Secrets Healthy Men know with PartridgeGP and Coles

Tim Ferriss asked a question in his book Tribe of Mentors.

 

 

‘If you could put a message on a billboard, to be seen by millions (or billions) of people, what would you say?’

 

 

I was lucky enough to have an opportunity to answer this in real life when a journalist from Coles contacted me. They wanted to know a GPs views on Men’s Health. The article we produced is here (and reproduced below). This is in the Coles Health and Beauty magazine – they have printed 500,000 copies of this! What was that one message I wanted to get across?

 

 

dr nick tellis coles health and beauty the money quote
The Message!

 

 

 

 

Our practice, PartridgeGP, our GPs, and the rest of our team are here for you. No billboards needed – just book in for an appointment 😎

 

 

 

 

 

 

 

 

 

 

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The Road to being a GP with PartridgeGP

Just check out this picture of what someone goes through to become a GP. Wow!

(thanks to Dr Jared Dart for finding this)

 

 

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PartridgeGP is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx.

 

 

 

This means that the GPs at PartridgeGP are teaching the Doctors and Medical Students who will be the future of medicine in Australia. It’s a big responsibility and a privilege we take very seriously.

 

 

 

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Teaching Practice of the Year

 

 

All of our doctors here at PartridgeGP are fully qualified ‘Fellows’ (or are studying towards this) holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.

 

 

 

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.

 

We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at PartridgeGP with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

 

 

Some of our recent GP registrars

Dr Katherine Astill

Dr Clare Mackillop

 

 

 

 

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Dr Gareth Boucher

 

Dr Nici Williams

 

Dr David Hooper

 

Dr Penny Massy-Westropp

 

Dr Monika Moy

 

Dr Clare Mackillop

 

Dr Katherine Astill

 

Dr Jen Becker

 

Dr Nick Mouktaroudis

 

Dr Nick Tellis

 

Welcoming Dr Katherine Astill back to PartridgeGP

Dr Katherine Astill Partridge Street General Practice new female registrar

 

 

Dr Katherine Astill commenced her specialist General Practice training with PartridgeGP in August 2017 and has returned to work with us at our new site in August 2019! She graduated with a Bachelor of Physiotherapy from the University of South Australia in 2009 and furthered her education with a Bachelor of Medicine and Surgery from Deakin University in 2013. After holding positions with the Muscular Dystrophy Association and the Women’s and Children’s Hospital, she decided to specialise in General Practice, with a special interest in Women’s and Children’s Health completing her Diploma of Child Health in 2016.

Dr Katherine has a passion for holistic care and preventative health.

 

 

 

She loves the local Glenelg area and is keen to hit the ground running with the rest of our Great Team here at PartridgeGP!

 

 

 

 

 

 

 

 

PartridgeGP is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx.

 

 

 

This means that the GPs at PartridgeGP are teaching the Doctors and Medical Students who will be the future of medicine in Australia. It’s a big responsibility and a privilege we take very seriously.

 

 

 

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Teaching Practice of the Year

 

 

All of our doctors here at PartridgeGP are fully qualified ‘Fellows’ (or are studying towards this) holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.

 

 

 

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.

We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at PartridgeGP with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

 

 

Dr Katherine Astill is a valuable member of our growing Clinical Team!

 

 

 

 

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Dr Gareth Boucher

 

Dr Nici Williams

 

Dr David Hooper

 

Dr Penny Massy-Westropp

 

Dr Monika Moy

 

Dr Clare Mackillop

 

Dr Katherine Astill

 

Dr Jen Becker

 

Dr Nick Mouktaroudis

 

Dr Nick Tellis

 

Welcoming Dr Nici Williams to PartridgeGP

PartridgeGP is proud to welcome Dr Nici Williams to our team!

 

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Born in South Africa, Dr Nici graduated from the University of New South Wales in 2010. She has worked in Indigenous Communities in Cairns, and spent two years on Thursday Island in the Torres Straits where she obtained her Fellowship of the RACGP as well as Fellowship in Advanced Rural General Practice. Following a further year practicing medicine in rural NSW, she and her family relocated permanently to Adelaide in 2018.

Dr Nici also works at the Refugee Health Service, and other interests include dermatology, contraception (including Implanon) and optimising health. She is accredited for Obstetric Shared Care in SA.

 

 

We welcome Dr Nici to Our Team here at PartridgeGP to be Your GP!

 

 

She is available to help you with all of your General Practice needs from mid April 2019 and you can book your appointment with her conveniently online right here – or call our friendly reception team on 0882953200.

 

 

Dr Nici Williams - your gp

 

All of our doctors here at PartridgeGP are fully qualified ‘Fellows’ (or are studying towards this) holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.

 

 

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.

 

 

We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at PartridgeGP with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

 

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DR PENNY MASSY-WESTROPP

dr penny massy westropp - your gp

DR MONIKA MOY

dr monika moy- your gp

DR JEN BECKER

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DR DAVID HOOPER

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Men’s Health Week 2019 at PartridgeGP 

June is Men’s Health Month and June 10-16, 2019 is Men’s Health Week at PartridgeGP. Men are important and Health is important so let’s look at some issues in Men’s Health.

 

 

 

Do you look after yourself like you do your car?

 

 

From the Men’s Health Week website:

 

A boy born in Australia in 2010 has a life expectancy of 78.0 years while a baby girl born at the same time could expect to live to 82.3 years old. Right from the start, boys suffer more illness, more accidents and die earlier than their female counterparts.
Men take their own lives at four times the rate of women (that’s five men a day, on average). Accidents, cancer and heart disease all account for the majority of male deaths.
Seven leading causes are common to both males and females, although only Ischaemic heart disease shares the same ranking in both sexes (1st). Malignant neoplasms of prostate (6th), Malignant neoplasms of lymphoid, haematopoietic and related tissue (7th) and Intentional self-harm (10th) are only represented within the male top 10 causes.

 

 

Smoking, Skin Cancer, Suicide, and So Much Alcohol

 

 

The above figures are taken from the Australian Bureau of Statistics. Furthermore, there are specific populations of marginalised men with far worse health statistics. These marginalised groups include Aboriginal and Torres Strait Islander men, refugees, men in prison or newly released from prison and men of low socioeconomic standing.

 

Men’s Health Week has a direct focus on the health impacts of men’s and boys’ environments. It serves to ask two questions:

 

What factors in men’s and boy’s environments contribute to the status of male health as indicated in the table above?

How can we turn that around and create positive environments in men’s and boy’s lives?

 

 

We’re going to ask and answer those questions this week. Stay with us online and in person – we’ve got your back!

 

 

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GET A GREAT GP!

(Here’s some we made earlier)

 

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Melanoma May – and Uveal (Ocular) Melanoma at PartridgeGP

Marissa Wreford writes (thank you!), and Dr Ian Kamerman from Northwest Health passes on:

 

May is Uveal Melanoma month.

 

Each year approximately 7 out of one million individuals are diagnosed with some form of Uveal (Ocular) Melanoma. Around half of those people will develop metastatic disease (Stage IV). Whilst average survival time has increased from 6 months to three years since my diagnosis in 2017, metastatic uveal melanoma still has a 5 year survival rate of just 15%.

 

 

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The best chance of survival is early detection. This May do something for your health, and the health of your eyes – a very underrated, yet essential, sensory organ.

 

 

So remember to go and get a dilated eye exam. A standard eye checkup with your optometrist may not show small changes, which when found early can make a big difference. Don’t take your eyes for granted. Don’t think that wearing sunglasses or eating “organic foods” and general healthy choices will spare you or someone you love from this disease. Research regarding lifestyle risks are still to this day inconclusive. Your best chance is, and likely always will be, early detection.

 

So this May ask specifically for a DILATED eye exam. Then continue to do this every May.

 

Use Ocular Melanoma Month as a reminder to give your eyes some love.

 

And for the rest of your skin:

 

Dr Nick Mouktaroudis is a GP and co-owner at PartridgeGP. He’s passionate about health education, has a special interest in Skin, and a lot of expertise to share when it comes to helping people cope with and improve Skin Conditions. With our recent move we thought back to how we started Skin Cancer Surgery and Medicine at PartridgeGP and the story is below.

 

 

Imagine a perfect day in a perfect General Practice. Focus on a busy yet unrushed GP, consulting with another valued patient. The flow of the consult is perfect, the communication great, everything is as it should be. 
 
We have to imagine days like this because they very rarely occur. Flow is fleeting and perfection is often aimed for and seldom reached. 
 
Going back to that consult, we can see that the GP is busy – but is definitely not unrushed. You can feel the pressure in the room as the patient seeks answers and closure and the GP senses the minutes ticking by. The consult comes to a close and both stand, the patient heading towards the door, the GP wishing them well, the patient’s hand is on the door and then. It happens. 
 
‘By the way Doc, what do you think of this?’
 
The GP turns away from the flashing screen and sees, across the room, a spot on the patients leg. 
 
Should we get the patient back at a later date? Offer reassurance we don’t feel confident giving?
 
Or, as the GP in this story does, do you reach for the dermatoscope, call the patient back, and look. There’s no such thing as a quick look and so the light comes out, the gel is applied, and a good thorough look is had. 
 
It’s an ugly duckling, a chaotic little mishmash of colours and globules. 
 
It would turn out to be a nasty – a nasty better appreciated in the pathologist’s dish than in the patients bloodstream.
 
A good result.
 
At the end of the day, the GP sat and wondered how this could be avoided in the future – how could we improve and be better. These challenges see us but we do not always see them.
 
This was our practice and so we had to change. 
 
Plan
Do 
Study
Act
 
Patient safety is paramount. We decided to solve for quality improvement and patient safety at the same time and made the decision to upskill one of our GPs, Dr Nick Mouktaroudis. He undertook multiple courses and extensive study in Primary Care Skin Cancer Medicine, Surgery, Therapeutics, and Dermatology. Following this we spent time and money upgrading our procedure facilities, equipment, and systems to support Dr Nick. We then allocated time for dedicated skin checks and adjusted our online booking and reception protocols. 
 
These were the first steps and in conjunction with our most recent AGPAL accreditation we have repeatedly run through this cycle, improving every time. We now have dedicated times for skin checks and skin cancer surgery, as well as protocols, systems, and education supporting Dr Nick and the other GPs in the practice. Patients enjoy seeing a GP they know and trust who can deliver appropriate care at a Primary Care level and price point. We receive great feedback from patients and local sub-specialists. It’s a clear win for patients, GPs, and our practice – and the mindset of continual quality improvement that we share with AGPAL was the way to get there. 
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What is a Skin Check?

 

 

A Skin Check is a Comprehensive Skin History and Examination which is done at PartridgeGP.

 

Your GP will ask you questions to assess the extent of Your risk/exposure to UV radiation and Your risk of solar related cancers.

 

They will examine you head to toe, examining the skin surface, focusing on any areas of concern (including the eyes, mouth, and anywhere else you may have noticed any spots, lumps, or bumps).

 

 

 

Are there any tools used for the Skin Check?

 

 

A proper examination needs proper equipment and we use handheld LED illumination with magnification as well as polarised light and clinical photography.

 

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A dermatoscope is used to examine specific skin lesions. This is a particular type of handheld magnifying device designed to allow the experienced examiner to further assess skin lesions and determine whether they are suspicious or not.

 

 

 

Who should have a Skin Check?

 

 

We encourage all Australians over the age of 40 to have a Skin Check annually. Australians have one of the highest rates of skin cancers in the world.

 

 

Australians who have above average risks should be having Skin Checks before the age of 40 and sometimes more than annually.

 

 

You should have a Skin Check at any age if You are concerned about Your skin or particular skin lesions/areas.

 

 

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We ask You to identify any lesions of concern prior to the Skin Check wherever possible.

 

 

These may include new lesions that You have noticed or longstanding lesions that may be changing in some way or that You are concerned about. If You are worried – Ask!

 

Skin cancer check risk dr Nick Mouktaroudis

Risk factors for skin cancer

 

 

 

People at higher risk of skin cancer are those who:

 

have previously had a skin cancer and/or have a family history of skin cancer

have a large number of moles on their skin

have a skin type that is sensitive to ultraviolet (UV) radiation and burns easily

have a history of severe/blistering sunburns

spend lots of time outdoors, unprotected, during their lifetime

actively tan or use solariums or sunlamps

work outdoors

 

 

 

 

Does My GP take photos of My Skin?

 

 

 

During a skin check at PartridgeGP Your GP will ask Your Specific Consent to take photos if they are concerned or want to make note of a particular skin lesion.

 

Photographs are useful as an adjunct to description of the lesion and act as a reference to position and comparison if required.

 

The photos will be uploaded onto Your Private Medical Record at PartridgeGP.

 

 

 

What if My GP finds something?

 

 

 

This will depend on what Your GP has found.

 

If they are concerned about a particular skin lesion they may suggest a biopsy to clarify the diagnosis.

 

A biopsy is a surgical procedure during which they take an appropriate sample of tissue from the lesion of concern and send it to a pathologist for review.

 

Generally pigmented lesions (coloured spots), will be biopsied in their entirety whereas non pigmented skin lesions may be sampled partially if the lesion is too large to sample in its entirety.

 

The results of the pathology report will guide further treatment.

 

Your GP may elect to treat without a biopsy if they are confident of the diagnosis.

 

This may include freezing/cauterising a lesion, cutting it out (excising), or offering topical treatments such as creams.

 

Biopsies are scheduled in the PartridgeGP theatre and our Practice Nurse will assist Your GP.

 

 

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What do I wear for a Skin Check?

 

 

 

Comfortable clothing.

 

Your GP will ask to examine you down to your underwear.

 

A sheet or towel will be provided for you to preserve your comfort and dignity.

 

A chaperone (Our Practice Nurse) is always offered.

 

Please avoid makeup or nail polish as the Skin Check involves the face and skin under the nails.

 

 

 

 

How long is a Skin Check?

 

 

Allow half an hour for Your GP to perform a thorough history and examination.

 

 

 

 

Do I need to see My GP or should I see a dermatologist?

 

 

GPs are Primary Care Physicians on the front line of Skin Cancer detection.

 

All GPs can check your skin, though not all GPs have formal training or a specific interest in skin cancer medicine and dermatoscopy.

 

Dr Nick Mouktaroudis has trained extensively in General Practice, Skin Cancer Medicine and Surgery, and has formal qualifications in Skin Cancer Medicine.

 

Dermatologists are non-GP specialists in all skin conditions including Skin Cancer Medicine and Surgery although some will focus on other skin conditions.

 

 

 

 

 

Can I do more than a Skin Check?

 

 

 

You can Reduce Your risk by:

Avoid unnecessary exposure to the sun

Wearing sunscreen regularly and on all sun exposed areas.

Wear Hats and Sunglasses when appropriate.

Be aware of Your skin – both You and Your partner can check at Home.

Having a yearly DILATED eye exam with Your Optometrist (anywhere that sells glasses!)

 

 

 

 

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Book Your Skin Check Right Here.

 

 

 

Need more information? Leave a comment or see us in person. We’re Here to Help!

 

 

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You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

Dr David Hooper

Dr Clare MacKillop

Dr Jen Becker

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Abby Mudford

Dr Katherine Astill

Dr Nick Mouktaroudis

Dr Nick Tellis

 

 

 

Welcoming Dr Jen Becker to PartridgeGP

PartridgeGP is proud to welcome Dr Jen Becker to our team!

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Dr Jen completed her medical degree at Flinders University in 2012 and since then has worked in hospitals across Adelaide and beyond. She most recently completed a 6 month term in public health in Darwin.

Her medical interests include sexual health, women’s health, and adolescent health. Outside medicine, her energies go into cooking, travel, and spending time with family.

We welcome Dr Jen to Our Team here at PartridgeGP to be Your GP!

She is available to help you with all of your General Practice needs from mid April 2019 and you can book your appointment with her conveniently online right here – or call our friendly reception team on 0882953200.

All of our doctors here at PartridgeGP are fully qualified ‘Fellows’ (or are studying towards this) holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.

We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at PartridgeGP with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

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DR NICK TELLIS

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Your Specialist In Life

DR NICK MOUKTAROUDIS

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DR GARETH BOUCHER

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DR PENNY MASSY-WESTROPP

dr penny massy westropp - your gp

DR MONIKA MOY

dr monika moy- your gp

DR ABBY MUDFORD

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DR JEN BECKER

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DR DAVID HOOPER

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Systemic Changes to Improve Quality and Safety in Aged Care

Dr Gaveen Jayarajan has taken the time and effort to write this excellent submission to the Royal Commission into Aged Care Quality and Safety. I think this is a great start and support it. I have made the following suggestions – and would be very keen to hear more.

 

Key recommendations 1 and 2 are laudable but unfunded (remember aged care panels) – I would suggest the ACAI be retained or these activities count towards the new QI pip payment. 

Key recommendation 5 – I would recommend RACFs adopt an EMR which can accept EMR notes from GP EMRs Sachin B Patel is the man in regard to this

Key recommendation 6 : good idea, would further recommended funding of this via ACAI retention and QI payment

 

 

We can do better and we owe it to our elderly patients to do so. Read on!

 

19 January 2019

 

Doctors in Aged Care Facebook Group Submission to the Royal Commission into Aged Care Quality and Safety

 

‘Systemic Changes to Improve Quality and Safety’

 

About us

 

The ‘Doctors in Aged Care’ Facebook group was started in September 2017 as a closed Facebook group for all doctors in Australia working in residential aged care facilities (RACFs) or with an interest in aged care. Its purpose is for doctors to discuss, share knowledge and experience, and seek advice about the clinical, administrative and financial aspects of working in aged care.

It has since grown rapidly to 1100 members and includes General Practitioners (GPs), geriatricians, psycho-geriatricians, palliative care physicians and other specialists and junior doctors. Many of these doctors are working at the coalface of aged care on a regular basis and have a unique perspective and insight on the issues faced by RACFs.

Key focus

Our key focus in this submission are systemic changes from a GP perspective that will improve both quality and safety in RACFs. One consistent theme throughout our submission is the need for better oversight, communication between facility nurses and GPs and engagement with family members. While we also support mandated minimum nursing staff ratios with more Registered Nurses (RNs) employed, improved clinical handovers and other issues such as improving dietary quality and options for residents, for the purposes of this submission we will focus on the following five key areas:

 

  1. GP input into the clinical governance of RACFS

  2. GP feedback at accreditation visits

  3. GP involvement in case conferences with families

  4. Uptake of full Electronic Health Records within RACFs

  5. Recognition of significant amount of unpaid work

 

GP input into the clinical governance of RACFs

 

We believe there should be greater GP input in the clinical governance of RACFs given that residents are being admitted at an older age and with more chronic and complex medical conditions. We believe that GP involvement will provide another level of oversight of clinical and care issues that may impact on quality and safety. This is to complement (not replace) existing strong clinical leadership of experienced RNs working within RACFs on a day-to-day basis and to foster a greater understanding and engagement between facility nurses and GPs at a systems level. This at present exists to some degree in Medication Advisory Committee (MAC) meetings held at some RACFs where all issues relating to medication management are discussed within a multidisciplinary team which can include nurses, pharmacists and one or more GPs.

We propose that this either be expanded in scope or a separate committee be created such as a “Clinical Governance Committee” that includes a multidisciplinary team dedicated to open discussion of all clinical governance issues faced by an RACF at a local level. This could consist of nursing staff and carers as well as other healthcare providers such as a physiotherapist, occupational therapist, speech pathologist, dietician, pharmacist and GP. Meetings could be held quarterly and attendance by healthcare providers should be funded by the RACF at a time-based hourly rate commensurate with the providers’ training and experience. Attendance at these meetings could be in person or by phone or videoconference. Outcomes and actions from such a committee should be fed back to the senior management of the broader RACF group for implementation at a local level.

 

KEY RECOMMENDATION 1

Formation of local “Clinical Governance Committees” at each RACF with direct feedback of outcomes and actions to senior management of the RACF.

 

GP feedback at accreditation visits

The current experience of many GPs when a facility is undergoing an accreditation visit by the Australian Aged Care Quality Agency is that feedback is rarely sought from them about their perspective on how the RACF is meeting quality and safety standards. We believe that it should be mandatory for accreditors to get feedback from all visiting GPs to get a broad perspective on all clinical and administrative issues faced by these GPs working at the RACF, and in particular how these issues may be impacting on quality and safety. This could be through either face-to-face or phone contact and should occur at the start of the accreditation period and also when changes have been made to assess any improvements from the GP perspective. We do not believe that GPs need to be paid for this, as most would happily provide constructive feedback if it were likely to improve their experience of providing care and it would ultimately benefit the care of their patients.

KEY RECOMMENDATION 2

Accreditors to obtain feedback from GPs at their visits (initial and follow up).

GP involvement in case conferences with family

Currently GPs are able to bill through Medicare for up to five case conferences per year if clinically indicated with the amounts received dependant on: the duration of the conference; whether the GP organises and participates in the conference;[1] or just participates in a conference that has been organised by someone else.[2]

If the duration of the conference is greater than 40 minutes and it was organised by the GP (ie. item 743) they would receive $201.65 from Medicare plus $6.30 if the patient is eligible for the bulk-billing incentive (item 10990), so $207.95 in total. Hypothetically if this happened 5 times per year this would generate up to $1039.75 in billings per patient per year which is quite substantial. Currently we believe the majority of GPs working in aged are not utilising these item numbers sufficiently and if they did, or if it was easier to do so, it would not only dramatically improve the financial viability of GPs working in aged care, it would also have significant positive impacts on patient safety and quality due to the benefits of having a multidisciplinary team discussing patient care.

We believe it should be mandatory for all new residents of RACFs to have a case conference soon after admission within 6 weeks, and for this to involve nursing staff, a carer, the family and the GP as a minimum, with other allied health staff depending on the clinical and care needs of the resident (and resident attendance optional and depending on their cognitive status). This is an excellent time to set the scene for how the resident’s care is to be managed going forward and also to discuss Advance Care Directives (ACDs) regarding a resident’s end-of-life wishes. These discussions are often not done in a timely fashion or done over the phone with family where there is no remuneration for the GP for this time and work. Ideally this type of case conference should be done annually thereafter and be a focal point for the resident’s annual care plan.

Currently we note that these conferences are done to varying degrees. Some RACFs facilitate conferences as described above, others facilitate conferences with the family but not the GP and others facilitate conferences with two or more facility staff but without the family or the GP. We believe “admission” case conferences and “annual” case conferences should be done with all present to give the maximum benefit to the patient and all healthcare providers providing care to the patient. We also note that case conferences do not require all members to be present in person, so one or more participants may be involved by phone or videoconference, therefore there is flexibility in how these conferences can be scheduled and run.

We note that while GPs can also organise these case conferences with RACFs themselves this requires buy-in to do so from facility staff, thereby making it harder to schedule and arrange.

KEY RECOMMENDATION 3

Mandatory admission case conference for all new residents followed by an annual case conference thereafter utilising existing Medicare item numbers.

Additional case conferences (either organised by the GP or another party) should be based on clinical indication and we believe that GPs should be invited to participate in all of these conferences (assuming they haven’t organised it themselves) with the patient/family consent. Often case conferences are held by RACFs with families with no GP invitation or input. We consider that there is significant benefit to patient safety and care in having the GP involved and engaged with family members in this way. We also note that this is a remunerated way of staying in regular contact with family without resorting to unpaid phone calls, emails or discussions without the patient present thereby again improving the financial viability of GPs working in aged care.

For these “additional” case conferences we believe the Medicare Benefits Schedule (MBS) rules need to be reviewed to make it easier for GPs working in RACFs to utilise these more frequently. Currently three different healthcare providers need to be present at a conference, either in person or via video/teleconference, in order to meet the MBS rules. These healthcare providers can include a GP plus two other different healthcare providers such as a facility nurse and carer and cannot include family members. Firstly, it is not always easy to find the two other different healthcare providers due to everyone’s own day-to-day work commitments. Secondly, we believe most case conferences would benefit from family involvement. Therefore we propose that for these additional case conferences they only require a GP plus one other healthcare provider (not two, but still allow two or more if necessary) plus a family member, so still three different people, but allow the family member to be part of the three.

KEY RECOMMENDATION 4

GP invitation and involvement in additional case conferences held during the year as clinically indicated, with amendment to Medicare item numbers to facilitate increased utilisation.

Uptake of full Electronic Health Records within RACFs

In our experience there are several inefficiencies and risks to the GP and patients associated with RACFs that still have solely or predominantly paper-based patient records. Paper records can be hard to read and take nursing staff longer to enter. Furthermore, only one person can read and enter notes at a time. Clinical information is also often spread across multiple folders separate to the patients record, for example some maybe in the nurses’ station, others in a medication room or at the patient’s bedside. It makes providing adequate oversight much harder to do, which we believe is a major issue in RACFs. It also makes it harder for senior nursing staff, clinical care managers as well other healthcare providers including GPs to monitor clinical issues and care provided to a resident remotely and without being physically where the relevant paper folders are.

We note that there are RACFs who have moved to almost full electronic health records for clinical, care, medication management and administrative functions and the efficiencies this provides and the benefits to improving quality and safety are significant. In particular these benefits are greater if the records are cloud-based, which allows for access from any device and web browser. We also note that other RACFs use a hybrid system where some records are electronic and other aspects remain on a paper-based system. Others remain in a completely paper-based system.

The benefits of full electronic health records are significant, for example the GP can be at the bedside of the patient and pull up all the information they need to make any clinical decision at the point-of-care when they need it the most, without spending time chasing up the various folders in different locations. Any gaps in the information required can be seen instantly with a quick scan of the relevant sections in the electronic record. This can also be fed back to facility nurses to ensure compliance with GP clinical and care directives.

KEY RECOMMENDATION 5

All RACF providers to move to full electronic health records , with a preference for cloud based software, for their residents within 2 years.

Recognition of significant amount of unpaid work

One recurring theme among GPs working in aged care is the vast amounts of unpaid work required. This comes about as GPs usually attend a facility approximately once a week and for the remainder of the week may work in their usual practice. During this time they still need to be on-call and available by phone, fax or email to RACFs to contact them. This work is not remunerated by Medicare and acts as a strong disincentive for GPs who work in a regular practice to continue to care for their patients as they enter an RACF. Examples of unpaid work for GPs working in aged care include: responding to phone calls/emails from/to nursing staff and families, writing prescriptions when off-site, completing letters of capacity, guardianship tribunal forms, Coroner’s reports, taxi vouchers and disabled parking permits, family meetings when the patient is not present, completing Advanced Care Directives (ACDs) when the patient is not present and completing death certificates.

A number of options could be considered to reduce this disincentive. We believe this should initially be focussed on remunerating unpaid phone calls taken directly by GPs from/to facility nursing staff or family members of patients. This will create an incentive for GPs to provide direct access to nursing staff at RACFs to deal with urgent/important clinical issues when they are not on-site and will also enable GPs to engage with family members about their loved ones more frequently. This could be done by phone or videoconference.

RACFs could therefore be a good starting point to introduce more MBS-funded telehealth item numbers. These could be untimed and start with a fixed fee per phone or video call and include a limit on the number of times it can be claimed per day. For example $15 per call with a limit of 5 calls per day. And with no requirement for the patient or other healthcare provider to be directly present at the telehealth consultation, as we note that the current telehealth items are only for a GP to sit in on a consultation between a patient and specialist.

We do recognise there were recent changes to Medicare item numbers for aged care (commencing 1 March 2019) by introducing a $55 call-out fee per visit (applicable to only 1 patient seen during that visit). However we note that at the same time the actual minimum rebate for each consultation was reduced. When the financial impact of this is compared before and after the changes, we view these changes as ineffective. For example if a GP were to see seven patients in a visit, before the changes the GP would generate $286.65 per visit, after the changes they would generate $318.20, so just $31.55 more. In our view this benefit is highly unlikely to encourage more GPs to visit RACFs. Furthermore if a GP were to see say 20 patients in a visit, before the changes the GP would generate $810 per visit, after the changes they would generate $807, so $12 worse off (both calculations exclude the bulk-billing incentive item number 10990 for simplicity). Even if a GP were to marginally benefit from this change due to seeing lower numbers of patients per visit, this benefit is far outweighed by the planned removal of the $5000 Aged Care Service Incentive Payment (SIP) worth up to $5000. So the recent Medicare changes are more likely to see GPs worse off financially (assuming the SIP is removed).

KEY RECOMMENDATION 6

Introduce new Medicare item numbers for GPs visiting RACFs for telehealth consultations directly with facility nurses and family members regarding their patients.

Doctors who supported this submission

Dr Gaveen Jayarajan

 

Dr Nick Tellis

 

 

[1]Medicare Benefits Schedule, Medicare item 735, 730 and 743.

[2] Medicare Benefits Schedule, Medicare item 747, 750 and 758.

 

 

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