AHPRA is currently consulting on amendments to the National Law in order to keep the Law up to date and fit for purpose. In particular, there are specific consultation questions relating to a number of issues including:
If you want to read the consultation paper or make a submission, you can find the links here:
Submissions close 31 October.
A potentially preventable hospitalization (PPH) indicator for general practice
Hot of the press, a consultation paper developed by the AIHW and RACGP was released by the Australian Government on 4 October.
The paper looks at the development of a potentially preventable hospitalization indicator for general practice.
Potentially preventable hospitalization indicators focus on conditions that may be prevented or managed best by general practice to minimise likelihood of hospital admission.
PPHs are used internationally and can be used to look at access to primary health care.
The RACGP’s aim is for a more clinically useful measure that may be better applied to education and performance assessment, targeted interventions for problem areas and performance monitoring.
A potentially preventable hospitalisation has been defined as:
Admission to hospital for a condition where the hospitalisation could have potentially been prevented through the provision of appropriate individualised preventative care and other health interventions delivered by general practice teams.
General practice teams are defined as:
The general practice team consists of all people who work or provide care within the practice. Practice teams are often multidisciplinary, made up of GP leaders, nurses and allied health professionals designed to service the unique requirements of each community.
There are a series of focused questions for feedback.
Find the paper here:
Submissions must be provided via email to the AIHW <PPH_feedback@aihw.gov.au> by 4 November, 2018.
New Medicare Schedule and other educational resource links
The Australian Department of Human Services has updated a number of its educational resources including the 1 July MBS Schedule.
Here are the most recent resource links:
You can find more here:
Department of Health is currently consulting on the Draft Charter of Aged Care Rights. The draft charter outlines these rights as follows:
| I have the right to:
a) receive safe and high quality care and services
b) be treated with dignity and respect and to have my individuality valued
c) have my identity, culture and diversity valued and supported
d) maintain my independence
e) live without abuse and neglect
f) be informed about my care in a way that meets my needs, have access to information about my rights, care, accommodation and anything else that relates to me personally, and get the information I need in a timely way
g) maintain control over, and continue to make decisions about, my care and personal and social life
h) be listened to and understood
i) choose to have another person speak on my behalf
j) complain, and to have my complaints dealt with fairly and promptly
k) exercise my rights without it adversely affecting the way I am treated
l) personal privacy and to have my personal information kept confidential
You can find the consultation paper, draft charter and online survey here:
With a Royal Commission into Aged Care Quality and Safety recently announced, consultations the Terms of Reference for the Royal Commission are currently being developed.
You can find out more here:
Colonoscopy clinical care standard
A colonoscopy clinical care standard was recently released by the Australian Commission on Safety and Quality in Health Care.
You can find the standard here:
The 70th anniversary of the much-maligned NHS was celebrated with a review!
The Lord Darzi Review of Health and Care has delivered a 10-point plan to reorient the NHS into the 2020s and a 10-point ‘offer to citizens’.
Here’s a teaser from the 10-point investment and reform plan:
And from the 10-point offer to citizens:
Read the summary here:
In this edition of Research Roundup we have a selection of 5 papers on some topics close to every GP’s heart!
Selection and recruitment, CPD, emotional intelligence, accreditation and continuity of care.
Feast your eyes on these!
Emotional intelligence – 12 tips
So all of you who have been following developments in GPSA research on the GP Supervisory Relationship Measure for Supervisors (GP-SRMS) and the newly minted partner tool, the GP-Supervisory Relationship Measure for Registrars (GP-SRMR) will have learned about the role that the registrar’s perception of the emotional intelligence of the supervisor plays in the educational alliance.
Beyond that, however, emotional intelligence is rapidly gaining currency for its potential contribution to the development of a culture of professionalism AND the good news is that some elements of it can be learned.
This 12 tips paper covers how to introduce EI into the curriculum.
This paper is well worth the read. My prediction? EI will be the next big thing.
Read all about it here:
2018 Ottowa Consensus Statement: selection and recruitment to the healthcare professions.
Everyone wants to recruit ‘the best’ people to healthcare, right? And we’ve been experimenting across the globe with all sorts of systems, processes and methods to select ‘the best’.
Well this paper is the update of the 2011 Ottowa consensus statement on selection.
It includes a terrific little summary of the evidence for selection methods including:
This paper goes to the nub of the issue: what outcomes are we trying to predict?
And if there is no generally agreed-upon gold standard that measures the performance of a practicing health professional, how can we choose a selection method that will predict that performance?
A bucket is tipped on some of the more recent trends in selection whilst others are supported.
The paper discusses the merits of these methods and makes 10 recommendations and calls for an expansion of methodological approaches.
Read all about it here:
Translating evidence into practice: lessons for CPD
We all love translational research, right? Getting that evidence into practice – nirvana!
So why does it so often go wrong with CPD?
Well this paper thinks it has the answers! And it involves 4 groups:
And there you have it! You don’t have to do a thing!
Read all about it here:
Is accreditation still relevant??
You bet! And for a couple of reasons.
This paper reflects on the role of accreditation as a driver for quality improvement and in particular, Australian Medical Council (AMC) accreditation of specialist training programs and compares accreditation systems internationally.
This paper notes that while the AMC’s objectives are similar to those of other accreditation bodies internationally, practices differ.
The paper goes on to suggest that the AMC could reorient its accreditation of specialist training programs from a focus on compliance and standards to one that emphasizes the colleges’ and facilities’ self-assessment and quality management processes and thus be more in line with international trends where the emphasis is on continuous quality improvement and self-evaluation.
The paper highlights that, in the Australian accreditation process, the colleges are entrusted with significant power and responsibility for training because the colleges set the curriculum and the standards for training and accredit the training sites themselves.
The authors also note that, by comparison with systems in Canada, the US, UK and the Netherlands; the AMC “is remote from the workplace” in terms of accreditation of training sites. They note that these other countries have accreditation processes that focus at a regional or training site level, not the national level as we do here in Australia via the colleges.
With the training program going back to the colleges, who knows what this may mean for accreditation???
Read it for yourself, here:
Continuity of care and mortality – is there a relationship?
As it turns out, yes, there is.
This paper is a systematic review of continuity of care and mortality and looks at the literature from 1996 to 2017 on continuity of care received by patients from any kind of doctor (i.e. generalist or specialist), in any setting, in any country and the measured mortality of the patients.
Continuity of care is defined here as “repeated contact between an individual patient and a doctor”.
The paper emphasizes the interpersonal aspects of care and challenges the notion that “non-personal care” (read ‘care by app’) should be the default option.
This (I think, scary) scenario was suggested in an opinion piece that describes some developments already happening driven by a business model that puts the face-to-face experience as a last resort option.
Although the evidence is lower quality (i.e. mostly observational) it does show that patients across all cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors and experience lower mortality rates.
Viva la face-to-face doctor visit!
Read the paper here:
And the scary opinion piece here: https://doi.org/10.1056/NEJMp1710735
You be the judge!
Become an ACRRM member today
The Australian College of Rural and Remote Medicine (ACRRM) is committed to making a positive difference to members through their exclusive member benefits. By becoming a member with ACRRM you’ll get:
As a member of ACRRM, you’ll play an integral role in shaping the future of rural medicine. Become an ACRRM member today!
There is great satisfaction in mentoring GP registrars in a rural practice, according to veteran South Australian GP supervisor Dr Martin Altmann.
These rewards range from helping registrars develop confidence and experience, teaching procedural skills needed in rural settings, to inspiring young doctors to immerse themselves in rural practice and lifestyle beyond fellowship.
Martin became the first GP supervisor at Bridge Clinic in Murray Bridge when he and GP wife Fiona Altmann joined the practice 26 years ago.
It was not long before his colleagues, Fiona included, followed suit: the practice now has a one-to-one supervisor-to-registrar ratio, with up to six supervisors each supporting a registrar at once.
Martin, a GP obstetrician, has supervised more than 30 GP registrars, and is enthusiastic about continuing his mentoring role.
“Because we are rural, we try to train registrars in procedural skills, such as obstetric, anaesthetic and emergency medicine,” he said.
“Our doctors at the clinic provide in-patient care, obstetrics, anaesthetics and emergency medicine care after hours.
“We try and get the registrars involved in community and sporting events. Patients love to see the doctors involved in their community.”
Martin credits great mentors throughout his own training, for his initial motivation to teach registrars.
The Altmanns settled in Murray Bridge in 1992 on the back of three years procedural training in Somerset, England.
“I worked half of the time in obstetrics at the hospital and half of the time as a rural GP. Fiona worked in anaesthetics and intensive care,” Martin said.
The pair’s commitment to medicine in rural Australia was recognised in 2013 when they were named joint winners of the Rural Doctors Association Australia Rural GP of the Year.
“We love the variety of work, the challenges and the rewards of cradle-to-grave care across many generations of local families,” Martin said.
In terms of his role as a supervisor, Martin said teaching – and learning from – registrars kept him young and up-to-date, and he credited patients’ receptiveness to care in a training practice as important to successful supervision.
He enjoys watching his registrars’ confidence and experience grow, and helping them understand their value in a rural practice’s workforce.
“Registrars are a great workforce contribution and are very valued by our practice and patients.
“It’s really rewarding to see them stay in our community or go to other rural communities where they are very valued.
“It’s always satisfying to hear they have progressed to supervision themselves.”
Martin’s advice to other supervisors is to touch base daily with their registrar and ensure they are coping.
“Through our experience we can help registrars problem solve, and teach them they don’t have to solve all problems on the same day; that often time, nature and common sense declare the problem.
“We can teach them to work through that uncertainty and not become overwhelmed by it.”
It is difficult to quantify the number of doctors veteran GP supervisor Dr Ewen McPhee has mentored in an official and unofficial capacity since his early career in rural medicine.
That’s because the GP Supervisors Australia Recognition of Service Award (30-plus years) recipient has supported young doctors since his first country post as a second-year doctor in Charleville, rural Queensland.
The long-time Emerald, Central Queensland GP obstetrician, estimates he has since supervised between 60 to 80 young doctors as GPs or rural generalists.
“It’s a unique environment in the country, which is something you have to teach clinicians when they move from the city,” Ewen said.
“For this reason, I have been supervising and supporting young doctors in the country since early in my career.”
The practice principal of Emerald Medical Group is among three supervisors and two medical educators at the clinic.
He is passionate about rural and remote primary care, and wears his heart on his sleeve about training, and retaining great doctors with a connection to rural areas.
Ewen is particularly excited by the success in the last four years of shifting primary care in Emerald from a locum-based model to a local GP model.
During this four-year period, he has supervised 17 registrars and along with his peer supervisors, is enthused by the new model’s high retention rate of young doctors in Emerald beyond fellowship.
He is also excited about the Queensland Rural Generalist Program.
“It’s about picking the right people and giving them the right training, and you need good supervisors in the country to teach them to be great doctors and to thrive and survive in the country.
“We need supervisors to talk about the positives of being out here, and we have been rewarded with that in the last four years with the high retention rate of getting young doctors to stay in our patch, Emerald.
“We are seeing good young doctors who have moved to the community and establishing themselves in general practice and the lifestyle here.
“It’s indicative of supervising in the country that we can role model the great benefits and rewards of rural practice and living in a rural community.”
Ewen credited training organisations and colleges for excellent preparation and providing registrars interested in rural medicine, and with a connection to country lifestyle and communities.
Ewen’s passion for country medicine and training doctors who will build their lives long-term in the bush, is evident in the numerous hats he wears.
Among his many commitments is a role as a senior academic clinician at the University of Queensland Regional Training Hub; board member of Australian College of Rural and Remote Medicine (ACCRM); and as a member of the World Organisation of National Colleges and Academies (WONCA) – Rural Working Party.
He hosts international doctors and speaks overseas about the evolving role of rural generalists and the international implications of the Australian methods of training our next generation of family doctors.
“Australia is an exemplar of how we train rural doctors,” Ewen said.
He encouraged other rural GP supervisors to “go with the flow”, understanding that every registrar is unique in their needs, career experience and goals.
He encouraged supervisors to link themselves with peer supervisors; work with their local Regional Training Organisation (RTO) to find the right candidates for rural practice; and to value the opportunity of supervision.
“Don’t look at registrars just as a workforce solution: it’s an absolute pleasure to teach them. They are there to learn; so to step back and teach, and be available to them, is really rewarding.”
Health professionals are invited to take part in the free Dementia Care Training and Education Program (DCTEP) developed by General Practice Training Tasmania to assist in recognising, diagnosing, managing and supporting dementia patients in their care.
This innovative Australian-first dementia care resource was launched in Hobart in March 2018 by Federal Aged Care Minister Ken Wyatt AM MP.
The free interactive program was developed with the entire practice in mind. The informative modules can be completed by all practice staff to improve the overall level of service and care provided to dementia patients and their loved ones, from making an appointment through to management of the condition.
With aged care services around the country stretched to their limit, the care and management of dementia patients often falls to GPs and Practice Nurses. The DCTEP gives health professionals and their support teams the tools and knowledge to confidently take on this responsibility and provide enhanced support to patients and their carers and loved ones.
The program only takes three hours to complete and can be completed in entirety or progressively to fit in with busy schedules.
Already, the evaluation of this program has demonstrated some early changes in health professionals’ clinical behaviour, resulting from improved awareness, knowledge and confidence in managing and supporting dementia patients in general practice.
To access the program please visit https://gptt.com.au/training/dementia-care-education-training-program/
We see this week what disunity and discord represents to the people of Australia – self-interest, futility and almost certain demise. Yet within the context of organisations, atmospherics can emerge and prevail from a raft of actions, feelings, internal and external factors.
It is clear in recent times that the world views of registrars and supervisors can be different. Is this a bad thing or is it to be expected? Are they really that different? We will all have a different perspective on these questions and that is part of the rich tapestry of general practice. In some ways it reflects the general practice team nationally. But do we work as a team?
Nothing could be more certain than if we do not collaborate and participate in the discussions about the future of general practice training as a team, then decisions about all of our futures will be made without us. Our internal and external orientation in general practice needs to be unity in order to survive.
From this perspective, discussions around the NTCER and pay for registrars should not occur without understanding that everyone in general practice is under pressure and financial strain. The challenge for us all is to grow the pie, not argue over our share of the crumbs.
Supervisors should be the very best friends of registrars, the colleges, the Department of Health and relevant Ministers. So, at a time of many uncertainties, it’s disconcerting to see some focus on immediate financial return without acknowledgment of the balance needed to support ongoing quality training.
So where is GPSA influencing the evolution of general practice? GPSA has provided feedback to the Rural Health Commissioner around the rural generalist pathway being developed, we have provided feedback to the Department of Health around the risk associated with supervision in after hours environments. We have pointed out to Ministers and government that a number of the key workforce initiatives specifically funded in the 2018 federal budget all hinge upon supervision. We need to enable the changes and additional activity and recognise the challenges associated with each for our GP supervisors.
July saw the indexation of MBS item 23 at 1.5% and this automatically triggers an increase in the NTCER base rates. Since the last increase was 5 years ago, it is perhaps reasonable that we are all unused to this mechanism within the NTCER and so GPSA have focussed on advising and supporting practices to implement the new base rate. Publication of our newest guide on teaching professionalism was also published in July. It’s part of a suite of guides scheduled for the second half of 2018 including this month the supervisor guide on Supervising in after-hours environments and in September a guide on performance management within general practice.
ACRRM launches new online learning system
The Australian College of Rural and Remote Medicine (ACRRM) have launched their brand-new online education platform, ACRRM Online Learning. The new platform replaces the existing RRMEO system with state-of-the-art, industry-leading software, making it easier for you to access our wide range of education resources.
ACRRM Online Learning provides whole-of-career support for Australian medical practitioners. The system is easy to use, continually being reviewed and revised, and will help you to keep up with the demands of the medical profession.
Key features of the new system
Search all available courses on the ACRRM website.
Registrar performance awareness
Training practices are boosting patient care and registrar development with the help of GP-designed software package Doctors Control Panel (DCP).
Belgrave Medical Clinic practice principal and GP supervisor Dr Dennis Gration likens DCP to “a personal assistant that thinks like a GP”.
“It’s a fantastic tool: it’s probably better than a stethoscope,” Dr Gration said of the package used in his Victorian clinic for six years.
Dr Gration, who is also an RACGP examiner and training supervisor for Eastern Victoria GP Training, said DCP was “the future of viable general practice operating at the standard we endeavour to teach our registrars.”
Queensland’s Victoria Point Surgery practice principal, GP Supervisor and GPSA immediate past chair Dr Bruce Willett said his practice had benefitted from DCP’s multi-faceted functions for about 10 years.
Dr Willett said the program’s dual ability to analyse data and flag immediate action during a patient consult; auditing tools; guidance for assessment tools, care plans and billing was very useful.
He said the program enhanced practice quality, optimised patient health, and taught good habits to GP registrars.
DCP links with the two major software programs used throughout Australia – Best Practice, and Medical Director – and their associated appointment and billing software.
Developed by practising Melbourne GP Anton Knieriemen, DCP has multi-faceted uses specific to best practice and administrative requirements of general practice.
Among these is the program’s ability to help supervisors and registrars ensure recommendations of routine care are attended to before a patient leaves a consultation.
A glance at the program’s colour-coded control panel enables the doctor to access the patient’s preventative care status, and therefore promote interventions.
A green indicator shows recommended guidelines have been met; orange indicates what is due; and red indicates overdue.
“It drills into a patient history and pulls out all that summary information in a format that makes sense of the whole history,” Dr Gration said.
“It doesn’t intrude into the consultation process. It just helps facilitate it.”
Health on Central practice owner and GPSA board member Dr Nicole Higgins introduced DCP to her clinic in Mackay, Queensland, when it opened, and has used the full version of the program for the last 15 months.
First introduced to Dr Higgins by a fellow supervisor, she describes DCP as a “a safety net and a quality improvement tool,” and “a small investment that pays back many times over”.
“As a new practice embedding new staff, it was a check and balance to ensure demographics were correctly entered,” Dr Higgins said.
“As a practice owner I find the performance charts and business intelligence invaluable. Each individual contractor and registrar can track their clinical data and billing trends.
“The performance charts give me an insight into how the practice and individual doctors are going with information needed for accreditation, such as recording of allergies, smoking, alcohol etc.
“If there is any data missing it is quickly identified and remedied through the software. It gets me a quick overview of the practice’s billings, billings/hr, percentage of bulk-billed consultations, etc.”
Dr Higgins said patients, registrars and supervisors all benefitted from the DCP software program.
She said it provided patients a safety net; supervisors an excellent tool for chart review with patients; and prompts which ensured registrars met all the preventative activities of the RACGP red book.
For more information about Doctors Control Panel and subscription costs, visit www.doctorscontrolpanel.com.au
Teaching is at heart of clinic’s mission
Moving to a purpose-built GP teaching clinic in regional Victoria has brought career growth and lifestyle rewards for United Kingdom-trained doctor Robert Campbell and his peers.
Empty nesters Robert and his GP wife Dr Elizabeth Kennedy embraced the unique opportunity to move Down Under in 2013 to practice and become GP supervisors alongside their medical school friends at the innovative University of Melbourne Shepparton Medical Centre.
Their UK friends ̶ doctors Derek Wooff and Jane Gall ̶ had taken up posts at the teaching clinic when it opened in 2010, and enthused Robert and Elizabeth to join them on their supervision journeys.
The University of Melbourne Shepparton Medical Centre was the first purpose-built teaching clinic in Australia, designed to provide primary (GP) and secondary (specialist) medical and allied health ambulatory care in a parallel consulting model for medical and allied health students.
Teaching and learning is at the heart of the clinic’s mission, and the message greets guests at the reception counter with signage announcing, “Students are our future.”
The clinic’s large student learning hub doubles as the practice tearoom, meaning registrars and medical students have constant access to peers, GPs, practice nurses, and visiting specialists in their collaborative learning environment.
It’s clear from the outset, this is a contemporary and vibrant medical clinic providing best-practice patient care and an all-inclusive, proactive learning space for young, and senior doctors alike.
“The attraction to come out from the UK was teaching,” Robert, the clinic’s medical director, said.
As a full-time GP in the UK, Robert had enjoyed some limited teaching experience in public health, as well as at Scotland’s Dundee and St Andrews universities, but has honed his skills as an experienced supervisor in Shepparton.
The modern, light-filled clinic is on the University of Melbourne Department of Rural Health Shepparton campus, opposite the Goulburn Valley Base Hospital, and is a collaborative teaching environment which has also attracted other overseas and interstate doctors.
“The University of Melbourne embed a core of students here in Shepparton who do the bulk of their learning in a general practice setting, which is quite unusual,” Robert said.
“We are the first in Australia which was built with this model in mind to try and overcome the shortage of doctors in rural places; that is, if you actually expose students to life in a regional centre, they may well see the attraction.”
Robert said the eight-year-old clinic had a proud culture of vertical integrated learning which involved everyone from administration staff through to visiting specialists.
“All four senior doctors are approved GP supervisors; but even within that structure, we involve GP registrars in supervising or helping peer support for their juniors.
“We are all involved with the undergraduate teaching we do with the University of Melbourne. That is, all the medical staff, whether they are GP registrars or fully fellowed.
“What we hope to do is instil into them an interest, or a passion for teaching because we are passionate about what we do.”
Robert and his colleagues hope this teaching ethos will in turn be paid forward by registrars and medical students throughout their careers.
He said registrars enjoyed the clinic’s vertical integrated learning structure, and giving these learners the opportunity to also teach others was ideal exam preparation.
“It’s really good revision for the GP registrars getting near exam times because they are having to think about what they are doing.
“A lot of it is attitudinal, so it’s teasing out ‘What is the thought process behind my decision making?’ and that is what the KFP (Key Feature Problems) is looking at.”
Robert said “wholistic wrap-around medicine” and teaching registrars how to work in partnership with patients was another element of the Shepparton Medical Centre’s teaching ethos.
“In teaching wholistic wrap-around medicine, it means we are not just interested in the symptoms put in front of us: you might come in for a prescription, or a referral, or because you have got a pain; but we are interested in who you are, who is at home with you, what’s your social background, what’s your academic attainment, at what level in terms of your health literacy do we need to pitch what we are doing for you and with you?
“It’s very much a partnership, and I think that’s what the patients here appreciate.
“The partnership is not just telling them what to do: it’s trying to help the patient understand what they need to do to optimise their health, minimise illness, and come to terms with things for which there is no cure; and that can be the hardest part.
“It’s an important thing to teach our registrars: there isn’t always an answer, there isn’t always a clear solution.”
With regular visits to their family in the UK, Robert and Elizabeth remain committed to their GP supervising journey in Shepparton.
Centrally located, two hours’ drive from Melbourne and close to wine, river, high and snow countries, Robert said the multicultural region was suited to any GP’s lifestyle.
“The area is suited to families, couples, sports enthusiasts and lovers of food, wine and art,” he said.
Currently seeking a GP supervisor (new or experienced) to join the clinic, practice operations manager Joanne Kinder echoed Robert’s enthusiasm for regional living.
“Shepparton is a thriving and vibrant region that is experiencing significant change and growth, in particular with recent budget announcements; we believe it is an attractive place to set up your family and embed yourself in the community,” Joanne said.