Congratulations Cam –

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					                                      GP ACTion

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

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
                                                                             the Australia Day awards for “his
Deputy CEO .................................... Kelly Gourlay
                                                                                service as a general practitioner
Business Services....................Deborah Cracknell                                                           and as a fundraiser for a range
                                                                                                                 of health organisations, and
Dr Sonia Res.......................                                                          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 .....................
                                               Finance Manager       though it would appear that this honour is indeed a worthy one. Cam
Anne Baynes ................                  has been teaching medical students since 1984, initially at Newcastle
                                                       Aged Care
Bronwyn                      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
                                 The Opiate Program Nurse
Chrissi Arthur               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
                                                   Mental Health     involved with fundraising efforts for the various stages of refurbishment
Hailey Shaw
                                                                     of the John Curtin School of Medical Research, assisting doctors in need -
Helen Cutler ...................              particularly after the 2003 bushfires, and fundraising for health projects
                                                   NPS Facilitator
Jane Sharman
                                                                     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
                                                Practice Services    northwest of Alice Springs in the Northern Territory, over the last 4 years
Janice Stewart                where clinics for cataract and ear surgery have greatly enhanced the
                                               Self Management
Joanne Gunn ....................                health outcomes for members of this 1000 strong population. For more
                                                       Reception     information see
Kerry Weller-Lewis
Liz Deaves .....................              The Division joins with colleagues to congratulate Cam on this award.
                                                  Finance Officer
Marilyn Wood
Peta Haesler
                                    Lifestyle Choice Support
Peter Wise ........................
                                                   Mental Health
Philip Habel ...................                         Inside this edition:
                                6247 5742 HIV/AIDS Nurse
Sarah Haltiner .............                          • 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

                    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, or by contacting Hilary Freeman RN/RM (Nurse Education Coordinator) on 6247
3077 or
                                                                           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

                      Congratulations Dr Peter
                         “Local Hero ACT”
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
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
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:, 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

   “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
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
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
         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
                   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                                  

         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

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
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
(AHSP) component of the initiative. A survey of
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:
• ‘Eat Well, Drink Well and Stay Upright’ a falls
  program in collaboration with ACT Health
• 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
                                                          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:
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

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:                     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:                      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                      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 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                                      
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

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
                                                                  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
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
      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
                                                                                     and to regis
                                                               phone Louise                        ter for the ne
                                                                                 or Tessa on                       xt group ple
                  Stepping Stones                                                              6205 4515 or
                                                                                                                6207 9977

       A Practical Course for Family Members

            Controlling Your Drinking
       Developing Awareness and Education

    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

  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

      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
                                                                                9.	After	a	busy	day	at	the	surgery	I	like	
                                                                                   listening to ... Coldplay Rush of Blood to the
                                                                                                                          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

                       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                                             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                                         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


   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
• 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
• 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

                                                          GP ACTion | January-February 2008 | 15

                  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
                                                      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.                             
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:
contact Chrissi Arthur 6287 8099 for an                 pnjcq, or for further information, please contact
application form.                                       Eamon Merrick on

                                                                     GP ACTion | January-February 2008 | 17

         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

                                                         Simple Steps for a Successful HMR
                                                         How to make a HMR easy
                                                         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    
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        –

                                                                           GP ACTion | January-February 2008 | 19

                             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

country paediatric experience, where children are
                                                                                                               90.9                                                                                                                                                    90.9
                                                                                                                                  90.7                                                     90.7

still dying from immunisable conditions will be able
                                                                                                                                                                         90.6                                                    90.6

                                                             % Fully Immunised

to help him in this role.
                                                                                  90                                                                                                                           90.0
                                                                                                                                                                                           89.9                                                                                 calculations
                                                                                 89.5                          89.5               89.5                                   89.5

9th Edition Australian Immunisation Handbook                                      89


The 9th edition of the immunisation handbook is                                   88

on its way! We are hoping that it will be available                              87.5













in the next couple of months and have been









                                                                                                                                                                    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













released. If you do not receive one after it has been










released please contact your division, your local
state or territory health department or you can order                             35                                                                                                                                             35


on line at:                                  40
                                                                                            39                                                                                                                                   39

                                                           National Ranking

                                                                                                                                  44                                                                          44                                                                    Recalc

An education event addressing significant changes                                 45

                                                                                            47                 47

and new additions to the 9th edn. AIH is planned                                  50

for mid March and invitations will be distributed                                                              51                                    51

shortly. Dr Greg Rowles, AGPN GP advisor on the                                   55

National Immunisation Committee has been invited
to present at this event.

                                                          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)           from 1st January 2008.
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

                                                                           GP ACTion | January-February 2008 | 21

                     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
                                                           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
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
osteoporosis, a dental extraction can increase the

22 | January-February 2008 | GP ACTion

      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                                               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             
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
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                        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
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

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
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

                                       2/52 Update
                                    is faxed to every surgery Monday fortnightly.
            Look out for it – as it contains reminders, announcements and interesting information.

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