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					                                                                                                       October 2010
                                                     Sutherland Division of General Practice


                                                                                                    Newsletter


 Inside this issue...

GP Census Results………......2
                                    GP Hotline
Monthly CPD…………….……..3
                                    Relaunched...
                                    The GP Direct Connect Project Team advises that the GP Hotline has
                                    been reviewed and improved and in now being relaunched. This
St George Hospital
Outpatients……………….…...3             hotline is to provide GPs with a direct line to the Admitting Team in the
                                    Sutherland Hospital Emergency Department.

                                    The hotline number is:
CDM…………….…..….……......4


                                    9540 7222
Immunisation.…………....…..5
                                    Feedback on this service can be provided to Dieuwke Chavez on (02) 9540 7123
                                    (M-F 8am - 5pm) or via email Dieuwke.chavez@sesiahs.health.nsw.gov.au

Mental Health………………….6




IT Program….………………….7
                                    2010 ANNUAL GENERAL MEETING
                                    THURSDAY 21 OCTOBER
Anxiety - not just for
adults……………………………..8
                                    Blackwater Restaurant
                                    1/8 Water Street, Sans Souci
                                    7 pm Registration; 7.30 pm AGM and Dinner
Antenatal Care - Changes to         Members of the Division are invited to join colleagues and friends at the beautiful
Shared Care Protocol………11
                                    Blackwater Restaurant for the 2010 AGM. This year Dr Robyn Napier from AMA
                                    NSW will speak on Health Reform and the impact on general practice.

SUTHERLAND                          We will also recognise the contributions of GPs who are standing down from the
Division of General Practice        Management Committee: Dr Philip Lye, a founding member of the board, Dr Jack
Phone:    9545 3533                 Ng and Dr Hannah Wright.
Fax:      9545 3522
                                    RSVP to Lynne on 9545 3533.
Website:
www.shiregps.org.au
Address correspondence to:
shiregps@shiregps.org.au
Suite 502, Level 5, 3-5 Stapleton
Ave, Sutherland NSW 2232

 DEADLINE FOR NOVEMBER -
        21/10/2010
     GPS AND WORK                                                                     CONTINUING PROFESSIONAL DEVELOPMENT
     Increasingly GPs are electing to work part time, with 62% of The five most popular topics for further education are:
     GPs who completed the survey indicating that they work less
                                                                            Paediatrics
     than 10 sessions a week. Almost 85% of GPs indicated that
     they did not expect to change the total number of sessions             Mental Health
     worked in general practice over the next 12 months.                    Orthopaedics
                                                                            Women’s Health
     GPs were asked if their visits to residential aged care
                                                                            Dermatology
     facilities have changed. 31% of GPs indicated that they do
     not visit RACFs and a further 12% indicated that visits had
                                                                  Some suggestions for the CPD program include “more
     decreased. The majority of GPs had maintained similar
                                                                  active and interesting learning modules with CPD points”
     numbers of patients in RACFs however 22% said that their
                                                                  and “lunch time CPD meetings”. The Education Sub
     visits had increased.
                                                                  Committee will take your preferences and these comments
                                                                  into consideration when planning the 2011 program.
     HOSPITAL COMMUNICATION
     100 GPs (42%) are registered with ARGUS and now receive                          SHIREGPS
     electronic discharge summaries from area hospitals.
                                                                                      The Division’s website (www.shiregps.org.au) has been
     Satisfaction levels were assessed with 48.5% of GPs
                                                                                      accessed by almost 70% of GPs in the last 12 months. Of
     indicating that they are satisfied to very satisfied. However,
                                                                                      those GPs, 86% found the information on the website
     there is still room for improvement with almost 19% of GPs
                                                                                      useful. The newsletter is still the major medium for
     dissatisfied and we are currently working with the Hospital to
                                                                                      communication between the Division and GPs, with 98% of
     improve the process.
                                                                                      GPs indicating that they found the newsletter useful.
     GPs commented that they were still not receiving discharge
                                                                                      Division programs and activities are supported by GPs with
     summaries for every patient and that it varied across the
                                                                                      94% indicating that the current programs support GPs:
     hospital with “good” summaries from Accident and
                                                                                      “I will be very concerned due to government legislation if we
     Emergency. Some GPs thought that there had been an
                                                                                      lose what divisions provide for the average GP.
     improvement, particularly in legibility now that the
     summaries are mainly typed.


              WHO Statement on Rotavirus Vaccines and Intussusception
    On 22 September 2010, the WHO released a statement relating to intussusception following rotavirus vaccination as,
    in Mexico, surveillance data had indicated a clustering of hospitalisations (no deaths) for intussusception in the
    period 1-7days following the first dose of Rotarix vaccination.

    At present, the WHO considers the benefits of rotavirus vaccination far outweigh the slightly increased risk of
    intussusception. The full statement can be found at: http://www.who.int/vaccine_safety/topics/rotavirus/
    rotarix_and_rotateq/intussusception_sep2010/en/index.html

    Questions and answers on this issue have also been posted on the US Food and Drug Administration web site at:
    http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm226690.htm
    At the time of writing, there has been no specific advice from Australian medical authorities.




                                                            SHIRE GPs NEWSLETTER
    The newsletter provides information and is distributed free to all GPs in the Shire, local specialists, some other Divisions, local hospitals, AHS, and selected
    national medical newspapers. Opinions expressed are not necessarily those of the Sutherland Division of General Practice.

    BOARD MEMBERS
    Chair: Dr Sharyn Wilkins; Deputy Chair: Dr Sheena Wilmot; Secretary: Dr Jack Ng; Treasurer: Dr Philip Dwyer
    Members: Drs Philip Lye; Craig Nelson; Rowan Vickers, Owen Brookes; William McConnell, Hannah Wright

    OFFICE STAFF
    CEO: Yvonne Rowling; Program Manager: Belinda Michie
    Accounts Supervisor: Barbara Boxall
    Program Officers: Jan Sadler; Gillian Minto; Shona Dutton; Liesl McCoy; Amanda Rattray; Laura Denegris; Thien Vo; Amy Young
    Programs’ Assistant: Lynne Durie; Newsletter Editor: Dr Fiona Long

2
“ANTENATAL UPDATE”
Thursday, 28th October 2010
Speaker: Dr’s Mark Brown, Steve Thornley & Andrew Zuschmann
               • Hypertension in Pregnancy
               • Diabetes Mellitus in Pregnancy
               • Post Date Management

Date:          THURSDAY,28th October 2010
Time:          7.00pm Registration & buffet dinner, 7.45pm Lecture
Venue:         HAZELHURST GALLERY & ARTS CENTRE, 782 KINGSWAY, GYMEA
Contact:       Jan at the Division on 9545-3533 or tick the fax back sheet
                                                                                                                RACGP QA & CPD
Thank you to our sponsors:                                                                                      Pts:Total 4 points
                                                                                                              (2 pts per hr Cat 2)
BAYER SCHERING PHARMA & BAYER CONSUMER CARE

OUTPATIENTS DEPARTMENT –                                           ASHM COURSES IN HIV AND
ST GEORGE HOSPITAL                                                 PRIMARY CARE
Please note that there has been some                               In conjunction with the Australasian HIV/AIDS Conference
changes made to the Outpatients                                    2010 (22nd Annual ASHM Conference), the Australasian
Department form for the St George                                  Society for HIV Medicine (ASHM) will be running two
Hospital.                                                          courses in HIV medicine.

You will find the          new form on our website                 The Introduction to HIV Care for General Practitioners
www.shiregps.org.au        under hospital forms for                (Saturday 23rd October 2010) is designed to cover HIV
downloading.                                                       management in primary care, and aims to encourage more
                                                                   GPs to engage in shared care management for HIV.
In an effort to improve service provision for patients
attending the clinics of the Outpatients Department there          Topics covered include risk assessment, testing,
will be an implementation of SMS Text messaging of                 management of newly diagnosed and basics of antiretroviral
appointment confirmations to those clients with mobile             therapy. This course is also suitable for nurses and other
phone numbers included on referral forms. It is important          health professionals.
to include mobile contact details within the form to enable
confirmation by SMS and also to facilitate contact around          The ASHM HIV s100 Prescriber Course (Sunday 24th and
notification of changes to clinics after the initial booking.      Monday 25th October 2010) is designed to provide
                                                                   clinicians with the necessary knowledge and skills to
Some key things to remember:                                       prescribe HIV s100 drugs for the management of HIV
                                                                   infection. This two day course builds on the content from the
           When completing the form it is essential that a         Introduction to HIV for General Practitioner and covers
           full birth date is included on the form not just the    common first line therapies and their associated toxicities,
           age of the patient.                                     monitoring patients on therapy, long term issues and
           If you do not have a preference for a particular        complex needs of people living with HIV.
           specialist in the clinic that you are referring to
                                                                   For more information and to register for this course please
           please tick all the specialists within that clinic to
                                                                   visit the ASHM website: www.ashm.org.au/courses. Please
           get the next available appointment.
                                                                   note that the Introduction to HIV Care for General
If you are requiring a priority appointment in any of the          Practitioners is a prerequisite for attending the ASHM HIV
clinics please make contact with the registrar attached to         S100 Prescriber Course.
the clinic via the hospital switchboard on 9113 1111 and
discuss your needs.

                                                                                                                                     3
    Tips for Practice Staff to distribute AUSDRISK Tool
    Practice staff can play an important role in identifying patients who may be eligible for the Lifestyle Modification
    Program. Because of this, the Division has developed a ‘Tip Sheet’ to help practice staff identify patients who may
    be eligible. Below is an outline of the tip sheet. If you or your practice would like any further assistance with
    identifying patients for the Lifestyle Modification Program, please contact the Division on Ph: 9545 3533 or email
    sdutton@shiregps.org.au

    Suggested activities for reception staff
             When patients report their arrival to the receptionist, check their date-of-birth/age
             If the patient is aged between 40 and 49 years, hand the patients an AUSDRISK Tool
             Ask these patients to complete the tool while waiting and give to the GP in their consultation
             Alternatively, ask the patient to complete the tool while waiting for the GP and give back to the reception
             staff. The reception staff can then provide the GP with a copy when the patient is called for their
             consultation. This step can aid with patient’s forgetting to give the tool to the GP.
             If the GP decides to refer the patient to a Lifestyle Modification Program, the referral form is available from
             the Division website www.shiregps.org.au in the Lifestyle
             Modification Program section

    Shona Dutton, Program Officer




4

                                                       A DVERTISEMENT
VARICELLA –                                                      Post-Vaccination rash
ALL IN THE FAMILY?                                                         A varicella-like rash within 14 days of vaccination
                                                                           is usually due to coincidental wild virus infection
A local practice rang for advice regarding a household                     Rashes due to the vaccine occur a median 21
where the baby was due for varicella vaccination but                       days post vaccination
someone in the household did not have antibodies to                        A rash >42 days post vaccination is considered
varicella post-vaccination: is it safe to vaccinate the child?             to be breakthrough varicella caused by wild virus
This raises a few issues regarding the safe use of varicella               infection.
vaccine and the place of serology.

The following points have been developed from the                Breakthrough varicella
Australian Immunisation Handbook, 9th edition and the                      Infection with wild varicella virus occurs in a
National Centre for Immunisation Research and                              percentage of vaccinees; however, in 70% of
Surveillance’s Varicella fact sheet*.                                      these the disease is mild with <50 lesions.
                                                                           Breakthrough infection can still be contagious
                                                                           and exclusion from child care or school is
The vaccine:                                                               recommended. There is evidence that two doses
          Varicella vaccine is available as a monovalent,                  of varicella vaccine for children under 14 years
          live attenuated vaccine.                                         provides improved protection and less
          The dose is 0.5mL administered subcutaneously.                   breakthrough infection.
          As a live vaccine, it can be safely given at the
          same time as other vaccines (though not mixed
                                                                 Serology
          in the same syringe) but if not given
                                                                           A reliable history of chickenpox correlates well
          simultaneously with other live viral parenteral
                                                                           with serological evidence of immunity. If there is
          vaccines, they should be given at least 4 weeks
                                                                           a clear history of clinical chickenpox, serological
          apart.
                                                                           testing is not required.
          At present, only one dose is required for children
                                                                           Adolescents or adults without a clear history of
          up to 13 years of age and this is thought to
                                                                           chickenpox or vaccination (2 doses in people
          prevent any varicella infection in 80-85% of
                                                                           aged 14+years) should be considered vulnerable
          recipients and prevents 95-98% of severe
                                                                           and offered serological testing and/or
          disease.
                                                                           vaccination. A majority of those with a negative
                                                                           clinical history will turn out to be immune, so
Who should be vaccinated?                                                  serological testing can be offered initially to
          Varicella vaccine is available on the National                   determine whether or not vaccination is required.
          Immunisation Program as a single dose at 18                      Alternatively, vaccination can proceed as the
          months of age (unless child has already had                      vaccine is well tolerated in seropositive people.
          chickenpox)                                                      (It may be more cost-effective to test first if
          Children in Year 7 are also offered a single dose                vaccination is not subsequently required.)
          of varicella vaccine at school if they do not have               Serological testing following vaccination is not
          a history of chickenpox or previous vaccination.                 recommended as the commercially available
          (If they have already turned 14 years, 2 doses                   tests are not reliable.
          are required, at least one month apart.)
          Vaccination is particularly recommended for
          people in certain groups if they do not have a         Discussion
          previous history of chickenpox. This includes:         Going back to the original situation, the baby should be
          health care workers, child care workers and            vaccinated as a) serological testing after vaccination is not
          household contacts of immunosuppressed                 reliable so if the household contact has received the
          people.                                                appropriate number of valid doses they are highly likely to
                                                                 be protected, and b) if a member of the household is
Who should NOT be vaccinated?                                    immunosuppressed, it is important to vaccinate all non-
          Patients with history of anaphylaxis following         immune household contacts to minimise the risk of the
          vaccination.                                           immunosuppressed person developing severe wild-type
          Pregnant women.                                        varicella virus infection. The risk of transmission of vaccine
          People with impaired immunity caused either by         strain varicella is extremely rare but if vaccinees develop a
          disease or immunosuppressive treatment                 rash, they should cover the rash and avoid contact with
          (including general radiation, X-ray therapy or         people with impaired immunity for the duration of the rash.
          high doses of oral corticosteroids – see Handbook
          for definition.)                                       *For further information see:
          See Handbook for precautions relating to               Australian Immunisation Handbook, 9th edition. Pp 309-321
          varicella vaccination before and after                 NCIRS Fact sheets on Varicella and Herpes Zoster: http://
          administration of immunoglobulin or blood              www.ncirs.edu.au/immunisation/fact-sheets/index.php
          products and patients on long-term salicylate
          therapy.                                               Gillian Minto, Program Officer

                                                                                                                                  5
    PERINATAL MENTAL HEALTH
    Last year, the National Perinatal Depression Initiative was launched and as part
    of that initiative, the Division was able to offer specialised ATAPS services for
    women and their families in the perinatal period through the local Child Youth and
    Family Counselling Service. Since then, 44 GPs have referred 51 clients who
    have attended 194 treatment sessions, either individually or in a group setting.

    At a national level, Draft Clinical Practice Guidelines for Depression and Related
    Disorders – anxiety, bipolar disorder and puerperal psychosis – in the Perinatal
    Period have been developed and will be submitted to the NHMRC for approval
    later this year. Beyondblue research indicates that 9% of women experience
    depression antenatally and 16% experience it postnatally.

    A nationwide community survey has also been conducted which revealed high levels of misunderstanding about perinatal
    mental health – including the fact that 52% thought it was “normal” for a woman to feel depressed during pregnancy and
    35% believed postnatal depression is due to being unable to cope with motherhood. Such perceptions mean that
    depression may not be perceived as a diagnosable or treatable illness and patients may therefore not seek help. Screening
    therefore becomes important and 74% of respondents agreed with screening during pregnancy and 81% agreed with
    screening after the birth.

    Screening
    Locally, all women attending Sutherland or St George Public Hospitals’ antenatal clinics will be screened using the
    Edinburgh Postnatal Depression Scale (which has been validated for antenatal use) and other questionnaires; however
    those attending private obstetric services may not. GPs should therefore consider screening patients during their
    pregnancy using the EPDS. Women with scores consistently 13 or more have a high probability of meeting diagnostic
    criteria for major depression.

    Postnatally, all women living in Sutherland Shire will be visited by Child and Family Health Nurses after the birth (no matter
    whether the birth was in the public or private systems) under the Universal Home Visiting program and screening with the
    EPDS should be performed by the nurse. However, in some circumstances this does not happen and, again, GPs should
    consider routinely using the EPDS postnatally, for example when the mother brings the child for the first vaccinations.

    beyondblue has developed some excellent resources for GPs on this issue which can be found at http://
    www.beyondblue.org.au/index.aspx?link_id=7.102 and there is an extensive range of consumer materials including “Hey
    Dad: Fatherhood – First 12 Months” (http://www.beyondblue.org.au/index.aspx?link_id=7.980)

    Referral Options
    If you consider a woman (or her partner) needs professional assistance, there are a number of options which are listed on
    the Division’s website (http://www.shiregps.org.au/mental-health-1542091103.php#Perinatal Mental Health Service). If you
    want to refer to the Perinatal ATAPS Program, first complete a GP Mental Health Treatment Plan then fax a copy of the
    Plan to the ATAPS clinician using the ATAPS referral fax coversheet. The website includes the documentation necessary
    to make a referral and also a range of information for GPs.

    Mainstream ATAPS
    The Division’s mainstream ATAPS program continues to operate for “low income” clients, based at Community Mental
    Health in Sutherland Hospital. Referrals should be made using the same referral fax coversheet and GP Mental Health
    Treatment Plan mentioned above (- select the appropriate fax number for perinatal or mainstream services).

    Gillian Minto, Program Officer




6
ANXIETY – not just a problem for adults
Anxiety and depression are the most common forms of psychological disorders but these conditions are
not only present in the adult population, children suffer too. While depression in children can be hard to
identify, anxiety is much more readily recognised. Parents are all too familiar with the symptoms, and it
must be remembered that anxiety is a normal part of life serving a protective function. So, when is
anxiety a problem that we need to do more about than reassure a child and their parents? When a
child’s anxiety produces symptoms that are severe enough to prevent them participating in activities
appropriate for their age, it is wise to seek professional help. We don’t expect a 2 year old to sleep in an
unfamiliar environment without anxiety but we do expect an 11 year old to be able to sleep at a friend’s
house or go to school camp. School refusal is a symptom that should be addressed as soon as possible at any age.

One of the most effective treatments for childhood anxiety is participation by both the child and parent in a group
programme that uses psycho education, behavioural and cognitive strategies. The Child Youth & Family Counselling
Service at Sutherland Hospital has been using such a programme with great success for the past 15 years. Cool Kids is run
by clinical psychologists for children in Years 3 -6 after school for 8 weeks. The group runs twice a year but referrals can be
taken at any time and families are assessed individually with standardised anxiety measures before being placed in a group.
As avoidance is the most common anxiety symptom in children this age, they are often reluctant to attend initially and need
firm encouragement and support from their parents and therapist. When they make it to the end of the programme, having
achieved most if not all their goals, it is satisfying for children, parents and psychologists alike!

Parenting skills are an integral part of managing childhood anxiety and if appropriate, parents may attend other group
programmes such as Triple P and TIPS offered by the service.

Wendy Conroy, Clinical Psychologist

Mental Health Training
As the end of the triennium nears, GPs should check their RACGP statements to ensure they have attended the
required mental health training in the past 3 years to allow them to retain their registration for either MBS item 2710 or
Focussed Psychological Strategies items. If not, there are a number of options including online courses and
attendance at a Black Dog Institute or NSW Institute of Psychiatry course.

GPs who are not currently registered to claim item 2710 for Mental Health Treatment Plans, but would like to do so,
may be interested in a new perinatal mood disorders course to be held by the Black Dog Institute at Randwick on
Saturday 6 November 2010.

For further information, see http://www.blackdoginstitute.org.au/healthprofessionals/educationtraining/gps/
coursedatesregistration.cfm or http://www.nswiop.nsw.edu.au/index.php?
option=com_content&view=category&layout=blog&id=44&Itemid=102



LTRAS & CHILDHOOD ASTHMA

UPDATED INFORMATION PAPER NOW AVAILABLE

The National Asthma Council has updated its information paper: Leukotriene receptor antagonists in the management of
childhood asthma to reflect the most recent clinical evidence.

It details the role of Leukotriene receptor antagonists (LTRAs), such as the PBS-listed montelukast (SINGULAIR), in the
treatment of children aged two to 14 years with mild persistent asthma, intermittent asthma, exercise-induced asthma or
allergic rhinitis. It examines the latest evidence-based findings and how they translate to everyday practice and includes
information about asthma diagnosis, assessing asthma severity, patterns of asthma in children and a suggested approach
to preventive therapy in children.

New evidence, contained in the paper, supports the use of LTRAs to protect against exercise-induced bronchoconstriction
in children, recommending that montelukast therapy be considered, in addition to inhaled corticosteroids, in children with
exercise-induced asthma that is not controlled by ICS at an optimal dose. The paper recommends that montelukast therapy
also be considered in children with seasonal allergic rhinitis, based on good evidence from recent trials.

The paper can be downloaded from the National Asthma Council Australia website: www.nationalasthma.org.au

                                                                                                                                  7
    THIS MAY BE SOMETHING YOU DIDN’T KNOW YOU NEEDED...
    Imagine being able to access your surgery workstation from anywhere in the world –
    whether it be from a café in France or from your laptop at home.

    The Basics:
    By using the internet we establish a Private ‘Highway’ between your remote computer and
    your surgery’s internet modem. Technically, this is called a VPN connection, or, Virtual
    Private Network Connection. This highway is created on demand and requires a password
    to ‘travel’ on it and all communication data is encrypted. At this stage your remote computer becomes a part of your
    surgery’s network.

    From here, we use the built in tools within Windows to access your chosen surgery workstation. This communication
    also requires a password and is encrypted once more.

    The End Result:
    The items and resources that are available on the surgery workstation travel down this private highway and down to
    your remote screen. You’ll have access to your surgery’s documents, shortcuts and of course your Medical software
    and data.

    Although a number of software solutions that can do this, the most secure method is to communicate exclusively
    over a VPN Connection.

    Requirements and Considerations:
          • A VPN Capable Internet Modem
          • High-speed broadband internet connection on the remote computer and at the surgery
          • The Surgery Server and Workstation must remain powered on during the time you wish to have remote
             access to them
          • The Scheduling of any automated nightly backup may need to be revised
          • Internet security measures may need to be modified or enhanced
          • The surgery workstation you wish to connect do must be one of the following;
                                Windows XP Professional
                                Windows Vista Business
                                Windows Vista Ultimate
                                Windows 7 Professional
                                Windows 7 Ultimate

    Thien Vo, IT Officer



                  Why use our IT Support Service ?
                Discounted hourly rate for GP Members
                Expertise in general practice software and IT systems
                Access to discounted computer hardware equipment
                Free initial onsite audit assessment of your practice IT systems
                Access to maintenance packages to assist general practices in maintaining IT systems to current
                accreditation standards, as well as increasing eligibility for PIP payments
                Remote and telephone support services

              FURTHER INFORMATION CONTACT THIEN AT SHIRE GPS ON 9545 3533
8
MELATONIN PROLONGED-RELEASE TABLETS (CIRCADIN)
Prolonged-release melatonin can now be prescribed for patients short-term for primary insomnia
who are aged ≥ 55 years. It improves quality of sleep and morning alertness in about one-third of
patients. The following excerpt from the latest issue of RADAR is a good summary of how this drug
fits into clinical practice.

          Melatonin prolonged-release tablets are approved for short-term treatment (up to
          3 weeks) of primary insomnia characterised by poor quality of sleep in people aged ≥ 55
          years. They are not PBS listed.
          Non-drug therapies are first line for treating primary insomnia.
          Melatonin is an alternative to a benzodiazepine or related hypnotic (zolpidem or zopiclone) if drug therapy
          is necessary for persistent primary insomnia.
          In clinical trials, people aged ≥ 55 years who received prolonged-release melatonin gained modest
          improvements in quality of sleep and morning alertness over those seen with placebo. Clinically meaningful
          improvements in both outcomes occurred in one-third of patients.
          Prolonged-release melatonin in short-term use has not been associated with impaired daytime alertness,
          dependence, withdrawal effects or rebound insomnia. Long-term safety is yet to be established.
          There is insufficient evidence at present to support treatment beyond 3 weeks or repeated use after an
          initial course.
          Melatonin (Circadin) is not listed on the PBS
Liesl is currently offering GPs and practice nurses an education visit on Management Options to Maximise sleep. If
you would like more information on this topic please fill in the fax back form.
Liesl McCoy, Program Officer


NPS - CLINICAL          AUDITS FOR       GPS
NPS clinical audits* are available for the QPI year: 1 May 2010 – 30 April 2011
A demonstration tool of this Clinical e-Audit is accessible on the facilitators’ website and online enrolment continues to be
available at www.nps.org.au/health_professionals.

Clinical e-Audit: Review of proton pump inhibitor (PPI) prescribing*. To date 1443 GPs enrolled, 535 GPs submitted
initial phase data and 482 GPs completed the review phase.

Clinical e-Audit: Optimising management of type 2 diabetes. To date 2557 GPs enrolled, 1032 GPs submitted initial
phase data and 961 completed the review phase.

Coming soon! Clinical e-Audit: Management of hypertension. Enrolment will be available in October 2010.
*These activities have been approved in the 2008–2010 triennium by: RACGP QA&CPD Program, total points 40 (Category
1) ACRRM PD Program for 30 points (extended skills).

New NPS flyer for consumers
NPS has developed a flyer for consumers which summarises key QUM messages.
The flyer reminds consumers of the things they can do to learn about, discuss and manage their health and medicines.
Order or download the flyer from the consumer orders page at: www.nps.org.au/consumers/order_free_information/
order_now. For more information, please contact Liane Johnson at ljohnson@nps.org.au




                                                                                                                                9
                                                      A DVERTISEMENT
                                                               - from GP NSW

     New DVD Taking Control:                                                 Brief online STI Training
     Diabetes, Depression & Anxiety                                          The management of STIs in general practice
     Beyondblue: the national depression initiative, in association with     requires GPs to have an effective but safe
     Diabetes Australia (Vic) has produced a FREE DVD aimed at helping       approach to achieve the best patient outcome.
     people with diabetes, their carers and health professionals to          This training is designed to quickly update GPs
     recognise the symptoms of depression and anxiety. The FREE DVD          knowledge of STI testing using the STI Testing
     can be ordered online at www.beyondblue.org.au or by calling the        Tool. To access the training tool, go to: http://
     Beyondblue info line 1300 22 4636                                       thinkgp.com.au/education/99966. The STI
                                                                             testing tool supports GPs with up to date
                                                                             information.
     Advanced prostate cancer:
     A guide for men and their families'                                     Other STI resources are available at:
                                                                             www.stipu.nsw.gov.au/stipu-resources-online-
     The Australian Cancer Network and the Australian Prostate Cancer        order-form.php
     Collaboration have released 'Advanced prostate cancer: A guide for
     men and their families' (1.23Mb, 133 pages).
                                                                             Men’s Liver Health Campaign
     To view the guide online, go to:
     http://www.prostatehealth.org.au/resources/                             Hepatitis NSW has initiated a liver health
     Advanced_Prostate_Cancer_Guide_2009.pdf                                 campaign, targeting men in the 35-60 year age
     Hardcopies of the Guide can be ordered from Andrology Australia by      group. Full page advertisements running in four
     phoning 1300 303 878.                                                   magazines highlight the common risks for liver
                                                                             disease and suggest men consult their GP for
                                                                             annual health checks that potentially include
     New Needs Assessment Tool for people with                               liver function tests. The adverts are expected to
                                                                             have a readership of 250,000 nationally.
     progressive disease                                                     Professor Jacob George of the Storr Liver Unit
     The team from the Centre for Health Research and Psycho-oncology        at University of Sydney/Westmead Hospital
     (CHeRP) at the University of Newcastle in NSW has now released a        assisted with the campaign.
     new tool to support the ongoing assessment and management of the
     unmet needs of people with any progressive chronic disease (including   For more information, go to:
     cancer, heart failure and chronic obstructive pulmonary disease) and    http://www.hep.org.au/index.php?
     their carers: Needs Assessment Tool: Progressive Disease.               article=content/media-room/2010-men-s-liver-
     http://www.newcastle.edu.au/research-centre/cherp/professional-         health-campaign
     resources/natpd.html


     'Resources Guide at Australian Centre for Grief and Bereavement
     The Australian Centre for Grief and Bereavement (www.grief.org.au) is located in Melbourne. In addition to a
     comprehensive nationwide education program, the Centre publishes a comprehensive 'Resource Guide' which details the
     materials they have available for children and adolescents; adults; professionals and students; general information.




10

                                                        A DVERTISEMENT
Referral form for Antenatal Care – Medical Director Template
The Medical Director Template/Form has been updated and placed on the Shire GPs website www.shiregps.org.au.

If you have MD3 or Best Practice – this template now works and can be downloaded off the website.

Additions to the referral form include:
          Pre-pregnancy weight and height (on patient information side)
          Investigation Results – Pregnancy Pathology Results

Changes to Shared Care Protocol
Recently the Area Antenatal Shared Care Committee met and there have been a few changes to the Shared Care
Protocol.

1.     Provider visits:
          GP: 37 – 39 weeks
          (weekly visits)
          This used to be 37 - 40 wks

          ANC: 40 weeks gestation onwards

2.     Early pregnancy information:
          Discuss Chlamydia testing with <25yr olds

3.     Earlier presentations to the Antenatal Clinic should occur if:
          There is a history of recurrent miscarriage; or
          If vaginal bleeding occurs. Any vaginal bleeding should be referred to the Early Pregnancy Assessment
          Service (EPAS)

       St George Hospital
       Early Pregnancy Assessment Service (EPAS) is a drop in service, patients are asked to arrive at the Women’s
       and Children’s Health Clinic at 8am.
       The Sutherland Hospital
       Contact the O & G registrar 9540-7111 page 125
       Royal Hospital for Women
       Early Pregnancy Assessment Service (EPAS) phone for appointments Monday – Friday Ph: 9382-6701

4.     Iodine:
       NHMRC recommends supplementation of 150 micrograms ( g) / day to ensure that all women who are
       pregnant, breastfeeding or considering pregnancy have adequate iodine status.

5.     GPs and Leave:
       If the GP is to take leave eg: sick leave, holiday leave etc, the GP should inform the patient that they are welcome to
       See one of their colleagues in their practice or contact the Antenatal Clinic to make an appointment for their next
       scheduled GP visit.


Antenatal Education Update - Thursday, 28th October 2010
Hazelhurst Gallery, Gymea
4 SANC points available

A rotation workshop including:
          Hypertension in Pregnancy – Dr Mark Brown
          Diabetes Mellitus in Pregnancy – Dr Steve Thornley
          Post Date Management – Dr Andrew Zuschmann

RSVP to the Division via Faxback sheet or phone the Division on 9545 3533
Jan Sadler, Program Officer
                                                                                                                                 11
     DO YOU VALUE YOUR PRACTICE NURSE?
     The 2010 Australian Practice Nurse Association (APNA) Best Practice Nurse Awards ARE NOW OPEN! With five award
     categories, the APNA Best Practice Nurse Awards aim to recognise and reward outstanding nurses working in general
     practice. The prize in each category is $5,000 to use in enhancing their continuing professional development and advance
     their role in general practice.

     Why don’t you nominate your practice nurse for their outstanding work in your practice?
     Award Categories: Immunisation - Continence Care - Chronic Disease Management - Muscoskeletal - Innovation

     For more information, application criteria and terms and conditions visit www.apna.asn.au


     HEIGHT ADJUSTABLE BEDS
     The 4th edition RACGP Accreditation standards will officially be launched at the RACGP annual conference GP10 later this
     month. It is anticipated that 4th edition will replace the current 3rd edition in late 2011 and be mandatory from 2012.

     One of the key changes is the inclusion of the mandatory indicator 5.1.3 “Our practice has a height adjustable bed”. Note
     that the indicator requires that the practice needs to have a height-adjustable bed, it does not specify per GP. Therefore at
     minimum, a practice will need to have at minimum one height adjustable bed.

     The RACGP is aware of the cost to practices and continues to advocate for infrastructure support for general practices to
     the Department of Health and Ageing.

     The following are the minimum requirements for a height adjustable bed
               Range of height adjustment: 45-95cm
               Weight capacity: 175kgs
               Width of table: 71cm
               Length: 193cms
               Number of Sections: Two sections, where the head section can be raised
               Specific Purpose Features: A side rail that can be moved up and down
               Stirrups for gynaecological examinations

     Suggested supplier à Majac medical supplies $1750 http://www.majacmedical.com.au/Couches.html

     Source: Royal College of General Practitioners www.racgp.org.au


     QUESTIONS ABOUT BEST PRACTICE
     Laura can organise a time to come to your practice for either a mock accreditation visit or a practice visit on best practice
     standards. For practices that have registered for accreditation or going through reaccreditation, a mock accreditation visit
     will help your practice to identify areas that may need improvement before the actual accreditation surveyor’s visit. For
     practices who are not accredited, a practice visit on the best practice standards may help your practice to identify areas that
     could need improvement or implementation of systems for optimal patient / staff care.

     Laura is available Monday-Friday to help you out with any Accreditation or Practice nursing questions/resources. Call the
     office on 9545 3533 or email ldenegris@shiregps.org.au

     Laura Denegris, Program Officer




12
                                                            A DVERTISEMENT
                        W hat’s On - UPCOMING CPD EVENTS
                                                                                     Hazelhurst Gallery & Arts Centre, 782
Thur Monthly CPD - Shire GPs       “Antenatal Update -                               The Kingsway, Gymea
                                   Hypertension, Diabetes and Post Date
Thursday 28 October 2010           Management in Pregnancy”                          7.00pm Registration 7.45pm
(4 Antenatal Shared Care Points)                                                     Presentation
                                   Dr’s Mark Brown, Steve Thornley &
                                                                                     Tick faxback sheet or contact Division
                                   Andrew Zuschmann
                                                                                     on 9545-3533

Thursday 21st October              Shire GPs -                                       Blackwater Restaurant
                                   Annual General Meeting                            1/8 Water Street, Sans Souci

                                   Dr Robyn Napier from AMA NSW will                 7pm Registration; 7.30pm AGM and Dinner
                                   speak on Health Reform and the impact on          RSVP: Division on 9545-3533
                                   general practice.

                                                                                     Hazelhurst Gallery & Arts Centre, 782 The
Monthly CPD                        Best Practice - Cardiology                        Kingsway, Gymea
Thursday 25 November
                                   Dr Rob Smith
                                                                                     7.00pm Registration 7.45pm Presentation
                                                                                     Tick faxback sheet or contact Division on
                                                                                     9545-3533
Tuesday, 30 November               “Managing Acute Low Back Pain in                  Rydges Hotel, Cronulla
                                   General Practice”
                                                                                     6.30pm Registration 7.15pm Presentation
                                   An NPS education workshop for GPs
                                                                                     Invitations out soon
                                   Dr George Pitsis
Practice Staff & Nurse Education                                                     Enquiries: Shire GPs 9545-3533

16 November                        Woundcare for Practice Nurses                     Stapleton Ave, Sutherland


2 December                         Safety in General Practice -                      Hazelhurst Gallery, Gymea
                                   for Practice Staff
                                                                                     Invites out soon




                                                                                                                                 15
                                                        A D V E R T I S E M E N TS
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