Thunderstorm asthma

BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

With then end of the year fast approaching, there are many joys that this time of year brings, but also many hazards. One such hazard is increased risk of thunderstorm asthma. It is now just over a year since the disastrous thunderstorm in Victoria that triggered a mass asthma emergency, with 8,500 people requiring hospital care and ten sadly losing their lives.

While Victorian hospitals featured prominently in the Victorian response, we also know that many patients accessed GP care and advice, including through after hours GP services.

Research is being conducted to better understand why epidemic thunderstorm asthma events occur. It is believed that grass pollens swept up into the clouds as a storm forms, absorb moisture and then burst open filling the air with small allergen particles. Unlike the larger grass pollen grains that cause hay fever, these particles are small enough to be drawn deep into the lungs. The irritation caused resulting in swelling, narrowing and additional production of mucus in the small airways of the lung, making it very difficult to breath.

Symptoms are quick to come on and typically involve wheezing, chest tightness and coughing, much like asthma.

As GPs, it important to be aware that it is not just people with asthma or a history of asthma that are susceptible to a thunderstorm asthma event. Anyone who suffers seasonal hay fever is also at risk. It is important that our at-risk patients understand this and know how to minimise their risks and manage any symptoms if they experience epidemic thunderstorm asthma.

Thunderstorm asthma is now recognised as a serious health threat and over the last year a range of resources have been made available to GPs to assist them in preparing their patients for the grass pollen season and any epidemic thunderstorm asthma event.

GPs should make sure they are up to date with the recommendations in the Australian Asthma Handbook and can undertake the free NPS Medicinewise Clinical E-Audit Asthma Management – supporting patients to achieve good control.This tool will help you improve the individual management of your patients by identifying risk factors, reviewing asthma control, adjusting management and reinforcing the benefits of maintaining an up-to-date written asthma action plan.

The National Asthma Council Australia has also made available a range of resources for GPs and other healthcare professionals in the event of another thunderstorm asthma event, which can be accessed here. These include information papers on epidemic thunderstorm asthma and managing allergic rhinitis in people with asthma and advice on preventative treatment.

In addition, the Asthma Australia website also contains general information about asthma which may be of use to GPs, including how to prepare for and respond to an asthma emergency. They also have specific resources for health professionals.

The key is ensuring at-risk patients understand the risks, know how to reduce them, and have an action plan for responding to symptoms.

This will be my last column for 2017, with the year seeming to go very quickly due to the never-ending advocacy of the AMA on GP issues. On behalf of the Council of General Practice I will take this opportunity to wish you all a safe and happy time with family and friends over the holidays.

Rural health in retrospect

BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS

As the second Chair of AMACRD, I feel that despite being a relatively new group within the AMA, we have much to be proud of. So, as 2017 turns into 2018, I look at the circumstances that surrounded us, and am glad to note that we have worked hard, we have little victories we can take credit for.

So, Rural Doctors, I invite you to commemorate all our work in the year 2017, but also to note the challenges that lay ahead.

First off, I want to address the slow internet in the Outback. We are getting attention concerning this slowly (but steadily) and have advocated consistently for improvements.

NBN Co attended an AMACRD meeting at the time of the rollout of Skymuster II and had a good opportunity to hear our stories. We advocated to end the data drought by increasing bandwidth, reducing the cost per gb to make our data needs more affordable. We know that NBNCo has now announced larger satellite data allowances and intends giving medical practice ‘public interest premises’ status, which should improve data allowances and speed even further.
We made a submission to the Productivity Commission for the Telecommunications Universal Service Obligation, some of which we were pleased to see was included in their Final Report
Council members appeared before the Joint Standing Committee on the NBN, making a case for improved access to superfast broadband by describing in vivid stories what internet is like for us. I am told the stories were received with amazement.

Workforce Distribution continues to be an issue. Despite the influx of new medical graduates, there are still unfilled workforce needs in rural Australia. The concept of maldistribution is on the minds of everyone who is trying to solve this problem.

AMA has been invited to the Distribution Workforce Working Group. This group will meet frequently to advise the Minister of Health and the Rural Stakeholders Forum with recommendations.
We have also updated the AMA Rural Workforce Initiatives Position Statement to reflect the current state of our workforce and to offer solutions: new wet behind the ears medical graduates, bewildered overworked International Medical Graduates (IMGs) feeling unappreciated, rural health still far behind but eager to catch up.
The Government has provided funding of up to $93.8 million from 2015-16 to 2018-19 to implement three components to support the rural pipeline that included: Regional Hubs; Rural Junior Doctor Training Fund; and Specialist Training Programme.

Infrastructure is an area where we have had some wins, but we cannot afford to relax on this front. Hospital, clinics and toilets all need walls, doors and privacy.

Following AMA advocacy, the Government, as part of the 2016/17 Federal Budget, announced a redesign of the Rural and Remote Teaching Infrastructure Grants (RRTIGP) to create a more streamlined Rural General Practice Grants Program (RGPGP) which intends to improve uptake. AMACRD provided input to inform the Department of Health revision of the RRTIGP. The AMA will push for continued infrastructure grant funding.
Closure of services in hospitals, especially maternity services is the trend. However there are some “wins” in Queensland with their Rural Generalist program bolstering rural obstetrics.

In the past, Rural Health has been pushed into the background, but we are beginning to see it given some attention by the Government.

Recently at an international rural medical conference I was eavesdropping on North American attendees. They were impressed with the focus that Australia has on rural health. To quote, “They think rural health is so important they have a Federal Minister for Rural Health!”
Now we have even gone a bigger step forward. We have a National Rural Health Commissioner, Professor Paul Worley. That should impress the International Rural community. It took an act of parliament to create this arms-length Commissioner separate from the governing bodies and he is one of us. We will have an advocate, speaking on our behalf. He will be rolling out a national Rural Generalist program and the AMA is keen to work with him.

The vexed issue of Bonded Placements has yet to be resolved, but we are seeing some developments here.

The Government is looking at potentially reforming Return of Service (RoS) obligations on doctors working in bonded placements. This issue will continue to be developed into the new year as well. AMA is in discussions concerning this.
We need to care for our young, as they are the next generation of doctors. If they are treated like prisoners they will rarely return voluntarily to their former jail cells.

Regarding 2018, AMACRD has additional areas it will be vigilant on including (but certainly not limited to) the following:

Support for IMGs and doctors who are struggling with Australian Medical Council and Fellowship exams
Monitor the development of the National Rural Generalist Pathway
Provide input to Health care Homes, Practice Incentives Program redesign, and Medicare Benefits Schedule Reforms
Invigilate the application of the Modified Monash Model for Rural Workforce Incentive programs
Support our new Rural Health Commissioner
Rural Aged Care
Foster team work amongst Rural health care providers both medical and allied health
Monitor the new Rural Junior Doctor Innovation Fund (a tweak on the former Prevocational GP Placement Program (PGPPP)) to see 60 Full time equivalents by 2019.

Although some of these discussions may be uncomfortable, it is essential that we keep rural health in the spotlight. I look forward to continuing to make advancements and am optimistic about AMACRD achieving more victories in 2018.

@drshirowatari

GPs are tops – ABS latest stats

Australians still love their local doctors.

At least that is the finding of the latest Australian Bureau of Statistics (ABS) data, which shows that patients around the nation are satisfied with their GPs.

The ABS’s latest Patient Experiences in Australia Survey reinforces previous findings that Australia’s dedicated GPs are meeting increasing demand and providing quality services.

GPs attracted a very high satisfaction rating from patients in the survey.

The survey produced positive results for medical specialists and emergency department doctors as well, but GPs are the doctors who have the most frequent contact with patients.

According to the survey, 83 per cent of Australians saw a GP in the last 12 months and around 78 per cent of patients have a preferred usual GP.

AMA President Dr Michael Gannon described the results of the survey as outstanding.

“Importantly, the proportion of people waiting longer than they felt acceptable for a GP appointment decreased from 23 per cent in 2013-14 to 18 per cent in 2016-17,” Dr Gannon said.

“Of those who patients who saw a GP for urgent medical care, 75 per cent were seen within 24 hours of making an appointment.

“The survey shows that cost is not a barrier to accessing GP care, with only 4 per cent of respondents saying that they at least once delayed seeing a GP or did not see a GP when needed due to cost.

“Of those patients who saw a GP in the last 12 months, 92 per cent reported that the GP always or often listened carefully to them, 94 per cent reported that their GP always or often showed them respect, and 90.6 per cent reported that their GP always or often spent enough time with them.

“These results are outstanding when you consider the pressure under which our GPs are working today.”

Dr Gannon said GPs are a critical part of the health system, and they must be valued and supported.

General practice remains under significant funding pressure due to cuts by successive governments, he said, but GPs continue to provide high quality and accessible primary care services across the country.

“When people are sick, they want to see a GP,” Dr Gannon said.

“As the Government looks to shape the future of our health system, it needs to build its investment in general practice, which remains the most cost effective part of the system.”

CHRIS JOHNSON

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.

GPs – more accessible than ever

BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

As a GP who is there for his patients, providing urgent appointments, aged care visits, home visits and palliative care, I am fed up with the claims being perpetuated by those pursuing their own agendas under the guise of improving access to health care. Time and time again, we hear that GPs are over-burdened and inaccessible. This is used to argue the case for expanded scopes of practice and healthcare models that fly in the face of medical evidence.

A quick search of online GP appointment booking systems quickly demonstrates the significant number of appointments available on any given today. While patients may not always be able to see the GP of their choice, the vast majority of practices provide patients with an option to see a GP.

The most recent Australian Bureau of Statistics Patient Experience Survey highlights that the proportion of patients who waited longer than they felt acceptable for a GP appointment has decreased, and has been decreasing in recent years, both in metropolitan and rural areas.

In my experience of general practice, practices always keep aside a number of appointments each day for acute cases. In addition, newer doctors to the practice will often have more appointments available as they build their patient lists. Cancelled appointments can be utilised by others who need them and we often squeeze in a patient between appointments.

All that is required is a little communication. Our patients should know that if they need to see us they only have to call to see if we can help them.

The story that it is too hard to see a GP is being perpetuated by other groups with their own agenda. Some use it to justify overhauling the health workforce while others use it to promote or improve their own business models. Most recently this argument has been propagated in an attempt aimed at circumventing the TGA’s recommended up-scheduling of codeine.

When it comes to pain management, the evidence is in. Low dose codeine is ineffective for the majority of people and it comes with significant health risks. Acute pain can be better treated with other combination analgesics which remain available over-the-counter (OTC).

Persistent pain should be a signal for patients to see their doctor, not a reason to escalate self-medication with a highly addictive drug. How many OTC purchasers of codeine products truly understand that, once metabolised, they are effectively using morphine. These ineffective medications not only carry the risk of addiction but the risk of harm by over use of their companion analgesics.

Frankly, I find the suggestion that GPs would be burdened by discussing with patients their pain and the best ways to treat or manage it, highly offensive. Reducing access to potentially harmful medications is good for patient care. A GP consultation for patients experiencing strong and persistent pain is the best pathway to a good health outcome.

GPs are busy, but we have seen a significant increase in GP numbers across the county. Access is much improved and our patients need to know that we are there for them, including on those occasions when they need more urgent care. Our politicians need to know this too.

As part of the AMA’s effort to spread this word, the Council of General Practice, at its recent meeting, agreed that the theme for next year’s Family Doctor Week will be ‘Your family doctor: here for you’. It is up to each of us to disseminate this message and to deliver on it.

Encouraging times for rural health

BY AMA VICE PRESIDENT DR TONY BARTONE

Readers of this column will know that improving access to health care for rural Australians is one of my chief motivating passions.

We know there are many indicators that show people living in the bush generally suffer worse health outcomes than those in major cities.

Regrettably, many of the initiatives put in place to increase training places in rural Australia and expand the local medical workforce have not improved these discrepancies, kept pace with the demand for rural medical services, nor resulted in a better distribution of suitably qualified doctors.

The challenge remains – we need to get doctors to rural communities, and give them the opportunity to experience rural and remote medicine and make it an attractive and valuable career option.

Some may feel achieving real change is a truly Sisyphean task.

But with the recent appointment of Professor Paul Worley as the nation’s new Rural Health Commissioner, there is perhaps some cause for optimism. Professor Worley has made a substantial contribution to rural health over many years; all of his experience will be needed for this welcome opportunity to build a strong health care workforce in regional, rural and remote Australia.

One of Professor Worley’s important tasks is to help the Government design and roll out a national rural generalist pathway. The pathway will try to address the lack of access to training for rural generalists with the ultimate aim of improving the supply of doctors to rural and regional communities.

Many people have been waiting for the announcement on the Rural Health Commissioner for a long time; we are not alone in believing that Australia’s medical workforce needs more generalists to meet the healthcare needs of rural (and metropolitan) communities as the demographics of the population shift and the numbers of patients with long-term chronic conditions and co-morbidities rises.

The AMA has been championing for a long time an improved and expanded advanced training pathway for rural generalists, with the proper resources to attract and train the appropriate number of doctors with the right skills mix necessary for rural practice.

The Queensland Rural Generalist Pathway is often put forward as the model for vocational training that could increase the numbers of doctors training and staying in rural locations, and able to deliver a broad range of hospital and community-based medical services, as well as the much-needed specialised services.

The Queensland model is a good starting point, and there is the potential to apply its principles to a national pathway that can be adapted to suit the geography and demographics of different regions.

Nonetheless, there are some contentious and vexing issues that will need to be addressed as the national rural generalist pathway is conceived and put into effect. For example, should there be quarantined procedural training places for rural generalist trainees? Should some thought be given to extending the training pathway beyond general practice as a strategy for ensuring a balanced rural workforce with the right skills mix?

Concerns around accreditation, training and recognition will need serious collaboration between the Colleges and health services.

Several AMA committees are considering the design principles for the national rural generalist pathway.

We look forward with great purpose to meeting with Professor Worley soon to discuss our ideas. Overall, the signs are positive for rural health.

How the decision was reached

The TGA’s announcement that all codeine products will be upscheduled from 1 February 2018, comes nearly two years after the TGA first began considering a proposal to shift all schedule 2 (over-the-counter) and 3 (pharmacist only) codeine preparations to prescription only (schedule 4 and S8).

The Advisory Committee on Medicines Scheduling (ACMS), an independent committee of experts, including several pharmacists, appointed by the Minister to advise the TGA on scheduling matters, invited public submissions on this proposal.

The AMA made a submission noting that it did not have the information to form a definitive view but raising a range of issues that should be considered.

The TGA delegate responsible for medicines scheduling decisions subsequently issued an “interim decision” supporting a recommendation by ACMS to remove codeine from schedules 2 and 3. The interim decision included a summary of all the information and issues considered by ACMS in making the recommendation.

A two-week consultation period was provided following the delegate’s interim decision, to allow any further comments to be made.

The AMA made another submission, this time supporting the decision on the basis that it was informed by advice from an independent, expert committee (ACMS), and based on best available evidence.

About 120 submissions were lodged in response to the interim decision. Of those opposing the upscheduling, more than 70 were from individuals opposing limits to codeine access (usually citing personal experience with migraine or musculoskeletalconditions); a handful from individual pharmacists; eight from pharmacy related organisations; five from consumer organisations. Those supporting included: the Society for Hospital Pharmacists; five medical related organisations; and seven individuals (again citing personal/close experiences such as harm and death resulting from over-the-counter codeine).

In addition, the Pharmacy Guild mounted a strong public campaign opposing the removal of non-prescription codeine from pharmacies.

Subsequently, in early 2016 the TGA announced that the delegate had deferred making a final decision … due to the large number of submissions.

The TGA then issued alternative proposals for public comment, which included options such as continuing to allow S2 and S3 codeine but in smaller pack sizes.

In 2016, the TGA commissioned KPMG to undertake a regulation impact analysis to quantify the impact of various scheduling options. Dr Richard Kidd, Chair of the AMA Council of General Practice, was interviewed by KPMG to provide a general practice perspective on the impact of any codeine scheduling changes. The report conclusively found that the social and economic benefits would outweigh the regulatory costs of upscheduling codeine.

The TGA subsequently announced its final decision to upschedule all codeine products to ‘prescription only’ in late 2016.

The AMA continues to advocate for the implementation of the Electronic Recording and Reporting of Controlled Drugs system in each State and Territory. This system would allow doctors and pharmacists to monitor in real time the prescribing and dispensing of a range of medicines with the potential for misuse and harm, not only Schedule 8 medicines.

However, the implementation of this system is unlikely for several more years. Victoria and WA are the only States so far to announce a timeframe for implementation – sometime in 2018.

Rural conference focuses on doctors’ health and training pathways

The peak national event for rural doctors is set to kick off next week in the distinctly unrural Melbourne, with a stellar line-up of presenters.

Among the speakers at Rural Medicine Australia 2017 are former Greens leader Dr Bob Brown; Dr David Gillespie, Assistant Minister for Health; and Shadow Minister for Health Catherine King.

The event will include a Presidents’ Breakfast forum facilitated by distinguished medical broadcaster Dr Norman Swan, with a panel including RAGCP President Dr Bastien Seidel and the AMA’s Vice President Dr Tony Bartone, along with Associate Professor Ruth Stewart, President of the Australian College of Rural and Remote Medicine (ACRRM).

Forum host Dr Ewen McPhee, President of the Rural Doctors Association of Australia (RDAA), says the forum will cover a range of issues, including the poor distribution of doctors between urban and rural areas, as well as political initiatives such as the implementation of a National Rural Generalist Pathway.

“Key government and opposition members will be in attendance at the breakfast and we’ll be having discussions around medicopolitical issues, but also the broader issues of Medicare and the Medicare rebate, as well as the codeine prescription issue,” Dr McPhee told Doctorportal.

Dr McPhee said some of the key themes of the conferences would be doctors’ mental health.

“This is an issue that’s really come to the forefront, particularly with the recent spate of suicides of young clinicians. We need to recognise the privations and difficulties that always challenge doctors when they go rural and we have to understand how to build resilience in our rural doctors.”

Dr McPhee said other subjects that will be discussed at the conference include the ins and outs of cannabis prescribing, and also the role of the rural doctor in sports medicine.

“We’re looking at the issues around the country doctor also being for example the local rugby GP, and what are the obligations, tips and tricks around how you look after sports people in a country town where you don’t have access to sports medicine specialists – issues like dealing with concussion, minor sporting injuries or maintaining fitness.”

Dr McPhee praised several government initiatives to improve access to care in rural, regional and remote communities.

“I think the government has done a lot. They’ve legislated for a Rural Health Commissioner; they’ve created 100 extra places for rural specialist training. They’ve developed the Junior Doctor Training Innovation fund and they’re in the process of allowing universities to develop rural training hubs to facilitate regional training of clinicians, be they specialists or generalists. There’s a lot happening in rural, but we still need to see greater investment in primary care. Funding for primary practice is at its lowest ebb – we need different models of funding and care that lead to sustainable clinicians, making sure they stay in the region and are supported in the long term.”

He said the medical training of Aboriginal and Torres Strait Islanders was another key issue in rural and remote medicine.

“Our goal is to have 1,000 Indigenous medical practitioners, and we’re sitting at around 200-300 at the moment. They absolutely need our support and we need to ensure First Nations people have the opportunities to get the training they need to become clinicians in their own communities. We’re still not doing enough and there’s no doubt it’s one of the issues we need to address.”

Rural Medicine Australia is the key annual rural medicine conference in Australia, and is jointly hosted by ACRRM and RDAA. You can access the program here.

Have a rural job vacancy? Doctorportal Jobs makes recruitment easy. Just select the Rural General Practitioner option when you post a job to reach the most qualified candidates. Or if you’re seeking a rural placement, sign up to post a private resume and let employers find you.

RACGP’s spectacular backflip on marriage equality

The Royal Australian College of General Practitioners (RACGP) executed a dramatic U-turn on marriage equality this week, which it now backs after initially claiming to be neutral on the issue.

Over the past few months, the number of medical colleges and associations officially coming out in support of marriage equality has grown to include the Australian Medical Association, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australian and New Zealand College of Psychiatrists and the Royal Australasian College of Physicians, to name a few.

And yet the RACGP remained curiously silent, until last Wednesday, when RACGP President Dr Bastien Seidel wrote that the college’s council “acknowledged that the organisation has a diverse membership” and that it believed that in regard to marriage equality, “members should consider the issues involved carefully for themselves.”

But the college’s carefully neutral position unleashed a storm of criticism on social media and elsewhere, with many GPs expressing deep disapproval of their college’s stance. Former AMA President Dr Kerryn Phelps expressed her “surprise” at the RACGP’s neutrality. The college, she said, “should be a thought leader. This is unequivocally a health issue so the RACGP should take a stand.”

After around 750 GPs signed a petition demanding that the college change its position, its council hastily convened an emergency meeting on Monday.

The outcome of that meeting was a new statement from Dr Seidel, in which he acknowledged that marriage equality “is a human rights issue”.

“When I became RACGP President a year ago, I clearly outlined that the RACGP could no longer afford to sit on the fence when it came to any issue that affected our members or our patients. I deeply regret that I did not meet my own standard,” Dr Seidel wrote.

He said that the RACGP acknowledged that discrimination, bullying and harassment of LGBTIQ people has a severe and damaging effect on their mental and physical health.

“As part of valuing diversity and inclusion, RACGP Council supports marriage equality,” he wrote.

He said the council acknowledged the right of all members to hold and express their own views on marriage equality. However, the council urged all members “to provide particular care and consideration to LGBTIQ groups during this trying period.”

The turnaround comes as the latest figures from the Australian Bureau of Statistics show around 60% of eligible Australians have already returned their marriage equality postal surveys, with the announcement of the results set for November 15th.

Emergency department use in developed countries

A global study undertaken by George Washington University has evaluated the use of emergency departments in seven developed countries and has identified areas where efficiencies are needed.

The study, conducted with Royal Philips researchers, found that Australia has a low use of emergency departments when compared to Canada, the US, the UK, the Netherlands, Switzerland and Germany.

This finding points to Australia’s strong access to primary care resulting in less frequent use of emergency resources.

The paper, Acute unscheduled care in seven developed nations: a cross-country comparison, compares the similarities and differences across nations with a focus on care delivery and the impact of socio-economic factors.

The research from Philips and the GWU School of Medicine and Health Sciences reveals unsustainable ED use in some developed nations.

Better access to primary care can result in lower ED use.

The findings of the report show Germany (22 per cent) and Australia (22 per cent) as having the lowest ED use, likely resulting from better and faster access to primary care — nearly two-thirds of Australians (58 per cent) and three-quarters of Germans (72 per cent) were able to make same or next day appointments with their primary care physicians (PCPs) compared to less than half of Americans (48 per cent) and Canadians (41 per cent).

“In looking at the way emergency departments are used around the world, we were able to obtain valuable new insights to help improve care delivery,” said Jesse Pines, from GWU.

“Because of research findings presented in this report, all emergency departments, no matter their location, have the opportunity to efficiently improve the way care is delivered in emergency department settings.”

Kevin Barrow, managing director of Philips Australia and New Zealand said the research shows Australia ranked relatively well when it comes to hospital emergency department admissions.

“And (for) the cost of health care for both government and individuals, in comparison to other countries surveyed, reflecting the relative ease of access to primary care in our country,” he said

“However, the findings also identified a need to improve departmental efficiencies and increase activities to minimise the burden on acute care facilities, by continuing to focus on preventive care, chronic disease management and the education of patients on the appropriate care for their health needs.”

Data has been formulated into a list of key areas researchers say impact the way care is delivered in emergency settings, and the broad differences in available treatments across countries.

They include:

• Social determinants (smoking, eating, violence, substance abuse and poverty) have a strong impact on the use of EDs;

• Reduced access to health insurance results in poorer population health; placing a greater strain on emergency departments;

• Sick patients do not make the most efficient decisions about when and where to seek medical care;

• Extensive provider training is mandatory for effective delivery of acute unscheduled care; and

• Quality measures for EDs are immature and not standardised.

“There’s a belief that easy access to primary care can result in lower emergency department use,” said Mark Feinberg of Philips North America.

“However, as a result of this report, it is clear that even if people have easy access to primary care and full healthcare coverage, there is no guarantee the patients will make economically prudent decisions to seek the most appropriate medical care setting.”

The complete report can be accessed at: www.healthsystems.philips.com/acute-unscheduled-care

CHRIS JOHNSON