AMA shines in Australia Day Honours

Former Australian Medical Association President Dr Mukesh Haikerwal has been awarded the highest honour in this year’s Australia Day awards by being named a Companion of the Order of Australia (AC).

He is accompanied by the current Editor-in-Chief of the Medical Journal of Australia, Laureate Professor Nick Talley, as well as longstanding member Professor Jeffrey Rosenfeld – who both also received the AC.

The trio top a long and impressive list of AMA members to receive Australia Day Honours this year.

AMA Federal Councillor, Associate Professor Julian Rait, received the Medal of the Order (OAM).

A host of other members honoured in the awards are listed below.

AMA President Dr Michael Gannon said the accolades were all well-deserved and made he made special mention of those receiving the highest Australia Day Honours.

“They have dedicated their lives and careers to helping others through their various roles as clinicians, researchers, teachers, authors, administrators, or government advisers – and importantly as leaders in their local communities,” Dr Gannon said.

“On behalf of the AMA, I pay tribute to all the doctors and other health professionals who were honoured today for their passion for their profession and their dedication to their patients and their communities.

“The great thing about the Honours is that they acknowledge achievement at the international, national, and local level, and they recognise excellence across all avenues of human endeavour.

“Doctors from many diverse backgrounds have been recognised and honoured again this year.

“There are pioneering surgeons and researchers, legends across many specialties, public health advocates, researchers, administrators, teachers, and GPs and family doctors who have devoted their lives to serving their local communities.

“The AMA congratulates all the doctors and other health advocates whose work has been acknowledged.

“We are, of course, especially proud of AMA members who are among the 75 people honoured in the medicine category.”

Dr Haikerwal, who was awarded the Officer in the Order of Australia (AO) in 2011, said this further honour was “truly mind-blowing” and another life-changing moment.

“To be honoured on Australia Day at the highest level in the Order of Australia is beyond imagination, beyond my wildest dreams and extremely humbling,” Dr Haikerwal said.

“For me to be in a position in my life and career to receive such an honour has only been made possible due to the unflinching support and unremitting encouragement of my closest circle, the people who have been with me through every step of endeavour, adversity, achievement, and success.”

CHRIS JOHNSON

AMA MEMBERS IN RECEIPT OF HONOURS

COMPANION (AC) IN THE GENERAL DIVISION

Dr Mukesh Chandra HAIKERWAL AO
Altona North Vic 3025
For eminent service to medical governance, administration, and technology, and to medicine, through leadership roles with a range of organisations, to education and the not-for-profit sector, and to the community of western Melbourne.

Professor Jeffrey Victor ROSENFELD AM
Caulfield North, Vic
For eminent service to medicine, particularly to the discipline of neurosurgery, as an academic and clinician, to medical research and professional organisations, and to the health and welfare of current and former defence force members.

Professor Nicholas Joseph TALLEY
Black Hill, NSW
For eminent service to medical research, and to education in the field of gastroenterology and epidemiology, as an academic, author and administrator at the national and international level, and to health and scientific associations.

OFFICER (AO) IN THE GENERAL DIVISION

Emeritus Professor David John AMES
East Kew, Vic
For distinguished service to psychiatry, particularly in the area of dementia and the mental health of older persons, as an academic, author and practitioner, and as an adviser to professional bodies.

Dr Peggy BROWN
Sanctuary Cove, Qld
For distinguished service to medical administration in the area of mental health through leadership roles at the state and national level, to the discipline of psychiatry, to education, and to health care standards.

Professor Creswell John EASTMAN AM
St Leonards, NSW
For distinguished service to medicine, particularly to the discipline of pathology, through leadership roles, to medical education, and as a contributor to international public health projects.

Professor Suzanne Marie GARLAND
Docklands, Vic
For distinguished service to medicine in the field of clinical microbiology, particularly to infectious diseases in reproductive and neonatal health as a physician, administrator, researcher and author, and to professional medical organisations.

Dr Paul John HEMMING
Queenscliff, Vic
For distinguished service to higher education administration, to medicine through contributions to a range of professional medical associations, and to the community of central Victoria, particularly as a general practitioner.

Professor Anthony David HOLMES
Melbourne, Vic
For distinguished service to medicine, particularly to reconstructive and craniofacial surgery, as a leader, clinician and educator, and to professional medical associations.

Dr Diana Elaine O’HALLORAN
Glenorie, NSW
For distinguished service to medicine in the field of general practice through policy development, health system reform and the establishment of new models of service and care.

MEMBER (AM) IN THE GENERAL DIVISION

Dr Michael Charles BELLEMORE
Croydon, NSW
For significant service to medicine in the field of paediatric orthopaedics as a surgeon, to medical education, and to professional medical societies.

Dr Colin Ross CHILVERS
Launceston, Tas
For significant service to medicine in the field of anaesthesia as a clinician, to medical education in Tasmania, and to professional societies.

Associate Professor Peter HAERTSCH OAM
Breakfast Point, NSW
For significant service to medicine in the field of plastic and reconstructive surgery as a clinician and administrator, and to medical education.

Professor Ian Godfrey HAMMOND
Subiaco, WA
For significant service to medicine in the field of gynaecological oncology as a clinician, to cancer support and palliative care, and to professional groups.

Dr Philip Haywood HOUSE
WA
For significant service to medicine as an ophthalmologist, to eye surgery foundations, and to the international community of Timor Leste.

Adjunct Professor John William KELLY
Vic
For significant service to medicine through the management and treatment of melanoma, as a clinician and administrator, and to education.

Dr Marcus Welby SKINNER
West Hobart, Tas
For significant service to medicine in the field of anaesthesiology and perioperative medicine as a clinician, and to professional societies.

Professor Mark Peter UMSTAD
South Yarra, Vic
For significant service to medicine in the field of obstetrics, particularly complex pregnancies, as a clinician, consultant and academic.

Professor Barbara S WORKMAN
East Hawthorn, Vic
For significant service to geriatric and rehabilitation medicine, as a clinician and academic, and to the provision of aged care services.

MEDAL (OAM) IN THE GENERAL DIVISION

Professor William Robert ADAM PSM
Vic
For service to medical education, particularly to rural health.

Dr Marjorie Winifred CROSS
Bungendore, NSW
For service to medicine, particularly to doctors in rural areas.

Associate Professor Mark Andrew DAVIES
Maroubra, NSW
For service to medicine, particularly to neurosurgery.

Dr David William GREEN
Coombabah, Qld
For service to emergency medicine, and to professional organisations.

Dr Barry Peter HICKEY
Ascot, Qld
For service to thoracic medicine.

Dr Fred Nickolas NASSER
Strathfield, NSW
For service to medicine in the field of cardiology, and to the community.

Dr Ralph Leslie PETERS
New Norfolk, Tas
For service to medicine, and to the community of the Derwent Valley.

Associate Professor Julian Lockhart RAIT
Camberwell, Vic
For service to ophthalmology, and to the development of overseas aid.

Mr James Mohan SAVUNDRA
South Perth, WA
For service to medicine in the fields of plastic and reconstructive surgery.

Dr Chin Huat TAN
Glendalough, WA
For service to the Chinese community of Western Australia.

Dr Karen Susan WAYNE
Toorak, Vic
For service to the community of Victoria through a range of organisations.

Dr Anthony Paul WELDON
Melbourne, Vic
For service to the community, and to paediatric medicine.

PUBLIC SERVICE MEDAL (PSM)

Dr Sharon KELLY
Yeronga, Qld
For outstanding public service to the health sector in Queensland.

Professor Maria CROTTY
Kent Town, SA
For outstanding public service in the rehabilitation sector in South Australia.

Christmas message from AMA President

It has been a very busy and very successful year for the Federal AMA. Your elected representatives and the hardworking staff in the Secretariat in Canberra have delivered significant achievements in policy, advocacy, political influence, professional standards, doctors’ health, media profile, and public relations.

We have worked tirelessly to ensure that health policy and bureaucratic processes are shaped to provide the best possible professional working environments for Australian doctors and the highest quality care for our patients.

Our priority at all times is to provide value for your membership of the AMA.

As 2017 draws to a close, I would like to provide you with a summary of the work we have undertaken on behalf of you, our valued members.

General Practice and Workplace Policy

Our strong advocacy led to a decision to lift the freeze on Medicare patient rebates.
AMA coordination of Doctors’ Health Services around the country, with funding support from the Medical Board of Australia.
Launched the AMA Safe Hours Audit Report, giving added focus to the issue of doctors’ health and wellbeing.
Maintained a strong focus on medical workforce and training places, with the National Medical Training Network significantly increasing its workforce modelling and projection work following sustained advocacy by the AMA.
Secured a number of concessions in the proposed redesign of the Practice Incentive Program (PIP), as well as a delay in the introduction of changes.
Lobbied at the highest level for a more durable solution to concerns over Pathology collection centre rents, focusing on effective compliance, and achieving a fair balance between the interests of GP members and pathologist members.
Led the Reforms to After-hours GP services provided through Medical Deputising Services (MDSs) to ensure that these services are better targeted and there is stronger communication between the MDS and a patient’s usual GP.
Successfully lobbied the ACCC to renew the AMA’s existing authorisation that permits GPs to engage in intra-practice price setting, potentially saving GPs thousands of dollars annually in legal and other compliance costs.
Ensured a proportionate response from the Government in response to concerns over the security of Medicare card numbers, avoiding more draconian proposals that would have added to the compliance burden on practices, and added a barrier to care for patients.

Medical Practice

Fundamentally altered the direction of the Medical Indemnity Insurance Review, discussing its importance to medical practice at the highest level, helping to ensure the review is not used as a blunt savings exercise, and saving doctors and their patients millions of dollars in increased premiums.
Led a nationally co-ordinated campaign with the State AMAs and other peak bodies to uphold the TGA’s decision to up-schedule Codeine.
Campaigned against an inadequate, poorly conceived, and ideological National Maternity Services Framework, which has now been scrapped.
Campaigned on the issue of Doctors’ Health and the need for COAG to change mandatory reporting laws, promoting the WA model.
Launched the AMA Public Hospital Report Card.
Pressed the case for vastly improved Private Health Insurance products through membership of the Private Health Ministerial Advisory Committee (PHMAC), my annual National Press Club Address, an appearance before a Senate Select Committee, and regular and ongoing media and advocacy.
Launched the AMA Private Health Insurance Report Card.
Successfully convinced the Government to address concerns with the MBS Skin items, and will continue to do so with the MBS Review more broadly.
Successfully lobbied for changes to the direction of the Anaesthesia Clinical Committee of the MBS Review.
Launched a new AMA Fees List with all the associated benefits of mobility and regular updates.
Saw a number of our Aged Care policy recommendations included in a number of Government reviews.
Lobbied against the ill-thought-out Revalidation proposal, which resulted in a vastly improved Professional Performance Framework based around enhanced continuing professional development.
Successfully held off the latest attempt to have a non-Medical Chair of the Medical Board of Australia appointed.

Public Health

Launched the AMA Indigenous Health Report Card, which this year focused on ear health, and specifically chronic otitis media, in conjunction with the Minister for Indigenous Health, The Hon Ken Wyatt AM.
Led the medical community by being the first to release a Position Statement on Marriage Equality, and advocated for the legislative change that eventuated in late 2017.
Released the updated AMA Position Statement on Obesity, following a policy session at the AMA National Conference, which brought together representatives from the medical profession, sports sector, food industry, and health economists.
Launched the AMA Position Statement on an Australian Centre for Disease Control (CDC), which was welcomed by experts in communicable diseases.
Released the AMA Position Statement on Female Genital Mutilation, which provided a platform for the AMA to engage in advocacy on preventing this practice.
Released the AMA Position Statement on Infant Feeding and Maternal Health.
Released the progressive and widely-supported AMA Position Statement on Harmful substance use, dependence, and behavioural addiction (Addiction).
Successfully lobbied against the proposal to drug test welfare recipients, including a strongly worded submission to a Parliamentary Inquiry on the proposal, which resulted in defeat of the proposed measure in the Parliament.
Released the AMA Position Statement on Firearms, generating considerable media coverage and interest, in Australia and overseas. Most importantly, it is a factor in Australia maintaining its tough approach to gun control.
Released the AMA Position Statement on Blood Borne Viruses (BBVs), which called for needle and syringe programs (NSPs) to be introduced in prisons and other custodial settings to reduce the spread of BBVs. This policy has been promoted by other health organisations and saw the AMA create strong ties within the sector.
Ongoing and prominent advocacy for the health and wellbeing of Asylum Seekers and Refugees, including a meeting with the Minister for Immigration and Border Protection, The Hon Peter Dutton MP, and lobbying on behalf of individual patients behind the scenes.
AMA lobbying of manufacturers saw a change to the sale of sugar-sweetened beverages in some remote Aboriginal communities, which will improve health outcomes.
Promoted the benefits of Immunisation to individuals and the broader community. Our advocacy has contributed to an increase in child and adult vaccination rates.
Provided strong advocacy on climate change and health.
Consistently advocated for better women’s health services.
Lobbied for the establishment of a No-Fault Compensation Scheme for people adversely affected by vaccines.

We promoted our carefully-constructed Position Statement on Euthanasia and Physician Assisted Suicide during consideration of legislation in Tasmania, Victoria, NSW, and WA.

I would like to thank Dr David Gillespie for his contribution to the Rural Health portfolio, and hope that his legacy will be seen in the success of the new Rural Health Commissioner, a position the AMA lobbied for and supports.

In the New Year, we will release new Position Statements on Mental Health, Road Safety, Nutrition, Organ Donation and Transplantation, and Rural Workforce.

As your President, I have had face-to-face meetings with Prime Minister Malcolm Turnbull, Opposition Leader Bill Shorten, Health Minister Greg Hunt, Shadow Health Minister Catherine King, Greens Leader Dr Richard Di Natale, and a host of Ministers and Shadow Ministers.

We also organised lunch briefings with backbenchers from all Parties to promote AMA policies.

In July, our advocacy was publicly recognised when the Governance Institute rated the AMA as the most ethical and successful lobby group in Australia.

I have met regularly with stakeholders across the health sector, including the Colleges, Associations, and Societies, other health professional groups, and consumer groups.

As your President, I have been active on the international stage, representing Australia’s doctors at meetings in Zambia, Britain, Japan, and the United States.

The highlight of the international calendar was the annual General Assembly of the World Medical Association. Outcomes from that meeting included high level discussions on End-of-life care, numerous ethical issues, Doctors’ health, and an editorial revision of the Declaration of Geneva.

But our focus remains at home, and your AMA has been very active in promoting our Mission: Leading Australia’s Doctors – Promoting Australia’s Health.

We have had great successes. We have earned and maintained the respect of our politicians, the bureaucracy, and the health sector. We have won the support of the public as we have fought for a better health system for all Australians.

We have worked hard to add even greater value to your AMA membership.

May I take this opportunity to wish you, your families, and loved ones a safe, happy, and joyous Christmas, and a relaxing and rewarding holiday season. I hope you all get some quality private and leisure time – you deserve it.

Dr Michael Gannon
Federal AMA President

Long-term investment for serious reform

The AMA has delivered its Pre-Budget Submission 2018-19 to the Government and released it publicly while calling for a new era of big picture health reform.

In releasing the submission, AMA President Dr Michael Gannon said the Government had a rare opportunity for initiate serious health reform, due the culmination of a number of key health policy reviews.

But, he said, any reform will need significant long-term investment.

“The conditions are ripe for a new round of significant and meaningful health reform, underpinned by secure, stable, and sufficient long-term funding to ensure the best possible health outcomes for the Australian population,” Dr Gannon said.

“The next Budget provides the Government with the perfect opportunity to reveal its health reform vision, and articulate clearly how it will be funded.

“We have seen years of major reviews of some of the pillars of our world class health system.

“The review of the Medicare Benefits Schedule (MBS) is an ambitious project.

“Its methods and outcomes are becoming clearer. Its best chance of success is if the changes are evidence-based and clinician-led and approved.

“A new direction for private health insurance (PHI) has been determined following the PHI Review.

“We must maintain flexibility and put patients at the centre of the system, but recognise the fundamental importance of the private system to universal health care.

“The Medicare freeze will be lifted gradually over the next few years.”

Dr Gannon said the Government needed to now look at all health policies as investments in a healthier and more productive population.

He said there was now a greater focus on the core health issues that will form the health policy battleground at the next election.

“There is no doubt, as shown at the last Federal election, that health policy is a guaranteed vote winner – or vote loser,” Dr Gannon said.

“Our submission sets out a range of policies and recommendations that are practical, achievable, and affordable.

“They will make a difference. We urge the Government to adopt them in the Budget process.

“Health should never be considered an expensive line item in the Budget.

“It is an investment in the welfare, wellbeing, and productivity of the Australian people.

“Health is the best investment that governments can make.”

The AMA Pre-Budget Submission 2018-19 covers:

General Practice and Primary Care;
Public Hospitals;
Private Health Insurance;
Medicare Benefits Schedule (MBS) Review;
Preventive Health;
Diagnostic Imaging;
Pathology;
Mental Health and the NDIS;
Medical Care for Older Australians;
My Health Record;
Rural Health;
Indigenous Health;
Medical Workforce;
Climate Change and Health; and
Veterans’ Health.

The submission can be found at ama-pre-budget-submission

It was lodged with Treasury ahead of the Friday, 15 December 2017 deadline.

CHRIS JOHNSON

SIDS and serotonin link confirmed

A new Australian study has confirmed abnormalities in serotonin, a common brain chemical, are linked to sudden infant death syndrome (SIDS).

SIDS is the leading cause of infant death (between the ages of one month and one year) in Australia and most of the developed world.

University of Adelaide’s Medical School conducted the Australian first study, investigating 41 cases of SIDS deaths, and found there were striking abnormalities in chemical serotonin within the brain. The study has been published in the Journal of Neuropathology & Experimental Neurology.

Dr Fiona Bright, the primary researcher, said the study was significant because it confirmed abnormalities in serotonin in the brain are most definitely linked to cases of SIDS.

“Our research suggests that alterations in these neurochemicals may contribute to brainstem dysfunction during a critical postnatal developmental period,” she said.

“As a result, this could lead to an inability of a SIDS infant to appropriately respond to life-threatening events, such as lack of oxygen supply during sleep.”

Her work builds on research conducted in the United States at the Boston Children’s Hospital and Harvard Medical School, where Dr Bright was based for 18 months during her combined studies.

The Sudden Infant Death Research Foundation Inc., now known as Red Nose, estimates that annually, 3,200 Australian families experience the sudden and unexpected death of a baby or child. They have been quick to welcome the results of a University of Adelaide study.

Risk reduction still remains the key preventer of SIDs. This includes evidence-based safe sleeping public health program. Since risk reduction campaigns began in 1989, the rate of SIDS in Australia has decreased by 80 per cent. Red Nose believes that an estimated 9,450 lives have been saved.

Dr Bright’s research also reinforces that risk factors are central to managing SIDS.

“Notably, the SIDS cases we studied were all linked to at least one major risk factor for SIDS, with more than half of the infants found in an adverse sleeping position and having had an illness one month prior to death,” Dr Bright says.

“Ultimately, we hope that this work will lead to improved prevention strategies, helping to save baby’s lives and the emotional trauma experienced by many families.”

For information on how to sleep baby safely to reduce the risk of sudden unexpected death in infancy, including SIDS and fatal sleeping accidents, visit https://rednose.com.au/section/safe-sleeping.

MEREDITH HORNE

Press Club address covers wide range of topics

AMA President Dr Michael Gannon’s Address to the National Press Club of Australia was both well delivered and well received – covering a wide range of topics of importance to health practitioners and their patients.

It was the second time Dr Gannon had addressed the Press Club, a Canberra-based national institution and forum for policy debate, and will likely be the last as President of the AMA.

During the nationally televised event on August 23, Dr Gannon laid out the AMA’s priorities for the future and highlighted its recent achievements in influencing policy outcomes.

He also fielded a range of questions from the Canberra Press Gallery.

Titled Beyond the Freeze – Time for Heavy Lifting in Heath, Dr Gannon noted there had been numerous changes in the realm of health policy since he last spoke at the Press Club 12 months ago.

“There is no more talk of co-payments,” he said.

“The cuts to pathology and diagnostic imaging bulk billing incentives have been reversed.

“The general practice pathology rents issue has, for the most part, been resolved.

“The Medicare freeze has a ‘use by date’. It can’t come soon enough.”

Dr Gannon said while the AMA wanted an immediate end to the freeze right across the Medicare Benefits Schedule, it didn’t quite get it.

The hour-long address, which involved both a speech and a question and answer session, was moderated by National Press Club President Chris Uhlmann.

Mr Uhlmann at the time was also the ABC News Political Editor, but has since resigned to join the Nine Network as Laurie Oakes’s replacement as Political Editor.

Not one to be passive while in the moderator’s chair, Mr Uhlmann joined in with his Press Gallery colleagues to grill Dr Gannon on a few policy areas.

One insightful exchange was over the emotive issue of euthanasia and the role doctors have in end-of-life care.

“Could you speak just a little bit more on the principle of double effect?” Mr Uhlmann asked.

“I don’t think that most people actually understand that it’s available and actually exists in Catholic canon law, that if someone dies as effect of their pain management being turned up to a point where that’s the secondary effect, that’s something you can even request in a Catholic hospital.”

Dr Gannon’s response was both revealing and informative.

“One of the things you have to be very careful doing when you’re talking on ethical matters is to invoke Catholic canon law, because there are some people who would have great concerns about that,” he said.

“But, Chris, who I know is a scholar in this area, will be able to tell you that this all goes back to St Thomas Aquinas. This is well established in Catholic ethics. And it’s a well-established ethical principle which is very much secular as well.

“But in very simple terms it means that if your primary intention is to relieve suffering, and by secondary effect it has the effect of hastening someone’s life, that is ethically, completely distinct from the intention of ending someone’s life.

“So, if we look at proposed assisted dying laws, the intention is to end the patient’s life. If you look at palliative care, the intention is to relieve pain and suffering. The intention is important.

“I can promise you that palliative care physicians, the nurses who work with them, the teams they work in, they’re a great example of multidisciplinary care for all of us, but they work very carefully and compassionately to provide a level of care which is seven levels above the morphine drip that you’ve all heard of.”

CHRIS JOHNSON

AMA letting legislators know its views on pharmacy review

Below is an edited version of the AMA’s submission to the Pharmacy Remuneration and Regulation Review Interim Report.

Overall, the AMA considers the recommendations, if implemented, will benefit consumers by improving access to affordable medicines and enhancing the quality of medicines related care provided by pharmacists.

The AMA’s submission focuses on the recommendations and options described in the interim report which impact patient care.

The recommendations and options relating to patient access to medicines and their experiences within pharmacies appear sensible and well considered.

In particular, the AMA supports:

improvements to the PBS Safety Net which would enhance patients’ understanding and access, for example, the introduction of a central electronic system that automatically tracks individual patient PBS expenditure;
audits of pharmacy compliance with medicines dispensing requirements, such as correct medicines labelling and the provision of Consumer Medicines Information leaflets, in line with State/Territory legislation and Pharmacy Board of Australia and Pharmaceutical Society of Australia guidelines; and
improvements to electronic prescription systems and medication records to enhance continuity of care and reduce medication errors. However, the AMA notes that prescribing software would require updating to enable full electronic prescribing and that a small, but still significant, proportion of medical practitioners do not use these systems, especially in rural/remote locations with poor internet connections.

The AMA supports the Review recommendation that homeopathic products should not be sold in PBS-approved pharmacies. Selling these products in pharmacies encourages consumers to believe they are efficacious when they are not.

The AMA notes the interim report proposal that if pharmacists provide a service that is also offered by alternative primary healthcare professionals, the same Government payment should be applied to that service. While a service may superficially appear the same, it is important to recognise that the delivery, quality and comprehensiveness of that service may differ between health professionals and the context within which it is provided.

For example, a patient administered a flu vaccine in a pharmacy just receives a flu vaccine. A patient receiving a flu vaccine administered by a General Practitioner also receives a preceding consultation which includes a health assessment specific to that patient, based on a sound understanding of the patient’s past history and health needs.

This might include a check whether the patient’s other recommended vaccinations are up-to-date, whether a cervical screening test is due, a blood pressure check if appropriate, a check of the patient’s adherence and tolerance of any prescription medicines, and any other appropriate and (evidence-based) opportunistic preventative health care.

Even if the General Practice employs nurse practitioners to deliver the vaccine itself, a patient has first been assessed by a General Practitioner who continues to be close at hand if needed.

If the Commonwealth Government were to consider paying pharmacists to administer flu vaccines to high risk populations, the services provided by a pharmacist and a medical practitioner in this context would not be equivalent.

Clearly there would also need to be research on whether flu vaccinations in pharmacies are cost-effective in comparison to a flu vaccination in a General Practice clinic given the value-add provided in the latter service.

Any cost-benefit analysis would also need to take into account the indirect costs of delayed or missed diagnoses leading to higher cost care, that are more likely when care is fragmented by patients relying on health care provided by a pharmacist.

The AMA agrees with the recommendations in the interim report that government-funded services should be evidence-based and cost-effective. Pharmacy-based services that do not meet these criteria, such as the Amcal’s Pathology Health Screening Service targeting “relatively young and fit customers … for general health purposes … as opposed to risk assessment or diagnosis” should not be eligible for government funding.

The AMA’s earlier submission to this review expanded in some detail regarding the push by the Pharmacy Guild, motivated by revenue generation, to expand the scope of practice of pharmacists into the provision of medical services.

The AMA has already stated its views on the barriers imposed by current pharmacy location rules in its previous submission to the Review, and in numerous earlier submissions to Government. The AMA supports changes to pharmacy regulation which would allow more pharmacies and medical practices to be co-located. The current restrictions are inflexible and are difficult to justify in terms of public benefit.

AMA understands that the Australian Government has entered into an agreement with the Pharmacy Guild of Australia to continue indefinitely the current protections the rules provide to Guild members. However, the AMA is disappointed that the Government has made this decision despite the obvious benefits that would accrue by allowing access to high quality primary health care services in a way that is convenient to patients, enhances patient access and improves collaboration between healthcare professionals.

Facilitating collaboration between medical practitioners and pharmacists will only improve patient outcomes through less medication mismanagement and better medication compliance.

The AMA agrees there are benefits in future community pharmacy agreements being limited to remuneration for the dispensing of PBS medicines and associated regulation. This would allow pharmacy programs, such as medication adherence and management services currently funded under the Agreement, to be funded in ways that are more consistent with how other primary care health services are funded.

Given these programs are about providing health services, rather than medicines dispensing per se, it makes sense for them to be assessed, monitored, evaluated and audited in a similar way to medical services under the MBS.

Approximately $1.2 billion has been provided to pharmacies under the current community pharmacy agreement without this level of transparency and accountability. No evaluations of pharmacy programs under the Sixth Community Pharmacy Agreement have been made public.

Moving pharmacist health services outside of the Agreement would also open the way for more flexible models of funding, for example, support for pharmacists working within a General Practice team and other innovative, patient-focused models of care.

The AMA would also welcome inclusion in future consultations undertaken prior to the finalisation of the next community pharmacy agreement, as proposed in the Review interim report. The AMA recognises the valuable contribution pharmacists make in improving the quality use of medicines.

Pharmacists working with doctors and patients can help ensure medication adherence, improve medication management, and provide education about medication safety. The AMA fully supports ongoing and adequate funding of evidence-based pharmacist services such as home medicine reviews and the provision of dose administration aids.

It is important that Government-funded pharmacy programs are monitored and evaluated for effectiveness and cost effectiveness to ensure the expenditure provides tax payers with value for money. The findings from these evaluations will help improve and strengthen the programs.

The AMA fully supports the recommendations made to enhance access to medicines programs for Indigenous Australians and to support Aboriginal Health Service pharmacy ownership and operations.

The full submission can be found at:

system/tdf/documents/AMA%20Submission%20-%20Interim%20report%20-%20Pharmacy%20remuneration%20and%20regulation%20review%20Jul17.pdf?file=1&type=node&id=46835

[Correspondence] Can post-mortem CT and angiography provide all the answers?

We commend Guy Rutty and colleagues on their Article (July 8, p 145)1 recommending the use of post-mortem imaging at autopsy. A fundamental role of the pathologist is to assist the coroner in fulfilling their statutory duty in establishing the cause and circumstances of death. How precise that cause of death needs to be depends on the requirements of the relevant legislation. To what extent pathology and radiology can satisfactorily provide the information to inform this advice depends on the circumstances of the case and, most importantly, on the questions being asked by interested parties, including families.

AMA’s successful stand for sensible and safe pathology testing

BY PROFESSOR ROBYN LANGHAM, CHAIR, MEDICAL PRACTICE COMMITTEE

One could be forgiven for thinking that he AMA thinks little of pharmacists, given the nature of the media reports around the recent successful AMA campaign to stop Amcal pharmacies ordering unnecessary pathology screening tests.

The truth is quite the opposite. The AMA greatly respects the valuable contribution pharmacists make in improving the quality use of medicines. Pharmacists working with doctors and patients can help ensure better medication adherence, improved medication management, and also help in providing education about medication safety.

The AMA agrees that pharmacists’ expertise and training are under-utilised in a commercial pharmacy environment where they are necessarily distracted by retail imperatives.

That is why the AMA is fully engaged in the current review of pharmacy remuneration and regulation being undertaken by an independent panel appointed by the Federal Government.

In a comprehensive submission to the panel lodged last year, the AMA was supportive of alternate models of funding being explored that would encourage and reward a focus on professional, evidence-based interactions with patients. Our submission also supported ongoing funding of effective and cost-effective pharmacist medication management programs, particularly those targeting Aboriginal and Torres Strait Islanders, and a relaxation of the restrictive pharmacy location rules.

The panel has now released an interim report revealing its likely recommendations to Government on the future of pharmacy funding and regulation.

The proposed recommendations pick up on many of the AMA’s suggestions and concerns, and, if implemented, would radically improve the transparency of pharmacy funding and refocus government investment on evidence-based and cost effective services.

Unsurprisingly, the Pharmacy Guild of Australia is highly critical of the report, slamming it as “without merit”, “ill-considered”, “threatening” and “undermining” as well as stating it has “serious concerns about the true intention of the review”.

Some of the key recommendations supported by the AMA include:

banning the sale of homeopathic products from pharmacies altogether;

physically separating other complementary medicines from “pharmacy only” (schedule 2) and ‘pharmacist only’ (schedule 3) in pharmacies to better help consumers understand that these medicines have not been assessed for effectiveness in the same way as S2, S3 and prescription medicines;

moving the funding of pharmacist services programs from the Guild-controlled Community Pharmacy Agreement to other government funding streams to improve transparency and facilitate coordination with other primary health care programs;

removing current bureaucratic barriers to medicines programs and pharmacy services that hinder access to indigenous Australians; and

changing the pharmacy location rules with potential to improve options for pharmacy co-location with general practices.

The AMA is very supportive of the interim report and lodged a favourable submission in response in July.

Unfortunately, the Guild has already brokered a deal with the Coalition Government to shelve any changes to location rules in the foreseeable future. It will be interesting to see what appetite the Government has for taking up the panel’s final recommendations, particularly given the next Federal election date is not so far away.

Relationships with industry

BY DR CHRIS MOY, CHAIR. AMA ETHICS AND MEDICO LEGAL COMMITTEE

A major priority for the AMA’s Ethics and Medico-Legal Committee (EMLC) will be the review of the Position Statement on Medical Practitioners’ Relationships with Industry 2012. The statement provides guidance for doctors on maintaining ethical relationships with “industry”, including the pharmaceutical industry, medical device and technology industry, other health care product suppliers, health care facilities, medical services such as pathology and radiology, and other health services such as pharmacy and physiotherapy.

The current Statement encompasses the following sections:

medical education;
managing real and potential conflicts of interest;
industry sponsored research involving human participants including post-marketing surveillance studies;
meetings and activities organised independent of industry;
meetings and activities organised by industry;
hospitality and entertainment;
use of professional status to promote industry interests;
remuneration for services;
product samples;
dispensing and related issues; and
relationships involving industry representatives.

Doctors’ primary duty is to look after the best interests of their patients. To do so, doctors must maintain their professional autonomy, clinical independence and integrity, and have the freedom to exercise professional judgement in the care and treatment of patients without undue influence by third parties (such as the pharmaceutical industry or governments).

But what happens when the impetus to change the relationship with industry comes from within the profession itself? For example, the AMA’s current policy on doctors and dispensing states that:

11.1 Practising doctors who also have a financial interest in dispensing and selling pharmaceuticals or who offer their patients’ health-care related or other products are in a prima facie position of conflict of interest.

11.2 Doctors should not dispense pharmaceuticals or other therapeutic products unless there is no reasonable alternative. Where dispensing does occur, it should be undertaken with care and consideration of the patient’s circumstances.

In recent years, we have heard from members who believe this position is too strict and doctors should be able to dispense pharmaceutical products, arguing that it’s more convenient for patients and leads to better compliance. For example, patients may be more likely to fill their prescriptions onsite at the doctor’s office than if they have to go offsite to a pharmacy. In addition, the doctor is there to answer any questions relevant to the prescription which will reduce pharmacy call backs and waiting times.

Historically, the AMA has strongly advocated that doctors do not make money from prescriptions. Allowing doctors to dispense pharmaceuticals or other therapeutic products (other than in exceptional circumstances) would be a fundamental shift in this position – but is that a sufficient reason not to change it?

After all, dispensing pharmaceuticals or other therapeutic products is not in itself unethical so long as it is undertaken in accordance with good medical practice. Unfortunately, however, there can still be a strong perception of a conflict of interest, particularly if doctors are making a profit rather than just recovering costs. So for many doctors – but more importantly our patients and the wider community who are our ultimate judges – this is a line which should not be crossed.

These are the types of issues the EMLC will consider in reviewing this policy and we will endeavour to seek members’ views during the process.

The EMLC will also be developing an overarching policy on managing interests, highlighting the potential for professional and personal interests to intersect, and at times compete, during the course of a doctor’s career. While a real, or perceived, conflict of interest is by no means a moral failing, it is important that doctors are able resolve any potential for conflict in the best interests of patients.

The Position Statement on Medical Practitioners’ Relationships with Industry 2012 is accessible on the AMA’s website at position-statement/medical-practitioners-relationship…. If you would like to suggest any amendments to the current Statement, please forward them to ethics@ama.com.au.

AMA a key player in federal politics

AMA President Dr Michael Gannon opened the 2017 National Conference letting delegates know that while the past 12 months had been eventful, much had been achieved in the realm of health policy.

He continued with that theme throughout the three-day event in Melbourne, which brought together not only the elite of the medical profession but also the highest level of Australian political leaders.

“The AMA is a key player in federal politics in Canberra. The range of issues we deal with every day is extensive,” Dr Gannon said.

“Our engagement with the Government, the bureaucracy, and with other health groups is constant and at the highest levels.

“Our policy work is across the health spectrum, and is highly regarded.

“The AMA’s political influence is significant.”

Describing the political environment over the past year as volatile – which included a federal election and two Health Ministers to deal with – Dr Gannon said the AMA had spent the year negotiating openly and positively with all sides of politics.

“Our standing is evidenced by the attendance at this conference of Prime Minister Malcolm Turnbull, Opposition Leader Bill Shorten, Greens Leader Senator Richard Di Natale, Health Minister Greg Hunt, Minister for Aged Care and Minister for Indigenous Health Ken Wyatt AM, and Shadow Health Minister Catherine King,” he said.

“Health policy has been a priority for all of them, as it has been for the AMA.”

While the Medicare rebate freeze was the issue to have dominated medical politics, there are still more policy areas to deal with in the coming year.

The freeze was bad policy that hurt doctors and patients.

“I was pleased just weeks ago on Budget night to welcome the Government’s decision to end the freeze,” Dr Gannon told the conference.

“The freeze will be wound back over three years. We would have preferred an immediate across the board lifting of the freeze, but at least now practices can plan ahead with confidence.

“Lifting the freeze has effectively allowed the Government to rid itself of the legacy of the disastrous 2014 Health Budget.

“We can now move on with our other priorities… We will maintain our role of speaking out on any matter that needs to be addressed in health.”

Dr Gannon said while the Medicare freeze hit general practice hard, it was not the only factor making things tough for hardworking GPs.

General practice is under constant pressure, he said, yet it continues to deliver great outcomes for patients.

GPs are delivering high quality care and are the most cost effective part of the health system.

“One of the most divisive issues that the AMA has had to resolve in the past 12 months is the Government’s ill-considered election deal with Pathology Australia to try and cap rents paid for co-located pathology collection centres,” Dr Gannon said.

“We all know that our pathologist members play a critical role in helping us to make the right decisions about our patients’ care. They are essential to what we do every day.

“It was disappointing to see the Government’s deal pit pathologists against GPs.

“The recent Budget saw the rents deal dumped in favour of a more robust compliance framework, based on existing laws. This is a more balanced approach.”

Other issues the President highlighted as areas the AMA is having significant influence included: Health Care Home Trial; the Practice Incentive Program; My Health Record; Indigenous Health; After-Hours GP Services; the MBS Review; public hospitals; private insurance; and the medical workforce.

Chris Johnson