GP ACTion THE BI-MONTHLY NEWSLETTER OF THE ACT DIVISION OF GENERAL PRACTICE | VOLUME 128 | JANUARY-FEBRUARY 2008 Unit 20, 41 Liardet St, Weston ACT 2611 Congratulations Cam – PO Box 3571, Weston Creek ACT 2611 Phone: 6287 8099 Fax: 6287 8055 Medal of the Order of Australia Email: firstname.lastname@example.org Web: www.actdgp.asn.au President ............................... Dr Rashmi Sharma Vice President .................................Dr Annie Lim Congratulations are in order for Secretary .....................................Dr Craig Brown Treasurer...................................... Dr David Jarvis Dr Cameron Webber of Manuka, ACT Director to AGPN .................... Dr Karen Flegg Non-GP Director ........................... Ms Lesley Piko who was awarded a medal in the Chief Executive Officer ............Richard Bialkowski General Division (OAM) ACT, in email@example.com the Australia Day awards for “his Deputy CEO .................................... Kelly Gourlay firstname.lastname@example.org service as a general practitioner Business Services....................Deborah Cracknell and as a fundraiser for a range email@example.com of health organisations, and GP ADVISORS Dr Sonia Res....................... firstname.lastname@example.org to education through the ANU Principal Medical Advisor medical school”. Dr Phillip Toua ............GP Advisor – Immunisation LOCAL AREA NETWORKS When interviewed after the Northside Coordinator ..................Dr Neena Sood announcement Cam was humble Ph: 6242 0029 Central Coordinator .................................. Vacant to point out that there are many Tuggeranong Coordinator .......Dr Charles Sleiman worthy recipients of such awards, Ph: 6299 6990 and he was a little embarrassed by ACTDGP STAFF PH: 6287 8099 all the fuss! On further questioning Angela Ryan ..................... email@example.com Finance Manager though it would appear that this honour is indeed a worthy one. Cam Anne Baynes ................ firstname.lastname@example.org has been teaching medical students since 1984, initially at Newcastle Aged Care Bronwyn Parsons.........email@example.com University, then Sydney University and now through the ANU Medical Education & Quality School. In 2003 he was the recipient of an Excellence in Teaching Award. Carol Guy ...........................firstname.lastname@example.org The Opiate Program Nurse Chrissi Arthur .................email@example.com It was however his fundraising efforts for which he was most passionate Practice Nurse about. As a member of Canberra Medical Society, Cameron has been Dawn Roberts ...............firstname.lastname@example.org Mental Health involved with fundraising efforts for the various stages of refurbishment Hailey Shaw ....................email@example.com Immunisation of the John Curtin School of Medical Research, assisting doctors in need - Helen Cutler ................... firstname.lastname@example.org particularly after the 2003 bushfires, and fundraising for health projects NPS Facilitator Jane Sharman ..........email@example.com amongst the indigenous community of Warlu people of the Tanami dessert. 6249 7555 The Opiate Project Team Leader Cameron has been involved with annual trips to Yuendumu, 300kms Janet Cossart .................firstname.lastname@example.org Practice Services northwest of Alice Springs in the Northern Territory, over the last 4 years Janice Stewart ...............email@example.com where clinics for cataract and ear surgery have greatly enhanced the Self Management Joanne Gunn .................... firstname.lastname@example.org health outcomes for members of this 1000 strong population. For more Reception information see www.warlu.com Kerry Weller-Lewis ........email@example.com Reception Liz Deaves ..................... firstname.lastname@example.org The Division joins with colleagues to congratulate Cam on this award. Finance Officer Marilyn Wood .................email@example.com eHealth Peta Haesler .................firstname.lastname@example.org Lifestyle Choice Support Peter Wise ........................ email@example.com Mental Health Philip Habel ................... firstname.lastname@example.org Inside this edition: 6247 5742 HIV/AIDS Nurse Sarah Haltiner ............. email@example.com • From the President – All set for a great year ........... 3 Mental Health ATAPS/HMR TBA ..........................................Aboriginal Health • Update on Collaboratives ..................................... 4 TBA ............................................ Chronic disease • Up close and personal .................................... 12-13 Sexual Health and Family Planning ACT (SHFPACT), the leader in integrated sexual and reproductive health services, education and workforce development, is pleased to announce the first ACCREDITED PAP PROVIDER COURSE for REGISTERED NURSES in the ACT. The course is designed to provide nurses working in General Practice settings with the skills, knowledge and attitudes required to undertake effective well women’s screening, and addresses the necessary requirements for GPs to be able to access new Medicare Item Numbers where services are provided by a practice nurse on behalf of the GP. This specifically focused Nurse Pap Test Provider Course consists of a theory module and a supervised clinical attachment of 15-20 hours, and has been developed to: • Offer an accredited training program for nurses working in the ACT to become Pap test providers. • Provide nurses working in General Practice settings with the skills, knowledge and attitudes required to undertake effective well women’s screening. • Recognise the diversity of different professional and educational needs, and increase professional development opportunities for nurses. • Allow GPs to be able to access Medicare item numbers 10994/10995 and 10998/10999 where the service is provided by a practice nurse on behalf of the GP. This course has been accredited by the Royal College of Nursing, Australia, according to approved criteria and participants will receive 25 Continuing Nursing Education (CNE) points, which may be used by nurses as part of their enrolment in RCNA Life Long Learning Program (3LP). The first theory intake for this course will commence in March 2008, with clinical attachments commencing at SHFPACT’s Clinical Training School (University Avenue, Civic) in April 2008. Places are limited – register early to avoid disappoinment. An ‘Advanced Standing’ process is available for nurses currently or recently providing Pap Test services. Eligibility criteria apply. More information about SHFPACT’s Nurse Pap Provider Course can be accessed via the “Education and Training” link on SHFPACT’s website at www.shfpact.org.au, or by contacting Hilary Freeman RN/RM (Nurse Education Coordinator) on 6247 3077 or firstname.lastname@example.org FROM THE PRESIDENT All set for a great year Dr Rashmi Sharma, President My practice nurse, Cathy, plunged Well, we have a Practice Support Team at the the surgery into crisis mode a few division and this is exactly the type of work they weeks ago by going on a (well could do. However, there is one big obstacle: we deserved) holiday … overseas need a local GP to guide this sort of work … lest (… and totally uncontactable). these sort of ridiculous questions arise again as we Fear gripped the doctors, as we plagiarise other people’s templates from different had to do our own childhood geographical areas. So without sounding too immunisations! Crowds formed around the fridge boring, please volunteer your expertise. (We don’t door as we peered in through the glass door with want to be accused of nepotism/cronyism if we have trepidation. With the ever-changing schedules, no option than to tap on shoulders to get help from we’d been listening to everything Cathy had been our colleagues.) telling us … but it hadn’t quite sunk in. Opening the Finally, the great news is that Dr Charles Sleiman fridge door was the worst part as the temperature has been appointed to board in the longstanding indicator would creep up as soon it was opened casual vacancy of Tuggeranong LAN coordinator and, on one occasion, the fridge started to make (also covering Queanbeyan). As a recently an alarming ‘beeping’ noise. The room was quickly qualified registrar, Dr Sleiman will offer a younger vacated and all denied that the door had been open generation’s perspective, which, after all, is our for more than a split second. Anyway, salvation future. The division board would like to thank him came a few days later when one of us noticed that for taking on this position and is looking forward to Cathy had stuck, on the corner of the fridge door, sharing his new ideas and skills. I would also like to the immunisation schedule table that had been extend a warm welcome to the registrars who have developed by the division immunisation project commenced their career in general practice in the officer, Hailey Shaw. It was all so clear now … and region and we look forward to your participation in Interpol’s search for Cathy was called off! division activities So what point am I trying to make? Well, firstly, good Before I sign off, may I warmly wish you a happy practice nurses are worth their weight in gold and New Year for 2008 … and hope your festive season are an invaluable asset. (If you have not taken the holidays were restful and rejuvenating and find you leap into this area then why not contact the practice all set for a great year ahead. nurse project officer at the division and have a chat). Secondly, this was a great example where a divisional resource had provided practical support at a practice level - guiding us through the ever- complex maze of childhood immunisation. How to enjoy your Another matter: New item numbers come out with dementia an alarming speed, and I recall with amusement my (without necessarily driving your carer crazy) first ‘aboriginal-health-check’ about a year ago. I am not sure where the template I used on my computer Alzheimers’ Australia ACT appeared from, but all was going reasonably well Copies of the above booklet were distributed to until I came to the question of whether my patient practices in the last newsletter. had enough money to buy firewood to cook her Additional copies are available through the meal! We both burst out laughing (she is a high Division and you are encouraged to make them ranking public servant in Medicare and had just available and give them away to patients. had her kitchen renovated which included a swanky The booklet aims to reach the general public Miele cook top!). Wouldn’t life be easier if we had through its “serious fun” comic-opera style meaningful templates developed for our local illustrations of household interactions and community by our local GPs? changing roles. GP ACTion | January-February 2008 | 3 AWARDS Congratulations Dr Peter “Local Hero ACT” AUSTRALIAN OF THE YEAR AWARDS 2008 Currently working as Medical Director at Winnunga Nimmityjah Aboriginal Health Service (WNAHS) in Narrabundah, Dr Peter also finds time to visit inmates at Belconnen Remand Centre, Cooma and Goulburn Jails. We caught up with Dr Peter after the award and asked him a few questions. How did you initially get involved with aboriginal health? I was interested in my university days, and then did some work in the NT. I filled in for a few weeks at Do you have any unusual hobbies you can tell us WNAHS on a locum 19 years ago, and things have about? grown from there. I enjoy fly fishing, does that count? What do you most enjoy about working at WNAHS? Do you have an interesting story to share? Working with Aboriginal people, despite the enormous difficulties, we can work together to make I’m always delighted when I leave the remand things better. centre/jails, after I’ve been helping an Aboriginal inmate, that as a ‘white fella’ I get a ‘black fella’ handshake to say goodbye. An update on the What are your hopes for the future? Collaboratives Program I’d like to see more aboriginal graduates, both in medicine and other professions. You may remember from the 2007 AGM I informed you that the next roll out of the Collaboratives I’d like improved health outcomes for Aboriginal program is coming to the ACT in 2008. people. Since the Division did not participate in the first I’d like to see Aboriginal people being asked, and offer, we are looking at a joint roll out with our listened to more, re problems in their communities. counterparts in NSW sometime around May/ I’d like to see some of the lessons learnt in June this year. Aboriginal health, e.g. holistic care, percolate into For those who are interested in finding out more mainstream community. about the program, a link can be found on the Improvement Foundation website: www.improvement.com.au, click on the APCC link. In the next newsletter, I plan to bring you some GP’s first hand experience of the benefits of being part of the Collaborative Program, so keep watching this space. Dr Annie Lim Collaboratives Program Coordinator 4 | January-February 2008 | GP ACTion NEWS “Test of Cure” – Medicare Rebateable The Ongoing Management of Women previously treated for High-grade Squamous Intraepithelial Lesion (HSIL) Background the Register and Screening Program that there may be other considerations that will affect clinical In June 2004, based on the strength of evidence, the decisions made by practitioners in consultation with Australian Government Minister for Health & Ageing their patients. endorsed an MSAC recommendation for approval of public funding for the use of high-grade HPV testing For further information, please contact Helen at 12 and 24 months following treatment of high- Sutherland, Program Manager of the ACT Cervical grade intraepithelial abnormalities of the cervix to Screening Program on 6205 1540. monitor the effectiveness of treatment.1 This has Australian Government NH&MRC 2005, Screening to prevent Cervical 1&2 become known as the “test of cure”. Cancer: Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities, Commonwealth of Australia Recommendation as per the 2005 NH&MRC Guidelines Under the new NH&MRC Guidelines, introduced in July 2006, it was recommended that, from the time Farewell to Anne of introduction of the new guidelines, a woman diagnosed and treated for HSIL should undergo cervical cytology and HPV typing 12 months after treatment and annually thereafter until she has Long term staff member of the Division, Anne tested negative by both tests on two consecutive Baynes resigned from the position of Aged Care occasions twelve months apart. Once she has Program Officer in December 2007. tested negative by both tests on two consecutive occasions, she should then be screened according Anne commenced with the Division in August to the recommendation for the average population.2 2001 and over the ensuring six years has worked on a variety of programs, including Quality Use of The HPV typing attracts a rebate from Medicare Medicines and then the Aged Care Program. only until there has been a negative result on two consecutive occasions. Any further testing is not Aged Care Forum Chair Dr Craig Brown, in covered under Medicare. thanking Anne for her contribution to the Division said, “Anne was a person who knew how to Women being followed up under 1994 NH&MRC encourage folk into action, whilst doing an Guidelines impressive amount of work herself. She was an It was recognised by the NH&MRC at the time the excellent team player, with a marvellous sense of new Guidelines were introduced in July 2006, that humour, who will be sorely missed”. there would be women who were undergoing annual The recruitment of a new Aged Care/Palliative cytology review as part of the recommended follow- Care Program Officer has commenced, and we up of treatment for HSIL under the old guidelines. hope to announce Anne’s successor in the next This recognition led to the recommendation that issue of GP these women also be offered the “test of cure” as Action. described in the new Guidelines. We wish Anne How the ACT Cervical Register can assist well in her future endeavours, and The ACT Cervical Register has identified over 1600 thank her for her women resident in the ACT who fall into the above friendship and category and is able to provide GP with lists of contribution to women in their practices who, potentially, are the Division over eligible for this test. many years. The list of women sent to practices should be considered indicative only as it is recognised by GP ACTion | January-February 2008 | 5 LIFESTYLE CHOICE Introducing Peta Haesler Project officer for the new Lifestyle choice project Peta comes to us from Dubbo, via Sydney and London! She brings her health promotion knowledge to our new Lifestyle Choice project, which is funded by ACT Health to address lifestyle risk factor management. Peta will spend her time between the Division office, and the Heart Foundation ACT Branch. Lifestyle Choice – a new project! The ACT Division of General Practice has succeeded in obtaining funding through an ACT Health Promotion Grant to address ‘Lifestyle Risk Factor Management’. We have called this project ‘LifestyleChoice’ and have developed this logo to help differentiate this project from others such as Lifescripts. The broad aims of this project are to: • source what local programs are available in • Document referral pathways for each of the ying advert: community to address Smoking, Nutrition, the identified lifestyle risk factors Physical Activity and Alcohol Consumption, • Provide education and training around • Develop and promote the Heartmoves integrated motivational interviewing and use of the exercise program in the ACT Lifescripts resources • Identify any other areas that general practice in the ACT requires support in dealing with lifestyle risk factor modification. Canberra Wollongong Gosford Newcastle Sydney An Advisory Committee is in the process of being set up to ensure that appropriate input is Pregnancy Termination received to this program by GPs, Private & individual treatment community groups and consumer Consultation, ultrasound & counselling prior to procedure Only a 2 hour visit representatives. 24 hour on call advice Mirena/IUD insertion with sedation 6-8 weeks post TOP For more information please D & C for incomplete miscarriage contact Peta on 6287 8099 or 0420 301 875 or email All Hours 6299 5559 email@example.com www.gcaus.com.au 6 | January-February 2008 | GP ACTion AGED AND PALLIATIVE CARE What’s happening in Aged and Palliative care? Anne Baynes The new funding tool is made up of three parts: Are you claiming for the work you are 1. Activities of Daily Living doing in RACFS? 2. Cognition and Behaviour The new Aged Care Funding Instrument 3. Complex Health Care. Comprehensive Medical Assessments To claim for funding in these areas there is a requirement to have evidence of a diagnosis and Presentation on Aged Care Funding information and history of health related issues. The Instrument – 4 March 7.15pm – 8pm – evidence used to support a claim in these areas, all welcome where a diagnosis or re-confirmation of a diagnosis GP Panel Respite Program is required must have been completed within the last 12 months, prepared and signed off by the MBS Update patient’s GP. Journal articles of interest One of the easiest ways of providing documentary Upcoming Conferences evidence of these conditions is to utilise the Palliative Care information gathered in the process of completing a Comprehensive Medical Assessment. > Read on for more information … Comprehensive Medical Assessments Comprehensive Medical Assessments (CMA item Are you visiting residents in a Residential Aged number 712) are available to new residents on Care Facility (RACFs)? Are you aware of the admission into a RACF and for existing residents items you can claim for using MBS? where it is required, because of significant change Comprehensive Medical Assessment $187.65 in their medical condition or psychological function. The Medicare rebate for a CMA is $187.65. Residential Medication Management $ 91.85 Review CMAs for residents of RACFs should include: Contribution to a Resident’s Care Plan $ 43.40 • A detailed medical history, • a comprehensive medical examination, Case Conferences (30-45 minutes) $125.65 • development of a list of diagnosis and problems, TOTAL $448.55 and • a written summary. While there has been an increase of CMAs in the The new Aged Care Funding Instrument and ACT in the last three years, there are probably still Comprehensive Medical Assessments opportunities to increase this further. The Aged Care Association of Australia is advising RACFs that the residential aged care sector is going through a major change to its funding system. A new funding tool – the Aged Care Funding Instrument (ACFI) – will be implemented from 20 March and it is based on measurable needs i.e. the need for care, not the care provided. It replaces the Resident Classification Scale. GP ACTion | January-February 2008 | 7 AGED AND PALLIATIVE CARE While a practice nurse or RN from the facility can their patient having respite although they are assist a GP in obtaining information relevant to the located in the same area. As a patient’s usual GP CMA, the CMA must include a personal attendance is familiar with their own patients, simple matters by the GP at the RACF. By completing a CMA you are around them could be sorted out over the phone. also providing a written diagnosis to support RACFs Please be aware this program is designed for the when the new funding tool starts in March 2008. geographical difficulties GPs may incur when they are providing respite. Come to our next GP Panel meeting and learn about the new Aged Care Funding Instrument MBS Update DoHA is coming to present to GPs on how the Aged The Nov 2007 Schedule is available at Care Funding Instrument (ACFI) will work. This will www.health.gov.au/internet/mbsonline/publishing. coincide with a GP Panel meeting on Tuesday 4 nsf/Content/Medicare-Benefits-Schedule-MBS-1 March 2008. So come along between 7.15pm – 8pm The key changes of interest to divisions GPs are: to get your questions answered and see how this will benefit your patients. • Changes to the dental care MBS items for chronic and complex patients with GPMP/TCA/ GP Panel meeting Contribution to Care Plan in a RACF. Eligible patients can claim rebates up to $4250 over two At our last GP Panel meeting last year we considered calendar years. For more information: options for the Allied Health Care Service Provider www.health.gov.au/internet/wcms/publishing. (AHSP) component of the initiative. A survey of nsf/Content/Dental+Care+Services RACFs and Panel GPs indicated that the AHSPs most needed in RACFs, bearing in mind that the • New Consultant Physician MBS items (132, 133) for Commonwealth has stipulated it is not for clinical expanded assessment, management and review of care, are physiotherapists, dieticians and dental chronic and complex patients. A GP or specialist therapists/oral hygienists. The Panel agreed on referral is required; and the items are intended for three proposals for this year: use for patients with at least two morbidities. For more information: www.health.gov.au/ • ‘Eat Well, Drink Well and Stay Upright’ a falls internet/mbsonline/publishing.nsf/Content/ program in collaboration with ACT Health MBSOnline-News-Consultant-Physician-QA • Oral Hygiene Training for RACF staff an education program in collaboration with the Dental Articles of interest Hygienists Association of Australia – ACT branch In the Medical Journal of Australia there are two and articles about GP services and consultations in • Competencies for Staff in Monitoring and RACFs that might be of interest: Interpreting Blood Glucose Levels, in collaboration • O’Halloran J, Britt H, Valenti L (2007) General with Diabetes ACT. practitioner consultations at residential aged-care facilities MJA 187(2): 88-91. A Reminder for GPs using the GP Panel’s Respite in RACF Program • Gladzhanova S, Reed R (2007) Medical services provided by general practitioners in residential There is a dedicated bunch of Panel GPs who have aged care facilities in Australia. MJA 187(2): 92-94 taken on this program, offering GP access for short-term respite patients, when their own GPs are A study of hospital costs for older people has also unable to do so. The program was designed because been published in the MJA: it was recognised that in the ACT, respite may occur some distance from the patient’s usual place of • Kardamanidis K, Da Cunha C, Taylor LK, Jorm LR residence, i.e. from across the lake or interstate, (2007) Hospital costs of older people in New South making it difficult for that patient’s usual GP to care Wales in the last year of life MJA 187(7): 383-38 for them during this time. These articles can be found at: www.mja.com.au However there have been a couple of reports when a patient’s usual GP has chosen not to attend 8 | January-February 2008 | GP ACTion EDUCATION Conferences Diversity in Health Conference 2008: Strengths and Education 2008 Sustainable Solutions Bronwyn Parsons – Education Officer When: 10-12 March Where: Sydney Welcome to 2008 and the new QA&CPD triennium. More info: www.dhi.gov.au/conference GPs will no doubt be aware that there have been Improving the Management of Cognitive Impairment changes in the RACGP requirements and the Division for Older People is keen to take these onboard and to continue to When: 17-18 April 2008 deliver quality education events. Where: Sydney • Please complete the 2008 Education Survey More info: www.changechampions.com.au enclosed in this newsletter Palliative Care • Do you want to establish a Small Group Learning, a journal club, or arrange a supervised clinical Did you know there is an ACT Medical Treatment Act attachment in any discipline? that discusses pain relief for incapacitated patients? If so please contact me on Medical Treatment Act 2006 firstname.lastname@example.org or call me at the Part 3 - Section 15 Division on 6287 8099. Researching your 17 Adequate pain relief requirements will help me to help others in future! (1) This section applies in relation to a person who – (a) has given a health direction that medical treatment be withheld or withdrawn from the person; and (b) is under the care of a health professional We are seeking a (2) The person has a right to relief from pain and suffering to the maximum extent that is MEDICAL PRACTITIONER reasonable under the circumstances. to join our practice. (3) In providing relief from pain and suffering to The current arrangement is payment at an the person. The health professional must give hourly rate with strong possibility of becoming a adequate consideration to the person’s account shareholder. The actual hourly fee will be discussed of the person’s level of pain and suffering. on application. The practice is conveniently located in the medical precinct in Deakin in a pleasant and attractive environment. We have immediate access to pathology, imaging and other allied health professional services. Being located in a specialist centre, we have good access and relationships with a wide range of specialists. We have on our site audiometry, spirometry, cholesterol and lipids breakdowns, vaccinations and other medical testing equipment. No hospital work, no after hours or weekends. This is not a high pressured organisation. The hours are negotiable and can be full-time or sessional. There is opportunity to be involved in general GP work, occupational health or travel medicine. In order to fit in with the ethic of our practice, we would prefer a doctor who takes pride in their Hippocratic Oath. Immediate start if suitable. To enquire please phone 0407 226 267. GP ACTion | January-February 2008 | 9 THE OPIOD PROGRAM TOP The Opioid Program Carol Guy – Clinical Nurse Consultant The Opioid Program [TOP] is a clinical There is a flyer for each group, and I service based within General Practice, would be happy to email them to you on which aims to improve the care request. Please email me on and treatment of people who are email@example.com experiencing dependency with opiate benzodiazepine or amphetamine use. Within this newsletter you will find a flyer for the Mindfulness Meditation The new Clinical Nurse Consultant, and Stress Management Group which Carol Guy commenced with the Division you may wish to display in your surgery late last year. Carol works three days waiting room. a week on Monday, Tuesday and Wednesday. She can be contacted on 0404 821 173 and will come to your practice for a comprehensive clinical assessment with the patient and the referring GP in your surgery. Carol brings to the position a broad range of clinical skills in the area of pharmacotherapy replacements. Most recently she was employed as a Clinical Nurse Alcohol and Drug Progra m Consultant for The Alcohol and Drug Program and has an interest in Co-Morbidity. Carol has completed 6 Week Mindf a Post Graduate Mental Health Diploma. ulness Meditation and Stre Management G ss Clients in the ACT are fortunate to have a range of treatment options available and future newsletters will highlight some of these, including services for roup families who have a relative with an alcohol or drug issue. The ACT Alcohol and Drug Program have introduced some new groups and a list of the current groups being offered are included below: This group is designed for ADP clients wh Effective Weed Control Meditation an How to identi d other mindful o want to lea ness techniqu rn: es Information Awareness and Coping with and urges fy and let go of unhelpful tho ughts, feelings your Use of Cannabis How to bette r manage stress , sensations Greater appre and unco mfort ciation and ac able emotion ceptance of the s HERE and NO When: Frida W Relapse Prevention Group Where: Traini y’s, 1 pm to 2:3 0 pm Develop and Maintain a Healthier Lifestyle Cost: Free ng Room 1, Le vel 1, ACT He alth Building For further information and to regis phone Louise ter for the ne or Tessa on xt group ple Stepping Stones 6205 4515 or 6207 9977 ase A Practical Course for Family Members Controlling Your Drinking Developing Awareness and Education Mindfulness Meditation and Stress Management Group 10 | January-February 2008 | GP ACTion As keen as a teen … ‘KEENAGER’ may be a curious term, but it symbolises a healthy, positive attitude towards growing older. Gail Aiken, mpowerdome Managing Director and Keenager instructor explained, “a Keenager® is someone who is as keen as a teen, with a growing sense that age shall not weary them.” ‘Keenagers®’ are participants in an exciting and innovative health and physical activity program designed by qualified instructors for people aged between 50 and 90+years of age which is offered from the mpowerdome facility in Fadden. Programs for Keenagers® address prevention against falls, low muscle tone, recovery from surgery, cardio vascular conditioning, poor coordination and physical activity prescription for various diseases. Such needs are addressed through gentle exercise (mpower age); strength & conditioning (mpower up) and a variety of modified sports and games to assist coordination as well as providing lots of laughter and social connection. In addition to these activities, mpowerdome instructors also facilitate tennis coaching play for the over 50’s – inclusive of people with disabilities. GP referrals have been an entry point for some Keenagers. Mpowerdome welcomes a holistic approach to client management to ensure appropriate physical activity options are recommended and duty of care exercised at all times. All Keenager instructors are trained and qualified in working with the mature aged population and are required to undertake continuous professional development. For more information about Keenager programs please call 6298 5500. GP ACTion | January-February 2008 | 11 GETTING TO KNOW YOU UP CLOSE and PERSONAL ... UP CLOSE and Welcome to a brand new section of the Rashmi Sharma is the new ACT Division newsletter, where we will get to know our of General Practice President, and she took a Division Board members, Division Staff and few moments out of her busy Friday morning to our very own Canberra GPs! answer a few questions. Each issue will feature 3 short interviews and Rashmi was born and schooled in England, and profiles of our ACT Division community and moved to Australia with her family in 1993. She (hopefully) some photos to help us discover spent the first five years on the Gold Coast where she sat the AMC exam and then completed her the many personalities and talents out there. Diploma of Obstetrics and FRACGP in Northern The first issue will introduce our newly elected NSW. President Dr Rashmi Sharma, Deputy CEO In the meantime, her family had moved to Kelly Gourlay and Dr Neel Roy. Watch out for a Canberra and persuaded her to join them in 1998. questionnaire coming to a fax near you! Like most of us, “I’ll stay for a couple of years” Sonia Res, Medical Advisor has become ten, and she has been busy building up a practice that started in (and roving reporter) Calwell and has since moved to Isabella Plains. In between seeing patients and being President, Rashmi also actively teaches both medical students and GP registrars. 1. At school I ... I had to wear a dreadful pink Rashmi’s vision for the Division in 2008 is to “encourage more GP uniform and never quite fitted into the snobbish involvement” and to use the many resources available at the Division to atmosphere that a private girls school in the city better help at the grassroots level, and to “make a difference out there in the of London exuded. surgeries”. 2. At the moment I am reading ... “Woman’s best friend”: a book about women who are dog owners Out of the surgery, Rashmi loves to travel with her husband Stuart, and and their relationship with them – can’t relate to spend time with their German Shepherd, Anghad. She likes to grow veggies those who sleep with their dog though! and ‘chill out’ with her pet cows on her farm property up north. Her surgery, 3. If I was a flower I would be ... an African patients and family are actively involved in a project sending clothes and daisy – hardy, indestructible, down to earth and books to a school in India. Patients bring in fabric pieces, which are then good value. It self seeds prolifically so I never made up into ready to wear garments for the children. One of her patients have to buy new plants when they die (the stingey has made over 2800 dresses! Indian coming out in me!) 4. The last belly laugh I had was ... on my farm in Murwillumbah a few weeks ago. I was sitting on a hillock watching hubbie slash the paddock below on his latest toy (new tractor). Mount Warning looked majestic in 1. I can’t live without ... my ‘me’ time which front of me and I was feeling very peaceful and meditative ... then my usually involves a bath, good book and a glass of German Shepherd started to lick my face on one side and our new Brahman red calf started to lick my face on the other side. Put it all into perspective really. 2. The FIRST thing I do when I wake up is ... 5. My ideal dinner party guest list would include ... my hubbie as he go for a walk, have a hot water and lemon drink is good at serving the simplest fare and making it look like restaurant food; and give my ‘girls’ (cats) a hug my mum and sisters to ensure the quality of the food; rest of the immediate family otherwise I would be in their bad books and finally my best friends 3. If I wasn’t ME I would be ... one of my ‘girls’. from Queensland to bring some vulgarity to the evening! They are completely spoilt! 6. My FATHER and MOTHER always told me ... to be satisfied with 4. What makes me SMILE is ... my husband what I have/life deals me – when I was a teenager I hated my thick head of Sean. He is a preschool teacher and reminds me hair – when it fell out when I had treatment for Hodgkins Lymphoma and to not take things too seriously, and to have fun. grew back thin my mother reminded me of the days I used to lament over my 5. My top 3 movies are ... Silence of the Lambs; thick plaits. Something’s Gotta Give; Bridget Jones’ Diary. Dr Rashmi Sharma Kelly Gourlay Kelly Gourlay is the Deputy CEO of Accident Care Evaluation Study (ACE), to the ACT Division of General Practice, and name a few. the Mental Health Development Liason Her background includes a Hospital Science Officer (DLO). She is responsible for all Traineeship (St George, Kogarah), B.Medical reporting requirements for government/ and Biotechnology, and is currently ACT health; policy development; undertaking MPH. proposals and tender development, and oversees any research done by the Kelly has worked at the Division since August Division. She also manages the dynamic 2005, and would like to see the Division and productive staff at the Division on a membership actively use the many resources day-to-day basis. and opportunities available to help GP’s in the daily running of their practice. At the Division level, Kelly is responsible for the National Bowel Cancer Screening Out of the Division, Kelly loves to play with her program, Serious and Continuing Illness two cats (The Girls) and spend time with her Policy and Practice Study (SCIPPS) and husband Sean. 12 | January-February 2008 | GP ACTion GETTING TO KNOW YOU d PERSONAL ... UP CLOSE and PERSONAL ... Dr Neel Roy works fulltime at the Dickson Travel and Medical Centre 1. My EARLIEST memory is ... watching the with 3 other GPs. He has been there ‘Flying Nun’ with my Mum for over 2 years and has an interest in 2. I don’t like talking about ... my addiction to travel medicine. Neel has also been a Saturday newspapers tutor for the 1st and 2nd year medical 3. I wish I had ... photo recall for all the patient’s names I forget students at ANU. 4. My favourite GADGET is ... my IPOD Outside the surgery, Neel enjoys 5. MOUNTAINS or SEA? ... Mountains bushwalking with his wife Rachel, 6. My worst job was ... Nursing Home assistant. good coffee and supporting the Indian Worth their weight in gold! cricket team. He likes a good game of 7. My IDEAL Friday night is ... sharing a golf and watching his beautiful baby glass of wine and the mixed grill plate at Kismet daughter Ashima grow up. (Manuka) 8. At the moment I am reading ... The Kite Runner 9. After a busy day at the surgery I like listening to ... Coldplay Rush of Blood to the Head Dr Neel Roy Poem, Untitled My childhood home Arts Corner is overrun with rats whose sharp teeth shred the eager, blind puppies of memory. My mother has shrunk, Do you have an artistic bone in your body? We’d like to expose her half-truths warp my bones. the ‘hidden talents’ amongst our GP ACTion readers. My father is lost, So if you write/draw/paint/sew/scrapbook/photograph we would like to hear hunting crabs on mud-flats from you! long ago drowned. Please contact Sonia Res or Bronwyn Parsons by phone 6287 8099 or fax This is the play, and not 6287 8055 as I hoped, • We will run a feature article about your ‘After Hours’ activities! the dress rehearsal. I look to the Great Actor, but she is improvising as badly as the rest of us. No-one watches. None but the rats whose eyes gleam redder Many thanks to Dr Joo-Inn Chew, with each coarse white hair who has agreed to be our first Arts contributor with one of her poems. I pluck from my head. As well as working part time at the Interchange General Practice, Joo-Inn loves And the bones of my friend writing “once she stops procrastinating”! unknit in a cemetery She has finished a Graduate Diploma of not far away. Professional Writing at UC, and is currently Only yesterday we sat in the warm dark. editing a collection of short stories from toasting our memories, daring • Canberra GPs. to dream of the future. Joo-Inn Chew GP ACTion | January-February 2008 | 13 NBCSP The National Bowel Cancer Screening Program Janine Spencer RN, Information Manager ACT and South NSW National Bowel Cancer Screening Register, Medicare Australia FOBT is 12 to 40 times more likely to have colorectal Information details at a glance: cancer than somebody with a negative test. • Not received a kit, or want additional kits, It is essential that any positive FOBT (even if just please call information line to order on 1800 one of the samples is positive) is appropriately 118 868. investigated. Colonoscopy is preferred as it allows • All information is available on-line at for biopsy and removal of adenomas. Haemorrhoids www.cancerscreening.gov.au and colon cancer can co-exist. • Free fax number to submit completed program **Please remember to complete the Assessment forms: 1800 115 062 Form – Referred for colonoscopy/Not referred for • Division contact – Kelly Gourlay, ACT colonoscopy and return to the NBCSP Register. representative, Divisions Network NBCSP Copies of this form can be found in the GP Group. Phone: 6287 8099 or Information Kit and can be ordered through the e-mail firstname.lastname@example.org Information Line 1800 118 868. Reminder letters are sent to the participant and their nominated GP if no notification is received 8 weeks following the The National Bowel Screening Program (the positive result. Program) uses faecal occult blood testing as the initial screening test. Two main types of FOBT are Did you know?? available: 41.9% of participants with a positive FOBT result 1. guaiac tests, which are based on the have been reported as having had a colonoscopy. pseudoperoxidase activity of Haem; and Please note that this is reported numbers and does not account for lags etc in reporting. 2. immunochemical tests, which utilise antibodies against human haemoglobin. In the first 12 months of the Program 62.8% of all positive FOBT results which were investigated Immunochemical tests have both a higher by colonoscopy, found pre-cancerous polyps, sensitivity and specificity than earlier guaiac adenomas or cancers. tests and do not require medication or dietary restrictions. For further information please contact NBCSP Information Line on 1800 118 868. Immunochemical FOBTs can detect 60-90% of cancers and many advanced adenomas under ideal conditions (NHMRC, 2005). The NHMRC (2005, Section 3.5) advises that a person with a positive National Bowel Cancer Screening Program – Statistics as at 31 December 2007 Invitations No. of Crude Participants with Positivity sent Participants participation rate* positive FOBT rate^ National 713,730 290,965 40.8% 21,906 7.5% * The crude participation rate will generally underestimate the true proportion of the population who will participate in the Program. This is because at any point in time there will be members of the population who are eligible to proceed to the next point on the screening pathway but who have not yet had time to do so. ^ Positivity rates exclude ‘no test results’ and ‘inconclusive test results’ 14 | January-February 2008 | GP ACTion NBCSP NATIONAL BOWEL CANCER SCREENING PROGRAM Role of the Screening Nurse at The Canberra Hospital & how you can help Virginia Bird, RN, National Bowel Cancer Screening Program Gastroenterology & Hepatology Unit, The Canberra Hospital • Patients who require colonoscopy as part of the National Bowel Cancer Screening Program (and wish to be a public patient) can be referred to the screening nurse at The Canberra Hospital, Virginia Bird, or they can be referred to a gastroenterologist. • Referrals should be clearly marked with the blue National Bowel Cancer Screening Program sticker. We appreciate your attention to this detail as it greatly enhances the promptness of the screening process and the quality of data collection for this important project. • Participants of the NBCSP are contacted by the screening nurse and will be seen in 1-2 weeks for a pre-colonoscopy assessment and booking. A gastroenterologist is consulted if the patient has complex issues. • A colonoscopy is performed usually within 4-6 weeks. • Patients requiring anaesthetic support for colonoscopy are booked on a heavy sedation list, which is usually attended within 8 weeks. • The screening nurse monitors pathology results and facilitates appropriate patient follow-up. • The screening nurse maintains a database of TCH patients and collects ACT data from the NBCSP. GP ACTion | January-February 2008 | 15 PRACTICE NURSING Nursing in general practice Chrissi Arthur – Program Officer Welcome to another year in Practice Nursing. The Clinical practice with Charles Darwin University ACTDGP will be offering education to Practice Graduate School of Health Practice. She is a Nurses throughout the year starting with Ear particularly enthusiastic and motivational speaker Irrigation in February. This course has been very who encouraged us to look at research in our well supported and is booked out however we workplaces to improve client care, for our own hope to run it again later in the year for those of professional growth and not to take things at you who have missed out this time. face value. Last year the ACTDGP, specifically the Nursing in I would like to thank the ACT Division of General General Practice Program, provided funding to Practice for the opportunity to attend this assist some of the Practice Nurses to attend both conference and would strongly recommend that The RCNA Nursing in General Practice Conference all practice nurses in the ACT should attend next in Hobart and the PNCE in Melbourne. This was year’s conference –location as yet undecided. a wonderful opportunity to network with other Practice Nurses from around Australia. Jill Pearson – Practice Nurse, Tillyard Drive Two of the nurses have written reports for your Medical Practice interest. MELBOURNE PNCE NOVEMBER 2007 Patricia Campbell – Practice Nurse Having made a conscious decision to follow a RCNA PRACTICE NURSES CONFERENCE different career path, & then coming back to Wrest Point Casino Hobart, 12-14 October 2007 a Practice Nurse position just two weeks prior to the Practice Nurse Clinical Education (PCNE) The theme of this 5th annual conference was Conference, held at the Melbourne Exhibition ”Maximising nursing’s contribution to primary & Conference Centre 17th & 18th Nov, 2007, I health care.” The conference aims were to bring found the timing & enthusiasm generated a real together all health professionals with an interest motivational boost. in general practice nursing to share information and develop collaborative relationships. There The sessions I attended were: - Sterilizing, Sports was to be a strong focus on current practices Injury Strapping, Acute Wounds, Chronic Wounds, and promoting continuous quality improvement Clinical Guidelines, Legal Issues & Professional through teamwork. Indemnity, Understanding Practice Scope, Spirometry, Understanding The RACGP 3rd Edition The keynote speaker was Dr Sue Pullon who is Standards, & Postnatal Depression. a Senior Lecturer in the Department of Primary Health Care and General Practice in Wellington, The opportunity to network with practice nurses New Zealand. She spoke about effective team from all around Australia, both within sessions and and interprofessional work amongst doctors and over meals was a vital component of the conference. nurses involved in primary health care. Dr Pullon The conference was run over two days, starting stressed the importance of trust, interprofessional at 0845 hrs, & running till 1600 hrs. There were education and appropriate leadership for this to be 5, 1-hour sessions per day, & each session was maintained. either run in a seminar or workshop format. There were also concurrent sessions covering Most presenters had either talk outlines, or topics on research and projects, chronic disease comprehensive notes, which added to the management, professional issues and the nursing opportunity to glean knowledge. workforce in general practice which were extremely I came away with a renewed enthusiasm to helpful and enlightening. endeavour to utilise the best practice knowledge The plenary speaker was Professor Sandra base out there, & more fully utilise the resources Dunn who is currently Professor of Nursing, available. 16 | January-February 2008 | GP ACTion PRACTICE NURSING For any Practice Nurse who hasn’t had the Australian Government Practice Nurse opportunity to attend a PNCE conference, I highly Scholarship Scheme recommend putting it on your calendar now, as you not only come away feeling rejuvenated by In 2005 and 2007, The Australian Government in the knowledge boost you’ve just received, but conjunction with the Australian Practice Nurses the shear size of the conference, along with the Association funded scholarships for Practice huge range of trade stands, makes the experience Nurses for Continuing Professional Development. truly worthwhile. I have been very fortunate in being the recipient of Thank you to the ACTDGP for the opportunity to two of these scholarships. In 2006 I completed the attend the PNCE Conference, & thank you to my ‘Immunisation For Registered Nurses’ as a distance employers who encouraged me to attend. education unit through the College of Nursing. This was an invaluable course as immunisation plays a major role in my duties. The doctors at the general PEPA (Program of Experience in the practice where I’m employed depend on me to Palliative Approach) have up to date knowledge in this area. PEPA is an initiative funded by the Australian I am currently studying ‘Wound Management” also Government Department of Health and Ageing through the College of Nursing. This will be of great through the National Palliative Care Program. benefit to both the practice and myself, as it will The overall aim of the program is to improve the increase my knowledge of all aspects of wound care. quality and accessibility of palliative care services I encourage all Practice Nurses to take advantage to all people with life-limiting conditions and of these scholarships when they are offered as their families. they provide a wonderful opportunity for learning PEPA may be a great opportunity for you to gain and knowledge enhancement. knowledge, skills and experience in the palliative Information is available on the APNA website approach to care. www.apna.asn.au Many nurses and allied health staff care for people Naida Fletcher, Practice Nurse with life-limiting conditions such as Parkinson’s Plaza Medical Centre, Woden disease, motor neurone disease, chronic obstructive pulmonary disease, end stage organ Research – Practice Nurse Job Content failure, cancer, cystic fibrosis or severe dementia. Research on general practice nurse job content is If you work in the primary health setting being carried out at the University of Technology supporting patients with these types of conditions, Sydney and has been endorsed by the Australian then PEPA may provide you with further skills and Practice Nurse Association (APNA) Policy and experience to improve your care for patients. Research Development Committee. PEPA includes: This research contributes to an understanding • funded clinical workforce placements up to ten of the professional roles that practice nurses are days with a specialist palliative care service engaged in - the results of which will inform future within a metropolitan or larger provincial service professional development and health sector policy. It explores the factors that effect the decision • a planned activity that you implement in your making of practice nurses working in general own workplace within three months of practice settings. For this research to be a success completing the placement the assistance of PNs is required, if you have not • establishing networks to assist you in your own already done so please consider participating in practice with people with life-limiting conditions. this research. The confidential survey should take no more than 15 minutes to complete. There are both placement and workshops available to nurses to learn more about the process of To find out more or to participate in this research Palliative Care. For information on the program please visit: www.nmh.uts.edu.au/chsm/research/ contact Chrissi Arthur 6287 8099 for an pnjcq, or for further information, please contact application form. Eamon Merrick on Eamon.email@example.com. GP ACTion | January-February 2008 | 17 HOME MEDICINE REVIEW Identifying patients for HMR with involvement of Practice Staff Sarah Haltiner Just like any task, getting started is always the that you would like all your patients taking warfarin hardest step. With HMR, you may have asked to have a HMR. Ask your Practice Manager to yourself, which patients should I refer? It’s the identify these patients in your computer records and patients you see everyday! Those with multiple put an HMR reminder in the patient’s file, ready for medications, recent discharges from hospital, you to see at the next visit. possible medication adverse effects or cognition Your practice staff can also be aware of incoming HMR difficulty just to name a few. The list of possible reports and call the patient to make the subsequent patients is long but can be summarized by appointment for follow up. Also giving them a considering that it can be any patient that you reminder phone call before the appointment to ensure feel would benefit from a clinical review to ensure completion of the management plan, allowing you to quality use of medicines. claim the MBS Item 900. Although you may see these types of patients Of course your practice staff can also start the every day, it might not occur to you at the time of process for claiming Item 900. It is essential to appointment to refer them for a HMR. Enlist the help keep communication open so they are aware a of your practice staff and Division. Medication Management Plan was completed during Item 900 indicates that other health care the consultation, and the appropriate MBS Item professionals can identify patients to you as well. number can be noted. There is a set form so be sure to let your staff know For more information, please call Sarah at the Division that these may be faxed through to the surgery. on 6287 8099 or email firstname.lastname@example.org. Simple Steps for a Successful HMR How to make a HMR easy DELEGATE Anyone can identify a patient for a HMR. Ask your practice staff to select patients that would benefit from a HMR and alert you at the time of consultation. Practice nurses doing health assessments are ideal staff members that have access to the patient’s medication history MAKE THE MOST OF YOUR COMPUTER Involvement of Practice Staff There is no need to muck around with referral pads Practice Staff are essential members of the HMR and paper notes. Even the most computer-phobic GP team. Their role can streamline the process and can manage a HMR referral. A HMR referral form can keep the role of the GP purely clinical. Your HMR be generated during a consultation with just a few Facilitator at the Division can come in and train your mouse clicks. All the necessary referral information staff about how they can help with HMR. is automatically incorporated from the patient’s file onto the referral form. Ask your HMR Facilitator for Identifying patients is a key area where practice a quick demo and for handy hints to speed up the nurses can be of most help. They regularly come process even more across patients, especially while conducting Health Assessments, who would benefit from a HMR. TALK TO YOUR PHARMACIST Why not ask them to put a HMR reminder on the HMR reports can be adapted to your preferred patient’s file? Next time that patient comes in for a method of receipt. Talking to your local accredited consultation you will see it. pharmacist will give them an appreciation of the types of reports you prefer and how you prefer Practice Managers can also help in finding a to receive them i.e. fax, email or post. Also if in particular target group. For example, you may find 18 | January-February 2008 | GP ACTion HOME MEDICINE REVIEW the referral you can give the pharmacists the your books to new patients. A HMR can identify information needed for them to write a great report. some of the patient’s problems or their anxieties This can avoid unnecessary delays and interruptions and help them to understand their medication and with the HMR process. conditions a little better. How HMR can improve your practice If would like more information on how your practice can become involved in HMR, or how your practice If you are too busy and do not have time for can improve the HMR process please contact Sarah anything more than your basic consultation, Haltiner, HMR Facilitator on 6287 8099 or email: HMR can give you a big picture of the patient’s email@example.com medication management, without having to spend the time to do the investigation yourself. You may sometimes find that the same patients take up a lot of your appointments, forcing you to close Completing just two HMRs a week can generate up to $13,000 in MBS Payment annually. One a day can give you up to $45,000 annually. Practice Services Janet Cossart 2008 is shaping up to be a big year for the Practice months, many of you have raised the subject of Services Program. medical records, including issues such as the rights and responsibilities of both patient and GP with regard CPR to access to an individual’s medical records; can a GP GPs are reminded that starting with the 2008-2010 charge for a patient to access their record; who owns triennium, a requirement of the RACGP QA&CPD the record; transfer of records to another medical program is that they must complete a basic CPR practitioner; what happens to medical records when course which meets Australian Resuscitation Council a practice closes down, or a GP retires; storage and guidelines. In conjunction with Parasol EMT the Division archiving of records and general privacy issues. We is again organising CPR updates for GPs, practice nurses are pleased to announce that we have organised for and practice staff be held on the following Tuesday the Human Rights Commission (ACT) to present two evenings – 19 February (now full!), 27 May, 29 July and workshops on this topic, to be held in the Division’s 28 October. Cost is $65 per person (including GST). Boardroom on the evenings of Wednesday, 2 April and Please contact me at the Division if you are interested in Wednesday, 27 August. Please note these dates in registering for one of these sessions. your diary – further information and an opportunity to Software training register will be sent out closer to the time. There has been a fantastic response to our request for Practice Services Workshop expressions of interest for training in various medical The date is set – Saturday, 21 June 2008 at Rydges software programs. In consultation with the trainers, Capital Hill. All other details are still being worked out, we are now fine tuning the modules and are expecting but it will be an informative day of sessions for GPs, to hold training sessions during February, March and practice nurses and practice staff, closely tied to the April. GPs and practice staff members who indicated RACGP Standards for general practices (3rd edition) and an interest in attending the training should watch out requirements for practice accreditation. Mark the date for a fax from the Division, outlining the details and in your diary now and stay tuned for further details. asking them to make a firm booking. Numbers will be limited, but if there is sufficient interest, we may If you would like more information on any of the above, consider running the training again later in the year. or would like to chat generally about what the Practice Services Program can offer, please call me on Medical records 6287 8099 (Tuesday to Thursday) or send me an email During my visits to local practices over the last few – firstname.lastname@example.org. GP ACTion | January-February 2008 | 19 IMMUNISATION Immunisation news Hailey Shaw Appointment of Dr Philip Toua as GP coverage. As you can see from the graph below the Immunisation Advisor overall Divisional coverage rates have improved as has the Divisional ranking. Your continued efforts Dr Toua works full time at the Isabella Plains Medical are much appreciated. If you would like to discuss Centre and has been there for the last 3 years. He immunisation in your general practice please graduated from UPNG in 1988 and has worked in contact Hailey on 6287 8099 or 0404 821 106. PNG, New Zealand and Australia in varying roles. One of the main reasons for applying for the GPII Coverage - ACTDGP Immunisation Advisor role was to be a part of the 92 local GP Division but he hopes that his developing 91.5 91.3 91.4 country paediatric experience, where children are 91.2 91.1 91 90.9 90.9 90.8 90.7 90.7 still dying from immunisable conditions will be able 90.6 90.6 90.5 % Fully Immunised 90.3 90.2 to help him in this role. 90 90.0 89.9 calculations recalculatoins 89.5 89.5 89.5 89.5 9th Edition Australian Immunisation Handbook 89 88.9 88.5 The 9th edition of the immunisation handbook is 88 on its way! We are hoping that it will be available 87.5 5 6 7 06 07 05 6 06 7 07 -0 -0 -0 -0 -0 b- b- g- g- g- in the next couple of months and have been ov ov ov ay ay Fe Fe Au Au Au N N N M M Calc/recal mths assured by the Department of Health and Ageing National Ranking that all providers will be sent a copy as soon as it is Calc/Recalc Mths 6 7 05 5 06 6 07 7 06 07 -0 -0 -0 -0 -0 g- g- g- b- b- released. If you do not receive one after it has been ay ay ov ov ov Au Au Au Fe Fe M M N N N 30 31 released please contact your division, your local state or territory health department or you can order 35 35 37 on line at: www.immunise.health.gov.au/internet/ 40 39 39 40 immunise/publishing.nsf/Content/publications National Ranking 42 Calc 44 44 Recalc An education event addressing significant changes 45 47 47 46 47 and new additions to the 9th edn. AIH is planned 50 48 for mid March and invitations will be distributed 51 51 52 51 52 shortly. Dr Greg Rowles, AGPN GP advisor on the 55 National Immunisation Committee has been invited to present at this event. Rotavirus Vaxigrip junior® funded An Immunisation Provider Guidelines booklet is now available in pdf form from the Australian Australian Divisions of General Practice are excited Government Department of Health and Ageing to hear that the Australian Government Department Immunise Australia website. The link is as follows: of Health and Ageing will be funding Vaxigrip junior® under the Pharmaceutical Benefits Scheme (PBS) www.health.gov.au/internet/immunise/publishing. from 1st January 2008. nsf/content/A008BA27166C36CACA25735A001521A D/$File/rotavirus-provider.pdf Vaxigrip junior® is a form of influenza vaccine suitable for children up to 35 months of age who ACT General Practice Immunisation Incentives are at risk of adverse consequences from lower (GPII) coverage and Divisional ranking respiratory tract infections (chest infections). This Congratulations on your hard efforts over the past will provide doctors with a more convenient form of year in achieving high childhood immunisation influenza vaccine for young children. 20 | January-February 2008 | GP ACTion MENTAL HEALTH Consultation-Liaison Psychiatry information for GPs The principal role of the Canberra and Calvary Hospital Hospital wards the CL service does not cover: Consultation- Liaison team is to support general • Patients in Paediatric Wards TCH 4A/4B. These hospital staff in the assessment and management of referrals are made to the Child and Adolescent Mental patients with mental health issues. Health Service (CAMHS). • The Emergency Department which is covered by the The Consultation-Liaison Service comprises of: Mental Health Crisis and Assessment Team (CATT). Consultant Psychiatrists, Psychiatry Registrar, a Clinical However, people in ED who have been admitted and Nurse Consultant and an Office/ Intake Manager. waiting for a bed are covered by C.L. CATT 24-Hour General practitioners admitting a patient with mental Access phone 1800 629 354 health issues or concerns, can request as part of the • Ward 11A: Geriatrics. These referrals are made to admission letter (with a brief summary of concerns) Older Persons Mental Health (OPMHS) requesting a Consultation-Liaison consult from the The most common mental health issues seen by CL hospital treating team. • Depression in medically ill The request to Consultation-Liaison is then made by the • Medically unexplained symptoms (Somatoform hospital treating team, as they need to address issues disorders) such as: • Bipolar Disorder • Is the patient aware and agreeable to the referral? • Suicidal ideation/behaviour • Delirium • The referral must be written in the patient’s notes, to • Psychosis, and enable CL access. • Personality Disorders. Should the patient require a transfer to a Psychiatric The Consultation Liaison Service operates during ward or discharge follow up with community mental business hours Monday to Friday 08:30 to 17:00.After health clinical management, the CL team can facilitate hours and public holidays use the on call Psychiatric that process. Registrar. Better access to psychiatrists, psychologists, and GPs through the Medicare Benefits Schedule National information and orientation sessions: Building the local mental health care team Peter Wise, Mental Health Education Officer In February, the ACT Division of General Practice Ageing and the Australian General Practice Network. will be running a module from the Better Access to The ACT Division of General Practice will be offering Psychiatrists, Psychologists, and General Practitioners Module C: Building the local mental health care team through the Medicare Benefits Schedule National on Wednesday 27 February. Flyers have been posted Information and Orientation Sessions. This Initiative to all GPs and early fax back of your registration is provides increased community access to mental health welcome. This session will discuss how to foster professionals and team-based mental health care, collaboration and communication between providers and encourages collaboration between GPs and other by providing: mental health professionals. • information on developing a multidisciplinary mental These sessions have been developed to provide a health team forum for skills development, education and local • facilitated small-group exercises of clinical scenarios networking between general practitioners, allied • discussion on the pitfalls and benefits of team-based mental health professionals, nurses, drug and alcohol care, and professionals, ATSI health workers, pharmacists, • networking exercises. personal helpers and mentors, and peer support workers. They are a collaboration between the For more information, please contact Peter Wise on Australian Government Department of Health and 6287 8099 or by email on email@example.com GP ACTion | January-February 2008 | 21 NPS Osteonecrosis of the Jaw Helen Cutler Following a television report late last year, risk in any patient taking a bisphosphonate by osteonecrosis of the jaw (ONJ) has been topical about a factor of 8.3,5 amongst practitioners, and in the wider community. Avoiding dental surgery during bisphosphonate In response to that report the National Prescribing therapy is especially important for people at risk of Service (NPS) prepared a fact sheet to provide osteonecrosis of the jaw, such as those receiving doctors and pharmacists with information on the large intravenous doses for malignancy. Other risk incidence of osteonecrosis of the jaw associated factors to consider include advanced age, long-term with the use of bisphosphonates. therapy, immunosuppression and co-morbidities Summary of evidence (e.g. diabetes).1-5 Osteonecrosis of the jaw is the breakdown of bone A dental assessment may be needed before in the jaw. It occurs rarely with bisphosphonate starting a bisphosphonate (including people therapy, but it is difficult to treat and may not with dentures).3,4 People already receiving a resolve.1,2 Assessing the patient’s risk, and bisphosphonate should not undergo dental referring them for a dental check-up before starting surgery until their risk of osteonecrosis of the jaw a bisphosphonate, may help to minimise the has been assessed.3 There is no evidence as to likelihood of this adverse effect.3 Patients who are whether bisphosphonates should or should not be taking a bisphosphonate need to be aware of the stopped before dental surgery or after the onset of a signs and symptoms of osteonecrosis of the jaw reaction.4,5 which can vary and include exposed bone, severe (References available on request from the ACT Division of General Practice) jaw pain, numbness, loose teeth, oral odour, infection, impaired healing and denture sore spots.4,5 The NPS Facilitator is currently providing The cause of bisphosphonate-induced educational visits on ‘Preventing osteoporosis osteonecrosis of the jaw is unknown, however the and reducing fracture risk’. Educational visits risk increases after dental surgery.3,4 A systematic are a Quality Prescribing Initiative within the review of 368 published case reports found that Practice Incentives Program. 60% of cases occurred after a tooth extraction or To book a visit please fax back the flyer included other dental surgery.5 Infection or local trauma, such in this newsletter, or phone Helen Cutler on as that caused by poorly fitted dentures, may also 6287 8099 or email firstname.lastname@example.org precipitate osteonecrosis of the jaw.3,5 Most reports of osteonecrosis of the jaw are associated with intravenous bisphosphonates (such as zoledronic acid or pamidronate) in people with multiple myeloma or metastatic breast cancer The Cancer Council provides on-site training who underwent dental surgery during treatment.1-6 for health professionals in An Australian study estimated the incidence in smoking cessation. people with osteoporosis taking bisphosphonates We’ll come to your surgery – or venue of to be about 0.01% to 0.04%, and in people with choice – and help you, help your patients malignancy using bisphosphonates to be about quit smoking. 0.88% to 1.15%.3 While the incidence is lower Please ring The Council on 6257 9999 or among people taking oral bisphosphonates for email email@example.com osteoporosis, a dental extraction can increase the 22 | January-February 2008 | GP ACTion CLASSIFIEDS 2/52 Job Opportunities Wanted VR assistant GP full or part-time, immediate opportunity to join a professional GP team in an accredited Kerry Weller-Lewis, Administration team urban general practice providing comprehensive care. Practice nurse present. For more information call Dr Ian Brown 2/52 Job Opportunities is distributed by fax at the on 0408 482 142. beginning of each month to each surgery. If you would like to include anything in the next VR GP LOCUM AVAILABLE 14/4/08 -18/4/08 Professional VR GP Locum with many years of experience edition of 2/52 Job Opportunities, please email available. NSW Graduate 1991 FRACGP registrant . For further firstname.lastname@example.org details please contact Susan Hill or Andrea Kennedy at Medical Recruitment on 1300 137 142 or email us at The Job Opportunities is a free service for GPs email@example.com in the ACT and surrounding areas. GENERAL PRACTITIONERS PRACTICE NURSES Washed Up Position Available Dr Ian Brown has at last lost a round with Registered Practice Nurse – Wakefield Gardens Surgery, Ainslie. a wave at the South Coast. The score is Ability to work within a great team. Modern & computerised Ian 40,000, Waves 1, but it only takes one practice. Preferably 4 days per week – Monday, Tuesday, to do the damage! A plate and 12 screws Thursday & Friday. Flexible hours. Please contact Marion, later, he is in urgent need of an assistant Eleanor or Margaret on 6257 4086. / locum cover at his accredited Mawson practice. If you can do sessions on a P/T Practice nurse on southside. Should be experienced short or long term basis, please contact Ian on 0408 482 142. in sterilisation, procedures, assisting in minor surgery, Any help at all would be welcome. immunisation, wound management, care planning and management of chronic diseases like diabetes. More Female VR GP wanted for busy surgery in Conder. Full information – Dr Ying Liu 6286 2577. computerised billing system. Full time Practice Nurse, friendly team. For all enquiries please contact Kim on 6294 9366. Canberra – FT/PT GP basic/advanced + mentorship reg req, PRACTICE STAFF busy, friendly ext hr accred fam prac, excel remun, priv bill, flex hrs, Ph 02 6259 1444. Part time medical receptionist The Interchange General Practice is a large medical practice located in University Avenue, Civic, close to ANU. We are GP Wanted - Fyshwick Medical Centre looking for a part time receptionist, able to work on one or more FT/PT female GP for accredited computerised practice. Private of the following days: Monday, Thursday or Friday. Friendly billing, no After Hours or Weekends. Phone 02 6280 4254 for working environment, good conditions, flexible working hours more information. and above award wages. Fluent English and basic computer skills necessary and receptionist experience an advantage. Applications by email only to Paul Hartigan on firstname.lastname@example.org Curtin Medical Practice FT/PT GP required for a busy, well established, friendly, accredited practice. Fully computerized, private billing, Practice nurse, hours negotiable. For more details contact Marie: 0411 879 149 or email@example.com FOR SALE Welch Allyn dermatoscopes with handle (takes 2xC matteries) - Chapman Medical Practice 3 available for sale @$150 (+ P&H) Please e-mail We are looing for a GP to work sessions or full time.Friendly firstname.lastname@example.org practice with Practice Nurse. Phone Kevin Gow/Tracey Baker on 6288 5000. Accred Family Practice seeks FT/PT GP Flexible hours, no after hours or weekends. Private billing. Mawson Medical Centre, Phone 02 6286 2577. GP North Canberra Join us. Our accredited family practice offers flexible hours, good remuneration, and a guaranteed minimum. Your presence will be appreciated. Please phone Dr Peter Ragg on 6248 7005. CHANGE OF ADDRESS If your mailing details have changed, VRGP needed for very busy modern family practice with please fax your new details to the Division attached Pathology provider. Flexible hours, no A/Hrs and good conditions to right candidate. Phone Jamison Medical Clinic on 6287 8055 Maquarie ACT 2614. Phone 6251 2300. GP ACTion | January-February 2008 | 23 Calendar of education events Date/Time Event Venue RSVP/Cost FEBRUARY 2008 Wed 27 February Better access to Psychiatrists, Arthur Streeton Room, RSVP: Peter Wise on 6:00 for 6:30pm Psychologists, and General Rydges Capital Hill 6287 8099 start – 9:30pm Practitioners through the Medicare Benefits Schedule – Module C: Building the local Mental Health care team MARCH 2008 Tue 4 March 2008 Aged Care GP Panel meeting ACT Division of General RSVP: Anne Baynes on 6:30-8:00pm Guest Speaker –DoHA Practice boardroom, 6287 8099 representative Weston Aged Care Funding Implement Tue 4 March 2008 NPS Case study – Selective use of The Boathouse by the RSVP: Hailey Shaw on 6:00 for 6:30pm Antibiotics Lake, Barton 6287 8099 presentation and dinner Tue 4 March 2008 Better General Health Program Bradman Pavilion, RSVP: Dawn Roberts on 6:00-9:30pm Seminar Manuka Oval 6287 8099 Wed 19 March 2008 Information evening re 9th Edition The Boathouse by the RSVP: Hailey Shaw on 6:30 for 7:00pm Immunisation Handbook Lake, Barton 6287 8099 start Guest Speaker Dr Greg Rowles If you would like to receive invitations to Division events electronically, please email your name and practice name to email@example.com 2/52 Update is faxed to every surgery Monday fortnightly. Look out for it – as it contains reminders, announcements and interesting information.