[Review] The primary health-care system in China

China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world’s population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidies and incentives that do not encourage cost savings and good performance, insurance policies that hamper the efficiency of care delivery, an insufficient quality measurement and improvement system, and poor performance in the control of risk factors (such as hypertension and diabetes).

What do you want from your CPD?

Have you completed your Training needs and Analysis Survey yet? Complete the survey by 10th of January and provide us with your training requirements.

Although continuing professional development (CPD) is a requirement of your medical registration, it’s not always easy to fit it into a busy practice life. At doctorportal Learning, we want to get a clearer idea of how we can best tailor our comprehensive CPD offering to your needs. To do that, we’ve put together a medical education survey that you should have already received in your inbox.

The survey should only take you around 15 minutes to complete. It will help us understand your CPD motivations and preferences in terms of access, pricing, learning interests and other key areas. We’ll use this information to better match our offering to your needs and help you meet your medical education requirements as easily as possible. An example of how new content responds to feedback is doctorportal Learning’s soon to be launched online CRANA Plus Advanced Life Support course. Requested by members, it’s the only completely online, accredited delivery of ALS certification in Australia and supports time poor and remotely located professionals who need to access this often mandatory piece of learning.

We’d appreciate if you could complete the survey by 10th of January, 2018. If you have any questions, please don’t hesitate to contact our team at memberservices@ama.com.au, or by phone on 1300 133 655.

Coordinated approach needed to improve Indigenous ear health

Ear health is the focus of the 2017 AMA Indigenous Health Report Card, with doctors calling on all Governments to works towards ending chronic otitis media.

Releasing the Report Card in Canberra on November 29, AMA President Dr Michael Gannon challenged the Federal Government and those of the States and Territories to work with health experts and Indigenous communities to put an end to the scourge of poor ear health affecting Aboriginal and Torres Strait Islanders.

The Report’s focus on ear health was part of the AMA’s step by step strategy to create awareness in the community and among political leaders of the unique health problems that have been eradicated in many parts of the world, but which still afflict Indigenous Australians.

“It is a tragedy that in 21^st century Australia, poor ear health, especially chronic otitis media, is still condemning Indigenous people to a life sentence of hearing problems – even deafness,” Dr Gannon said.

“Chronic otitis media is a disease of poverty, linked to poorer social determinants of health including unhygienic, overcrowded conditions, and an absence of health services.

“It should not be occurring here in Australia, one of the world’s richest nations. It is preventable.

“Otitis media is caused when fluid builds up in the middle ear cavity and becomes infected.

“While the condition lasts, mild or moderate hearing loss is experienced. If left untreated, it can lead to permanent hearing loss.”

Dr Gannon said that for most non-Indigenous Australian children, otitis media is readily treated, but for many Aboriginal and Torres Strait Islander children, it is not.

Estimates show that an average Indigenous child will endure middle ear infections and associated hearing loss for at least 32 months, from age two to 20 years, compared with just three months for a non-Indigenous child.

The Report Card, A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities, was launched in Parliament House by Indigenous Health Minister Ken Wyatt

Mr Wyatt commended the AMA on its 2017 Report Card.

Over the past 15 years, he said, the AMA’s annual Report Card on Indigenous Health has highlighted health priorities in Australia’s Aboriginal peoples and communities.

“Reports can be daunting and they can be challenging,” the Minister said.

“But above all, they can be inspiring.”

Mr Wyatt said it was a tragedy that the most common of ear infections and afflictions were almost entirely preventable.

Yet left untreated in Indigenous children, they had lifelong effects on education, employment and well-being.

“It’s not somebody else’s responsibility. It’s the responsibility of all of us,” he said.

“Hearing is fundamental.”

Shadow Indigenous Health Minister Warren Snowdon also commended the AMA on its report.

He said the Government and the Opposition worked collaboratively on Indigenous health issues.

“We’re not interested in making this a point of political difference, we’re interested in making it a national priority,” he said.

Green’s Indigenous Health spokeswoman Senator Rachel Siewert welcomed the Report and stressed the importance of addressing Indigenous health issues.

Australia’s first Indigenous surgeon, ear, nose and throat specialist Dr Kelvin Kong, who is also the Chair of the Australian Society of Otolaryngology Head and Neck Surgery’s Aboriginal Health Subcommittee, received the report with enthusiasm.

He said cross-party support on this issue had been “phenomenal”.

Dr Gannon said the AMA wants a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous infants and children in Australia.

The Report calls on Governments to act on three core recommendations: namely, that a coordinated national strategic response to chronic otitis media be developed by a National Indigenous Hearing Health Taskforce under Indigenous leadership for the Council of Australian Governments (COAG); that the wider impacts of otitis media-related developmental impacts and hearing loss, including on a range of areas of Indigenous disadvantage such as through the funding of research as required are addressed; and that attention of governments be re-directed to the recommendations of the AMA’s 2015 Indigenous Health Report Card, which called for an integrated approach to reducing Indigenous imprisonment rates by addressing underlying causal health issues.

“We urgently need a coordinated national response to the lasting, disabling effects and social impacts of chronic otitis media in the Indigenous adult population,” Dr Gannon said.

The AMA Indigenous Health Report Card 2017 A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities can be found at article/2017-ama-report-card-indigenous-health-national-strategic-approach-ending-chronic-otitis

CHRIS JOHNSON

Royal Commissions must spark changes for treatment of young people

Two recent Royal Commissions have inquired into systemic and institutional failure to protect vulnerable young people. The formula is roughly consistent. Both inquiries, Royal Commission into the Protection and Detention of Children in the Northern Territory and Royal Commission into Institutional Responses to Child Sexual Abuse, began with an initial exposé which generated enough public outrage to force a Government response.

In both cases, the subsequent investigations uncovered layers of abuse and neglect far more pervasive than anybody could have ever imagined. What remains to be seen, is the extent to which these Royal Commissions generate enough momentum to result in meaningful and positive change.

The findings of the Royal Commission into the Protection and Detention of Children in the Northern Territory are abhorrent. Children as young as ten serving custodial sentences in conditions that could not be deemed appropriate for any child, let alone some of our most vulnerable.

The final report of the Royal Commission delivered 43 recommendations, all with a subset of more detailed recommendations. In essence, the Report demands a drastic overhaul of the entire juvenile justice system.

A major finding from the Royal Commission is the relationship between Fetal Alcohol Spectrum Disorder (FASD) and juvenile incarceration. FASD occurs as a result of fetal alcohol exposure, and results in lifelong neurodevelopmental impairments. At present, we do not know the extent of its prevalence in Australia but it is thought to be endemic in some custodial settings.

Overseas studies have found that young people with FASD are almost 20 times more likely to enter the criminal justice system than their peers. Unsurprisingly, this carries a significant financial burden for both adult and youth justice systems. The relationship between FASD and the criminal justice system is dual in that FASD increases the likelihood a person will come into contact with the system, and then subsequently impedes their ability to navigate it. A particularly troublesome aspect of FASD is that many of its manifestations can simply appear as disobedience or behavioural problems to the untrained eye.

Young people are not routinely screened for FASD upon entering the juvenile justice system, and the Commission was told there are currently no plans to implement such an initiative. The Department of Health maintains that rates of FASD within the Northern Territory custodial settings are likely to be relatively low due to the high proportion of alcohol-free communities in the NT. However, the Commission received expert advice to the contrary, suggesting that as many as a third of all of the young people in youth detention could have FASD.

While there is no cure for FASD, behavioural and education interventions can improve outcomes for people with a diagnosis of FASD. Routine and psychosocial support are both beneficial to people with FASD, yet if the findings of the Royal Commission are anything to go by, these were not on offer to any of the young people in the care of the Northern Territory detention and protection systems.

In 2016, the AMA released a position statement Fetal Alcohol Spectrum Disorders (FASD) – 2016. The statement calls for strategies to identify and support people with FASD who come into the education, criminal justice and child protection systems consistent, broadly similar with the findings of the Royal Commission.

So far, these calls remain unmet.

It is vital that the findings of the recent Royal Commission are not simply a catalyst for collective shame, but for meaningful and positive change. Remorse and reflection can do very little for the young people in the youth justice system, and those that are yet to enter it, but they stand to benefit a lot from systemic changes to the youth criminal justice system.

BY GEORGIA BATH
AMA POLICY ADVISER

OPINION – Can safer surgery be legislated?

BY DR PETER SUBRAMANIAM

In June, a Royal Australasian College of Surgeons Queensland Audit of Surgical Mortality report sparked Queensland government action that may trigger new federal and state laws for public reporting of patient safety data across public and private hospitals. By August, Queensland had released a discussion paper and its push for such standards nationally was supported by federal and state health ministers at COAG Health Council. The Council tasked the Australian Commission on Safety and Quality in Health Care to work with ‘interested jurisdictions’ on such standards and to incorporate the work into national performance and reporting frameworks.

Compliance with audits of surgical mortality like the Queensland report is a mandated professional practice requirement for all surgeons while all public hospitals and almost all private hospitals already participate in the audits. So, the question doesn’t appear to be hospitals’ compliance with public reporting of performance data on patients admitted to hospital under a surgeon. The relevant questions seem to be what constitutes metrics of patient safety-oriented surgical performance and whether legislation can protect patients’ safety.

What are the metrics of patient safety-oriented surgical performance?

Patients admitted under a surgeon in a hospital are treated by a surgical team regulated by the hospital’s organisational framework that is part of a public or private hospital network. So, correctly, the metrics of patient safety-oriented surgical performance are metrics of the effectiveness of both surgical team performance and organisational performance of the hospital and its parent organisation. Only if both sets of metrics are reported will the public be fully informed about whether the hospital, public or private, is effective at protecting their safety.

This concept of patient safety-oriented surgical performance is backed by evidence. Patient safety depends on effective surgical team communication and adverse events by individual surgical team members are typically rooted in faulty systems and inadequate organisational structures. This evidence is reflected in local experience of more than 33,000 cases over eight years reported in the Australian and New Zealand Audit of Surgical Mortality National Report 2016. Its key points include that surgical team communication is a key element of good patient care and delayed inter-hospital transfers of patients with limited reserves can significantly affect surgical outcomes.

So, metrics of patient safety-oriented surgical performance must show effective surgical team communication as being timely decisions and actions to prevent, diagnose and treat surgical complications and deteriorating patients e.g. prompt resuscitation and surgery for postoperative bleeding. Likewise, such metrics must also show effective hospital and parent organisational systems enabling surgical teams’ decisions in a way that protects patient safety e.g. prompt inter-hospital transfers, timely ICU bed and OR access, safe working hours and staff levels.

Can legislation protect surgical patient safety?

The results of the Australian and New Zealand Audit of Surgical Mortality suggest surgical patient mortality represents a segment of Australia’s aging population who are at the extreme of life with co-morbidities that are a stronger predictor of death than the type of surgery. When an acute surgical condition supervenes, they have a rapidly shrinking window of opportunity with almost a quarter being irretrievable. They are prone to surgical complications which often leads to cardiac or respiratory failure with rapid deterioration and death. Nonetheless, surgical mortality in Queensland and nationally has been improving over the last eight years so it is difficult to envisage how new legislation will add much to improving surgical patient safety.

Is legislation necessary?

In 2016, a number of NSW private hospitals did not participate in the audit of surgical mortality despite compliance by all public and private hospitals in all other jurisdictions through the system funded by all State and Territory Governments. If legislation is to bring private hospitals in line with this public reporting system, it should be directed specifically for this reason. If it is to improve surgical patient safety or to inform patient choice, it is not clear how it will improve on the current public reporting system supported by governments. If a national performance and reporting framework is being developed, it should be directed at metrics of surgical team and organisational performance.

It remains to be seen if Government will be surgical in its approach to patient safety.

___________________________________________________________________________

Dr Peter Subramaniam MBBS MSurgEd FRACS is a cardiothoracic surgeon in Canberra who is currently pursuing a Juris Doctor law degree at the Australian National University. He established the Australian and New Zealand Cardiac and Thoracic Surgeons national cardiac surgery database in the ACT as well as the multidisciplinary ACT Cardiac Surgery Planning Group. He also has extensive experience in undergraduate and postgraduate surgical education.

Views expressed in the opinion article reflect those of the author and do not represent official policy of the AMA.

Government launches online resource to fight antimicrobial resistance

The Federal Government has used Antibiotic Awareness Week in November to launch a new online resource for industry and the community, as part of Australia’s ongoing work to tackle the rise of antimicrobial resistance.

Antimicrobial resistance (AMR) occurs when microorganisms, like bacteria, that cause infections resist the effects of the medicines used to treat them, such as antibiotics.

As a result of antibiotic resistance, standard medical and veterinary treatments may become ineffective and infections may persist and spread to others.

The Government’s funding commitment to help tackle the rise of AMR is $27 million – including $5.9 million from the landmark Medical Research Future Fund.

The planned AMR website, is one of the first priority areas of the Implementation Plan. It will aim to provide information for the community, health professionals, animal health professionals, farmers, animal owners and the broader agriculture industry.

Australia is one of the developed world’s highest users of antibiotics – one of the main causes of AMR. In 2015, Australian doctors prescribed more than 30 million antibiotic scripts through the Pharmaceutical Benefits Scheme.

Many patients are not aware that antibiotics only work against infections caused by bacteria and should not be used to treat viruses like colds, flu, bronchitis and most sore throats.

AMA President Dr Michael Gannon said in a recent ABC interview that AMR is a concern and there needed to be: “Better stewardship in hospitals, better education for GPs, but perhaps most importantly better education for people in the community for them to understand when antibiotics are not only not required, but they’re potentially dangerous or risky.”

AMR has both a health and economic impact with infections requiring more complex and expensive treatments, longer hospital stays, and it can lead to more deaths.

The World Health Organisation (WHO) believes global urgent change is needed in the way antibiotics are prescribed and used because antibiotic resistance is one of the biggest threats to global health, food security, and development today. Antibiotic resistance can affect anyone, of any age, in any country, including Australia.

WHO also believes that even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. Behaviour changes must also include actions to reduce the spread of infections through vaccination, hand washing, practising safer sex, and good food hygiene.

“A lack of effective antibiotics is as serious a security threat as a sudden and deadly disease outbreak,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.

“Strong, sustained action across all sectors is vital if we are to turn back the tide of antimicrobial resistance and keep the world safe.”

A recent study published in the Medical Journal of Australia shows that antibiotic resistance is on the rise and is present in our communities in Australia.

Lead researcher Dr Jason Agostino from the ANU Medical School said about 60 per cent of drug-resistant staph infections were picked up in the community, so infection control needed to shift from hospitals to the community.

“The problem of infections resistant to antibiotics in our community is not just a theoretical problem that will happen some time in the future – it’s happening right now,” Dr Agostino said.

Until the early 2000s in Australia, staph infections resistant to antibiotics mostly occurred in hospitals. The researchers found hospital infection rates are improving, with decreased infections in two of the region’s largest hospitals.

The study found that patients most at risk of the drug-resistant staph infection in the community are young people, Indigenous Australians and residents of aged-care facilities.

“We also need to improve the way we share data on antibiotic resistance to staph infections and link this to hospitalisation across health systems,” Dr Agostino said.

You can find out more about the progress of the Implementation Plan actions in the National Antimicrobial Resistance Strategy Progress Report at www.amr.gov.au.

MEREDITH HORNE

The future health curriculum

BY ROB THOMAS, PRESIDENT AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION

In many ways, the health system in Australia is on the brink of transformation. From moving away from fee-for-service as with NDIS and healthcare homes, to standardisation of private health insurance, to improving the use of personal data through information technology, disruption is clearly on the horizon.

However, in many ways medical education is still well behind when it comes to revolution. From outdated assessment methods, to courses no longer fit for purpose for the learner or the community, it is interesting to see where change must be made.

Thankfully, we have seen this year in both the Australian Medical Council (AMC) and the Medical Deans of Australia and New Zealand (MDANZ), a renewed push to improve teaching and learning into the future. But what might this look like?

I recently attended a workshop by the AMC focussing on the usefulness of programmatic assessment. Programmatic assessment as I understand it is a method of assessment where no one task is designed to ‘pass’ or ‘fail’ a learner. Instead, assessments are seen as individual data points that reflect an aspect of the learner’s knowledge at a certain time point. Through multiple assessments, at different times and through different methods, assessors can more accurately discover the strengths and weaknesses of the learner, leading to a clearer pass or fail.

While this may sound ‘softer’ than old school competencies, this may represent the opportune way of ensuring safe practice. No one OSCE or Mini-CEX assesses all aspects of the medical job, but together they give a picture of the learner. The added benefit is that programmatic assessment lends itself to more useful and more personalised feedback. Even through web-based adaptive testing, learners may now receive ‘tailored’ feedback on their performance. This is starting to gain traction in medicine, in useful teaching tools such as AMBOSS out of Germany. Question banks like those used for the USMLE are fast-becoming a way in which medical teaching is already transforming.

Another crucial part of the future health curriculum is social accountability. I was introduced to social accountability as an issue at the International Federation of Medical Students’ Associations (IFMSA) general assembly. Built upon the 5 pillars of equity, quality, relevance, efficiency and partnerships, social accountability in medical school means that students should get taught what they need to benefit their community. This may often go against the university’s business interests, in favour of providing education that is most appropriate to the learners. In an Australian context, curricular inclusions of indigenous health in context, treating those from culturally and linguistically diverse (CALD) backgrounds, and even tackling rural health issues falls under this banner. Similarly, medical school needs to be accessible to diverse members of the community, just as healthcare is.

Finally, interprofessional education (IPE) has a long way to go in Australian medical schools. Interprofessional education refers to classes or courses where learners from different health disciplines learn together. Multidisciplinary teams are now the foundation of the health unit in Australia, and yet most new medical graduates couldn’t tell the difference between an occupational therapist and a physiotherapist. Early silo-ing may be convenient but it adds to a culture of distrust and confusion, and students co-learning and co-producing their educational experience would be the key to solving this.

These are just a few of the many changes going on in medical teaching now and into the future. For me it comes down to preparation of the learner; and in medicine, we are lifelong learners. With programmatic assessment, social accountability and interprofessional education, we will hopefully continue to see the best doctors, prepared for the needs of our patients.

Email: rob.thomas@amsa.org.au

Twitter: @robmtom

[Editorial] Hearing loss: time for sound action

Half a billion people, almost 7% of the global population, had disabling hearing loss in 2015, state Blake Wilson and colleagues in a Review examining the burden of hearing loss in this issue of The Lancet. Hearing loss is now the fourth leading cause of years lived with disability, up from the 11th leading cause in 2010 and ahead of headline-grabbing conditions like diabetes and dementia. The 32 million children affected experience delays and usually limits in their communication, literacy, and educational attainments.

AMA PHN member survey

In response to the recommendations of the Hovarth Review into Medicare Locals (the Hovarth Review), the Government established 31 Primary Health Networks (PHNs) across Australia, commencing in July 2015. These replaced Medicare Locals (MLs) that were established by the previous Labor Government.

The fundamental purpose of PHNs is similar to that of their predecessors “to facilitate improvements in the primary health system, promote coordination and pursue integrated health care.” However, GPs are expected to play a more central role in PHNs than they did in MLs. PHNs are also expected to focus more on improving the linkages between primary and hospital care.[1][2]

In 2013, leading up to the Hovarth Review, the AMA conducted a survey of GP members to gauge their views on the performance of MLs. More than 1,200 GPs participated in that survey, with members particularly critical of their engagement with GPs and the extent to which many had failed to help improve patient access to primary care services. This survey formed the basis of AMA submission to the Hovarth Review, which recommended significant reforms including a more central role for GPs.

The AMA recently conducted a similar survey to provide members with the opportunity to give us their views on the performance of PHNs to date. Participants were provided with a number of statements and, were asked to select the options (strongly agree, mostly agree, neither agree or disagree, mostly disagree, or strongly disagree) that best reflect their opinion.

A total of 399 GPs participated in the survey, which represents a much smaller sample size than the 2013 survey. Nonetheless, it does provide a snapshot of the views of those members who participated in the survey and the results should be used to provide helpful guidance on areas where PHNs need to increase their focus.

The survey results are summarised as follows:

Understanding of the role and functions of PHNs:

61.5 per cent of respondents indicated that they have a reasonable understanding of the role and functions of PHNs (comparative data is not available for MLs).
Information about activities and services:
47.9 per cent of GPs surveyed believe they have not been kept informed about the work their PHN is undertaking and the services it supports (48.9 per cent for MLs).
GPs access to information and events of relevance:
51.4 per cent indicated that they have not been provided with information and access to events of relevance to day to day practice (57.8 per cent for MLs).
PHN engagement with local GPs:
62.6 per cent indicated that their PHN had failed to engage and listen to them about the design of health services needed in the local area (68.8 per cent for MLs).
Practice staff access to useful and effective education and resources:
46.3 per cent of GPs surveyed indicated that their practice staff have not been provided with access to useful and effective education and resources (comparative data is not available for MLs).
Valuing GP contribution:
52.8 per cent believed that their PHN does not value or recognise the inputs of local GPs (60.8 per cent for MLs).
Timing of meetings and information sessions:
46.1 per cent indicated that their PHN was holding meetings and information sessions at times that were not easily attended (52.4 per cent for MLs).
Supporting targeted programs for disadvantaged groups:
50.6 per cent indicated that their PHN has not been supporting well targeted programs that could help patients, particularly those who are disadvantaged (comparative data is not available for MLs).
Facilitating services that complement existing general practice:
52.8 per cent indicated their PHN is not focused on facilitating services that complement existing general practice services s (comparative data is not available for MLs).
Practice support for MyHealth Record:
57.4 per cent indicated that their PHN had not provided effective support for practices to implement the MyHealth Record (56.6 per cent for MLs re PCEHR).
Access to psychological services:
48.0 per cent indicated that their PHN had failed to improve patients’ access to psychological services (48.9 per cent for MLs regarding improved Access to Allied Psychological Services (ATAPS)).
Accessible mental health services for ATSI patients:
35.5 per cent of GPs surveyed indicated that their PHN had not facilitated appropriately funded and accessible services to meet the mental health care of Aboriginal and Torres Strait Islander (ATSI) patients (comparative data is not available for MLs).
Delivery of mental health and suicide prevention services and supports to ATSI patients:
43.3 per cent of GPs surveyed indicated that their PHN had not been able to improve the delivery of mental health and suicide prevention services and support to ATSI patients (comparative data is not available for MLs).
Access to services for patients requiring mental health care, but who are not eligible for National Disability Insurance Scheme (NDIS) packages:
52.7 per cent indicated that their PHN had been ineffective in facilitating for the needs of patients requiring mental health care, but who are not eligible for NDIS packages (comparative data is not available for MLs).
Psycho-social supports for patients with mental health problems:
55.9 per cent indicated that their PHN had been unable to ensure effective and timely psycho-social supports to patients with mental health problems (comparative data is not available for MLs).
Overall PHN performance:
58.0 per cent indicated that their PHN had not improved local access to care for patients (73.0 per cent for MLs).
Overall delivery of primary care:
62.6 per cent indicated that their PHN had not improved the capacity to deliver better quality healthcare overall (71.6 per cent for MLs).

PHNs have an important role to play in improving the integration of health services within primary health care, enhancing the interface between primary care and hospitals, and ensuring health services are tailored to the needs of local communities. They have the potential to have a strong impact on aged care services, mental health outcomes, chronic disease management, Indigenous health services, and services for the disadvantaged.

The AMA believes that for PHNs to be successful they must: have a clear purpose, with clearly defined objectives and performance expectations; be GP-led and locally responsive; focus on supporting GPs in caring for patients and working collaboratively with other health care professionals; have strong skills based Boards; be appropriately funded to support their operations, particularly those that support the provision of clinical services; focus on addressing service gaps, not replicating existing services; not be overburdened with excessive paperwork and policy prescription; and be aligned with Local Hospital Networks (LHNs), with a strong emphasis on improving the primary care/hospital interface. [3]

They should focus on the following areas:

Population Health – Identifying community health needs and gaps in service delivery; identifying at-risk groups; supporting existing services to address preventive health needs; and coordinating end of life care.
Building General Practice Capacity – Supporting general practice infrastructure to deliver quality primary care through IT support; education and training of practices and staff; supporting quality prescribing; training to support the use of e-Health technology and systems; enhancing practices capacity and capabilities to embrace the principles in being a medical home to their patients, and facilitating the provision of evidence-based multidisciplinary team care.
Engaging with Local Hospital Networks (LHNs)/Districts – Identifying high risk groups and developing appropriate models of care to address their specific health issues (e.g. those at high risk of readmissions, including non-insulin-dependent diabetes mellitus, congestive cardiac failure, chronic obstructive pulmonary disease, and other chronic diseases); and improving system integration in conjunction with local health networks.[4]

Given that PHNs are still a relatively new feature on primary care landscape, the jury is still out on the performance of PHNs. The AMA believes that they should be given every chance to succeed and intends conducting the same survey in a couple of years’ time to see how much of a difference they are making for GPs and their patients.

Dr Moe Mahat
Manager Policy
AMA General Practice Section

[1]Ducket et al (2015) Leading change in primary care: Boards of PHNs can improve the Australian health care system.

[2] Prof. John Hovarth AO (2014) Review of Medicare Locals: Report to Minister for Health and Minister for Sport.

[3] AMA Position statement Primary Health Networks 2015 position-statement/primary-health-networks

[4] Op Cit.

Secretary General to change next year

AMA Secretary General Anne Trimmer will next year leave the organisation she has led since 2013.

Ms Trimmer recently announced she has decided to pursue a different career direction when her five-year contract with the AMA expires in August 2018.

She informed the AMA Board of her decision before announcing it to staff in November.

AMA President Dr Michael Gannon Ms Trimmer had provided strong, stable leadership of the AMA Secretariat.

Under her direction, he said, the Secretariat had delivered a well-informed and strategic platform for the work of the AMA’s President, Vice President, Board, and Federal Council.

“Anne has maintained the AMA’s reputation as the peak medical advocacy group in the country and one of the most significant and successful lobby groups in Federal politics,” Dr Gannon said.

“The AMA has direct and personal access to the Government, the Parliament, and the bureaucracy from the Prime Minister down.

“Our leading and collaborative role in political and health circles is influential and agenda-setting.

“Anne has been at the helm through the controversial co-payment crisis, the subsequent Medicare freeze debate, the successful Scrap the Cap campaign against reforms to self-education expenses, the AMA’s survey of members to update our position on euthanasia, the AMA’s first ever Health of Asylum Seekers Summit, and the launch of our position on marriage equality.

“At the same time, she drove significant governance reforms for the Association, including establishing the AMA Board, implementing resource-sharing arrangements between the AMA and its subsidiary, the Australasian Medical Publishing Company (AMPCo), and building stronger relationships with the State and Territory AMAs, especially on membership issues.

“She is also the AMA’s representative on the Government’s Private Health Ministerial Advisory Committee (PHMAC).

“Anne has built strong personal and professional relationships with key decision makers in Canberra, which helped drive the AMA’s advocacy and influence in national politics.

“On behalf of the Board and the Federal Council, I thank Anne for her outstanding contribution to the AMA and the health sector, and wish her every success in her future endeavours.”

The AMA Board has commenced a process for a seamless transition to a new Secretary General in 2018.

CHRIS JOHNSON