Flu season preparations begin

Free influenza vaccines are scheduled to be available from early April as the Federal Health Department ramps up preparations for the 2016 flu season.

The Commonwealth’s Chief Medical Officer, Professor Chris Baggoley, has written to GPs and health services nationwide advising of plans to supply two age-specific quadrivalent influenza vaccines which will be available free of charge to eligible patients under the National Immunisation Program.

The advanced warning follows criticisms of delays in supplying flu vaccines last year.

The National Immunisation Program usually commences in March, but was held back until late April last year as manufacturers scrambled to produce sufficient stocks of the vaccines.

At the time, the Health Department blamed the delay on the decision to include vaccines for two new flu strains.

Last year was also the first time that single-dose quadrivalent vaccines were approved for use by the Therapeutic Goods Administration.

Professor Baggoley said this year the intention was to have the vaccines available from early April, “subject to…supply”.

The two vaccines being supplied under the National Immunisation Program are Sanofi’s FluQuadri Junior, for children younger than three years of age, and GlaxoSmithKline’s Fluarix Tetra, for people aged three years and older.

Under the Program, the vaccines will be available free of charge for pregnant women; Indigenous children aged between six months and five years; Aboriginal and Torres Strait Islander people aged 15 years and older; people aged 65 years and older; and those six months or older with a predisposition to severe influenza.

Professor Baggoley said both the quadrivalent vaccines and trivalent vaccines will also be available for purchase on the private market.

The Australian Technical Advisory Group on Immunisation has urged the use of quadrivalent vaccines, but has advised that trivalent vaccines are an acceptable alternative, particularly where quadrivalents are not available.

Professor Baggoley will provide an update on the National Immunisation Program in mid-March as well as resources including promotional posters. Fact sheets for both providers and consumers will be available for download from the Immunise Australia website (http://www.immunise.health.gov.au/) around the same time.

Adrian Rollins

Latest news:

A 3-year study of high-cost users of health care [Research]

Background:

Characterizing high-cost users of health care resources is essential for the development of appropriate interventions to improve the management of these patients. We sought to determine the concentration of health care spending, characterize demographic characteristics and clinical diagnoses of high-cost users and examine the consistency of their health care consumption over time.

Methods:

We conducted a retrospective analysis of all residents of Ontario, Canada, who were eligible for publicly funded health care between 2009 and 2011. We estimated the total attributable government health care spending for every individual in all health care sectors.

Results:

More than $30 billion in annual health expenditures, representing 75% of total government health care spending, was attributed to individual costs. One-third of high-cost users (individuals with the highest 5% of costs) in 2009 remained in this category in the subsequent 2 years. Most spending among high-cost users was for institutional care, in contrast to lower-cost users, among whom spending was predominantly for ambulatory care services. Costs were far more concentrated among children than among older adults. The most common reasons for hospital admissions among high-cost users were chronic diseases, infections, acute events and palliative care.

Interpretation:

Although high health care costs were concentrated in a small minority of the population, these related to a diverse set of patient health care needs and were incurred in a wide array of health care settings. Improving the sustainability of the health care system through better management of high-cost users will require different tactics for different high-cost populations.

Enhancing maternity data collection and reporting in Australia: National Maternity Data Development Project Stage 2

This report presents findings of Stage 2 of the National Maternity Data Development Project, which was established in response to the National Maternity Services Plan. The aim of the Project is to build a more comprehensive and consistent national data collection for maternal and perinatal health. Stage 2 has seen substantial progress in: data development for clinical data items and maternity models of care; maternal and perinatal mortality reporting; and online dissemination of perinatal data.

AMA in the News – 23 February 2016

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online

AMA attacks health insurers’ clawback, Adelaide Advertiser, 5 February 2015
Private health insurance customers could finally see a slowdown in the rate of premium rises, amid criticism of insurers for scaling back members’ entitlements. AMA President Professor Brian Owler accused some insurers of scaling back members’ coverage.

Sticking up for all children, Northern Territory News, 8 February 2016
The AMA wants all children who fall behind on their vaccination program to be allowed to catch up for free, calling for further Federal Government funding to boost immunisation rates. AMA President Professor Brian Owler said Government claims that health spending was unsustainable were not backed by evidence.

Medicare plan risks privacy, Adelaide Advertiser, 12 February 2016
A private company would know whether a patient had an abortion, herpes or was getting mental health treatment if the Government proceeds with a plan to privatise Medicare and medicine payments. The AMA is calling on the Government to change the system so a patient’s Medicare rebate could be assigned directly to the doctor.

Anti-vax nuts crack at last, The Sunday Telegraph, 14 Februay 2016
Almost 260 extra children are being immunised every week as even the most hardened anti-vaccine fanatics change their view. AMA President Professor Brian Owler said people are starting to realise the anti-vaccination lobby does not hold weight, and some of the policies are starting to take effect.

Indigenous health vital, The Herald Sun, 18 February 2016
AMA President Professor Brian Owler, in Alice Springs visiting health groups and clinics, said the Closing the Gap report, released last week, indicated that health had fallen off the radar.

Bulk-billing on the rise despite mooted cuts, The Australian, 19 February 2016
Bulk billing rates have continued to rise despite health groups warning patients will be left out-of-pocket because of a Federal Government freeze on Medicare rebates. AMA President Professor Brian Owler said the plan to remove the bulk billing incentive from pathology services was a sign the co-payment had risen from the grave.

Radio

Professor Brian Owler, 666 ABC Canberra, 8 February 2015
AMA President Professor Brian Owler discussed the AMA’s Pre-Budget Submission. Professor Owler criticised the Federal Government for telling basic ‘untruths’ about health spending.

Dr Brian Morton, 2GB Sydney, 9 February 2016
AMA Chair of General Practice Dr Brian Morton discussed homeopathy. Dr Morton said he was concerned that people who chose homoeopathy might put their health at risk.

Professor Brian Owler, ABC News Radio, 11 February 2015
AMA President Professor Brian Owler talked about health spending and the MBS Review.

Professor Brian Owler, ABC South East NSW, 15 February 2016
AMA President Professor Brian Owler discussed hydrocephalus. Professor Owler said shunt registry for hydrocephalus could be used as a quality assurance tool in order to decrease blockages and infections which affect morbidity and increase costs to the health system.

Television

Professor Brian Owler, ABC News 24, 28 December 2015
Landmark legislation will be introduced into Parliament to legalise medicinal cannabis. AMA President Professor Brian Owler said medicinal cannabis should be regulated in the same way as other narcotics.

Professor Brian Owler, CNN, 16 February 2016
AMA President Professor Brian Owler slammed Government policy on asylum seekers. Professor Owler said doctors who work with asylum seeker children face an incredible ethical dilemma, because they cannot allow children to be discharged into an unsafe environment.

Professor Brian Owler, SBS Sydney, 17 February 2016
Prime Minister Malcolm Turnbull said there would be no change to Australia’s border protection policies despite an offer from New Zealand Prime Minister John Key to take in children headed for offshore detention. AMA President Professor Brian Owler said this was a complex issue, but the issue facing the AMA is to ensure the health care of asylum seekers and getting children out of detention.

Your AMA Federal Council at work

What AMA Federal Councillors and other AMA members have been doing to advance your interests in the past month:

Name	Position on Council	Activity/Meeting	Date
Dr Chris Moy	AMA Federal Councillor	NeHTA (National E-Health Transition Authority) Clinical Usability Program (CUP) Steering Group	18/2/2016
Dr Brian Morton	AMA Federal Councillor & Chair AMACGP	Consultation on-screen presentation of discharge summaries	21/1/2016
Dr Chris Moy	AMA Federal Councillor	Consultation on-screen presentation of discharge summaries	/1/2016
Dr Richard Kidd	AMA Federal Councillor & Deputy Chair AMACGP	Consultation on-screen presentation of discharge summaries	19/1/2016
Dr Brian Morton	AMA Federal Councillor & Chair AMACGP	Practice Incentive Program Advisory Group (PIPAG)	18/2/2016
Dr John Gullotta	AMA Federal Councillor	TGA Medicines Shortages Working Group	12/2/2016
Dr Brian Morton	AMA Federal Councillor & Chair AMACGP	Meeting with expert panel reviewing pharmacy regulation and remuneration	1/2/2016
Dr Richard Kidd	AMA Federal Councillor & Deputy Chair AMACGP	Health Sector Group (HSG)	9/2/2016
Dr Stephen Parnis	AMA Vice President	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	10/2/2016
Dr Antonio Di Dio	AMA Member	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	10/2/2016
Dr Roderick McRae	AMA Federal Councillor – Salaried Doctors	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	10/2/2016
Dr Susan Neuhaus	AMA Federal Councillor – Surgeons	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	10/2/2016
Dr Johnathon Burden	AMA Member	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	10/2/2016
Dr Brian Morton	AMA Federal Councillor & Chair AMACGP	GP Roundtable	19/1/2016
Dr John Gullotta	AMA Federal Councillor	NeHTA (National E-Health Transition Authority) eReferral Reference Group	25/11/2015
Dr Ian Pryor	AMA Member	MSAC (Medical Services Advisory Committee) Review Working Group for Paediatric Surgery, including Circumcision	8/12/2015
Dr Ian Pryor	AMA Member	MSAC (Medical Services Advisory Committee) Review Working Group for Percutaneous Coronary Artery Interventions	3/12/2015
Dr Brian Morton	AMA Federal Councillor, Chair of AMACGP	Profession Services Review Advisory Committee	2/12/2015
Dr Iain Dunlop	AMA Federal Councillor	Profession Services Review Advisory Committee	2/12/2015
Dr Stephen Parnis	AMA Vice President	National Medical Training Advisory Network (NMTAN)	1/12/2015
Dr Katherine Kearney	AMA Member, DiT proxy	National Medical Training Advisory Network (NMTAN)	1/12/2015

Pathologists on the warpath

Pathology and diagnostic imaging providers have vowed to flex their political muscle as part of an election-year campaign to force the Federal Government to dump controversial cuts to bulk billing incentives.

In a stark warning to Government MPs, pathology and diagnostic imaging groups have vowed to mount a vigorous campaign over last December’s decision to save $650 million by axing the bulk billing incentive for pathology services and reducing it for diagnostic scans.

Emphasising their political impact, industry leaders said there were about 5000 pathology collection centres around the country that were used regularly by millions of Australians.

Sonic Healthcare Chief Executive Colin Goldschmidt told Fairfax Media that his company alone had around 2000 collection centres.

“We reach something like 1 million to 2 million patients per month through those collection centres,” Mr Goldschmidt said. “We have access to a lot of people.”

The Government’s cuts have particularly angered pathology providers, who have not had an increase in the Medicare rebate for their services in 17 years.

Primary Health Care Chief Executive Peter Gregg said the decision was “ludicrous” because it would force providers to begin charging a co-payment, which would in turn deter some patients – including those with chronic conditions such as diabetes – from being tested as regularly, resulting in more serious and expensive health problems later on.

Mr Gregg told The Australian pathology services could not absorb any more Government cuts without changing their business model, and said Primary, which operates 71 medical centres, more than 2000 collection centres and 168 radiology clinics, had begun trials of co-payments for some pathology and diagnostic imaging tests to gauge their effect on demand.

Mr Goldschmidt said Sonic currently bulk billed 98 per cent of its services and, although it had not yet moved to introduce more co-payments, “we are tending in that direction”.

But both executives insisted their preferred option was to block the bulk billing incentive cuts altogether.

The change was announced by the Government in its Mid Year Economic and Fiscal Outlook. Health Minister Sussan Ley argued the incentive, worth between $1.40 and $3.40, had done little to boost bulk billing rates, and had instead served to plump up the bottom line of providers like Primary and Sonic.

She said the companies could comfortably absorb the cut.

Related: Graham Jones: Pathology power

But AMA President Professor Brian Owler said the Government’s real intent was to introduce a co-payment “by stealth” by forcing pathology and diagnostic imaging providers charge out-of-pocket expenses for their services.

“It’s very clear that to be viable, that if these bulk billing incentives are taken away, then of course they’re going to have to pass those fees onto patients,” Professor Owler said. “That’s what this strategy is all about. It’s about the Government saying ‘no, we’re not paying any more; we’re going to make the provider charge you a fee’.”

The AMA President said the likely fee providers would have to charge would be considerably more than the incentive, because providers would have to introduce and operate billing systems, chase up bad debts, make provisions for losses and other additional tasks.

“They’ve got to actually introduce a whole new system to enable this to work, so of course they’re going to start to charge more. They’re not going to charge one of three dollars; it’s going to be much more than that,” he said.

Adding to the pressure on Government MPs, the ACTU has revealed it will mount a campaign involving doorknocking and targeted advertising in Coalition marginal seats.

The campaign has been triggered by the cuts to bulk billing incentives and the Government’s plan to outsource the Medicare payments system to the private sector.

Adrian Rollins

Latest news:

Govt funding goes begging because of bungling

The Health Department has been accused of bungling a multi-million dollar program intended to boost GP training in rural areas.

AMA President Professor Brian Owler has taken the Department to task over revelations that fewer than 50 Rural and Regional Teaching Infrastructure Grants have been awarded, despite funding for double that number.

In its 2014-15 Annual Report, the Department advised that just 10 of 100 grants provided for by the Government in that year had been approved. Professor Owler said that since then a further 38 had been awarded, and negotiations on another “20 or so” were underway.

But the AMA President said this still fell well short of expected targets. In its 2014-15 Budget, the Government committed $52.5 million over three years to fund at least 175 grants worth up to $300,000 each.

There are ongoing concerns about the difficulty of recruiting and retaining doctors to practise in country areas, and the grant program was established to help rural clinics to expand their facilities to accommodate medical students and supervising GPs.

Professor Owler said the program’s underperformance was particularly disappointing given the Government’s crackdown on spending in most areas of health.

“Many health services and programs and organisations are struggling as the Government puts the Budget bottom line ahead of improving health outcomes,” he said. “So it’s a surprise to find an area of health where funding targets are not being met or, to put it another way, precious allocated health funding is not being spent.”

The AMA President said the implementation of the program had been flawed – it took the Department four months to invite applications, and set a deadline during the 2014-15 Christmas-New Year holiday period.

“Give the Department’s extensive experience with infrastructure grants, this should have been a straightforward exercise. Clearly it has bungled the process,” Professor Owler said. “This ineptitude has wasted a rare opportunity to enable more medical students and GP registrars to experience and develop an interest in rural practice, and give patients better access to health services in their community.”

He said that what made it all the more galling was that this had occurred at a time when the Government was slashing GP funding.

The episode also showed the destructive effect of health spending cuts.

Professor Owler said the financial uncertainty created by Government policies such as the Medicare rebate freeze and the MBS Review had made general practices increasingly risk averse.

In order to qualify, practices have to commit to matching the grant provided by the Government, and the AMA President said many were reluctant to make the investment in the current environment.

He said it was unsurprising that, given the lacklustre response, the Government was reconsidering its approach to infrastructure grant funding.

Adrian Rollins

RACGP launch first draft of standards for general practices

The Royal Australian College of General Practitioners has launched their first draft of the fifth edition of the RACGP standards for general practices.

The aim of the standards is to keep pace with the changing environment and support patient safety in contemporary general practice.

The RACGP are urging GPs, practice staff and other stakeholders to read the standards and participate in the consultation.

“This first draft consultation is just that – a draft of what is a multifaceted set of requirements – and it is an opportunity for all involved in general practice to put forward their thoughts and perspectives in order to shape future drafts and the final version,” RACGP President Dr Frank R Jones said.

Dr Jones hopes some key additions to the latest draft will spur debate amongst the GP community.

“Some of the new proposed Indicators relate to the use of defibrillators in general practice, documentation of a third party in the patient’s medical record, changes to patient feedback requirements and developing a practice strategy for planning and setting goals,” Dr Jones said.

Other key changes to the edition includes a focus on outcomes and patient focused indicators.

Some of the suggestions for new indicators and newly mandatory indicators include:

Our patients can access resources translated into a language in which they are fluent.

The standards suggest having a directory of resources, services, online tools and websites that facilitate or provide resources that translate information into languages other than English.

Our patients can access up to date information about the practice. At a minimum, this information contains information on the range of services we provide

This could be done through a website or information sheet with pictures and simple language for patients who may not be able to read or understand the information.

Our patients are informed of the out-of-pocket expenses for health care they receive at our practice and potential out-of-pocket expenses for referred services

For some patients, the cost of treatment and investigations could be a barrier to care so providing information before they begin potential treatments to help them make an informed decision. If the patient indicates cost is a barrier, discuss potential alternatives such as referral to public services.

Our clinical team considers ethical dilemmas

Situations such as end of life care, pregnancy termination and receiving gifts from patients can all be ethical dilemmas. Practices need a process to resolve ethical dilemmas in a timely way.

Our patients receive information on health promotion, illness prevention, and preventive care

Health promotion is distinct from education and helps patients improve and increase their control over their health.

Our clinical team can exercise autonomy in decisions that affect clinical care (this is now mandatory)

Practitioners can use their knowledge of evidence and their credentials to determine the appropriate clinical care for each patient and decide which specialists to refer a patient to, which investigations to order and how and when to schedule follow-up appointments.

Our practice has a policy on the use of email and social media.

The policy should contain information about password security, updating email addresses and obtaining patient consent to communicate with them via email.

Our clinical team is trained to use the practice’s equipment

Keep a training and development calendar and training log to ensure all clinical and non-clinical staff have completed the appropriate training for the practice’s equipment.

Our practice seeks feedback from the team about our quality improvement systems and the performance of these systems

Giving all members of the practice team a chance to provide feedback gives the practice team the opportunity to consider how the practice can improve.

Our practice team undertakes activities aimed at improving clinical practice

Collecting clinical data can help improve practice care but helping with practice audits, PDSA cycles and using processes to identify patients with particular medical conditions

Time-critical results identified outside normal opening hours are managed by our practice

The practice needs to have procedures in place to ensure timely receipt of seriously abnormal or life-threatening results when received outside opening hours.

Our practice initiates and manages patient reminders

Our practice tracks and logs the patients on which reusable medical instruments have been used

The practice needs to be able to trace patients and track reusable medical devices in case there is failure to follow up on sterilisation or a medico-legal issue related to sterilisation.

Our practice team is aware of the risks associated with equipment use

Our practice has a defibrillator

This is not mandatory. The standards team specifically ask whether stakeholders believe they need an automated external defibrillator (AED) in their practice.

Consultation on this draft will run until 1^st April 2016 with the final version expected to be officially launched in October 2017.

To read a copy of the draft, visit the RACGP website.

Latest news:

Of politicians and rectal probes

Despite it being summer and the mercury hitting the 40s in many rural areas, Medicare rebates remain frozen.

It is time all practitioners got active in stirring their electorates up to resolve this bloody-minded impasse. Please talk to your colleges, and get them to get down and get their hands dirty doing some political pushing in this election year.

See your local MP, put up signs in your place of practice informing patients that bulk billing is going to have to end if the freeze continues, and ask patients to get involved to save Medicare as we know it. Universal access for all is under severe threat.

It is well and truly time the people sought honest answers from their politicians as to what the Government’s real plans are for Medicare. It cannot be left to slowly and sneakily strangle it by shrinking patient rebates. As the election draws closer, ramp up your actions.

The Australian Competition and Consumer Commission has a strict embargo on collusion and price fixing so act independently and, if you have any doubts, check your planned actions with the Federal AMA.

You will shortly receive a Rural Medicine Issues Rating Survey, the result of which will be used to guide the AMA in its lobbying on your behalf. Please devote a few minutes to filling it out and telling us what most needs fixing.

The Rural Classification Working Group meets on 25 February, so if you have concerns regarding the Modified Monash formula as it affects you, please let me know now.

I am about to purchase a basic ultrasound with a 40 centimetre rectal probe for the farm to let me know which cows have failed to conceive. I only continue to feed the productive members of the herd.

It is a pity a similar device cannot be used to scientifically sort our politicians into the “keepers” and the “oxygen thieves”.

The annual revelation of the small number of doctors rorting the Medicare system by the Professional Services Review should be accompanied by a similar release of data on politicians rorting the taxpayer, billing us for useless overseas junkets, trips to sporting events and family travel, with the odd helicopter flight and over-the-top entertainment expenses tossed in.

Before the political pot calls the medical kettle black, it needs to get its own house in order.

Thoughtless largesse by our political masters does not engender a culture of thrift in the community, let alone encourage respect.

Dead tired, or just plain dead?

By Dr John Zorbas, Deputy Chair, Council of Doctors in Training

Medicine has come a long way over the years. We’ve swapped barber shops and razors for sterile theatres and harmonic scalpels. We’ve changed our plague masks for hand hygiene. We’ve traded leeches for phlebotomy.

But there’s one thing we haven’t managed to change, and that is the body’s need for a good night’s rest.

Like an old Nintendo that had played just a touch too much Super Mario Bros., we still need to hit the reset switch and start again, clear and refreshed.

And, like an old Nintendo, there are no shortcuts. You can pull out the cartridge and blow on it in a vain attempt to get things going again, but there’s just no substitute for rest.

We work ourselves harder and harder to supposedly get more and more.

And if medicine does ever crack the puzzle that is fatigue, we’ll almost certainly destroy ourselves.

Our need for sleep is that last bastion of defence against taking these sub-par shortcuts. Our biology is clear on this: a mandatory period of unconsciousness is required every 24 hours.

The problem is that health is a 24-hour game. We don’t get to choose when our patients have their subarachnoid haemorrhages, their inflamed appendixes or their persistent nocturnal croup.

Illness happens around the clock, and we must work with this clock.

But pressures are increasing. This has led to doctors-in-training working increasingly unsociable and, oftentimes, plain dangerous shifts.

We’re not talking about missing out on the odd social event here and there. We’re talking about fatigue management, and this is no idle matter at all. Interstate truck drivers have strict schedules and relief patterns that are tracked via GPS to ensure compliance.

Pilots and their crews have rotations so strict that entire planes will be delayed to prevent fatigue from setting in, at the cost of hundreds of thousands to the airline.

The critics of fatigue management will often counter with the inadequacies of a 38-hour work week.

Let me be very clear on this: nobody is asking for hours to be restricted to 38 hours a week.

This isn’t like alcohol control, where a beer is illegal at 17 years and 364 days of age, but feel free to get plastered the next day. Fatigue is cumulative. It’s as much about the pattern of shifts as the duration of shifts, if not more so.

If fatigue management was as simple as an hour cut-off, we’d have it sorted already. Fatigue is more complicated than just your weekly hours.

The AMA has long been an advocate for safe working hours for doctors and, naturally, most of this work falls into the space of doctors-in-training rostered for shift work.

Since 1999, there has been a National Code of Practice in place to help both employees and employers best assess risk and manage fatigue in the workplace.

It is currently being reviewed by the Council of Doctors in Training, which is planning to a Safe Hours Audit later this year.

We have undertaken many such audits over the years to monitor working hours. Sadly, unsafe working hours are still all too common.

The literature is quite clear on fatigue. Fatigue kills, and it doesn’t matter whether you are a driver, a pilot or a doctor. If you’re a human, you’re subject to the never-ending diurnal requirement for restful sleep.

It has taken a gargantuan culture shift to show that working safer hours isn’t about laziness, it’s about safety and necessity.

Our next battle will be with health services who try to provide the same or increased services with less doctors and no technological advancement or true efficiencies.

If fatigue management is not a core component of working hours, you can guarantee that there’ll be a price to pay in blood, whether it be the doctor’s life or the patient’s life.

We are all human, and we’re are all tired at points in our lives. Fatigue management isn’t about being tired. It’s the difference between being tired, being dead tired and being dead.

Name

Position on Council

Activity/Meeting

Date

Our patients can access resources translated into a language in which they are fluent.

Our patients can access up to date information about the practice. At a minimum, this information contains information on the range of services we provide

Our patients are informed of the out-of-pocket expenses for health care they receive at our practice and potential out-of-pocket expenses for referred services

Our clinical team considers ethical dilemmas

Our patients receive information on health promotion, illness prevention, and preventive care

Our clinical team can exercise autonomy in decisions that affect clinical care (this is now mandatory)

Our practice has a policy on the use of email and social media.

Our clinical team is trained to use the practice’s equipment

Our practice seeks feedback from the team about our quality improvement systems and the performance of these systems

Our practice team undertakes activities aimed at improving clinical practice

Time-critical results identified outside normal opening hours are managed by our practice

Our practice initiates and manages patient reminders

Our practice tracks and logs the patients on which reusable medical instruments have been used

Our practice team is aware of the risks associated with equipment use

Our practice has a defibrillator