Did you know it is election season? It’s almost time to decide on the leadership teams that the RACGP and AMA will have moving forwards in these uncertain days.
First, the RACGP.
Three GPs have thrown their hats into the ring so far – I wish them all the best of luck, a fair hearing, and look forward to the RACGP elections as a beacon of probity and ethical behaviour rarely seen in our country’s elections.
Vote! The turn out for the RACGP elections is quite small (why?) and so your vote really does count. Take the time to be informed and again, vote!
Now, the AMA.
National Conference 1 August
At the recent Federal AMA Annual General Meeting the Association’s Constitution was amended to authorise the AMA National Conference to be held on-line. The AMA National Conference, at which election of a new Federal President and Vice President will be conducted, will be held by Zoom video conference from 10am AEST on Saturday 1 August 2020.
Nominations for President and Vice President are now open. Nominations can be made by way of email to email@example.com. Nominations close at 5pm AEST on Friday 17 July.
The AMA has adopted a target of 40% women, 40% men, and 20% flexible for all AMA Councils, Committees and Boards, with a gender diversity target of women holding 50% of Federal AMA representative positions overall by 2021. AMA members are invited to help achieve these targets. These targets will particularly inform the finalisation of the expression of interest assessment for uncontested delegate positions.
Of course, if you want to vote for a great General Practice, supporting great GPs to serve their patients, with wonderful services and facilities…the choice is clear!
Did you know medical certificates expire? They have an end date! So when an employer or other entity asks for a clearance certificate, this is what we are going to write:
The whole point of a medical certificate is to certify someone unwell or unfit. This is why there is a beginning date AND an end date. At the end date, the patient is no longer certified unwell/unfit. I have enclosed the negative COVID results and you will note your employees certificate has reached its end date. I further enclose professional advice from our professional organisation in regard to this. It follows that the certificate of ‘clearance’ you are suggesting is unprofessional and those who would provide one are acting similarly.
I hope this information finds you well.
Doctor Nick Specialist GP
Hope this helps! If you are still unwell or need any further information, say hi to your PartridgeGP and book in here for a phone or face to face consult!
Romance of the Three Kingdoms is one of China’s four Great Classical Novels. The title of this blog post is more fully:
The empire, long divided, must unite; long united, must divide. Thus it has ever been.
PartridgeGP is based on a triple promise that we will be great for our patients and our community, GPs and our staff, and for the owners and the practice. Further, we will provide a comprehensive, professional, empowering, and sustainable service at all times.
Our friendly neighbourhood pharmacist sent this to me (see below). He was a little worried about the threat to his full service pharmacy and also to great General Practice.
Now different companies will have different service offerings at different levels of the market. Think Porsche and Hyundai. Both very acceptable to different groups. Maybe even acceptable to the same group at different times. I’m not sure they are competitors.
I put my thoughts down here:
So keep playing to your strengths, keep doing your best, and unite not divide.
Patients who require long-term treatment of chronic pain with opioids will still be able to access larger pack sizes and prescribers will be able to prescribe repeats where they meet the new restrictions requirements.
For chronic pain, increased quantities and/or repeats may be authorised by Services Australia where the patient meets the restriction requirements. Increased quantities to extend treatment up to one month may be requested via telephone/electronic authority request, and up to 3 months’ supply (up to 1-month quantity and up to 2 repeats) may be requested via an electronic/written authority request.
To be eligible for treatment with high strength opioids such as morphine, patients will need to be unresponsive or intolerant, or have achieved inadequate relief of their acute pain, following maximum tolerated doses of other lower strength opioid treatments.
These new arrangements apply to all PBS listings for opioid medications and therefore there will also be amendments to the tramadol and paracetamol/codeine restriction requirements.
All new and amended restrictions will be updated on the PBS website (pbs.gov.au) from 1 June 2020.
What does this change mean for prescribers?
The new opioid listings for reduced pack sizes will provide a simplified way for prescribers to prescribe smaller quantities of immediate release opioids for acute, short-term treatment.
Prescribers must ensure that patients meet the relevant restriction criteria when prescribing opioids under Restricted Benefit and Authority Required (STREAMLINED) PBS listings. The ‘streamlined authority code’ is located on the relevant PBS listing on the PBS website. To prescribe an Authority Required (Telephone/Electronic) item, the prescriber is required to request authority approval from Services Australia through the Online PBS Authorities System or by calling 1800 888 333.
To ensure appropriate use of opioid medicines for the management of pain, patients must be referred to a pain specialist or alternative prescriber for clinical review if opioid use exceeds or is expected to exceed 12 months. The date of the review and name of the medical practitioner consulted must be provided for every authority application.
So from June 1:
If these addictive narcotic medications are required, your GP may prescribe smaller packs for your use
Please please please speak to your GP about any issues you are having – we have lots of options including counselling, physical therapy, diversional therapy, physiotherapy, non-drug therapy, other medications, and referrals to non-GP specialists for complex problems
We still care, we still want to help, we want to be safer and better for you
If you are on medications for 12 months or more, you will need to have a formal consult with another GP or specialist in addition to your usual GP to keep getting medication on a PBS (subsidised) prescription.
We are only a phone call (with video if needed!) away if you need more information.
SA has guidelines – the roadmap back!
And in the future
Did you also know that we can Test You for COVID 19 / Coronavirus if
Unexplained fever / chills Unexplained cough/sore throat/short of breath High risk settings:
Aged care and other residential care facilities Healthcare settings Military – group residential and other closed settings, such as Navy ships or living in accommodation Boarding schools and other group residential settings Educational settings where students are present Childcare centres Correctional facilities Detention centres Workplaces where social distancing can’t be readily practised Remote industrial sites with accommodation (e.g. mine sites) Aboriginal and Torres Strait Islander rural and remote communities, in consultation with CDCB Settings where COVID-19 outbreaks are occurring, in consultation with CDCB
Testing at Australian Clinical Labs 670 Anzac Highway Glenelg IN YOUR CAR
We all want to provide great general practice care. Most of this comes from time, curiosity, and interest in our patients. When we turn our attention and medical skills to their problems and issues we do better work.
Physical examination has been around since antiquity and is a useful adjunct to taking a great history. Much like over investigating, physical examination is not always needed.
General practice is so much more than compliance and paperwork.
So much can be pared away to reveal the essence of what we do.
In the time of #COVID19, perhaps we can chip away to reveal our statues of David rather than be inflexible blocks of government marble.
Since 1986, federal law has mandated that any patient requesting emergency medical care must be evaluated by a physician to assess for any threatening conditions. The law, often referred to as the “anti-dumping law,” requires that physicians perform a medical screening evaluation, including a physical examination.
Over time, the interpretation of this mandate has slowly expanded, not by law so much as by custom. This is why emergency rooms have become our nation’s safety net for care. Despite increasing popularity of urgent-care clinics and telehealth, many patients who could have safely been cared for elsewhere still end up in emergency rooms.
While many of us embrace that mission with pride, it is dangerous and wasteful in the coronavirus pandemic. We need to course-correct to keep everyone safe. Exposing patients to emergency rooms is now far riskier than it was before. In turn, health-care workers must assume that all patients are infected. This forces us to blow through personal protective equipment that we desperately need so that we do not become infected ourselves.
Over the past few decades, we have learned that many, if not most, of our physical examination maneuvers provide little reliable information. In most cases, the information we need can be obtained simply by interviewing patients. But old habits die hard, and patients seem to love our stethoscopes. In our current situation, that simply won’t do.
We need the federal government to allow us to perform medical screening exams via video or through glass doors, even for patients entering emergency rooms. The removal of the requirement that we evaluate every patient by hand will save resources and keep everyone safer.
In recent meetings and phone calls with stakeholders, the Centers for Medicare and Medicaid Services has signaled that it is seriously considering making this change. But it has not materialized, and time is of the essence. The moment to act is now.
Jeremy Samuel Faust is an emergency physician at Brigham and Women’s Hospital in the Division of Health Policy and Public Health, and an instructor at Harvard Medical School.
The RACGP SA&NT in conjunction with SA Health and a local panel of presenters, will be presenting a webinar update on Telemedicine, discussing tips and tricks related to undertaking telehealth in your practice.
Those bits of paper your GP gives you to get medications from your Pharmacist are changing. Scripts are now DIGITAL!
GPs can now send prescriptions to pharmacists electronically as an interim solution during the pandemic.
As part of the COVID-19 National Health Plan telehealth model, the new interim measure allows GPs to send prescriptions electronically to pharmacists without having to mail out a physical copy of the original paper prescription with a GP’s wet-ink signature.
Patients can then have their script filled and medication delivered to their door, helping to minimise the risk of virus transmission in accordance with social-distancing measures.
‘It’s certainly going to make it easier for practices, because they are being inundated with pharmacists asking them to post prescriptions to them,’
‘I know at my practices it’s causing substantial concern.
‘We’re getting calls every day from pharmacists saying, “I can’t dispense unless you send me the hardcopy paper”, and we’re saying, “We don’t have the resources to keep running out and buying stamps, and it’s just not safe to put staff in that position”.
‘So we’ve had a bit of a stalemate for the last few weeks and this is a great outcome in the short term.’
As outlined in guidelines issued by the Department of Health (DoH), GPs will be required to do as follows:
Create a paper prescription during a telehealth consultation. This will need to be signed as normal or using a valid digital signature
Create a clear copy of the entire prescription (a digital image such as a photo or PDF including the barcode where applicable)
Send via email, fax or text message directly to the patient’s pharmacy of choice
Schedule 8 and 4(D) medicines such as opioids and fentanyl are not part of the interim arrangement.
While not legally required, the DoH encourages practices that are able to continue sending the original script to pharmacies to do so as soon as possible. All other practices must retain the paper prescription for a period of up to two years for audit and compliance purposes.
This is a great step forwards!
Changes have been made to Commonwealth legislation to recognise an electronic prescription as a legal form to allow medicine supply. This provides prescribers and patients with an alternative to paper prescriptions. Paper prescriptions will still be available.
Electronic prescribing will not fundamentally change existing prescribing and dispensing processes. It provides patients with greater choice and patients can still choose which pharmacy they attend to fill their prescription.
Under the Australian Government’s National Health Plan for COVID-19, electronic prescriptions are now being fast-tracked to support telehealth and allow patients to receive vital healthcare services while maintaining physical distancing and, where necessary, isolation.
A significant amount of work has already been done to ensure that necessary upgrades to both pharmacy and prescriber software can be done quickly and electronic prescriptions are expected to be available from the end of May.
Electronic prescriptions are an alternative to paper prescriptions which will allow people convenient access to their medicines and will lessen the risk of infection being spread in general practice waiting rooms and at community pharmacies.
The solution being fast-tracked will see a unique QR barcode known as a “token” sent via an app (if you have one), SMS or email. The token will be sent to you from your doctor, which is then presented or sent to a pharmacy, to supply your medication.
The token will be scanned by your pharmacist as a key to unlock the electronic prescription from an encrypted and secure electronic prescription delivery service.
If you have any repeats of a prescription, a new token will be sent to you when the prescription is dispensed. You will need to keep the token to send to your pharmacy when you need to get the repeat filled.
Active Script List
By the end of this year, more functionality will be available and in addition to the token, there will also be an option for your pharmacy to have a list of your active prescriptions in their software, so you don’t have to forward it on.
To get your medicines you will need to prove your identity to the pharmacist and provide consent for the pharmacist to view your prescriptions.
Steps to take in preparation for using an electronic prescription
Ensure your address, email address and mobile number are up to date with your doctor and pharmacy.
Check that your pharmacy can take an electronic prescription and are delivering medicines.
Those who don’t know history are doomed to repeat it.
Typhoid Mary was a cook who moved from one rich employer to another in New York and Long Island, infecting seven households with typhoid between 1900 and 1907 before doctors traced her as the common cause of the infections. The key point is that she was in good health herself throughout. When confronted, she indignantly refused to submit stool samples for analysis, until eventually imprisoned for this refusal.
After three years she was released while promising not to work as a cook. Unhappy with the low wages of a laundress, she changed her name, resumed cooking and resumed causing typhoid. After a 1915 outbreak in a hospital for women in which 25 people fell ill and two died, Mary Mallon/Brown was again arrested and kept in quarantine for the rest of her life, refusing to have her gall bladder removed. When she died in 1938, an autopsy revealed a thriving colony of typhoid bacteria in her gall bladder. For some genetic reason they had not caused any symptoms in her.
What is the current understanding of the ability to return to work and risk of reinfection/further complications for clinicians who have recovered from COVID-19? The department will determine when a confirmed case no longer requires to be isolated in hospital or in their own home, in consultation with the treating clinician. This will be actively considered when all of the following criteria are met: • The patient has been afebrile for the previous 72 hours, and • At least ten days have elapsed after the onset of the acute illness, and • There has been a noted improvement in symptoms, and • A risk assessment has been conducted by the department and deemed no further criteria are needed. Apparent re-infection has been reported in a small number of cases. However, most of these reports describe patients having tested positive within 7-14 days after apparent recovery. Immunological studies indicate that patients recovering from COVID-19 mount a strong antibody response. It is likely that positive tests soon after recovery represent persisting excretion of viral RNA, and it should be noted that PCR tests cannot distinguish between “live” virus and noninfective RNA. For further information, go to the department’s website and see Advice for clinicians / epidemiology!
Social distancing. Try and stay 1-1.5m away from people. Don’t hug, kiss, shake hands…and DON’T do group meetings / big gatherings. These will soon be cancelled (Monday, if over 500 people) but really, it starts with you!
Cough into your elbow and clean your phone! Both of these will limit spread of those little virus particles!
Now that you’ve cleaned your phone, and are practicing your social distancing, USE the phone. Telehealth is here via your phone, no special equipment needed.
STAY AT HOME, USE THE PHONE
Great advice if you’re unwell, good advice just for day to day. Call PartridgeGP on 08 82953200 for a phone appointment!