Qi at Partridge Street General Practice

We’ve just celebrated the Chinese New Year – the Year of the Dog. People born in Dog years display loyalty and honesty amongst many other good qualities. However it is said that they can also be critical – maybe overly so. Segueing to another Chinese concept, we meet Qi, the vital life force that flows through the body. Let’s put these together.

 

 

 

A wise man once told me that the three pillars (the vital life force) of general practice are quality, service, and finance. All three of these come together in the form of the Practice Incentive Payments (PIP) scheme. You can read about this here but in summary Accredited General Practices are paid amounts of money for reaching certain quality measures. These include planning the management of a proportion of patients with diabetes and asthma, and ensuring women are screened for cervical cancer. There are also Incentive Payments for managing aged care and quality in prescribing.

 

 

 

 

These payments were due for a change on May 1st 2018. Were they promoting the vital life force of General Practice, were they tick box exercises for busy GPs, or were they overly critical of General Practice, not focusing on true quality? Enter QI – Quality Improvement. Rather than Qi, QI may be an altogether different beast.

 

 

But!

 

 

The Department of Health has confirmed that the Practice Incentive Program Quality Improvement Incentive will now occur from 1 May 2019.

 

 

From their press release:

 

 

The Practice Incentive Program (PIP) has been a key driver in quality care in the general practice sector and the PIP QI Incentive will continue to build on this important work, further strengthening quality improvement in primary health care. The additional 12 months will enable the Department, with the support and advice from PIPAG, to ensure that any implementation issues are identified and addressed and that general practices have adequate opportunity to prepare. It will also allow the Department to continue to consult with stakeholders on refining the design of the PIP QI Incentive.

 

The changed time frame will mean that the following five incentives which were to cease on 1 May 2018, will now continue through to 30 April 2019.

 

 

The five incentives are:

Asthma Incentive

Quality Prescribing Incentive

Cervical Screening Incentive

Diabetes Incentive

General Practitioner Aged Care Access Incentive

 

The six PIP Incentives that continue to remain unchanged are:

eHealth Incentive

After Hours Incentive

Rural Loading Incentive

Teaching Payment

Indigenous Health Incentive

Procedural General Practitioner Payment

 

 

What next? Will the new QI beast be reflective of quality in General Practice? Will the measures align with what we as General Practitioners believe is high quality Great General Practice care? Or will it aptly be launched in the Chinese Year of the Pig in 2019?

 

For what it’s worth, here are my measurements of quality, service, and finance in General Practice – the Qi of GP:

 

 

Quality – Time and Presence with Our Valued Patients

 

Service – Charging a private fee to those who can pay, allowing us to be charitable to those who cannot

 

Finance – Running Practices efficiently and well, with clinicians as owners steering the course of patient centred practices.

 

 

I would love to hear other views on this. We are all professionals or patients or both and we can always improve. Let me know here on the blog (or on our website) – or, if you’re a GP, on the fantastic GPDU FB Group – where GPs are invited to a festival of education and collegiality (#FOAMed – #GPDU18) May 30 – June 1! My last quality ltip – for personally better Qi – is below!

 

Get a Great GP!

(Here’s some we made earlier)

Dr Nick Tellis

Your Specialist In Life

Dr Nick Mouktaroudis

Dr Gareth Boucher

Dr Gareth’s Cycle of Care

Dr Penny Massy-Westropp

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Monika Moy

Dr Katherine Astill

Dr Katherine Astill 1

We look forward to seeing you soon!

Happy Birthday Partridge Street General Practice!

In 2014, Dr Nick Mouktaroudis and Dr Nick Tellis opened the doors of Partridge Street General Practice at Glenelg!

 

 

 

img_9445

 

 

We’ve gone from strength to strength since then and we’re now well established in our own Health Precinct with Aspire Physiotherapy and Pilates next door.

 

 

 

General Practice and So Much More

 

 

 

The future is bright as we continue to grow! Our Principal GPs :

 

 

Dr Nick Tellis

 

 

 

Your Specialist In Life

 

 

 

Dr Nick Mouktaroudis

 

 

 

 

 

 

Dr Gareth Boucher

 

 

 

Dr Gareth’s Cycle of Care

 

 

 

 

Dr Penny Massy-Westropp

 

 

 

Dr Penny Massy-Westropp

 

Dr Monika Moy

 

 

 

Dr Monika Moy

 

Dr Katherine Astill

 

 

 

 

Dr Katherine Astill 1

 

 

We’re providing great General Practice care including:

 

Mental Health Care/Plans

 

Skin Checks and Skin Cancer Care

 

Travel Medicine

 

Immunisations

 

Workcover/Compensable Medicine

 

Emergency Care

 

Antenatal Care

 

Men’s Health and Screening

 

Women’s Health and Screening

 

Babies and Children’s Care

 

Nutrition and Weight Management

 

Executive Health Checks

 

Stop Smoking Help

 

Pathology Services

 

 

AE5A2E0E-AC9E-436F-B33E-13798EC6AEFE

 

 

We’re Here to Help You – in 2017 and beyond.

 

 

img_4949

 

 

 

We look forward to seeing you soon!

 

 

 

The Last Referral

 

rey offers pen for luke to do a referral
Rey offers a pen to Luke to write a Referral

 

 

 

The good GP has a stewardship role in the Australian medical system and part of this is referring to subspecialist and hospital care. This is an important role and we don’t take it lightly. We want to do our best for our patients and help them get the care they deserve. One of the challenges is referring to public hospitals, where our referrals sometimes get ‘bounced’ back to us. In private practice, for the patient to receive a (Federal) Medicare Benefit (like when you see Your GP), the GP referral must be to a named provider (Dr Smith, Dr Jones, for example). When referring to a public hospital, there has historically been no Medicare rebate for the patient – public hospitals are funded by the State Governments and Medicare is funded by the Federal Government, and care is free at the point of service. This is changed recently, and public hospitals are now using Medicare funds to run their services. Therefore they now seek named referrals. But to who? It’s very hard to find out exactly which doctor will be seeing you, and so it’s hard to do a named referral, which may delay you being seen.

 

 

 

Dr Mark Raines has written an excellent piece on the role of referrals – I’ve taken some sections and highlighted them below, but you can read the whole piece here.

 

 

In Australia you don’t need a Referral to see a (sub-) Specialist. So, say you wanted to see a Plastic Surgeon about a skin lesion, you can just find a Plastic Surgeon on the internet or ask a friend and make an appointment and off you go. But be prepared for a bill – sometimes a really big bill. This is because, you won’t be able to access a Medicare rebate for the Plastic Surgeon’s fees. To do so you need to first have a valid referral from your GP. But it is not as simple as just calling your GP and asking for a referral.

 

 

 

 

Referrals from a GP are valid for 12 months whereas referrals from one sub-specialist to another are only valid for 3 months (for example when the surgeon that fixes your knee refers to the medical specialist to look after your heart). GPs can also do INDEFINITE referrals – for when you are seeing the same sub-specialist for the same problem for a long period of time (for example when a heart specialist is looking after an ongoing heart problem). Remember though, often your GP can manage your ongoing conditions very well together with your sub-specialist – saving you money and making it more convenient for you!

 

 

 

There are, however, rules!

 

 

 

Backdating Referrals

As a Referral is a legal document, Medicare does not permit backdating a Referral.

A Specialist can see a patient without a valid referral only in an emergency. Apparently, if your dog ate your referral, or another good excuse, there is a exemption available for you to claim your rebate if the Specialist notes that the “Referral is lost”. I am sure that Medicare would get suspicious if this happened a lot. Medicare do audit what GP’s and Specialists get up to make sure the rules are being followed. There are fines for not following the rules!

If you need a Referral make sure you see your GP before seeing the Specialist if you wish to get a Medicare rebate for the service. Asking your GP for a backdated Referral is like asking the Specialist to forward date your consultation so you can get a Referral. Both are not permitted under Medicare.

 

 

Some more rules and regulations.

 

 

 

directive+medicare+billing+outpatients

 

 

 

medicare+directive+and+outpatient+private+practice

 

 

 

 

 

 

 

img_8445-2

 

 

 

So when You need a referral – or it’s time to manage Your health more conveniently – You can see any of our Great GPs right here:

 

 

 

Dr Gareth Boucher

 

 

 

Dr Penny Massy-Westropp

 

 

 

Dr Monika Moy

 

 

 

Dr Katherine Astill

 

 

 

Dr Nick Mouktaroudis

 

 

 

Dr Nick Tellis

 

 

Dude, where’s my Outpatients?

Hi from South Australia! Summer has come! Our flagship hospital and one of the most expensive buildings in the Southern Hemisphere, the New Royal Adelaide Hospital (nRAH), came online in September 2017 after a 2 year wait.

 

 

nRAH New Royal Adelaide Hospital

 

 

 

Another big change to the South Australian Hospital System is that the Repatriation General Hospital is gone. Where did the subspeciality clinics go? See below!

 

 

Right Here!

 

arrow down

 

 

 

RGH Clinics – Quick Reference Guide as at November 2017

 

 

 

SALHN Outpatient Clinics Locations and Details

 

 

 

4th Generation Rehab Clinics

 

 

 

 

Bernie Cummins (see below) previously spoke to the Southern Regional GP Council about Outpatients Services in SA and she generously spoke to us again about how things will proceed over the coming months and years.

 

 

 

Here is some information she prepared.

 

 

 

 

royal adelaide hospital and nRAH and outpatients and health pathways

 

 

 

You can find further information right here.

 

 

gpdu.jpg

 

 

The good GP has a stewardship role in the Australian medical system and part of this is referring to subspecialist and hospital care. This is an important role and we don’t take it lightly. We want to do our best for our patients and help them get the care they deserve. One of the challenges is referring to public hospitals, where our referrals sometimes get ‘bounced’ back to us. In private practice, for the patient to receive a (Federal) Medicare Benefit (like when you see Your GP), the GP referral must be to a named provider (Dr Smith, Dr Jones, for example). When referring to a public hospital, there has historically been no Medicare rebate for the patient – public hospitals are funded by the State Governments and Medicare is funded by the Federal Government, and care is free at the point of service. This is changed recently, and public hospitals are now using Medicare funds to run their services. Therefore they now seek named referrals. But to who? It’s very hard to find out exactly which doctor will be seeing you, and so it’s hard to do a named referral, which may delay you being seen.

 

 

 

So, as a public service, we’re Here to Help! Bernie Cummins (Director of Nursing Statewide Outpatient Reform) has provided the following documents to help GPs and patients navigate this system and avoid the ‘named referral bounce’.

 

 

 

 

 

 

 

directive+medicare+billing+outpatients

 

 

 

medicare+directive+and+outpatient+private+practice

 

 

 

 

Good luck, and may the odds be ever in your favour!

 

 

 

img_8445-2

 

 

 

You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

Sore Throats at Partridge Street General Practice

Spring is here but it has been a big flu season at Partridge Street General Practice!

 

 

 

What should you do when you have a cough, cold, or sore throat?

 

Flu-Shot-logo
This may have helped before getting ill…

 

 

Here’s some information:

 

 

Do I have the flu?

 

 

 

Should I be on antibiotics?

 

 

 

My ear is sore?

 

 

 

Should I be immunised?

 

 

 

How do I stay healthier?

 

 

Any other ways to stay healthier?

 

 

Got anything else?

 

 

 

And, of course, What should I do instead?

 

 

There’s a new paper, at the link, saying this:

 

 

 

steroids in sore throat at Partridge Street General Practice

 

 

 

Need more information? Leave a comment or see us in person.

 

 

 

We’re Here to Help!

 

 

 

img_8445-2

 

 

You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

Check Your Skin with Dr Nick Mouktaroudis at Partridge Street General Practice

Dr Nick Mouktaroudis is a GP and co-owner at Partridge Street General Practice. 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. Let’s hand over to Dr Nick!

 

img_2998

 

 

 

What is a Skin Check?

 

 

A Skin Check is a Comprehensive Skin History and Examination which is done at Partridge Street General Practice.

 

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.

 

skin check dr nick mouktaroudis light

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.

 

img_2746-1

 

 

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 Partridge Street General Practice 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 Partridge Street General Practice.

 

 

 

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 Partridge Street General Practice theatre and our Practice Nurse will assist Your GP.

 

 

img_2745

 

 

 

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 sub-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.

 

 

 

525436572488

 

 

 

Book Your Skin Check Right Here.

 

 

 

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

 

 

 

img_8445-2

 

 

You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

Lemons and Lemonade

We live in an age of wonders. Generations past would be amazed by the ease of travel, free information, and the standard of living enjoyed by the majority of the Western world. One of these wonders is Modern Medicine and part of that is medications. We are privileged to live in a time when cancer can be cured, fatal diseases are controlled, and previously life curtailing conditions can be managed.

 

 

‘Nothing is all good and nothing is all bad’ is something I heard from a trusted friend. Does this apply to medications? General Practitioners are Your Specialist Generalists – we do a LOT more than just prescribe medications! Read on.

 

 

Oseltamivir

 

Lemon: This blockbuster drug was supposed to deliver us all from pandemic flu. The Australian government stockpiled it at a cost of many millions. It will expire before we do. It promised the world but perhaps shortened the duration of symptoms by not much.

 

Lemonade: Get a yearly influenza vaccine and if you’re unlucky enough to still get the flu – rest, fluids, paracetamol, and see Your GP if you’re not improving as you think you should.

 

 

Donezepil

 

 

Lemon: Life expectancy increases every year and so do our expectations of our older age. This drug promised an end to Alzheimer’s, later downgraded to ‘it may delay the rate of the decline in your mental abilities’. How would we know if it worked? What would have the rate of decline been without this drug?

 

donepezil lemon

 

Lemonade: Save your money and try some alternatives without side effects. Keep your mind and body as healthy as possible for as long as possible with diet, exercise, rest, and the support of family, friends, and Your GP. Should age related decline set in, there are many supports you can access – check out My Aged Care. Medications can play a role – ask! Also, if you are on this medication, or considering it – have a look here…

 

 

achi yes or no

 

 

Codeine

 

 

Lemon: This drug has been available over the counter at pharmacies for many years. Evidence shows that products with low dose codeine are no more effective than products without for pain relief and so the regulatory authorities have recommended it be rescheduled to prescription only from February 2018. This will be a big change for the community – some of whom will have been taking large amounts of this drug on a regular basis.

 

 

codeine lemon

 

 

Lemonade: Partridge Street General Practice is proud to be a low prescribing practice and especially of this drug. Our advice is to see us for advice on alternatives and non drug alternatives in particular.

 

 

 

Need more information? Have you any other lemonade thoughts? Leave a comment or see us in person. We’re Here to Help!

 

 

 

img_8445-2

 

 

You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

The New Royal Adelaide, Ramping Up and Down, and Health Pathways PS: Where did the Repat go?

Hi from South Australia! Winter is here but change is coming. Our flagship hospital and one of the most expensive buildings in the Southern Hemisphere, the New Royal Adelaide Hospital (nRAH), is about to come online in September after a 2 year wait.

 

 

 

Another big change to the South Australian Hospital System is that the Repatriation General Hospital is gone. Where did the subspeciality clinics go? See below!

 

 

Right Here!

 

arrow down

 

RGH Clinics – Quick Reference Guide as at November 2017

 

 

 

Bernie Cummins (see below) previously spoke to the Southern Regional GP Council about Outpatients Services in SA and she generously spoke to us again about how things will proceed over the coming months and years.

 

 

 

Here is some information she prepared.

 

 

 

royal adelaide hospital and nRAH and outpatients and health pathways

 

 

 

You can find further information right here.

 

 

 

 

 

The good GP has a stewardship role in the Australian medical system and part of this is referring to subspecialist and hospital care. This is an important role and we don’t take it lightly. We want to do our best for our patients and help them get the care they deserve. One of the challenges is referring to public hospitals, where our referrals sometimes get ‘bounced’ back to us. In private practice, for the patient to receive a (Federal) Medicare Benefit (like when you see Your GP), the GP referral must be to a named provider (Dr Smith, Dr Jones, for example). When referring to a public hospital, there has historically been no Medicare rebate for the patient – public hospitals are funded by the State Governments and Medicare is funded by the Federal Government, and care is free at the point of service. This is changed recently, and public hospitals are now using Medicare funds to run their services. Therefore they now seek named referrals. But to who? It’s very hard to find out exactly which doctor will be seeing you, and so it’s hard to do a named referral, which may delay you being seen.

 

 

 

So, as a public service, we’re Here to Help! Bernie Cummins (Director of Nursing Statewide Outpatient Reform) has provided the following documents to help GPs and patients navigate this system and avoid the ‘named referral bounce’.

 

 

 

 

 

 

 

directive+medicare+billing+outpatients

 

 

 

medicare+directive+and+outpatient+private+practice

 

 

 

 

Good luck, and may the odds be ever in your favour!

 

 

 

img_8445-2

 

 

You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

Welcoming Dr Penny Massy-Westropp to Partridge Street General Practice

 

Dr Penny undertook her medical training at the University of Adelaide prior to travelling to the UK to complete a Diploma in Anaesthetics. She then worked in WA & SA while completing Fellowship in General Practice. Bringing 21 years of GP experience to Partridge Street General Practice, she also has an ongoing commitment to Indigenous health with regular visits to remote NT communities.

 

 

 

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

 

 

 

 

 

 

 

 

 

We look forward to having Dr Penny Massy-Westropp as part of our growing Clinical Team and sharing her experience with us and our valued patients.

 

 

 

 

 

 

 

Professional. Comprehensive. Empowering.

 

 

 

 

See just how we do it here.

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

Welcoming Dr Monika Moy to Partridge Street General Practice

 

Dr Monika Moy graduated from the University of Adelaide in 1991 and after training in various Adelaide hospitals and general practices, completed her general practice qualification in 1996.

 

 

Dr Monika has particular interests in preventive health, women’s health and contraception and is trained to insert and remove the Implanon contraceptive device.

 

 

She is accredited for Obstetric Shared Care which involves providing part of a patient’s pregnancy care in conjunction with public hospitals and particularly enjoys this aspect of her practice.

 

 

Dr Monika is enthusiastic about explaining her patients’ conditions to them so that they have a better understanding of their health.

 

 

 

Special interests:

 

Women’s Health including contraception and menopause

 

Chronic disease management

 

Cardiovascular (heart disease) risk factor reduction

 

 

 

 

Dr Monika Moy

 

 

 

 

 

We are very excited to have Dr Monika Moy share her experience and skills with our valued patients as part of our growing Clinical Team!

 

 

 

 

 

 

 

Professional. Comprehensive. Empowering.

 

 

See just how we do it here.

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis