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					                  The Royal Australian and New Zealand
                       College of Ophthalmologists
                                      A.C.N. 000 644 404

                                    94 – 98 Chalmers Street,
                             SURRY HILLS NSW 2010 AUSTRALIA
                       Telephone 61 2 9690 1001 Facsimile 61 2 9690 1321
                                  E-mail: ranzco@ranzco.edu
                                     http://www.ranzco.edu




Submission to Discussion paper:

National Health and Hospitals Reform Commission

A Healthier Future for all Australians.
Contact Details

The Royal Australian and New Zealand College of Ophthalmologists

Mr Robert L. Guest
Chief Executive Officer

Address:          94-98 Chalmers Street
                  SURRY HILLS NSW 2010

Phone: (02) 96901001
Fax: (02) 9690 1321
Email: ceo@ranzco.edu



Background

This submission has been prepared by the Royal Australian and New Zealand
College of Ophthalmologists (RANZCO).

RANZCO, formed in 1969, is a non-profit organisation with membership of
approximately 95 per cent of all ophthalmologists practising in Australia and New
Zealand.

As a higher education institution, the College’s broad goal is to train future
ophthalmologists via its postgraduate Vocational Training Program and maintain
the surgical standards of ophthalmologists in Australia and New Zealand through a
comprehensive continuing medical education program, including the annual Scientific
Congress. It also designs and delivers education and training to other eye care
professionals including GPs and optometrists to improve their capacity to meet eye
care needs.

As a learned society, the College, promotes the science and practice of
ophthalmology and the vision sciences through a range of scientific, clinical and
professional services; provides information and library services to keep members and
other interested parties informed of developments affecting eye care as well as
College activities; and provides external relations and government policy services
covering relationships between the College and other stakeholders, as well as
provision of policy advice to governments on health policy and eye care issues.

The College also provides community services to improve eye care within Australia
and New Zealand, as well as services delivered on behalf of Government. This
include provision of information to the community on practical measures to improve
the quality of eye care, as well as advice on current eye care issues, such as the
dangers posed to sight by commonly used products including equipment and toys.
The College participates in programs intended to improve eye care within groups with
particular problems such as our indigenous peoples and those living in rural and
regional areas. The College provides advice to government agencies on the
qualifications and experience of overseas-trained specialists wishing to practise in
Australia or New Zealand.




The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) submission to   2
National Health and Hospitals Reform Commission Discussion paper:
A Healthier Future for All Australians
General Comment

Broadly, the NHHRC Interim Report (dated December 2008) covers a) scope of
practice, b) competencies, c) training agencies and d) changes of the funding within
Medicare.

The College Board examined the positive and negative implications for
ophthalmology and possible impact on the College of a number of key
recommendations in the report. Details are outlined below:

Recommendations Supported

DELIVERING BETTER HEALTH OUTCOMES FOR REMOTE AND RURAL COMMUNITIES:
i)   Expanding telehealth and telemedicine and Medicare billing
     arrangements (9.2). It was acknowledged that these aspects of the report
     were an important tool in relation to up-skilling and confidence-building of all
     practitioners involved and ultimately a benefit to patient care. There was
     agreement that associated Medicare funding should reflect all aspects of
     clinical care and training.

ii)    Expanding patient travel and accommodation assistance schemes for
       access to specialists (9.3). These proposals were supported.

iii)   Allocating a higher proportion of postgraduate training places in remote
       and rural areas (9.4). The value of these posts for training and the quality of
       supervision would need to be maintained. Training posts should not be used
       solely as a means of fulfilling a workforce need. It was accepted that such a
       proposal would meet a “service” need; and could enhance and broaden the
       training experience (possibly with specific incentives). Overall, there was
       support for increasing training experiences for final year trainees in these types
       of posts.


Recommendations that Need Further Consideration and/or Amendment

DEVELOPING A SUSTAINABLE HEALTH                  WORKFORCE – FACILITATE ACCESS TO CARE
WHERE DOCTORS ARE SCARCE:
         iv)    Expanding the use of diagnostic and specialist medical services to
                other health professionals according to defined scope of practice
                and similarly expanding PBS and Medicare benefits to patients
                (14.2). The proposed National Registration and Accreditation Scheme
                (NRAS) includes all groups of health practitioners. Each group has its
                own Board which would stipulate its own scope of practice. The College
                maintains that Boards must “cross-consult” but this has not yet been
                accepted in the model. Accreditation for standard of care should be
                defined by the people most qualified.

                The College Board also maintains that in a “team” approach, ultimately,
                the doctor must take responsibility for the patient, including where care
                is delivered in teams. A team approach was the best model to ensure
                safety and quality of patient care to meet best practice.

                It was noted that all allied health practitioners are seeking access to
                Medicare and that this has the potential to put significant financial strain
                on the system.
The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) submission to   3
National Health and Hospitals Reform Commission Discussion paper:
A Healthier Future for All Australians
         v)     Rationalising the education and training of all health professionals
                (14.3). Dedicated funding could mean that the Government itself may
                control all education and training. Caution was expressed with this
                proposal.

                Establishing a National Clinical Education and Training Agency
                (NCETA) (14.4). The rationale for a NCETA was unclear and it was
                noted that CPMC and AMC are considering this matter on behalf of
                Colleges. The College has also submitted a separate response to the
                National Health Workforce National Health Workforce Taskforce
                Discussion paper: Health Education and Training - Clinical
                Governance and Organisation


Position Reserve

RANZCO reserves its position in relation to any of the recommendations of the
NHHRC Interim Report report not addressed in the points above.




The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) submission to   4
National Health and Hospitals Reform Commission Discussion paper:
A Healthier Future for All Australians

				
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