The storms that hit the Hunter Valley over the 21st and 22nd of April 2015 have left a trail of tragedy and destruction. Among the many services affected, an unprecedented number of General Practices and Pharmacies have been damaged, isolated, or left without power for extended periods of time. Information for GPs and patients is available on this webpage.
On the NPS website: "Choosing Wisely Australia will launch on 29 April 2015. The initiative is led by Australia's medical colleges and societies and facilitated by NPS MedicineWise...Dr King [inaugural Chair of Choosing Wisely Australia Advisory Group & Medical Director of Medicaine at Monash Health] says he is excited about his involvement in Choosing Wisely Australia, "The aim of the initiative is to both help identify and reduce investigations and treatments that are of proven low value, with the outcome of improving healthcare provided to Australians. Australia's medical colleges and professional societies are leading the way by discussing best practice and identifying those practices that warrant scrutiny by drawing on the expertise of members."
Focused on high quality care, Choosing Wisely Australia will enable health professionals, healthcare stakeholders and Australians to start important conversations about tests, treatments and procedures where evidence shows they provide no benefit and in some cases can lead to harm. At the upcoming April launch, the first recommendations developed by participating colleges and societies will be released.
The following medical colleges and societies will be represented at the April launch:
From a Health Report transcript: "We've spoken before on the Health Report about the Choosing Wisely campaign in the United States and now it's washing up on our shores...[Ass Prof Adam Elshaug, Uni of Sydney]: "In fact it's the first truly physician-led program anywhere in the world where medical groups have got together, doctors, to try and identify healthcare services, practices and tests, interventions, that they think have little or no benefit for their patients...I think some of the resistance to these sorts of campaigns in the past have been this notion that we are either saying something is high value or low value. That is, it should be done or it shouldn't be done...'Sometimes' is the answer. So it's actually about really trying to target those patient groups for whom the most benefit can be achieved, and in fact then the test should be avoided on patients who it could actually cause some harm...I did an analysis in the US Medicare system where we looked at just 26 low value healthcare practices and how prevalent they are in the US Medicare system, and we found that there's over $8 billion of waste just on those 26 services in the US. If we were to translate that directly to the Australian Medicare system, that would equate to almost $600 million annually in savings...we've suggested that anybody considering going down the Choosing Wisely path consider not only a top five list of clinical services but perhaps a top five list of administrative system process services as well."
Justin Coleman is chairing the RACGP working group for Choosing Wisely, and has published the working list of 28 suggestions and shortlist of 10. This will be whittled down to the top five and with be formally launched on 29/4/15. The criteria for making the list were:
"This list is not trivial. Even if you disagree with a few here or there, I believe that if most GPs followed these recommendations in most cases, it would substantially improve patient safety, reduce harms caused by overtesting, overdiagnosis and overtreatment and, as a bonus, free up tens of millions of dollars annually within our health system."
List of recommendations:
[n.b These are hitherto unpublished, so I may not have worded them quite as accurately, or included all caveats.]
news.com.au has reported that: "Ms Ley was considering allowing doctors to introduce their own GP fee by changing Medicare rules to allow them to bulk bill patients but add a small fee on top. Ms Ley has now told doctors she won’t support their bid for a new form of GP fee called direct billing because it does not have support in the Senate. Such a measure would have delivered a massive pay rise to doctors without generating any savings for the government."
ABC news has reported: "Minister for Health Sussan Ley announced the wide-ranging review, saying Medicare needed to be revamped. "It has come back to me through every single consultation with doctors that the Medicare system is sluggish, bloated and at high risk of long-term chronic problems," Ms Ley said. "Patching it up with band-aids is not a solution." Among the measures, the Government will:
The SMH has reported: "She has asked for advice on priority actions for each of the three areas by late this year. This means there will be no structural reform of Medicare in next month's budget, and raises the possibility that the Coalition could seek a mandate for any significant proposals at the election due in the second half of 2016.
The Guardian adds: "Labor has previously backed the review on rebates but only if the money saved is pumped back into the health system. “These cannot and should not be savings for savings sake. It is critical that the focus of such reviews is on quality and safety and that any savings are reinvested back into the healthcare system, and particularly in areas of healthcare reform,” shadow health minister Catherine King said."
Pharmacy News has reported: "Independent MP Andrew Wilkie met with Ms Ley to discuss his concerns over proposed and current allied health cuts. Mr Wilkie, who represents the Tasmanian electorate of Denison, said the government had introduced as co-payment by stealth on optometry services and had not given any guarantees on funding for dental services in next month’s federal budget. His concern over these and other measures prompted his meeting with Ms Ley. While she wouldn’t budge over optometry Medicare cuts, she had better news for pharmacists...“the Minister said it was her personal view that pharmacies should not be opened in supermarkets, and that there was no appetite in the Government for such a move,” Mr Wilkie reported."
Sussan Ley has announced new training regions and governance arrangements for the delivery of GP specialist training, commencing from 2016. "Ms Ley also announced the establishment of a new profession-led General Practice Training Advisory Committee to provide advice to government on GP training policy and delivery. This advisory committee will undertake evaluation of the Australian General Practice Training programme and be jointly managed by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine. The advisory committee will include representatives of General Practice Registrars Australia, General Practice Supervisors Australia, an independent Aboriginal or Torres Strait Islander GP, two independent clinicians, the Department of Health and an independent chair. The Australian Government will shortly conduct a tender to deliver the AGPT programme from 2016 onwards. This will ensure new regional training organisations and arrangements are in place for the 2016 intake of GP registrars."
The official webpage with the announcement is here.
The Australian General Practice Training FAQ page on the Training Boundaries and future Training Organisations is here.
As reported in Pharmacy News: "Media criticism of community pharmacy regulation has continued unabated over the Easter long weekend. A series of articles in major newspapers has sustained the ongoing public critique of the lobbying power of the Pharmacy Guild of Australia."
In the SMH, there is an article titled "The Pharmacy Guild: the most powerful lobby group you've never heard of", in which Matthew Knott writes: "In his final report on competition policy - the first of its kind in more than two decades - economist Ian Harper lays down a challenge to the government: to rip up the rules that make community pharmacy one of the most protected sectors in the economy. New entrants are now banned from opening a pharmacy within 1.5 kilometres of an existing business and must be owned by registered pharmacists. This has shielded community pharmacists from competition from the likes of Coles and Woolworths. Ripping up these rules should, in theory, bring prices down for consumers. The government is considering the report's recommendations and has not indicated whether it accepts or rejects Harper's call to deregulate the pharmacy sector...The consequences of taking action won't need to be spelt out: a campaign, fronted by community pharmacists around the country, against the government (and any crossbench senators who support deregulation).These include pharmacists in marginal seats. Surveys show that pharmacists are highly trusted by the public - rating well above politicians and, for that matter, journalists. As well as self interest, the pharmacy lobby has a set of potent arguments on its side. Most notably that deregulation would allow Coles and Woolworths to become more dominant than they already are."
Another SMH article about the Harper Review notes: "Few believe that the Abbott government has the stomach for another fight. Not after the bruising losses on things like the GP co-payment, university reform, "wait for the dole", and now its pension indexation plans which look unlikely to get through."
A summary article in the Canberra Times is titled - "Pharmacy explainer: what are the benefits of deregulating the pharmacy industry?". Dan Harrison echoes the SMH when he concludes by writing: "Various reviews dating at least as far back as 2000 have considered these issues and made recommendations for reform. Most recently, last year the Commission of Audit recommended location and ownership rules be removed.Why no government has been brave enough to implement reform probably has a lot to do with the legendary lobbying power of the Pharmacy Guild."
A commentary article in The Age is titled, "Harper Competition Review finds bitter pills in pharmacy industry". Peter Martin, the Economics Editor, writes: "The best estimate suggests the [UK] decision to allow supermarkets to sell medicine cut the prices charged by 10 to 30 per cent. Few in Britain would turn back the clock. The rules governing Australia's pharmacies are so strange we've come to think of them as normal. They apply in no other industry. Whereas any Australian can own a doctor's surgery or an electrical or plumbing business, only qualified pharmacists can own new pharmacies. The restriction isn't to ensure that those qualified pharmacists work in the pharmacies, as many of them own many pharmacies or are retired. It's to make sure no-one else can own them, because apparently supermarket goods and pharmacies don't mix...The more important effect of the location rules is to protect pharmacies from price competition and from competition for the government payments that make up over half of pharmacies' incomes. Harper says if there are areas of Australia left unserved after the location rules go (as there are now in Indigenous areas) the government should consider allowing doctors to dispense medicines themselves. It's far from true that Australian pharmacists support the restrictions. The Pharmacy Guild of Australia represents only the 4000 who own pharmacies. Another 20,000 are locked out of ownership and forced to work for those who got in early. These "employee pharmacists" are represented by Professional Pharmacists Australia, which supports a review of the location rules and has incidentally asked the Audit Office to conduct a complete audit of all public money handed to the Guild."
Philip Clarke, Professor of Economics at the University of Melbourne, has written an article for The Conversation, titled "The right prescription: pharmacy sector in dire need of reform". He writes: "The high profitability of established pharmacies mean business sale prices for inner city and suburban pharmacies can run into the millions. And this high purchase price locks out many pharmacy graduates from ever owning their own business. It also means new entrants are saddled with levels of debt that turn what should be profitable business into marginal ones. All this creates what might be termed a cycle of rent-seeking: while the ownership and location rules protect existing owners, the next generation of pharmacy owners will have to buy their businesses at inflated prices. And this makes new owners seek ever more protection from competition to make their business profitable and, in some cases, viable."
ABC news has reported that, "The ABC has obtained key parts of a report on mental health services, which was commissioned by the Government but has yet to be released. It says the current system is poorly planned and is a "massive drain on people's wellbeing", and recommends redirecting more than $1 billion from acute hospital care to community-based services. But in an exclusive interview with ABC TV News, Ms Ley said she had ruled the move out."
Read the full article here.
As reported in The Age: "Childcare and medical organisations have welcomed the federal government's decision to strip parents who are conscientious objectors to childhood vaccination of family tax and childcare payments. Prime Minister Tony Abbott announced on Sunday parents would no longer receive payments worth up to $15,000 a child from 1 January 2016. "The choice made by families not to immunise their children is not supported by public policy or medical research nor should such action be supported by taxpayers in the form of childcare payments," Mr Abbott said. "The government is extremely concerned at the risk this poses to other young children and the broader community." Although Australia's overall childhood vaccination rates remain high - about 97 per cent - the numbers of people who are registered conscientious objectors has risen in the past 10 years. Over the past decade the number of children aged under seven who are not vaccinated because their parents are conscientious objectors has risen by 24,000 to 39,000. The change to family tax and childcare payments will need to be agreed to by Parliament but has the support of the opposition. "Labor supports promoting the safety of our children," Opposition Leader Bill Shorten said on Sunday."
Not everybody thinks it will be effective. Associate Professor Julie Leask, from the University of Sydney: "The Abbott government's tough new stance on immunisation will only increase vaccination rates by an "absolute maximum of one per cent," a Sydney immunisation expert says. University of Sydney associate professor Julie Leask said the federal government's move to prevent parents who don't vaccinate their children from accessing childcare payments and family tax benefits would not have a "meaningful" impact on overall immunisation rates. Professor Leask said about 2 per cent of parents were currently registered as conscientious objectors to immunisation and of those, half were "hard core" while the other half would still give their children some vaccines. She said that the hard core group would not be moved by the new policy, with only those who were partial objectors potentially open to changing their view. Professor Leask said that there was a much larger group of parents - of about 4 or 5 per cent - who did not vaccinate their children or keep them updated for practical or logistical reasons."
Christian Scientists will be the only exempt group.
ABC News has reported: '"The service, which provides after hours care for thousands of Hunter patients, only has funding till June, with the Government yet to announce details for further support. Dr Mark Foster who is a director of Hunter Medicare Local said GP Access provides a vital service, unmatched by any other provider. "There are other service providers who provide services in after hours periods but they can't provide the full packages of services that GP Access provides," he said. "They are not sitting right next door to emergency departments...They don't have all the close arrangement that this service has with the emergency departments so we can make sure patients have the right care, in the right place."'
Read the full article here.