy support services’ in the near future. The impact of patients presenting to pharmacies instead of general practice will result in more fragmentation of care, missed opportunities for screening and preventive health care, unnecessary and non-evidence based care, and possibly increased risk and wasted health resources. It also clashes with the innovative national medical home model.

We should avoid a trade-off between our values and creating monetary value; recommendations for treatment and prescribing must only be evidence-based and should not be influenced by commercial factors.

Medical groups should continue to monitor these developments, highlighting the risks to policy makers and reinforce the message that we need evidence-based decision making in healthcare. It is dangerous to rely on short-term financial benefits at the expense of long-term, whole-of-system considerations. In the interest of all Queenslanders, decision makers should focus on strengthening general practice, not dismantling it.

The RACGP remains committed to working collaboratively with both state and federal governments to develop innovative and effective models of care, and strongly advocates for solutions that support integration, not fragmentation.

This article was originally published in AMA QLD’s Doctor Q and in Doctors Bag. Dr Edwin Kruys is Chair of RACGP Queensland and member of the AMA Queensland Council of General Practice. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch.

Other doctorportal blogs

Study finds 5:2 diet is useful weapon in fight against diabetes

A popular diet is proving to be effective for improving the health of people with type 2 diabetes.
In a pilot trial conducted by the University of South Australia, use of the 5:2 diet resulted in a significant reduction of
blood glucose level and weight loss.
In the three-month trial involving 35 people, participants reduced their haemoglobin A1C (HbA1c) by an average of
0.6 per cent and also reduced their bodyweight by 6-7kg.
The results have prompted a larger year-long study to begin in the coming months, which aims to involve 100
participants.
University of South Australia PhD candidate Sharayah Carter said there had been a lot of research to support the
new diet, but none that looked into its potential benefit for people with type 2 diabetes mellitus (T2DM).
“One of the major struggles with weight loss is people’s ability to stick to a daily-restricted calorie diet,” she said.
“On top of that, people with T2DM have medication to consider. A person with diabetes is not going to be able to take
the same amount of medication on those two days because they’re not eating enough food to support that
medication.
“What we found was that two days of severe energy restriction basically achieves similar results to a daily restriction
diet.”
The UniSA trial was the first of its kind and tested the effects of a two-day intermittent energy restriction (IER) diet
with 5-days of habitual eating for people with T2DM. This was compared to a daily restricted diet.
The results showed that while the IER diet has less of an impact on lifestyle and medication, both diets achieved
similar reductions on weight and in haemoglobin A1C levels.
The standard calorie restriction diet consisted of 1200 calories a day for women and 1500 calories for men. All
participants were asked to walk an extra 2000 steps per day to increase their level of exercise.
People who are obese are up to 80 times more likely to develop type 2 diabetes than those with a Body Mass Index
(BMI) of 22. Weight loss can help control and possibly halt the disease.
According to the World Health Organisation, the number of people with diabetes in 2014 was 422 million, up from
108 million in 1980. In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2
million deaths were attributable to high blood glucose.
Type 2 diabetes, which accounts for the majority of diabetes cases, is a progressive condition in which the body
becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough insulin in
the pancreas. The cause of type 2 diabetes is unknown.
“IER uses short periods of severe energy restriction – 500 calories for women and 600 calories for men – followed by
periods of habitual eating to achieve similar health improvements as daily dieting but unlike some IER diets, does
not require non-fasting days to involve restricted dieting,” Carter said.
“We achieved a 0.6 per cent drop in HbA1c in both groups which was a significant drop in that time frame and
importantly all our participants who were on medication reduced their dosages which is important for both the
individual and the health budget.
“Essentially you are achieving the same total energy restriction after seven days by following the two-day restriction
and getting the same results.”
The study was conducted in collaboration with the Sansom Institute for Health Research. It is a consortium of
leading researchers with the aim of intervening early to prevent illness, improve health systems and services,
creating more effective therapies and advancing health equality.

We need transformative change in Aboriginal health

Overcoming the soft bigotry of low expectations

Change is complex and invariably poorly managed and understood in Aboriginal affairs, including Aboriginal health. At worst, it is a competition between recycled ideas that have gained or lost currency with changes in the dominance of political ideologies. At best, it is developmental change, a slow and marginal improvement on what we are currently doing.

Comparison of the 1989 National Aboriginal Health Strategy (NAHS) Working Party report and the 1994 evaluation of the implementation of the NAHS with the current National Aboriginal and Torres Strait Islander Health Plan (2013–2023) (http://www.health.gov.au/natsihp) shows that we continue to seek change in the same key areas. Holistic approaches rich in evidence-based thinking, emphasis on community control of health services, inter-sectoral collaboration and improved monitoring and accountability are themes that have repeatedly been highlighted in almost the same way despite the passage of almost a quarter of a century. So what is wrong with this?

Let’s start with the sustainability of public interest in, and commitment to, Aboriginal health and the consequential lack of willingness of our political leaders to live up to their promises. Politicians regularly overpromised and underdelivered in Aboriginal affairs. Former Disability Discrimination Commissioner Graeme Innes describes the “soft bigotry of low expectations”1 as a barrier that people living with disability confront in health care. Sarra has similarly highlighted the impact of low expectations on Aboriginal education outcomes.2 I think the same “soft bigotry” applies to public expectations of Aboriginal health.

It is true that incrementally, slowly, too slowly, things are changing in some areas. Infant mortality in the Aboriginal and Torres Strait Islander population is declining,3 and we have seen significant decreases in avoidable deaths in some jurisdictions4 and improvement in access to medications.5 Aboriginal health is better today than it was in 1971 when the first Aboriginal Medical Service was established, but we need to ask ourselves whether the incremental gains, given elapsed time and effort invested, are sufficient? Where is the tectonic shift that will propel change in Aboriginal health forward at a much more rapid rate? Where is the new strategy that will deliver the Closing the Gap targets on time?

Prime Minister Malcolm Turnbull has said of the Closing the Gap campaign that “we cannot sugar-coat the enormity of the job that remains”6 and has called for innovative and new approaches. Leader of the Opposition Bill Shorten has encouraged us to listen to the “whispering at the bottom of our hearts”7 because it speaks honestly to the unease arising from the knowledge that we can and must do better.

Incremental change is insufficient if our aspirations for Aboriginal and Torres Strait Islander health and the results we deliver are to better align. We need to eschew the soft bigotry of low expectations, of slow incremental change, and embrace a more transformative change agenda.

We need change that not only develops new knowledge but, importantly, puts what we already know into practice efficiently and equitably. The research, for example, supporting the importance of access to high quality, consistent, comprehensive primary health care is extensive,8 but we have largely taken a patchwork approach to coverage in Aboriginal health.

It is still too much the case that Aboriginal and Torres Strait Islander peoples are confronted by a system in which the core services necessary to underscore a successful healthy journey across life are inconsistently available and of varying quality.9 Not all can access prenatal, infant, early childhood, adolescent, adult life and later life services as individuals or as cohorts when, and at a level, they require.10 In this issue, Ah Chee and colleagues provide an example of how transformative change can be implemented through an innovative model based on intervention before Aboriginal children reach school age.11

We need to shift from a program of low expectations to an approach that reinvents organisations and transforms structures, systems, technologies and processes to provide change that transforms the culture of organisations, professions and the workforce and the relationships across societal silos; change that reshapes public policy, financing and accountabilities. We need transformation not incremental change and it will be complex and risky. Tolerating incremental change costs lives, money and economic and social capital.

If we continue to rely on the slow and incremental, we will continue to bear these unacceptable costs. Without transformative change, we are doomed to be haunted by the whispers at the bottom of our hearts.

On assisted dying

The AMA National Conference hosted a special policy session on the highly contentious issue of assisted dying as part of an on-going AMA policy review.

The session, moderated by ABC presenter Tony Jones, brought together a panel of doctors, ethicists and lawyers with a range of views on whether doctors should be involved in assisted dying.

The debate began with an account of the death of an elderly patient who had had a breathing tube removed without anaesthetic because the treating doctor was fearful that if they administered a drug they might be charged with causing their death.

The scenario prompted discussion of the degree to which doctors were uncertain about the law around assisted dying and the so-called double effect doctrine.

Professor of Ethics at the University of Queensland, Malcolm Parker, said it was “widely understood the doctor knowledge of the law in all sorts of areas is not particularly good,” and many doctors were worried that if the treatment they provided had the effect of causing death, “they will get into trouble”.

Avant Head of Advocacy, Georgie Haysom, said the issue hinged around intent: “If you intend to cause someone’s death, that is murder”.

Dr Karen Hitchcock, who works in acute and general medicine at Melbourne’s Alfred Hospital and last year wrote a Quarterly Essay on caring for the elderly, said there needed to be much greater education around the double effects doctrine, under which the death of a patient is a side effect of treatment.

“Double effect is the bedrock of medicine, which is to treat symptoms,” Dr Hitchcock said. “We never treat life, we treat symptoms. So hastening death is not an issue. [Doctors] do not set out to kill; alleviating symptoms is the aim.”

Associate Professor Mark Yates, a geriatrician at Ballarat Health Services, said the double effects doctrine “is used on a day-today basis”, and rather than changing its position on assisted dying, the AMA should devote its efforts to promoting good palliative care.

But Emeritus Professor Bob Douglas from the Australian National University said the double effects doctrine was “a nonsense”, and was causing serious concern for both doctors and the broader community.

Professor Douglas agreed that there needed to be greater investment in palliative care and advance care planning, but said patients should have the choice of assisted dying.

“From the perspective of a patient, my concern is that when I get to the point of incurable illness and inevitable death, I don’t want to put all my relatives through the pain and suffering of an unnecessarily elongated process,” he said.

Professor Douglas said laws similar to those enacted in the US state of Oregon, which allow terminally ill adults to obtain and use prescriptions from their physicians for self-administered, lethal doses of medications, would “give a lot of people comfort”.

Dr Hitchcock said, however, that Oregon-style laws were unnecessary and could actually be harmful, by making the elderly and disabled feel pressured into seeking assisted dying, such as because of the fear of being a burden to their relatives.

“Every patient [already] has a right to choose to have treatment withdrawn,” she said. “The main reason people request physician-assisted suicide is because of feelings of uselessness and hopelessness. If we give people the choice, it will influence them.”

Dr Hitchcock disputed claims that Oregon-style laws put doctors at arms’ length from killing their patients, arguing it was “ridiculous” to pretend that writing a prescription for a lethal dose of medicine was not an act.

“What we are proposing is that instead of [a palliative care team], doctors can give a patient a prescription to go ahead and kill themselves,” she said. “We are talking about replacing the palliative care team with a script.”

But Professor Douglas countered that just knowing assisted dying was an option could bring people enormous comfort, and experience showed that far from all who acquired a prescription for lethal medication went on to use it.

Figures published by the Oregon Public Health Division show that from the time the laws were introduced in 1997 and the end of 2013, 1173 had obtained prescriptions and 752 had used them. During 2013, 122 people were provided a prescription, and 71 had killed themselves.

AMA President Dr Michael Gannon, who initiated the policy review as Chair of the AMA Ethics and Medico-legal Committee, said the National Conference session would, along with 3500 responses to an AMA member survey, be used to help inform the AMA Federal Council’s deliberations on the issue.

Adrian Rollins

AMA Awards

President’s Award

Dr Paul Bauert OAM and Dr Graeme Killer AO

Two doctors, one a passionate advocate for the disadvantaged and the other a pioneering force in the care of military veterans, have been recognised with the prestigious AMA President’s Award for their outstanding contributions to the care of their fellow Australians.

Dr Paul Bauert, the Director of Paediatrics at Royal Darwin Hospital, has fought for better care for Indigenous Australians for more than 30 years. More recently, he has taken up the battle for children in immigration detention.

Dr Bauert arrived in Darwin in 1977 as an intern, intending to stay for a year or two. In his words: “I’m still here, still passionate about children’s health and what makes good health and good healthcare possible for all children and their families. I believe I may well have the best job on the planet.”

Dr Graeme Killer, a Vietnam veteran, spent 23 years in the RAAF before becoming principal medial adviser to the Department of Veterans’ Affairs. Over the next 25 years, he pioneered major improvements in the care of veterans, including the Coordinated Veterans’ Care project.

Dr Killer has overseen a series of ground-breaking research studies into the health of veterans, including Gulf War veterans, atomic blast veterans, submariners, and the F-111 Deseal and Reseal program. He was also instrumental in turning around the veterans’ health care system from earlier prejudicial attitudes towards psychological suffering.

Dr Bauert and Dr Killer were presented with their awards by outgoing AMA President, Professor Brian Owler, at the AMA National Conference Gala Dinner.

Excellence in Healthcare Award

The Excellence in Healthcare Award this year recognised a 20-year partnership devoted to advancing Aboriginal health in the Northern Territory.

Associate Professor John Boffa and Central Australian Aboriginal Congress CEO Donna Ah Chee were presented with the Award for their contribution to reducing harms of alcohol and improving early childhood outcomes for Aboriginal children.

Associate Professor Boffa has worked in Aboriginal primary care services for more than 25 years, and moved to the Northern Territory after graduating in medicine from Monash University.

As a GP and the Chief Medical Officer of Public Health at the Central Australian Aboriginal Congress, he has devoted his career to changing alcohol use patterns in Indigenous communities, with campaigns such as ‘Beat the Grog’ and ‘Thirsty Thursday’.

Ms Ah Chee grew up on the far north coast of New South Wales and moved to Alice Springs in 1987. With a firm belief that education is the key pathway to wellbeing and health, she is committed to eradicating the educational disadvantage afflicting Indigenous people.

Between them, the pair have initiated major and highly significant reforms in not only addressing alcohol and other drugs, but in collaborating and overcoming many cross-cultural sensitivities in working in Aboriginal health care.

Their service model on alcohol and drug treatment resulted in a major alcohol treatment service being funded within an Aboriginal community controlled health service.

AMA Woman in Medicine Award

An emergency physician whose pioneering work has led to significant reductions in staph infections in patients is the AMA Woman in Medicine Award recipient for 2016.

Associate Professor Diana Egerton-Warburton has made a major contribution to emergency medicine and public health through her work as Director of Emergency Research and Innovation at Monash Medical Centre Emergency Department, and as Adjunct Senior Lecturer at Monash University.

Her just say no to the just-in-case cannula has yielded real change in practice and has cut staff infections in patients, while her Enough is Enough: Emergency Department Clinicians Action on Reducing Alcohol Harm project developed a phone app that allows clinicians to identify hazardous drinkers and offer them a brief intervention and referral if required.

Associate Professor Egerton-Warburton has been passionate about tackling alcohol harm, from violence against medical staff in hospitals to domestic violence and street brawls.

She championed the first bi-annual meeting on public health and emergency medicine in Australia and established the Australasian College of Emergency Medicine’s alcohol harm in emergency departments program.

In addition, she has developed countless resources for emergency departments to facilitate management of pandemic influenza and heatwave health, and has authored more than 30 peer-reviewed publications.

Professor Owler said Associate Professor Egerton-Warburton’s tireless work striving for high standards in emergency departments for patients and her unrelenting passion to improve public health made her a deserving winner of the Award.

AMA Doctor in Training of the Year Award

Trainee neurosurgeon Dr Ruth Mitchell has been named the inaugural AMA Doctor in Training of the Year in recognition of her passion for tackling bullying and sexual harassment in the medical profession.

Dr Mitchell, who was a panellist in the Bullying and Harassment policy session at National Conference, is in her second year of her PhD at the University of Melbourne, and is a neurosurgery registrar at the Royal Melbourne Hospital.

Presenting the award, Professor Owler said Dr Mitchell had played a pivotal role in reducing workplace bullying and harassment in the medical profession and was a tireless advocate for doctors’ wellbeing and high quality care.

MJA/MDA National Prize for Excellence in Medical Research

A study examining the impact of a widely-criticised ABC TV documentary on statin use won the award for best research article published in the Medical Journal of Australia in 2015.

Researchers from the University of Sydney, University of NSW and Australian National University found that tens of thousands of Australians stopped or reduced their use of cholesterol-lowering drugs following the documentary’s airing, with potentially fatal consequences.

In 2013, the science program Catalyst aired a two-part series that described statins as “toxic” and suggested the link between cholesterol and heart disease was a myth.

The researchers found that in the eight months after program was broadcast, there were 504,180 fewer dispensings of statins, affecting more than 60,000 people and potentially leading to as many as 2900 preventable heart attacks and strokes.

AMA/ACOSH National Tobacco Scoreboard Award and Dirty Ashtray

The Commonwealth Government won the AMA/ACOSH National Tobacco Scoreboard Award for doing the most to combat smoking and tobacco use, while the Northern Territory Government won the Dirty Ashtray Award for doing the least.

The Commonwealth was commended for its continuing commitment to tobacco control, including plain packaging and excise increases, but still only received a B grade for its efforts.

The Northern Territory received an E grade for lagging behind all other jurisdictions in banning smoking from pubs, clubs, and dining areas, and for a lack of action on education programs.

State Media Awards

Best Lobby Campaign

AMA NSW won the Best Lobby Campaign award for its long-running campaign to improve clinician engagement in public hospitals.

The campaign started after the Garling Inquiry in 2008, which identified the breakdown of trust between public hospital doctors and their managers as an impediment to good, safe patient care.

It led to a world-first agreement between the NSW Government and doctors, signed in February 2015 by Health Minister Jillian Skinner, AMA NSW and the Australian Salaried Medical Officers’ Federation NSW, to embed clinician engagement in the culture of the public hospital system, and to formally measure how well doctors are engaged in the decision-making processes.

Best Public Health Campaign

AMA NSW also took home the Best Public Health Campaign award for its innovative education campaign on sunscreen use and storage.

The campaign drew on new research which found that many Australians do not realise that sunscreen can lose up to 40 per cent of its effectiveness if exposed to temperatures above 25 degrees Celsius.

The campaign received an unexpected boost with the release of survey results showing that one in three medical students admitted to sunbaking to tan, despite knowing the cancer risk.

Best State Publication

AMA WA won the highly competitive Best State Publication award for its revamped Medicus members’ magazine.

The 80-page publication provides a mix of special features, clinical commentaries, cover articles and opinion pieces to reflect the concerns and interests of WA’s medical community and beyond.

The judges said that with its eye-catching covers, Medicus made an immediate impact on readers.

Most Innovative Use of Website or New Media

AMA WA won the award for its Buildit portal, a mechanism for matching trainee doctors with research projects and supervisors.

The judges described Buildit as taking the DNA of a dating app and applying it to the functional research requirements of doctors in training, allowing for opportunities that may have otherwise been missed.

National Advocacy Award

AMA Victoria won the National Advocacy Award for its courage and tenacity in tackling bullying, discrimination and harassment within the medical profession.

AMA Victoria sought the views and concerns of its members, and made submissions to both the Royal Australasian College of Surgeons’ inquiry and the Victorian Auditor-General’s audit of bullying, harassment and discrimination within state public hospitals.

The judges said that tackling a challenge within your own profession was a particularly difficult task, especially in the glare of public scrutiny, making the AMA Victoria campaign a standout.

Maria Hawthorne

AMA Fee List Update – 1 July 2016

The AMA List of Medical Services and Fees (AMA List) will be updated on the 1 July 2016 to amend existing items and include new items. These items are provided in the Summary of Changes for 1 July 2016, which will be available from the Members Only area of the AMA website at article/1-november-2015-31-october-2016-current

The updated AMA Fees List Online will be available from http://feeslist.ama.com.au.  Members can view, print or download individual items or groups of items to suit their needs.  The comma delimited (CSV) ASCII format (complete AMA List) is available for free download from the Members Only area of the AMA Website (www.ama.com.au).  To access this part of the website, simply login by entering your username and password located at the top right hand side of the screen and follow these steps:

1)      Once you have entered your login details, from the home page hover over Resources at the top of the page.

2)      A drop down box will appear. Under this, select Fees List.

3)      Select first option, AMA List of Medical Services and Fees – 1 July 2016.

4)    Download either or both the CSV (for importing into practice software) and Summary of Changes (for viewing) detailing new, amended or deleted items in the AMA List.

If you do not have Internet access please contact us on (02) 6270 5400 for a copy of the changes.

AMA calls for fair go for bush health

The AMA has encouraged all major political parties to deliver significant real funding increases for health care in regional, rural and remote Australia.

Immediate-past President Professor Brian Owler made the appeal when he launched the AMA’s plan for Better Health Care for Regional, Rural, and Remote Australia at Parliament House last month.

Professor Owler said that the life expectancy for those living in regional areas was up to two years less than the broader population, and up to seven years less in remote areas, and needed to change.

“It is essential that Government policy and resources are tailored and targeted to cater to the unique nature of rural health care and the diverse needs of rural and remote communities to ensure they receive timely, comprehensive, and quality care,” Professor Owler said.

The AMA plan focusses on four key measures – rebuilding country hospital infrastructure; supporting recruitment and retention; encouraging more young doctors to work in rural areas; and supporting rural practices.

The plan encourages Federal, State and Territory governments to work together to ensure that rural hospitals are adequately funded to meet the needs of their local communities. More than 50 per cent of small rural maternity units have closed in the past two decades.

Professor Owler said rural hospitals needed modern facilities, and must attract a sustainable health workforce.

“We need to invest in hospital infrastructure,” Professor Owler said. “When hospitals don’t have investment, when their infrastructure runs down, it makes it much harder for rural doctors to service patients in their communities.”

He called on the Council of Australian Government (COAG) to consider a detailed funding stream for rural hospitals, backed by a national benchmark and performance framework.

Professor Owler visited a rural GP practice at Bungendore and spoke with the local doctors about the issues and barriers of delivering high quality timely health care to the community.

“General practice is the backbone of rural health care, providing high quality primary care services for patients, procedural and emergency services at local hospitals, as well as training the next generation of GPs,” Professor Owler said.

“Rural GPs would like to do more, but face significant infrastructure limitations in areas such as IT, equipment, and physical space.

“Rural general practices need to be properly funded to improve their available infrastructure, expand services they provide to patients and support improved opportunities for teaching in general practice.”

The AMA has recommend that the Government fund a further 425 rural GP infrastructure grants, worth up to $500,000 each, to assist rural GPs.

Professor Owler added that timely access to a doctor was a key problem for people living in rural areas, with the overall distribution of doctors skewed heavily towards the major cities. He said the burden of medical workforce shortages fell disproportionately on communities in regional, rural and remote areas.

The number of GP proceduralists or generalists working across rural and remote Australia has steadily been declining. In 2002, 24 per cent of the Australian rural and remote general practice workforce consisted of GP proceduralists. By 2014, this level had dropped to just under 10 per cent.

The AMA and the Rural Doctors Association of Australia have together developed a package that recognises both the isolation of rural and remote practice and the need for the right skill mix in these areas.

The AMA Better Health Care for Regional, Rural, and Remote Australia is available at gp-network-news/ama-plan-better-health-care-regional-…

Kirsty Waterford

Radiologists abandon campaign on promise of Govt review

The Coalition has convinced the diagnostic imaging industry to drop its campaign against cuts to bulk billing incentives in exchange for a review of the commercial pressures the sector is working under.

After last month striking a peace deal with pathologists to end a damaging campaign over the axing of bulk billing incentives for pathology services, the Government has headed off similar action by the nation’s radiology providers.

Health Minister Sussan Ley announced on 5 June that the Coalition, if re-elected, would commission an “independent evaluation…of the commercial pressures facing diagnostic imaging providers”.

Ms Ley said the evaluation would also be used to help identify ways to make Government spending more targeted and efficient.

“Advancing technology in many areas of the health system creates a much more efficient and automated service, leading to decreased costs,” the Minister said. “However, this is not the case for most diagnostic imaging services, which need specialist doctors to supervise the examination and analyse the results, not machines.

“This independent evaluation will ensure we can work together with the diagnostic imaging sector to pinpoint exactly where possible improvements can be made in the broader system, and ensure this significant additional investment is targeted where it will have the most benefit for patients.”

Ms Ley up to $50 million a year could be saved through greater efficiencies in Government spending.

The Minister’s announcement came just days before the Australian Diagnostic Imaging Association planned to launch a public campaign warning that cuts to bulk billing incentives, coming on top of an 18-year freeze on patient rebates, would force the cost of crucial of crucial diagnostic and treatment services beyond the reach of many patients, including those with cancer.

The Association had said that average out-of-pocket costs for x-rays, ultrasounds, CTs and MRIs had reached $100, and practices were “extremely concerned” that the freeze on rebates would “continue to drive more patients away from essential diagnosis and treatment”.

But, following Ms Ley’s announcement, Association Chief Executive Officer Pattie Beerens said she was confident the Coalition’s plan, which includes maintaining the bulk billing incentive for concession card holders and children, a three-year moratorium on changes to Diagnostic Imaging Services Table and a resumption of rebate indexation in 2020, would “show a path” to adequate Medicare rebates.

“We had to fight the case for patients and we are really pleased that our advocacy has resulted in the diagnostic imaging sector and the Government working constructively to achieve a positive outcome for patients, providers and taxpayers,” Ms Beerens said.

Adrian Rollins