Topics October 2016
Chairman's Report 2016
CQ Rural Health is an incorporated association, members include General Practitioners, general practice staff and allied health professionals from across the Central Queensland region. The organisation’s vision ‘Excellence and Sustainability in Rural Health’ drives the organisation’s key activities.
Dr Michael Belonogoff – Chair
Dr Ewen McPhee
Dr Richard Tan
Dr Mary Dunne
The 2015/16 year has seen the full establishment of Primary Health Networks to replace the Medicare Local’s across the region. The new organisations continue to establish their own identities. Politically there has been pressure on general practice and the health dollar has seen further reviews.
CQRH has maintained its financial position, with funds raised through the donations made to support the health promoting objectives of the organisation. These funds are limited and we will need to consider our finances as we go forward with the organisation which has been a key consideration during a strategic review.
Membership support has remained strong and there has been a small increase in numbers. Again, the membership is a changing dynamic and membership structure and board composition will be a key consideration for the organisation in the coming year.
Management Committee Highlights
CQ Rural Health Education Weekend – March 2016
Over 100 delegates benefited from the Central Queensland Rural Health Education weekend. Presentations across the health educated health professionals including GP’s, practice nurses and a range of allied Health Professionals.
Twenty-four presenters covered a range of topics including;
- Business development in Allied Health
- Practical Simulations
- Emergency Scenarios
- Specialist’s Updates
- Practice Support tools in General Practice
The conference dinner was a weekend highlight and a contingent of Japanese medical students and rural generalist advocate Manabu Siato and local rural generalist champion, Dr Ali Kirby entertained the crowd. Special guests, Honourable Ken O’Dowd Federal Member for Flynn and Honourable Lachlan Millar, State Member for Gregory enjoyed the conference dinner and networking opportunity that it provided.
The weekend attracted excellent support from Sponsors and trade displays. The trade displays added immense value to the event and provided an opportunity for networking across the primary health sector.
CQ Rural health has continued to provide CPD events which have included;
- Rural Health Weekend
- NDIS Presentation
- Dr Stephen Moore
- Dr John Roy
- Dr Tommy Tran
- Dr Gerard Connors
- Burnett Education Day
Other CPD events have been delivered in Central Queensland by other providers, however CQ Rural Health has played an active role in advertising and facilitating the opportunities for CQ Rural Health members and rural health professionals to attend.
The CQ Rural Health Board has commenced a strategic review of the organisation in an endeavour to maximise benefits for members, clear strategic direction for management and ensure that the entity structures are the best fit for the organisations. The membership structure for CQ Rural Health will also be reviewed due to the changing nature of the medical and health professional workforce. This will require a constitution review to formalise any changes.
CQ Rural Health offered two scholarships to the value of $1500 each this year to students studying at Central Queensland universities. The two students, a paramedic and a podiatry student were the recipients and they look forward to using their skills in a rural setting.
Student accommodation in Emerald continues to provide future medical staff with the opportunity to have a rural experience.
Allied Health Project
The Integrated Allied Health Services in Rural Communities project has been established in the Banana Shire. This project will result in coordinated allied health planning, providing integrated service provision, shared infrastructure and the development of tele-health in allied health. CQ Rural Health are well positioned to deliver this project and have already looked at opportunities to replicate it in the Central Highlands.
CQ Rural Health have fostered key strategic partnerships with a number of organisations. These include, but are not limited to the following organisations;
- Central Queensland, Wide Bay and Sunshine Coast PHN
- Central Queensland Hospital and Health Service
- Centacare CQ
- Central Highlands Regional Resources Use Planning Cooperative
- Anglicare CQ
- Banana Shire Council
- Rural Doctors Association of QLD
- Health Workforce QLD
- Rural Medical Schools – Central Queensland University, University of Queensland and James Cook University.
- Royal Australian College of General Practice
- Australian College of Rural and Remote Medicine
Rural Health Management Services
Rural Health Management Services (RHMS) is a Company Limited by Shares and CQ Rural Health is the only shareholder. The RHMS Company is a business that provides an alternative option, which allow practices to remain open and continue to provide services to the community when the more traditional practice management options are not available. RHMS practice management is not in competition with traditional general practice models but is about ensuring equitable access to general practice for rural people. The RHMS model supports the vision of CQ Rural Health, which is ‘Excellence and Sustainability in Rural Health’.
Current communities’ receiving direct support via RHMS are;
- Mt Morgan
Throughout the year, the communities of Gayndah and Nebo were supported by RHMS.
The 2015/16 financial year has proven a financially challenging one for RHMS. The board have recognised the following key risks;
- Recruitment and retention of quality medical workforce
- Formal service agreements with relevant Hospital and Health services
- Locum workforce and provider numbers
Consequently, negotiations with the Hospital and Health services have commenced. The RHMS board and management are committed to providing rural general practice services in a sustainable manner with the support of the hospital health services.
I would like to take this opportunity to thank the board for their commitment to the vision of CQ Rural Health and for providing their knowledge to guide the organisation over the last twelve months.
I would also like to thank CEO Sandra Corfield for her contribution to the organisation as well as all of the staff of CQ Rural Health and Rural Health Management Services.
To conclude, an organisation is only as strong as the membership that it represents. I would like to thank the members for their continued commitment and involvement which allows CQ Rural Health to support and enhance equitable access to quality health services in rural QLD.
I encourage you to become actively involved in guiding the future direction of the organisation, and one way to achieve this is taking on a board position. If you would like to more information on this opportunity, contact Sandra Corfield or myself.
Dr Mike Belonogoff
Is it October already? As someone reminded me this morning there are only 71 days until Christmas, a thought which evokes an odd sense of dread and a slight panic. The year has gone too quickly but so far it has been a good one, so that’s okay.
Our little Biloela Office has seen a lot of changes lately. We have been able to welcome three new staff members! Ellen Agius, Donna Johnson and Anne Marshall have all started in the last few weeks. Ellen and Donna will be working together on an exciting new Project (don’t worry, I’ll get to telling you all about that in a few short pages) and Anne has come in to replace me in most of my duties and to take care of the newly revamped Website. (I haven’t quite resigned but have reduced my hours.) We have also been able to welcome Shannon MacElroy into a new role as Practice Support for Biggenden, Eidsvold and Monto. She was previously the Practice Manager in Monto.
Making room for all these extra bodies in our rather small office space was quite a task, but not to fear Penny is here. With guidance from Penny, and her natural gift for motivating the reluctant, we performed the biggest Spring Clean I have ever witnessed. No bit of clutter or neglected filing was safe, desks were moved and people were shuffled until there was room for everyone.
Cardiology Update – HeartCare Partners
Earlier this month a group of 20 health professionals benefited from a presentation given by cardiologists Dr Karen Phillips and Dr Gerard Connors from HeartCare Partners.
Four medical students from the University of Queensland, currently in their third year, attended as well. CQ Rural Health was able to support them by sponsoring their attendance and assisting with their accommodation at Egan St House.
The event was a great success with positive feedback from participants.
North Burnett Education Day
On Saturday the 8th of October the North Burnett Education Day was held at the Billabong Motor Inn in Mundubbera. The workshop was organised in conjunction with the Central Queensland, Wide Bay and Sunshine Coast PHN. It featured 6 different speakers who gave talks on a variety of topics including Immunisation data Management, Wound Care and Shared Antenatal Care.
There was a group of 20 health professionals, including GPs, practice staff, nurses, allied health and med students, in attendance. The feedback was very positive with attendees saying;
“Great opportunity to network”
“The catering and venue was excellent”
“Very informative, very good speakers”
We look forward to working with the PHN again in the future.
Annual General Meeting
The AGM took place on October 12th via teleconference. Dr Michael Belonogoff, Dr Mary Dunne, Dr Richard Tan and Louisa Backus were all re-elected as directors, with Dr Belonogoff remaining as Chair. Dr Charles Mutandwa and Dr Ewen McPhee did not stand for re-election this year. We are sad to see these two men leave our board and we wish them luck in their future endeavours. We also wish John Evans and Dr Ross Woodward well as they resigned from the board in the last twelve months.
Board vacancies may be filled in the next twelve months. Interested CQRH members should contact any of the board members, Sandra Corfield (firstname.lastname@example.org) or Emma McCullagh (email@example.com).
The Integrated Allied Health Services in Rural Communities Project (not a very easy name but fairly descriptive) is in its early stages. It hasn’t even been officially announced yet.
Despite this, Ellen and Donna have been busy getting things moving. Right now its all about gathering information and support, setting up the various groups an getting everything ready so that as soon as it is announced we can spring into action.
This Project really started with the Banana Shire Allied Health Forum. This was an event where community members, funders and allied health professionals all came together and started talking about the issues affecting access to allied health services and the steps that might be taken. It has been really good to see how community members can effect change in this way and I am excited to see what happens with this project over the next couple of years.
The Project Information Sheet on the bottom of this page gives some more detail.
(very) Casual Administration Officer
Project Information Sheet
We don’t deliver: GPs avoid home visits unless taught
If you graduated as a GP Fellow within the past five years and perform medical consultations outside your surgery, you are in the minority.
Fewer than half of recently graduated GPs do any home visits and only 40% set foot in a nursing home, according to the latest Australian survey. And those whose GP training experience did not involve home or nursing home visits are far less likely to venture outside their doors.
Researchers from Newcastle, publishing in Family Practice, surveyed 270 Australian doctors in their first five years post GP fellowship. Most striking was the impact of mentorship as a GP registrar.
Nearly all (95%) of the respondents who currently do home visits were taught to do these as part of their GP training, and those who visited nursing homes as a registrar were ten times more likely to continue doing this as an independent GP.
Dr Simon Morgan, one of the study authors, told me, “If you can get GP Registrars comfortable seeing patients in their homes and nursing homes, they are far more likely to undertake this work as established GPs.”
Medicare data indicates the rate of home visits halved between 1997 and 2007. Older Australians and patients receiving palliative care are particularly vulnerable to the trend away from visits.
Other factors strongly associated with these newly-minted GPs providing home visits included; training as a medical student in Australia (three times as likely as overseas-trained); working full-time (five times as likely as part-timers); and current involvement in teaching or supervising (four times as likely as non-teachers—reflecting the ‘full circle’ of leading by example).
Although it has been noted elsewhere that Australia increasingly relies upon older, male GPs to provide nursing home care, interestingly this survey showed only a small, non-statistically significant, trend towards males.
The survey did not enquire as to the reasons for avoiding visits, but previous research has found the reasons cited include time constraints, inadequate remuneration, lack of equipment and concerns about safety.
The recent rise of corporate after-hours home-visiting services is possibly acting as both chicken and egg—servicing a need by filling the void, but also making it easier for GPs to shape a practice which doesn’t involve after-hours work. This may become particularly evident for GPs working in smaller practices; of those surveyed, GPs working in practices with four or fewer colleagues were only half as likely to do home visits.
Dr Morgan believes that although working beyond the surgery walls has its difficulties, it is important for patient care. “Exposure to these visits should ideally be a core part of GP training, so our GP workforce can meet the future needs of an ageing population.”
Justin Coleman, Medical Observer, 20 September 2016
RACGP calls time on faxes and letters
The RACGP is calling time on the era of the fax machine and the letter, officially telling the government and other health services to catch up and integrate with the electronic communication systems of general practices.
The shift should happen within three years, the college says in a new position statement, citing cases where a lack of timely communication between general practice and other health services have put patient safety at risk.
In one well-known case, a South Australian coroner found that a specialist’s “archaic” practice of sending a letter by ordinary post contributed to the warfarin-related death of an elderly Adelaide woman.
The statement says general practice has led the way in moving towards electronic clinical and administrative systems, but that the rest of the healthcare sector has been slow to move away from paper.
As a result, general practices are often required to manually transfer information from their systems into paper-based or online forms. This information is sent via post, fax, online upload, or unsecured email.
Hardcopy letters, reports and requests must be manually scanned and added to the patient’s clinical record. These inefficiencies create “a heavy burden on GPs”, diverting their time away from patient care.
The college says:
- All electronic communications templates and systems should where required use existing data and information from general practice clinical information systems to pre-populate documents and forms
- All communications should be:
- Created and sent from within the general practice’s electronic clinical software system and
- Automatically received into the local patient electronic health record via the clinical software system inbox
- All electronic communications to external healthcare providers and agencies should be sent securely using secure messaging to align with to best practice data privacy handling principles protect re patient privacy and confidentiality.
The college is confident that the National Health Services Directory should ease the path towards two-way secure electronic communication.
You can read the position statement here.
Medical Observer, 22 September 2016
Six things GPs should know about new mandatory CPD requirements
MORE than 25,000 GPs will have to complete mandatory “self-evaluation” from January as the RACGP revamps CPD.
The new module, dubbed PLAN (short for planning, learning and need), is the college’s response to the Medical Board’s push on revalidation. The idea is to have GPs reflect on their strengths and weaknesses instead of covering the same ground year after year.
Here are the key points:
- It will be a mandatory element of the new triennium, and the college says GPs should do it early in 2017;
- It’s included in the QI&CPD program, meaning it will be mandatory in order for doctors to access higher A1 Medicare rebates;
- It will not be formally evaluated;
- GPs will first complete a 60-90 minute online practice profile analysis and self-assessment. They’ll then review an automatically generated report, and use it to identify five key areas they should work to improve;
- GPs then work on those five areas over the course of the triennium;
- In the next triennium, GPs will still have to obtain a minimum of 130 points, including one category one activity and a CPR course.
Medical Observer, 07 October 2016
Eight key changes in the new Red Book
A revised Red Book launched at GP16 puts a new emphasis on the risks as well as the benefits of preventive interventions.
Many changes have been made after a 15-month process of reviewing the evidence. Here are eight of the updates.
- The cancer section includes new information on the risks of screening mammograms, including psychological distress and unnecessary treatment after false positives;
- The PSA test: spells out that “GPs have no obligation to offer prostate cancer screening to asymptomatic men”;
- Another 10 tests have been added to the chapter on screening tests which should not be used in general practice, including cardiac calcium scoring for coronary heart disease and thermography for breast cancer;
- The genetics chapter offers a simple screening questionnaire to identify patients who might need follow-up because of their family history of cancer, heart disease or diabetes;
- Lesbian, gay and bisexual people have been added to the list of patients who might be at increased risk of depression;
- A new section on the role of quantitative ultrasound in assessment of fracture risk has been added to the osteoporosis chapter;
- New information on the consent process for vaccination emphasises that people should agree voluntarily “without pressure, coercion or manipulation” and after receiving written advice about benefits and harms;
- New emphasis on identifying and treating the cause of atrial fibrillation and which scores to use in assessing the need for anticoagulation.
The ninth edition of the RACGP’s Red Book can be downloaded here.
Rada Rouse, Medical Observer, 30 September 2016
ACRRM welcomes report which highlights urgent need to support Rural Generalism
The Australian College of Rural and Remote Medicine (ACRRM) President, Professor Lucie Walters, has welcomed the release of research which evidences both the importance and potential vulnerability of Rural Generalism.
The Australian Journal of Rural Health (AJRH) 2016 report, How does the workload and work activities of procedural general practitioners compare to non-procedural general practitioners, by Russell and McGrail, found that provision of procedural care by general practice qualified doctors significantly increased with remoteness in all key skill areas – emergency medicine, surgery, anaesthetics, and obstetrics and gynaecology. It also found that these proceduralists are working between eight to 18% longer hours than non-procedural GPs.
Professor Walters said that while the report further highlighted the pivotal role Rural Generalists play in providing rural and remote communities with their procedural care, it also drew attention to the urgent need to better reward and recognise these doctors.
“The study highlighted that rural proceduralism is at risk. These findings point to the need for better recognition and remuneration for the proceduralist workforce in remote and rural Australia, and the need to build rural hospital resources in order to ensure rural Australian’s have appropriate access to hospital care into future,” she said.
Professor Walters noted that the report marks the timeliness of the Federal Government’s announcement to support the establishment of a national Rural Generalist program.
“The College is moving apace to support these plans. We have held discussions with the Assistant Minister for Rural Health this week and will host a meeting of the national peak body, the Rural Generalist Medicine Jurisdictional Group, at the national Rural Medicine Australia conference (RMA2016) in October.
“ACRRM will also be continuing its efforts to advance the international Rural Generalist movement and will host the Third World Summit on Rural Generalist medicine in 2017.”
Professor Walters said that ACRRM has been pivotal to all key developments in this area including designing and delivering the Rural Generalist Procedural Grants program.
“The College was formed to define and support the unique rural doctor model of practice which involves provision of both primary care and extended skills in procedural and non-procedural disciplines, and coined the term Rural Generalist to describe this role. For almost two decades ACRRM championed the development and support of a sustainable, national Rural Generalist workforce,” she said.
For more information or comment, please contact Mersija Mujic on 07 3105 8200.
Media Release from the Australian College of Rural & Remote Medicine, 22 September 2016
Rural GPs need to know about this deadly amoeba
Infectious diseases specialists are calling for greater awareness of the danger of primary amoebic meningoecephalitis (PAM), particularly in regions where bore water is used.
Although infection with the causative agent, Naegleria fowleri, is rare, the consequences are devastating.
Professor Cheryl Jones, president of the Australasian Society for Infectious Diseases (ASID) says rural families need to know of the dangers of swimming in warm fresh water and of children playing with hoses with bore water which gets warmed by long surface pipelines.
Her comments follow publication in the MJA of the cases of three child fatalities in rural Queensland linked to the amoeba, likely through infection of the nasal cavity from where trophozoites migrate to the brain.
Most cases have not been in the tropics, however, the authors say. Twenty cases occurring from the 1950s to the 1970s were recorded in South Australia but only one case since the introduction in SA of continuous water chlorination in 1972.
PAM has a clinical presentation similar to bacterial meningitis and it’s impossible to clinically distinguish between the two, they say.
“Diagnosis requires identification of motile trophozoites in cerebrospinal fluid or characteristic morphology in stained specimens by a trained microbiologist,” they write.
Obtaining CSF samples is often impossible in small clinics with limited medical imaging or local laboratory services. Performing a lumbar puncture may be contraindicated by symptoms of raised intracranial pressure.
“The presentation of an acutely unwell child with a history of bore water exposure and signs of meningitis or encephalitis should … prompt consideration of PAM as a potentially life-threatening diagnosis,” they say.
Treatment requires combination therapy with multiple anti-parasitic agents but the prognosis is poor.
Doctors in rural and remote regions have a crucial role in primary prevention, the authors say.
While families have lived with hot artesian bore water for decades, they say modern taps, hoses and toys increase the changes of water being forced into a child’s nose under pressure. Filtering the water can remove the threat.
Rada Rouse, Medical Observer, 26 September 2016
The 2016 GP of the Year is...
Australia’s new GP of the Year is encouraging the speciality to “stand up and say when things aren’t right” to defend the value of the profession.
Dr Jane Cooper, from Devonport in Tasmania, was honoured by the RACGP at its national conference in Perth last week.
The award acknowledges her work at the Don Medical Clinic, a practice attached to a local secondary school, which she set up specifically to support young people.
“We GPs are the gatekeepers and that’s totally unappreciated,” Dr Cooper says. “We need to have our own voice. We have to stand up and say when things aren’t right.”
Following her graduation, Dr Cooper spent time in rural NSW where she trained in obstetrics. She said she considered becoming an obstetrician, but in the end, general practice won out.
“I realised the lifestyle wasn’t something I found attractive and I missed other areas of medicine. I wasn’t for me to focus on just one thing,” she says.
She set up the Don Medical Clinic in 2013.
“I reached a point in my career where it was time to add a little spice to it, to step outside my room and service a need that was serious for my community,” she tells Australian Doctor.
Young people are often nervous about seeing their GP, especially for mental health conditions, Dr Cooper says. “It’s traditional things around confidentiality, a feeling of being judged, and cost.
“We bulk-bill patients up to the age of 18. The Medicare bulk-billing incentive stops at 16 but we continue, because 17- and 18 year-olds don’t have any money either.”
However, she says she tries not to worry too much about Medicare or its freeze.
“I’ve got other work to do. It’s always a struggle but I’m passionate about my work so we plod on.”
Antony Scholefield, Australian Doctor, 05 October 2016
10 commandments for preventing burnout
With health professionals under more work pressure than ever, British GP Dr Simon Tobin has developed some guiding principles for the resilient practitioner.
- Look after yourself as well as your patients.
- Keep a sense of perspective.
- Treasure your time away from work.
- Remember that your main role is to support individual patients to make the best possible decisions for them at this time.
- Don’t be too hard on yourself when you make mistakes, as long as you learn something from them.
- Accept that on some days being adequate is acceptable.
- Sit down and talk with close colleagues every day.
- Learn how to say ‘no’ sometimes.
- Develop an interest within medicine.
- Do not ignore early signs of burnout.
Michael Woodhead, Australian Doctor, 04 October 2016
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