In The Media

ABC News: GPs call for radical rethink of health funding in Tasmania to ease pressure on state’s hospitals


Dr Bastian Seidel
, the immediate past president of the Royal Australian College of General Practitioners agrees that a radical overhaul of the state’s healthcare system is needed.

“There is next to no investment in preventative care here in Tasmania, the Government is really only focusing on hospital care,” he said.

“The patient will call the ambulance which is perceived to be free and the patient will be taken to the hospital, quite frankly that is going to cost the taxpayer even more,” he said.

“A visit to the emergency department costs the taxpayer $250, the ambulance costs $800, if you go and see your GP, the Medicare rebate costs the taxpayer an average of $37.60.”

Dr Bastian Seidel said it was time to have a “grown-up” conversation about health funding, with all levels of government, to change the way health is funded.

He said Victoria and Queensland were already leading the way.

“The state governments there have taken responsibility for funding some general practice activity, in particular when it comes to diabetes, chronic disease,” he said.

The Mercury: Cafe Society: Community care the key for our health

Dr Bastian Seidel has learnt croissants do not travel well on his bicycle. The Huonville GP, who completes his two-year presidency of the Royal Australian College of General Practitioners today, often rides to work from his Mountain River home.

But not on Saturdays, when he travels by car so his colleagues receive their pastries intact from the Summer Kitchen Bakery at Ranelagh. Taking his car also means he can make home visits on a meandering return drive to his 40ha farm, where he lives with his wife Alexandra, toddler son and new baby boy.

Two years ago the German Australian became a father on the same day he was elected to his national role. Life has only become busier. He has since married Alexandra, become an Australian citizen and expanded his Huonville practice.Throughout, he has aimed to amplify the GP voice, shifting it from the periphery, reacting to health policies, to play a proactive role in trying to shape them.

As he steps down, Seidel is calling for the State Government to lead an urgent overhaul of the Tasmanian health system.

His biggest insight over his presidency is that we are too hospital-centric. Nationally, he points to a $4 billion annual saving to be made by reducing avoidable hospital admissions.

Seidel believes the only way to reduce Tasmania’s heavy chronic disease burden is to strongly back a community-based system, with GPs working alongside allied health teams that include psychologists, physiotherapists and nurse practitioners.

“It’s far more cost-effective and frankly it is what people want,” he says.

Over time, this approach would not only decrease the emergency presentation rate, but shift the emphasis towards preventive care.

Seidel holds little hope of the Royal Hobart Hospital redevelopment alleviating pressure, with the Premier admitting last weekend the health system is failing to meet demand. Emergency department admissions have soared over the past two years.

“When it comes to health funding, the smart money is on preventing hospital admissions in the first place,” says Seidel.

“If we feel the solution is just to have a renovation of a building, then clearly something hasn’t been understood.“We need more sophistication in our thinking about how we keep Tasmanians healthy.”

Catholic News Agency: Provision for abortion delayed in Australian state


Government authorities in the Australian state of Tasmania have promised that low-cost surgical abortion will be provided starting in October, but general practitioners and the state’s Women’s Legal Service say they have not been provided any information on who the provider will be and how abortions will be delivered, according to local media reports.

The state’s only dedicated abortion clinic closed in late 2017 due to declining demand for surgical abortions, ABC news reported.

Bastian Seidel, president of the Royal Australian College of General Practitioners, told ABC News that no information from the government about how the procedures would be delivered had yet been passed on to general practitioners. Susan Fahey, Women’s Legal Service chief executive, also expressed frustration that the government had so far provided so few details.

ABC News: Tasmanian health providers still in the dark about state’s new abortion service


Tasmania’s GPs and the Women’s Legal Service say they have not yet been given any information about a new low-cost surgical termination provider in the state, despite government promises that the service would begin in October.

The state’s only low-cost abortion clinic closed at the end of last year and some women have since been forced to fly interstate for the procedure.

In July the Government announced that the Health Department had signed an in-principle agreement with a private provider to deliver low-cost surgical terminations in Hobart from October.

On Tuesday morning Attorney-General Elise Archer was asked who the provider was, but said she was not sure if the information had been made public.

“I know that the provider will be contacting local GPs and clinics and making all of the details aware in due course,” she said.

“We’ve certainly been assured that will be opening this month.”

But Royal Australian College of General Practitioners president and Tasmanian GP Bastian Seidel said no information had yet been passed on to GPs.

He said there were standard channels used to let GPs know when a new service provider entered the state, but no information on a low-cost surgical termination provider had been disseminated through those channels.

The Guardian: ‘Robbed of precious time’: chemical restraints and aged care


The first national audit of psychiatric medication prevalence in aged care homes earlier this year found nearly two-thirds of all residents are prescribed psychotropic agents regularly, with more than 41% prescribed antidepressants, 22% antipsychotics and 22% of residents taking benzodiazepines.

The overuse of sedative medication as “chemical restraints” in aged care homes is not a new problem. In the past 20 years, there have been several government inquiries into an over-reliance on medication to manage the behaviour of residents. These inquiries recommended educating staff working in aged care homes about alternative ways to manage behavioural problems. The elephant in the room, however, is doctors who prescribe the medication.

Royal Australian College of General Practicioners president, Bastian Seidel, said: “Medical sedation is a foul compromise for ­inadequate nursing care”.

SBS: ‘We were desperate’: Family turns to black market for medical cannabis


Alice is one of a growing number of parents giving their children cannabis oil to help mitigate the effects of chronic illnesses. But they do so knowing there is a risk: uneven legislation across states governing the prescription and use of medical cannabis means that some risk fines, even jail, for obtaining, growing or supplying the drug.

The Royal Australian College of General Practitioners is one group working hard to ensure the legislation is standardised.

“If we look at the scientific evidence, there’s now conclusive and substantive evidence that [medicinal cannabis] is effective in patients with severe and disabling pain,” says Dr Bastian Seidel of the college.

“There’s no nationally consistent regulatory framework covering cannabis. It’s very confusing if you’re a medical practitioner and you feel you’ve exhausted all other avenues to treat a patient, it’s almost impossible to jump through all these hoops and prescribe cannabis in a timely and reasonable fashion.”

Dr Seidel says obtaining medicines on the black market limits the capacity of the medical profession to monitor how patients respond.

“In 2018 it’s completely unacceptable to have to get drugs on the black market,” says Dr Seidel. “If a medical professional feels it’s appropriate to prescribe medicinal cannabis then they should be able to. If it’s being accessed on the black market we don’t know what’s being put in, we don’t know the dose being given, and this isn’t in the interests of the patient, of parents, or of society.”

60 Minutes: How ‘doctor shopping’ is letting addicts access deadly painkiller


While Sandra McGivern can’t do anything to bring her son back, she’s doing everything she can to make sure his death wasn’t in vain.

Sandra’s son, Angus, died from a fentanyl overdose in September last year in Queensland.

She’s dedicating her life to campaign politicians and warn others about her son’s death.

Fentanyl is a painkiller fifty times stronger than heroin, used treat anything from cancer pain to back to injuries.

Fentanyl is easy to use and available in patches, which are stuck on the skin and last for three days, making overdosing on the patches easy.

New figures obtained by 60 Minutes show there have been 514 fentanyl related deaths between January 2010 and December 2015.

For Doctor Bastian Seidel, the president of Australia’s Royal College of General Practitioners, this number constitutes as a crisis.

“It is a disaster,” he said.

Dr Seidel doesn’t think fentanyl should be prescribed for minor pains.

“It’s quite inappropriate,” he told Steinfort, adding alternatives were difficult to come by.

“It’s a difficult situation… we can’t reign the prescribing in.”

Sydney Morning Herald: ‘Antibiotics don’t cure colds’: Calls for prescription crackdown


Many Australians have a stack of paper prescriptions stuffed in a drawer or at the bottom of a cupboard – either leftover repeats or scripts that haven’t been filled but are yet to expire.

Now a leading expert on drug resistance has suggested that in numerous cases, prescriptions for antibiotics should not be offered on repeat, nor handed over with a lengthy, 12-month expiry.

It comes after evidence tens of thousands of patients could be hoarding their scripts and using them months later to treat an unrelated illness. In other cases, patients are receiving repeats for antibiotics when it is not medically required.

Professor Karin Thursky, director of the National Centre for Antimicrobial Stewardship, said a review of longstanding drug prescriptions at a Melbourne aged-care facility unearthed a resident who had been on antibiotics for more than a decade.

The Royal Australian College of General Practitioners supports the idea of new date limits on prescriptions to prevent patients from taking an unnecessary second antibiotics course or using them later to treat unrelated ailments.

But the college’s president Dr Bastian Seidel said the emphasis needed to be placed on public education and funding GPs to spend more time to explain to patients how they should use the medicines prescribed to them.

MJA InSight: Code of Conduct changes spark 700 submissions


The Medical Board of Australia has been inundated with submissions on the proposed update of the doctors’ Code of Conduct, receiving about 700 submissions and counting.

In June, the Board invited the profession to provide feedback on the proposed changes. The Board said it was “not proposing significant changes” to the current code, and any impact on practitioners was expected to be “minor”.

Key changes included:

  • strengthened guidance about discrimination, bullying, sexual harassment and vexatious complaints;
  • changes to the section on culturally safe and sensitive practice to be clearer about the responsibilities doctors have to provide care that is culturally safe and respectful and to support the health of Aboriginal and Torres Strait Islander peoples;
  • expanding sections on professionalism and patient safety; and
  • new guidance on career transitions for doctors.

In the RACGP’s submission, President Dr Bastian Seidel said the College was supportive of most of the changes to the code, however it identified several issues that required further consideration before the code was finalised.

In relation to the section that states that “recognising the impact of fatigue on your health and your ability to care for patients, and endeavouring to work safe hours wherever possible”, the College said it was important to also recognise the system and institutional influences on a doctor’s ability to manage their own fatigue.

Dr Seidel also wrote in the submission that the College had previously raised frustrations regarding the code’s inability to identify health practitioners’ responsibilities for follow-up of health services or tests they have ordered. He said this was particularly concerning for GPs who, as central co-ordinators of care, often referred patients to other health professionals.

“Responsibility for the timely review and action on tests and results ultimately rests with the health professional who ordered the test. However, expectations of who is responsible for follow-up can become blurred – especially if the patient’s interaction with the secondary service is ad hoc,” Dr Seidel wrote.

“The code should explicitly outline that medical practitioners have responsibility for following up the health service they initiate. This will ensure that GPs are not expected to follow up tests (or other services) that they may not be aware of.”

The Advocate: Australian Institute of Health and Welfare releases data on out-of-pocket medical expenses


The Royal Australian College of General Practitioners is calling for the Medicare rebate to increased amidst concern people are being deterred from regular doctor appointments due to out-of-pocket expenses.

The body’s president and Tasmanian-based general practitioner, Bastian Seidel (pictured), said GPs were regularly being asked by patients to bulk-bill them which placed them in a precarious ethical position.

He said more regular visits to the GP would clearly lead to better health outcomes and reduce pressure placed on the hospital system and emergency departments.

“People are trying to avoid or delay seeing a GP because of the high costs,” Dr Seidel said.

He used the example of skin cancers and melanomas on Tasmanian patients which could be easily removed at a GP surgery in the early stages but often resulted in more invasive treatment as consultation was delayed.

Dr Seidel said there was an opportunity for structural reform in the state and greater investment by the state government in GP services, rather than having all funding go into hospitals.

He said the government had a role to play in ensuring people went to their GPs first and were released into GP care once they left hospital.

The Australian: Aged-care homes’ drug use slammed as ‘elder abuse’


Nearly two-thirds of Australian aged-care residents are every day given psychiatric drugs — many inappropriately prescribed — that cause deaths and strokes or are linked to falls and seizures.

The “horrifying” findings of a University of Tasmania study have prompted the Royal College of GPs to warn that aged-care homes can no longer be ­assumed to be safe places, and an expert to condemn ­resident-medicating practices as “elder abuse”.

Reporting on the first national audit of psychiatric medication prevalence in aged-care facilities, the study finds homes are beset by “high rates and inappropriate use”, that use of highly sedating antipsychotics and benzo­diazepines is “of major concern” and interventions are “urgently ­required”. The findings are likely to deepen turmoil over dysfunction and abuses exposed within Australia’s residential aged-care system, with experts saying the study numbers show “chemical restraint” — where sedation is used to control the behaviour of residents, particularly those with dementia — is “widespread”.

Branding the survey findings “horrifying”, RACGP’s president, Bastian Seidel, said: “Medical sedation is a foul compromise for ­inadequate nursing care. People think they’re in a safe place in residential care and everything (will) be fine, but the reality is what’s being reflected in this research.”

Asked if he was saying aged-care homes could no longer be assumed to be safe places, Professor Seidel said: “That’s correct.”

Tasmania Talks:  Sixth meningococcal case confirmed in Tasmania


A 66-year-old Claremont man is currently being treated for meningococcal disease at the Royal Hobart Hospital, the Director of Public Health has confirmed.

“It’s important for people not to panic the department is taking appropriate action to contact again family members and to people close to the sixth case now. But if you are concerned please make an appointment to speak to your GP about treatment options and preventative options,” President of the Royal Australian College of General Practitioners Dr Bastian Seidel said.

For anyone older who is worried, President of the Australian College of General Practitioners Doctor Bastian Seidel recommends you visit your GP.

“The recommendation is for anyone to have the vaccination if they want to protect themselves against meningococcal disease. The government is funding the vaccination for everybody under the age of 21 but there would be a private charge for people who want to have the vaccination,” he said.

President of the Australian College of General Practitioners Doctor Bastian Seidel said if you want to protect yourself against meningococcal disease it’s important you have all the vaccinations.

“The problem is type B vaccination is very expensive it’s at least $115 and it’s really not affordable for most Australians. As in the past I call on the government to make a subsidy available so that patients that want to have the vaccine can actually get access,” he said.

The Examiner: Royal Australian College of General Practitioners want free meningococcal-B vaccinations


Doctors have recommended at-risk Tasmanians be vaccinated against the B-strain of meningococcal.

The National Centre for Immunisation says meningococcal-B remains the most common cause of the disease in children, adolescents and young adults.

Royal Australian College of General Practitioners president Bastian Seidelsaid it had regrettably not been included as part of free vaccinations because of the cost.

“It is recommended that people are immunised but the pharmaceutical advisory body has said it is not cost effective,” Dr Seidel said.

“But how much is a life worth?

“People should be encouraged to take preventative action but it is very hard for families because of the cost.”

Dr Seidel said it would cost $115 per vaccine and two shots were needed.

“It is a health inequality when people are missing out because they can’t afford the cost which could be around $1000 for a family.”

Tasmanian Liberal Senator Eric Abetz is lobbying the federal government to have free meningococcal-B vaccines for children.

“I believe the federal government should make the meningococcal-B vaccine available to high risk groups to ensure that no more children suffer from this terrible illness.”

The Mercury: Senator Eric Abetz joins fight for meningococcal B-strain vaccination


Liberal Senator Eric Abetz will lobby Federal Health Minister Greg Hunt to make meningococcal disease B strain vaccines available to children.

Senator Abetz is backing a petition from Tasmanian B-strain survivor Erica Burleigh and will meet with Mr Hunt to discuss the issue.

The Liberal State Government has made vaccination for the A, C, W and Y strains of the disease free for Tasmanians under the age of 21.

The Royal College of General Practitioners immediately backed Senator Abetz’s move.

“I’m always delighted when political decision-makers are following clinical recommendations,” RACGP president Bastian Seidel said.

The RACGP has lobbied for the B-strain to also be subsidised by government.It currently costs Tasmanians $230 for its two jabs.

Around a quarter of those receiving the ACWY shot were also requesting the B-strain inoculation, Dr Seidel said.

“It puts patients in a very difficult situation because all of a sudden you have to make a financial decision when it comes to your preventative health care,” Dr Seidel said.

Tasmanian Health Minister Michael Ferguson said the State Government response was focused on the greatest risk.

“Tasmania’s meningococcal B disease rate is consistent with the national rate, whereas meningococcal W is currently higher,” Mr Ferguson said.

“However, the Government recognises public concern on this issue and we will continue to consider coverage for all vaccine-preventable strains and take advice from public health experts.”

Daily Mail: Turnbull government backs down over My Health Record rules and will force police to get a court order to access private files


Privacy provisions for My Health Record will be strengthened so that a court order is needed for information to be released without consent.

Health Minister Greg Hunt announced the changes following talks with the Australian Medical Association and Royal Australian College of General Practitioners.

RACGP president Dr Bastian Seidel welcomed the move, calling it ‘a very positive step towards the meaningful use of My Health Record’.

‘A patient’s medical record contains highly sensitive, confidential and privileged information. It needs to be protected, not just shared – and I’m pleased that Minister Greg Hunt has agreed to do so,’ Dr Seidel posted on Twitter.

The Guardian: Australian GPs will accredit offshore detention centres if given full access


The Royal Australian College of General Practitioners has said it is willing to work to accredit the medical services in offshore immigration to Australian standards, but only if the government gives it full and free access to the centres offshore, and makes its audit public.

The president of the Royal Australian College of General Practitioners, Bastian Seidel, said the college would be willing to accredit the offshore medical services, but that they must be given full access free from any interference, and their findings made public.

“The RACGP has been very vocal about the circumstances of offshore detention. We have said repeatedly our members are willing to go to detention centres to look after patients and to see the circumstances.

“In order to audit, there can be no caveats, or pages and pages of terms of references, or where a report then just get lost in a file in the bureaucracy somewhere. There can be only two conditions: that the RACGP has full access to these centres; and that the results of the audit are available publicly, so people can know the situation.”

Seidel told Guardian Australia: “It happens all the time, that bureaucrats overrule the clinical decisions of doctors who are employed to provide care for people in offshore.”

“If a doctor had made the wrong call in treating Hamid Kehazaei, the discussion would have been around medical negligence and professional responsibility. But in this case, bureaucrats overruled the doctors’ clinical recommendations. Should the discussion be around the professional responsibility of people in those positions?”

Croakey: Health groups urge action from coronial inquiry into death of Manus detainee Hamid Khazaei


Doctors and refugee groups have called on the Australian Government to act urgently on coronial recommendations for better health care for asylum seekers in Australia’s offshore detention facilities – including that decisions about medical transfers to Australia be guided by “clinical considerations” rather than “bureaucratic and political imperatives”.

Health groups, including the Royal Australian College of GPs, have repeated long-standing calls for independent oversight of health care for asylum seekers following the damning findings of a coronial inquest into the death of Iranian asylum seeker Hamid Khazaei, who died after suffering severe sepsis from a leg infection on Manus Island.

Queensland Coroner Terry Ryan found on Monday, as Guardian Australia reported, that Khazaei’s death was preventable but had been caused by “a cascading series of errors and systemic failures in the Australian-run offshore detention centre”.

He said: “I am satisfied that if Mr Khazaei’s clinical deterioration was recognized and responded to in a timely way at the MIRPC clinic, and he was evacuated to Australia within 24 hours of developing severe sepsis, he would have survived.”

The finding prompted this tweet from Royal Australian College of GPs President Dr Bastian Seidel:

In a statement, Seidel welcomed the Coroner’s recommendations on improved standards and audits for healthcare facilities in offshore detention facilities.

“The majority of people in detention have complex health conditions which are exacerbated by a prolonged period of uncertainty. It is vital that they receive health services that improve their condition and not add to it,” said Seidel.

ABC News: Asylum seeker Hamid Khazaei’s death from leg infection was preventable, Queensland coroner finds


The death of Iranian asylum seeker Hamid Khazaei was preventable and the result of “compounding errors” in health care provided under Australia’s offshore immigration detention system, the Queensland coroner has found.

Coroner Terry Ryan found 24-year-old Mr Khazaei, who died in a Brisbane hospital in September 2014 after he contracted a leg infection in Manus Island detention centre, would have survived had his rapid deterioration been recognised.

Royal Australian College of General Practitioners (RACGP) president Bastian Seidel blasted the policy which allowed immigration officials to ignore a doctor’s call.

“Bureaucrats should never ever be allowed to override a clinical decision made by a medical doctor,” he said.

“There comes a point when [Home Affairs] Minister Peter Dutton needs to be asked to take responsibility for the actions of his department.”

The Guardian: Hamid Kehazaei: Australia responsible for ‘preventable’ death of asylum seeker


The family of the Iranian asylum seeker Hamid Kehazaei, whose death from infection on Manus Island was caused by a cascading series of errors and systemic failures in the Australian-run offshore detention centre, say “nothing will replace the life of their beloved son and brother”.

But they have urged the Australian government to heed the findings of the Queensland coroner Terry Ryan, which were handed down on Monday.

Ryan found that Kehazaei’s death was preventable and recommended that healthcare on the offshore islands be properly funded and run – and under the control of doctors – or asylum seekers and refugees be moved to Australia.

The president of the Royal Australian College of General Practitioners, Dr Bastian Seidel, said bureaucrats should never be allowed to override a clinical decision made by a medical doctor: “There comes a point when Minister ⁦Peter Dutton⁩ needs to be asked to take responsibility for the actions of his department.”

Tasmania Talks: Calls for Tasmania to abandon gun changes


Health groups are calling on the Tasmanian government to back away from proposed changes to gun laws.

The Liberals in March revealed plans to double the duration of some gun licences and make weapons such as pump-action shotguns more readily available.

 

On Sunday, groups including the Royal Australian College of General Practitioners called on Premier Will Hodgman not to push ahead with the changes.

 

“I’m not only concerned about patients but I’m also concerned about health professionals … who need to look after people who have been affected by gunshot wounds, who have been killed,” the college’s president Bastian Seidel said in Hobart.

 

After being returned to government in Tasmania’s March poll, the Liberals agreed to an upper house inquiry into the proposed changes.

ABC News:  Port Arthur massacre health workers call on Tasmanian Government not to weaken gun laws


Health workers who responded to the Port Arthur massacre are calling on the Tasmanian Government to abandon its proposal to water down gun laws.

The Liberals’ policy to weaken Tasmania’s gun laws was revealed in the media on the eve of the March state election.

The Government promised changes to gun laws that would allow greater access to Category C firearms — such as self-loading rifles, pump-action shotguns — for farm workers and sporting shooters.

RACGP president Bastian Seidel said he was flabbergasted by the Government’s proposal.

“We would like to see gun violence eradicated, the same as measles, the same as meningococcal disease,” he said.

“It shouldn’t be encouraged by watering down existing gun laws.”

Dr Seidel said he was also concerned about the effect the changes would have on Tasmania’s health system.

“Our health system here in Tasmania can’t cope on a good day. What’s going to happen if we see more gun violence,” he said.

“If you have to treat injuries and get ready and prepare for massacres again, this doesn’t make any sense in 2018.”

The Examiner: Royal Australian College of General Practitioners opposes state government’s proposed gun control changes


Proposed changes to Tasmania’s firearms lawswould place extreme pressure on the state’s health system, according to a peak body.

The Royal Australian College of General Practitioners announced on Saturday it was formally opposing the state government’s push to relax gun control legislation.

Proposed changes to the laws, announced just one day prior to the March election, include increasing access to gun silencers, allowing more access to pump action shotguns, self-loading shotguns and self-loading rim-fire rifles and permitting farmers to carry those same weapons unlocked in cars.

RACGP president, and Huon Valley native, Dr Bastian Seidel said softening firearms legislation would increase the risk of gun-related trauma, heaping pressure on GPs and the hospital system.

Dr Seidel particularly emphasised the potential toll the changes would have on first responders at the scene of gun violence and noted the state’s hospital and mental health services were already stretched to the limit.

“An activity that presents a risk to the health and safety of our patients is of concern to GPs,” he said.

“Softening of firearms legislation would increase the risk of firearm incident or misadventure, including risk of suicide, to our patients.

“It does not take a genius to understand that there is no good outlook to this situation should guns become more readily available.“

The Mercury: Medical groups urge Hodgman Government in fight against proposed gun law changes


Frontline medical professionals will today demand the State Government strengthen rather than water down gun laws, with submissions to an inquiry into the proposed changes closing this week.

Representatives from across the medical professions will front the media to send a message to the Liberal Government that the post-Port Arthur laws work and changes promised to gun users breach the National Firearms Agreement (NFA).

A Liberal Party pledge to loosen restrictions on some semiautomatic weapons and to double licence periods became public on the eve of the state election in March.

Medical groups including the Royal Australian College of General Practitioners, the Australian Nursing and Midwifery Federation and the Health and Community Services Union have all made submissions to the Upper House inquiry.

A submission from the Royal Australian College of General Practitioners highlights the toll on first responders, daily code black security alerts in hospitals and stretched mental health services.

“To soften gun control laws would increase the risk of firearm-related trauma to all Tasmanians and this must be avoided,” college president Bastian Seidelsaid.

ABC News: Doctors alarmed by unsecured Child Protection Tasmania website


The website used to make reports about child abuse and neglect in Tasmania is not secure, and information about the state’s most vulnerable children and those who make notifications has been at risk for years, a cyber security expert says.

Dr Bastian Seidel, with the Royal Australian College of General Practitioners, was shocked to find that sensitive information had been at risk for years.

He said he and other doctors had assumed the site was secure.

“It’s personal details, personal circumstances of family and it’s certainly personal and professional details of the doctor who’s making the referral,” he said.

“At the very least, in 2018, you would expect the transmission to be secure. That’s not rocket science.”

Dr Seidel is now recommending doctors not use the site.

“The website needs to be made secure immediately,” he said.

He said while doctors often used telephone notifications in urgent cases many liked to use the online form for documentation reasons.

Dr Seidel wants an audit of all the information transmitted through the website.

The Examiner: More free vaccines to be rolled out


Doctors are urging all Tasmanians aged between six weeks and 20 years to get free meningococcal vaccines.

Royal Australian College of General Practitioners president Dr Bastian Seidel commended Health Minister Michael Ferguson’s decision to expand the government’s vaccine program after the fifth confirmed case of meningococcal disease.

“The message is simple –  if you are older than six weeks and under 21 go to your GP and get your vaccine,” Dr Seidel said.

“The expansion is well overdue but it is better late than never. We need all hands on deck and the challenge is to deliver it on time.”

Mr Ferguson said the expansion of the program would cost millions of dollars and would begin in Hobart’s northern suburbs in the next week.

“This is a massive expansion and will be rolled out for 100,000 people statewide over the next three months,” Mr Ferguson said.

“The broader program will see eligible Tasmanians receive a free meningococcal vaccine from either a general practitioner, a pharmacist (for children aged 10 and over), special public clinics, and some high schools.

“The vaccine will cover the meningococcal strains A, C, W and Y.”

ABC News: Meningococcal vaccine program rollout to combat disease spike, Tasmanian Government confirms


Vaccines covering the A, C, W and Y meningococcal strains will be available free for under-21s in response to the five recent cases of the disease in Tasmania, the Government has confirmed.

The announcement comes a day after the ABC reported the fourth case for the year had presented at the Royal Hobart Hospital without the public being made aware.

The Tasmanian Health Service announced there were in fact two new cases, making it five in less than two weeks.

Earlier today, the President of the Royal Australian College of General Practitioners, Dr Bastian Seidel, said the “political point scoring, poor communication and blame” over the disease cases had been unhelpful for clinicians and patients.

“Now is the time to work together, to get clinicians on board and communities on board to protect Tasmania from the very serious meningococcal disease,” Dr Seidel told ABC Hobart.

“This political point scoring that’s going on, the poor communication, the blame, the really difficult way of how things are being communicated to patients and communities is really not helpful.”

The Mercury: It’s healthy to communicate


The State Government’s commitment to extend the ACWY meningococcal vaccine scheme to all Tasmanians born after August 1, 1997, is welcome. That means every Tasmanian child will be eligible to get the vaccine for free.

Improving access to vaccines to protect more at-risk Tasmanians is sensible public health policy and few would argue against the extra funding needed to ward off such a dangerous and debilitating disease. Every effort should now be made to encourage parents to ensure they take the opportunity to vaccinate their children.

While action by the State Government is appropriate, there remains concerns at how the latest public health issue has been handled.

There have now been five cases of meningococcal in just over two weeks — one which led to the death of a teenage schoolgirl.

It is a significant outbreak, yet the information provided by the health department has been vague at best.

Yesterday, the Royal Australian College of General Practitioners president Bastian Seidel criticised the lack of clear communication by the health department to inform the public and clinicians.

“We as GPs, who are seeing patients on a daily basis — with concerned parents asking how they can protect [their children] against meningococcal — we are pretty much left in the dark. It’s very disappointing,” he said.

The Mercury: Doctors want meningococcal updates daily


The State Government is under fire over claims it has failed to provide enough information quickly on the meningococcal outbreak.

General practitioners inundated with calls from anxious parents want daily updates on the unfolding situation as the number of cases climbs.

Royal Australian College of General Practitioners president Bastian Seidelsaid communication from Public Health on the outbreak had not been good enough.

“We as GPs, who are seeing patients on a daily basis, with concerned parents asking how they can protect [their children] against meningococcal, are pretty much left in the dark,” Dr Seidel said.

“We as clinicians need to know what we are advising our patients on.

“We have received nothing from the Department of Health since July 13 and that was just to inform that there is a vaccination for teenagers.”

Dr Seidel said more information was needed, more often.

“I would expect literally updates on a daily basis,” he said.

“If it’s good enough to come out with a headline that we are going to introduce a nation-leading vaccination program, then we also need a commitment to deliver beyond that headline.”

WHAT YOU SHOULD DO

President of the Royal Australian College of General Practitioners, Dr Bastian Seidel, talks about how to deal with meningococcal.

1 CONSULT YOUR GP

“Now is not the time for generalised advice. The appropriate advice really is to seek specific information from your usual GP to see what vaccinations would be appropriate for you.

“The most important thing people can do right now is to contact their usual GP to really ask about specific, individual advice on how they can protect themselves and whether a vaccination is the appropriate way for them.”

2 GET VACCINATED

“There often is no one size fits all approach, the best way to [protect] yourself from suffering from meningococcal disease is to have the vaccinations.

“There are different types of vaccinations available, and some people might have already had one vaccination, other people might not have had the vaccination.

“Vaccinations are available over the age of six weeks … there are various vaccines available, there are various schedules available, the schedule depends on the age of the person as well.

“It’s very different for a six-year-old compared to a 60-year-old person.

“[Once you have a prescription,] the vaccinations, I believe, are still very much available in Tasmania from the chemist.”

3 DON’T PANIC

“There is no need to panic, but it is absolutely appropriate for communities to seek advice.”

The Mercury: Two more cases of meningococcal confirmed


A further two cases of meningococcal in Hobart have been confirmed, with a 36-year-old man and a man in his 70s admitted to hospital.

Royal Australian College of General Practitioners president Dr Bastian Seidel said the lack of communication between the Department of Health with the public and clinicians is not good enough.

“We as GPs, who are seeing patients on a daily basis – with concerned parents asking how they can protect [their children] against meningococcal – we are pretty much left in the dark. It’s very disappointing,” he said.

“It’s 2018. People are concerned and I think it would be really good practise to improve communication, certainly with the state’s GPs for starters.

“What we need in Tasmania now is leadership. And we need to have competence in the matter.

“It’s what patients expect, it’s what the community expect and it’s what clinicians expect as well. Otherwise it just leads to more speculation, more uncertainty and that’s the last thing we need knowing this particular situation.”

Dr Seidel said it is unfortunate that more cases of the disease have presented.

Newsweek: Australia wants to be the world’s top medical marijuana exporter, but many nationals can’t get a prescription


Many Australians are struggling to get access to legal medical cannabis, despite government leaders suggesting the country could become the largest exporter of the plant for medicinal use in the future.

Australia allows medical marijuana in certain cases, but the application procedure is long and tedious, according to national broadcaster ABC. Bastian Seidel, president of the Royal College of General Practitioners, told the TV channel that he is frustrated by the fact that so few patients are provided with the option to access medicinal pot. He also said few doctors are allowed to prescribe medicine derived from the plant.

“There are 38,000 GPs [general practitioners] in the country—only one of them is an authorized prescriber for medicinal cannabis,” Seidel pointed out.  “It is frustrating for us because medicinal cannabis might be an option of last resort for patients where we’ve tried absolutely everything in the book.”

In January, Australia’s Health Minister Greg Hunt said that he hopes his country can become the world’s largest exporter of medical cannabis after the industry won approval to start shipping the product internationally.

“By helping the domestic manufacturers to expand, this, in turn, helps to ensure an ongoing supply of medicinal cannabis products here in Australia,” Hunt said, The Guardian reported. Despite the minister’s hopes, Australians are struggling to access the plant for medicinal purposes due to a complicated application process.

ABC News: Medical cannabis in Australia ‘pretty much inaccessible’, leaving patients looking to US


A father who escaped jail time for juicing cannabis to treat his two daughters is now considering sending one of them overseas for treatment.

“We’ve been thinking about me going to America for a while,” Morgan told 7.30.

“We may have to do that,” Mr Taylor said.

“Such a shame we can’t do [cannabis juicing] in our own country.”

Bastian Seidel, president of the Royal College of GPs, is frustrated that so few patients are being given the option to access medicinal cannabis and so few doctors are being allowed to prescribe it.

“There are 38,000 GPs in the country — only one of them is an authorised prescriber for medicinal cannabis,” he told 7.30.

He said medical marijuana was still “pretty much inaccessible” for those who need it.

“The hurdles are still in place,” Dr Seidel said.

“It is frustrating for us because medicinal cannabis might be an option of last resort for patients where we’ve tried absolutely everything in the book.

“Certainly this is not what patients expect. That’s not what should be in place when it comes to medicinal cannabis.

“If your GP thinks you would benefit from medicinal cannabis as a treatment of last resort, then your GP should be allowed to prescribe it.”

The Mercury: How many have to die before free jabs? Docs want vaccines for meningococcal free for everyone


All Tasmanians should be given access to government-funded vaccinations against meningococcal disease — or more people will die, the nation’s peak GPs body says.

President of the Royal Australian College of General Practitioners Bastian Seidel said the current approach to vaccination was piecemeal and did not reflect the best medical advice.

“How many people do we need to die before we take action? That’s a question I don’t want to ask as a doctor,” he told the Sunday Tasmanian.

“We know that piecemeal approach doesn’t work otherwise we wouldn’t be having this conversation right now.

“The medical evidence is very clear: vaccinations for all serotypes are strongly recommended for all Australians.

“We have to stop trying to predict stuff and cover comprehensively. We need to introduce a vaccine program here in Tasmania that covers all serotypes.”

Dr Seidel said governments were due to show leadership and protect patients.

“The money is there to fund it. It needs to be allocated. Whether it comes from the state or the federal government is a political argument, not a medical argument,” he said.

ABC News: Meningococcal disease fears grow for Tasmanians with vaccines months away, as calls mount for subsidies


Tasmanian chemists are reporting a surge in demand for meningococcal disease vaccinations, with customers being told one much-requested shot for children aged under 12 months won’t be available before the end of the year.

New Town pharmacist Dr Jon Mathers said he was unable to secure a supply of the vaccination for babies and his pharmacy was not alone.

He said there had been a rush on all meningococcal strain vaccinations and supply had simply outstripped demand.

With three confirmed cases of the potentially deadly infection in Hobart in the last two weeks and the strains unknown, GPs are also reporting a rush for vaccinations, including for strain B — the only strain not publicly subsidised and requiring its own unique vaccination.

The four other strains of the disease are treated with a single shot.

The strain B vaccinations cost about $130 each and with a booster shot needed, it is estimated the measure could cost families more than $1,000, prohibiting those on lower incomes from accessing the drug.

Huonville GP Dr Bastian Seidel, also the President of the Royal Australian College of GPs, said on Friday the vaccination was “the only option”.

With the disease having such a rapid onset, Dr Seidel expressed a particular concern for Tasmanians living in rural areas, “hours and hours and hours away” from an intensive care unit.

“It’s just a no-brainer,” Dr Seidel said.

ABC News: New meningococcal disease case reported in Tasmania, with baby hospitalise


A three-month-old baby is being treated for meningococcal disease at the Royal Hobart Hospital, in the third case of the disease detected in Tasmania in just over a week.

Tasmania’s public health director Dr Mark Veitch said the boy was doing “reasonably well”.

Dr Veitch said Tasmania would have more cases this year, and although the three cases were close together it would normally be expected that there would be three or four cases by late July.

He said the main messages were to get immunised and to recognise the symptoms.

Royal Australian College of General Practitioners president Dr Bastian Seidel said all vaccinations needed to be funded by the government to make them accessible for everyone, not just those who could afford to pay.

Dr Seidel said there had been increased interest in vaccinations against the type B meningococcal strain over the past week, which was costing families up to $1,000 to fully immunise their children.

“I’m concerned about this. What we need is a comprehensive vaccination program for Tasmania so we don’t have this discussion year after year after year, where we talk about people who have been affected by meningococcal disease, and if they’re lucky, have been able to get into intensive care emergency treatment,” he said.

“I don’t want to talk about death notices caused by meningococcal disease. I don’t want to be involved anymore justifying the difficulties we are seeing when we are trying to prevent deadly diseases.

“What is required is funding of a vaccination program. That shouldn’t happen in 10, 20 or 25 years, it needs to happen now as it happens in South Australia.”

The Mercury: Increase in requests for vaccinations against meningococcal disease


Clinics across the state have been flooded with phone calls about meningococcal vaccines after health officials confirmed a second case of the potentially deadly disease.

National president of the Royal Australian College of General Practitioners Bastian Seidel said his Huon Valley clinic received seven calls from people asking about vaccinations between 8am and 9.30am yesterday.

“It is my full expectation that most GP practices will be getting plenty of calls from parents that are very concerned,” he said.

“We’ve spoken with local pharmacists to make sure all the vaccinations are stocked.”

There are two vaccines on the market which protect people from the disease, one against meningococcal A, C, W, and Y, and another which covers strain B.

Infants aged 12 months and teenagers born between 1 August 1997 and 30 April 2003 are eligible for a free ACWY meningococcal vaccination.

Everyone else must pay at least $70 for the ACWY vaccine and up to $280 for the strain B injection, Dr Seidel said.

“We need to have a look at how we can introduce a vaccination program for subtype B,” he said.

“There’s no reason why it shouldn’t be free. It’s foolish to assume a bacterium will stay in a single state, with Tasmania becoming more and more popular for tourists we’re going to be exposed to more meningococcal.

“Why we wait for someone to take action year after year, more and more people will be dying from meningococcal disease, which is not acceptable in 2018.”

Medical Republic: Pressure grows for ‘visionary reform’


A push is under way within the AMA for Medicare reform to reward GPs for continuity of care and wind back the current “perverse incentives” in general practice.

Putting a draft motion to the conference floor, NSW delegate Dr Ross Kerridge said the AMA should show leadership with ACRRM and the RACGP to develop a new MBS item recognising continuity of care.

“The most valuable service GPs provide is not rewarded,” Dr Kerridge, a Newcastle-based anaesthetist, said.

The motion called for the AMA to work on a redesign of Medicare to recognise and support the central role of GPs in providing long-term healthcare.

It should also address  “perverse incentives that the corporates are brilliant at exploiting” and determine how this could support long-term sustainability, Dr Kerridge said.

So far, the RACGP has its sights on the goal of lifting the MBS rebate for longer consultations by 18.5%, to bring GPs in line with other medical specialist items.

“The RACGP encourages all specialist GPs and their patients to ask the federal government if we are any closer to seeing complex care rewarded more appropriately,” RACGP President Dr Bastian Seidel told The Medical Republic. With a federal election looming, “now is a great time” for the government to start showing their commitment to preventive healthcare.

ABC News: Meningococcal vaccination program needs to be wider in Tasmania: GP body


Tasmania should follow South Australia’s lead and fund free vaccinations for type B meningococcal disease, a national GP body says.

Authorities expect to know by the end of the week which strains of the infection are involved in both cases.

A nationwide immunisation program covers types W, A, C and Y for children aged one-year-old and onwards, with a catch-up program distributed through schools for teenagers between the ages of 15 and 19.

But type B is not included in the program.

The South Australian Government is the first state to offer free B vaccines to children aged between six weeks and one year of age.

Huon Valley GP and national president of the Royal Australian College of General Practitioners Bastian Seidel has called for changes to the current program.

“Let’s have a look at how we can introduce a vaccination program for type B in exactly the same way South Australia is doing,” Dr Seidel told ABC Radio Hobart.

“We know that people are travelling and infections are going to spread, so it’s just a matter of time before subtype B is hitting Tasmania as well.

“We are currently missing out on type B [vaccination programs] and that’s certainly concerning, because we’re never quite sure what type of meningococcal disease people really have.

“We’ve got to make sure that we have vaccination programs in place that covers everything, and not just some subtypes.”

Dr Seidel said he was concerned about the cost of the vaccinations, and said the state needed to make them more affordable and accessible for Tasmanian children.

“We can’t just say, ‘If you can afford it you are covered, and if you can’t afford it, tough luck’,” he said.

“We need to do so much better here in Tasmania to make sure we are protecting the ones who are also financially vulnerable.

“There’s no need to panic, but we need to mindful and we need to make an effort in preventing these conditions.”

The Mercury: Second case of meningococcal at the Royal Hobart Hospital increases pressure for access to vaccines: 


Pressure is mounting on the State Government to increase availability of vaccinations against meningococcal disease as a second case is confirmed.

Health officials said yesterday a 20-year-old man had been admitted to the Royal Hobart Hospital with the infection. His case follows the death last week of a 16-year-old Hobart girl from the killer bacterium.

Deputy director of Population Health Services Scott McKeown said a public health response had begun following the second case.

The president of the Royal Australian College of General Practitioners, Huon Valley GP Bastian Seidel, says vaccination is the best way to protect against the deadly disease.

Dr Seidel told the Mercury yesterday more support was needed to help vulnerable Tasmanians who could not afford the $100-plus cost of the vaccine for the B strain of the disease.

He said said patients with meningococcal deteriorated so quickly it was extremely difficult to treat.

“It’s devastating … quite frankly the only thing we can do is to vaccinate,” he said.

Dr Seidel said parents started coming into his practice last Friday, after the death of the teenager, saying they wanted their children vaccinated.

“Parents were coming in saying they are concerned, but when I explain the cost, some people can’t afford it,” he said.

9 News: TGA calls on drug company to improve warnings over children’s asthma drug after suicides


The Therapeutic Goods Administration (TGA) has called on manufacturers of the asthma medication Singulair to add warnings inside the drug’s packaging about its potential side effects, including suicidal thoughts.

The directive comes after an urgent safety review of the medication ordered by Health Minister Greg Hunt in February in response to a nine.com.auinvestigation.

National Asthma Council director Bastian Seidel said Singulair was often used as a last resort option for patients whose asthma could not be controlled by other medications and could be life-saving for severe asthma sufferers.

“It is a drug that works well for quite a few patients who have tried everything else. For them it’s literally a lifesaver. No doubt about it, from some patients it’s a complete game changer,” Dr Seidel said.

“But for some there are adverse reactions and we should take them very seriously and really discuss with parents what are the benefits and potential negative reactions to the drug.”

The Mercury: Warning issues on jabs as flu season nears


The flu season is off to a slow start in Tasmania this year, with a full-scale winter outbreak still around the corner.

Doctors have urged Tasmanians to get vaccinated against the flu if they have not already, as the season is still a couple of weeks away and likely to peak next month.

Commonwealth health data shows 128 cases of the flu were recorded in Tasmania from January to July 2.

With between 10 and 30 cases being recorded each month, the low numbers are not yet considered an outbreak.

Royal Australian College of General Practitioners president Bastian Seidelsaid the flu was getting off to a slower start than last year, both in Tasmania and interstate.

“We are seeing lower levels of confirmed flu cases this year compared with what we saw last year … the peak is yet to come,” Dr Seidel said.

He said that, nationally, the number of flu cases reported in June this year was 1530 — compared with 7761 cases reported in June last year.

The timing of the outbreak varies from year to year, with the peak typically hitting at the end of July and into August and September.

Dr Seidel said it was unlikely that vaccination rates were the reason for this year’s slower flu season outbreak.

“Vaccination rates are not high enough to account for that,” he said.

He urged anyone not yet vaccinated to get the flu jab, as it took a couple of weeks to be effective.

Medical Republic: Finally, medicinal cannabis is on a roll


Medicinal cannabis is putting down roots in Australia with an expansion of clinical education, federal support and the start-up of local supply due by the year’s end.

The shape of change has been evident in the past few months, after NSW became the first jurisdiction to withdraw from a two-step approval process in which states can stonewall a doctor’s application despite the TGA’s assessment of a product’s clinical suitability for a patient.

Since March, more scripts have been authorised for cannabis-derived medicines in NSW than in the entire 20-month period following the adoption of enabling laws in 2016.  GPs in the state are now receiving approvals in significant numbers for the first time.

GPs interested in learning about medicinal cannabis and its potential for bringing relief to their patients have also found a friend in the RACGP.

College President Dr Bastian Seidel made an important appearance at a seminar held by advocates in February, at which he described the complex regulatory regime for medicinal cannabis products as a “basket case”.

The RACGP allotted CPD points to a two-day workshop in May hosted by the National Institute of Integrative Medicine (NIIM) in Melbourne, featuring international and Australian clinicians with expertise in medicinal cannabis.  A follow-up is slated for Sydney in September.

The college has extended the same support to a seminar in Queensland on July 6, where clinicians will share their experience.

One of them, Dr Towpik, says this will include practical advice, such as how to approach an initial consultation and dosing protocols and follow-ups.

The Examiner: Medical marijuana creates hard choices


It has been 10 months since medicinal cannabis was made legally available in Tasmania.

The Controlled Access Scheme is designed to give medical specialists the ability to prescribe medical cannabis products for patients for whom conventional treatments have failed.

It was a scheme that many advocates had fought hard to see realised, in the state.

This week, it was revealed that six Tasmanians have so far accessed the scheme.

There is a suggestion to nationally streamline the medical marijuana process, so that it can be prescribed directly by GPs, to patients who have tried every other avenue available to them.

This idea has merit. It is, as Dr Bastian Seidel pointed out in The Examiner on Thursday, a similar process that exists currently for the “dangerous” drug morphine.

Daily Telegraph: Doctors see patients more often to make up for the four-year freeze in Medicare rebates


Medicare rebates for a GP visit have increased for the first time in four years but the 55 cent rise goes nowhere near covering the $38 gap fees now paid by one in three patients.

And a News Corp investigation has found the rebate freeze, which was designed to save the government $2.8 billion over six years, may have backfired with doctors making up lost income by seeing patients more often.

Australians are now seeing their GP on average 6.1 times a year up from 5.8 times per year before the Medicare freeze began.

And the amount the government spends per person on Medicare rebates has risen by $34 from $274.07 per year in 2013-14 to $308.39 per year in 2016-17 Australian Institute of Health and Welfare data shows.

Royal Australian College of General Practitioners president Dr Bastian Seidel says general practice was already underfunded before the rebate freeze and the situation has now worsened.

His organisation has asked a government review of Medicare to doubled rebates for GPs so they are paid the same rebate as specialists and he claims better GP care will save the health system money by keeping people out of hospital.

“We are specialists, we do the same years of training as specialists,” he told News Corp.

ABC RN Drive:  Are some patients too ‘complicated’ for a bulk billing GP?


For bulk billing general practitioners, seeing patients with complex needs is leaving them worse off due to stagnating Medicare rebates.

As a result, patients with complex mental health issues, along with children are reportedly being turned away from bulk billing GPs.

RN Drive speaks with Dr Bastian Seidel, President of the Royal Australian College of Practitioners.

3AW: GPs at bulk billing clinics feeling the pressure to spend ‘just 10 minutes’ with patients


A peak doctors group says GPs are being penalised by the Medicare system, as bulk billing clinics increasingly feel the pressure to spend just 10 minutes with patients.

The story, first reported in The Age, says GPs could be turning away children with chronic health conditions and patients with mental health issues and Medicare isn’t covering the cost of longer, complex cases.

President of the Royal Australian College of General Practitioners Dr Bastian Beidel told 3AW Breakfast changing the system would reduce pressure on GPs.

“Patients want to spend more time with the GPs and that’s what GPs want as well,” he said.

“We need a Medicare system that allows us to do it and shouldn’t penalise us if we want to spend more time with our patients.

“Some doctors are saying well we don’t see children with chronic medical problems or we don’t see people who have mental health conditions, because it just takes longer.”

Sydney Morning Herald:  Bulk-billing clinics ‘turning away’ complex patients


Doctor’s surgeries are reportedly turning away mental health patients and children because stagnating Medicare rebates do not cover the cost of complex consultations.

Instead the system perversely encourages GPs to churn through 10 patients an hour, it has been claimed.

Australians can see a doctor for free at bulk-billing clinics, but the president of the Royal Australian College of General Practitioners said it is common for longer appointments to be refused because they are not financially viable.

“They are saying, ‘it’s 10 minutes and the patient goes out’. And people are being told ‘if you have a mental health condition you probably have to go elsewhere’,” Dr Bastian Seidel said.

“I’m concerned that some places are refusing to see children for the same reason.

“So all of a sudden, you don’t have the comprehensive care that patients deserve. If it’s more complicated, you have to go elsewhere.”

Dr Seidel said longer consultations were better for patients, as they allowed doctors to talk through health issues, making them less likely to prescribe medication.

Yet most bulk-billing centres offer standard consultation times of just 10 or 15 minutes. Record numbers of Australians are now using their services, with the bulk billing rate at 85.8 per cent.

The Examiner: Tasmanian Greens and GPs want a review of medicinal cannabis access


Only six Tasmanians have accessed medicinal since it was legalised prompting a call for a review.

Greens Franklin MP Rosalie Woodruff said Health Minister Michael Ferguson’s controlled access scheme was “overly bureaucratic, with patients being effectively locked out of access.”

Royal Australian College of General Practitioners president Dr Bastian Seidel said the scheme should be uniform across Australia and allow GPs to prescribe it for patients who had exhausted other options.

“It is easier to prescribe morphine, which is a very dangerous drug, but one that can be prescribed by a junior doctor any time of the day,” Dr Seidel said.

“It is not logical.”

Dr Seidel said he had one patient who had “tried everything else” who had referred to a specialist in August last year who was still waiting to see a public hospital specialist to determine if he could access medicinal cannabis.

“I am sure that is the same for a vast majority of patients,” he said.

ABC News: Patients ask 60 per cent of GPs about medicinal cannabis


There are calls for more general practitioners to become educated about medicinal cannabis and authorised to prescribe it, after a survey of 640 Australian GPs found almost two thirds have had patients ask about the drug.

More than half the doctors said they supported the drug being available by prescription for use in cancer pain, palliative care and epilepsy, with their preferred ‘access model’ involving GPs prescribing independently of specialists.

Dr Bastian Seidel from the Royal Australian College of GPs said the college was working with state and federal governments to develop a national framework that would allow GPs who want to prescribe medicinal cannabis to be able to do so.

“Medicinal cannabis prescribing is a basket case here in Australia and it’s completely inappropriate — it should be much more straightforward, it should be streamlined as well,” Dr Seidel said.

“If your GP feels it’s appropriate for you to have medicinal cannabis and if it’s appropriate for medicinal cannabis to be prescribed for your medical condition, then of course the GP should be authorised to prescribe that.

“I think it’s a no-brainer.”

However he added that the drug should only be considered as a last resort.

“I believe we need to be open-minded, we need to think of the opportunity medicinal cannabis offers, but we also need to be aware of the risk and benefits.

“We need to be very careful here because I recall very much that 20 years ago opioids were heavily promoted for the treatment of chronic pain and now we know they’re actually doing more harm than good — we don’t want to fall into the same trap when it comes to medicinal cannabis.”

9 News:  Popular asthma drug linked to death in Australia


A popular asthma medication commonly prescribed to children has been linked to at least one death in Australia this year, according to the Therapeutic Goods Administration (TGA).

Three reports of a death relating to suicide were lodged with the TGA’s database of adverse events between January and March this year, however it is understood they may all relate to the same case.

The drug montelukast, which is more commonly known by its branded name Singulair, is prescribed to children as young as two in Australia and is popular among kids because it comes in chewable tablets.

But the medication has been linked to psychotic episodes in children, including suicidal thoughts, depression, nightmares and aggression.

Royal Australian College of GPs president and National Asthma Council director Bastian Seidel said he was saddened to hear of the death of a patient taking montelukast, however asthma was a deadly condition in itself.

“Of course it’s devastating to hear that a patient has experienced so significant side effects that ultimately led to a suicide,” Mr Seidel said.

“It’s devastating for practitioners who are trying to do everything right by optimising the treatment for patients with asthma because they are concerned that they could have a significant asthma attack that could also lead to death.”

“Asthma is very prevalent in Australia. People are dying from this. You are damned if you do and damned if you don’t, that’s the dilemma we practitioners are in.

“If you do nothing people are going to die from asthma and if we do something we are at times causing significant problems. But again having a suicide that is associated with a medication is of course devastating for all of us.”

Dr Seidel said it was imperative all patients and their families were warned of the risks associated with Singulair and montelukast.

“If I prescribe Singulair to patients and I do, I will make mention that if you notice a change in your mood, stop the medication immediately and let me know. I will specifically ask my patients, ‘Are you aware there are side effects?’”

Daily Mail Australia: Doctors hit back at government’s crackdown on opioids, claiming it’s preventing them from prescribing the drugs for legitimate reasons


Doctors have hit back over an opioid crackdown issued by the federal government.

The Department of Health is investigating doctors who are reportedly over-prescribing opioids.

The government’s concern about the nation’s opium crisis stems from the high rate of fatal opioid overdoses over the last few years.

Yet Australia’s peak body for general practitioners, the Royal Australian College of General Practitioners (RACGP), hit back the Department of health’s crackdown, stating that certain doctors who work in palliative care are required to prescribe opioids more than others.

RACGP president Dr Bastian Seidel warned the Department of Health before the letters were sent out that the crackdown risks doctors’ ability to prescribe the drugs for legitimate reasons.

‘GPs working in palliative care, rural hospitals or aged care may be more likely to prescribe opioids than GPs working in other contexts,’ Dr Seidel told the Department of Health.

‘These GPs are therefore more likely to be identified in this campaign as problematic prescribers when they are in fact providing suitable care,’ he said.

9 News:  ‘Blaming GPs isn’t helpful’: Doctors protest opioid prescription warning


A move by the federal government to crack down on the over-prescribing of opioids has upset GPs who say it risks unfairly targeting some doctors.

Earlier this month Australia’s Chief Medical Officer Brendan Murphy sent a letter to almost 5000 GPs who prescribe the most opioids, warning them of the risks of dependence on the drugs.

“Seventy percent of all fatal opioid overdoses in Australia involve prescription opioids and pharmaceutical opioid deaths now exceed heroin deaths by a significant margin,” the letter states.

The doctors’ prescriptions will be monitored over the next 12 months and they could face restrictions on practice or being struck off, News Corp Australia reports.

But the Royal Australian College of General Practitioners earlier flagged concerns over what’s been seen as a heavy-handed approach with the Department of Health.

RACGP president Dr Bastian Seidel warned it risks targeting those with legitimate reasons to prescribe the drugs, including doctors working in palliative care.

On the RACGP’s website one anonymous doctor said the letter had been “intimidating and unhelpful”.

The doctor said that alternatives to opioids for chronic pain, such as pain management clinics, often have very long waiting lists.

“We don’t have a lot of alternatives, and putting the blame on GPs is totally unhelpful.”

The Courier Mail:  Govt wants to avoid US-style opioid crisis


The federal government wants to stop Australia facing a US-style opioid crisis as health authorities work to rein in doctors who are handing out tens of thousands of doses.

Health Minister Greg Hunt confirmed on Saturday one country doctor has handed out 68,000 doses in less than a year and a city doctor has handed out 56,000.

The Royal Australian College of General Practitioners earlier flagged concerns over what’s been seen as a heavy-handed approach.

On the RACGP’s website one anonymous doctor said the letter had been “intimidating and unhelpful”.

The Saturday Paper:  Focus on endometriosis


Endometriosis is a condition where cells that normally line the inside of the uterus implant and grow elsewhere within the pelvis. These cells respond to the hormone cycle, leading to irritation, inflammation and scarring.

Symptoms of varying intensity include pain, fatigue, heavy periods, painful intercourse and infertility. Because the bladder and bowel are often affected, symptoms can also include painful urination, bloating and constipation or diarrhoea. The cause is unknown and there’s no cure. It affects about 700,000 Australian women.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, explains that the lack of a better diagnostic tool means women can wait up to 10 years to get a diagnosis. Blood tests and scans are inadequate, so laparoscopy remains the “gold standard”, he says. “That’s a test that’s often only performed in hospitals. It’s invasive, it takes a while to be put on the waiting list, it takes a while for the procedure to occur. Women rightly say there’s an unacceptable delay.” Unfortunately, there are no other promising tests on the horizon.

Seidel explains that another barrier to early diagnosis is the variety of presenting symptoms. “It would be completely unrealistic to say we can diagnose a patient with endometriosis in a single consultation by taking a history and doing a basic physical exam,” he says. “Endometriosis is too complex. It’s too individual and unfortunately the presentations don’t always follow the symptoms we see in the textbook.”

Bastian Seidel says it’s disappointing that women still feel they are being discriminated against or labelled as neurotic just because they have symptoms that can’t be immediately explained. “Discrimination should not be playing a role in health care,” he says. “I’m really positive that GPs in 2018 here in Australia are doing the right thing by their patients.”

Celebrity Rave: Thousands of Australians rush to get a SECOND flu jab amid fears the vaccine doesn’t protect from a deadly strain of the virus – so are you at risk?


Many senior Australians are rushing to get a second flu shot amid fears the over 65s vaccine doesn’t protect from a deadly strain of the virus.

The Federal Government’s 2018 over-65s flu shot does not cover the Brisbane B strain, which is included in the jab designed for younger Australians.

While many older people are going against Queensland Health recommendations and opting for both injections, experts argue it is unnecessary.

Robert Booy, head of clinical research at the National Centre for Immunisation Research and Surveillance, described the over-65s jab as a ‘super vaccine’.

The Royal Australian College of General Practitioners (RACGP) says the timing of influenza vaccination is critical to ensuring patients have the highest level of protection when the flu season arrives.

Rushing out to getting the flu vaccination too early may put people at serious risk, warns RACGP President Dr Bastian Seidel.

‘Typically, flu season affects Australia from June to September, with the peak being August,’ Dr Seidel said.

‘Recent evidence suggests that protection following flu vaccination may begin to wear off after three to four months, so timing of vaccination is critical,’ he said.

Concerned some vaccine providers are already advising patients to receive the flu vaccination, Australians are encouraged to consult a specialist GP about when to get the annual flu jab.

‘The last thing we want to see this year is patients doing the right thing and receiving a flu vaccination, only for the vaccination wear off by the time we reach flu season,’ said Dr Seidel.

The Age: Aged-care residents to gain better mental health services from budget


The federal government will send psychologists and other mental health professionals into aged-care homes across Australia under one of its budget measures, offering hope to tens of thousands of residents with psychiatric disorders who are now denied effective therapies.

The Coalition’s announcement of $82.5 million over four years will target the widespread neglect of aged-care residents’ mental health, which was exposed by a Fairfax Media investigation in early 2017.

Budget documents have acknowledged a key finding of the investigation: aged-care residents are ineligible for the same Medicare-funded psychological treatments that other Australians receive. Experts have branded the situation a “blatantly discriminatory … disgrace”.

The government’s response of a special funding stream for nursing homes has been welcomed by several health, aged-care provider and elderly rights groups, but the Royal Australian College of GPs says the money should instead be funnelled through a new Medicare item for residents.

The government’s model is to fund its 31 regional primary health networks – healthcare administration bodies – to source mental health professionals to treat residents with a diagnosed disorder in the homes.

Royal Australian College of GPs president Bastian Seidel welcomed any “genuine and additional funding” but said funding channelled through primary health networks would be diminished by administrative costs.

He called for a Medicare item that would provide residents with equal access to GP mental health treatment plans and associated psychological therapies.

Medicare funding was “stable and certain”, while commissioned services “might be there for half a year and disappear”.

The Daily Telegraph:  Medicare rebates slashed by $7 if GPs refuse to train up


Medicare rebates for GP visits could be slashed by 20 per cent for some patients if their doctor refuses to undertake extra training.

The measure announced in the federal Budget is designed to improve the qualifications of around 3000 practising GPs who have not undertaken a three-year specialist GP training program.

The vocational registration training is offered by the Royal Australian College of General Practitioners or Australian College of Rural and Remote Medicine.

If doctors don’t have time or refuse to undertake the training, they will have the Medicare rebates their patients receive cut by more than $7 per visit.

Most of the GPs affected work in the bush and many were trained overseas and doctors’ groups say the new requirement will ensure they have the same qualifications as Australian-trained doctors.

The affected doctors will have a five-year period in which to upgrade their qualifications.

The measure will be a big money spinner for the RACGP which charges $3000 for the GP exam and then $1400 for membership of the RACGP.

In addition, GPs then have to pay for regular training courses to keep their qualifications up to date.

The RACGP says it is a not for profit charity and any funds it receives goes to college programs.

“There is recognition of prior learning, most of them are very experienced, but again they all have to undergo a formal training program, they all have to sit a final fellowship exam, it’s really important,” RACGP president Dr Bastian Seidel said.

The Daily Telegraph: Federal Budget 2018: Changes will push patients onto generic medicines


Australians will be automatically shifted off their brand name drugs on to generic medicines under a $335 million cost-saving move in the budget that could prove confusing for elderly people.

A new electronic prescription software program will default to prescribing generic versions of medicines and patients who want to continue getting the brand name drugs will have to ask their doctor to go through a multi-step process to override the system.

Generic medicines contain the same ingredients as brand name drugs and are just as effective but despite this 40 per cent of Australians continue to use the brand-name drugs.

The government wants to shift people over to generic medicines because it will save the government money.

Royal Australian College of General Practitioners president Dr Bastian Seidel said he was not aware of the details of the changes and was seeking more detail.

“Prescribing medicine is between the prescriber and the patient and it’s got to work for both and the government should not interfere,” he said.

There were very good reasons sometimes that patients wanted a particular brand of medicine because of its colour or shape, he said.

The Australian: Federal budget 2018: Greg Hunt looks to the next health challenge


Health Minister Greg Hunt will again turn his attention to reforming private health insurance and public hospital negotiations after the Turnbull government’s budget initiatives were largely welcomed by stakeholders.

However, four years after the incoming Coalition government made sweeping cuts to prevention and primary care, some still question the policy and budget focus on expensive acute care.

Tuesday’s budget included long-awaited rural workforce reforms, changes to the Pharmaceutical Benefits Scheme, medical research investments and funding for mental health programs.

Australian Medical Association president Michael Gannon said it was a “safe and steady budget”, although he was critical of the decision to allow some universities to offer more places to fee-paying overseas students, as was the Australian Medical Students ­Association.

Royal Australian College of General Practitioners president Bastian Seidelwelcomed a commitment to GP training, while Australian Healthcare and Hospitals Association chief Alison Verhoeven said funding to improve data would enable broader ­reforms.

The Examiner: Tasmanian doctors are pleased with the federal budget


The national president of the Royal Australian College of General Practitioners, Bastian Seidel, said the federal budget provided more funding for an internship program with GPs which began last year.

“A lot of medical graduates who weren’t able to get internships at hospitals in Tasmania have left and don’t come back,” Dr Seidel said.

“The program that began last year allows doctors to do their internships with GPs instead of in a hospital.

“We don’t want to lose graduates from the University of Tasmania so we are pleased that some of them will be able to stay in Tasmania and not have to move interstate.

“We have problems with training accreditation at the Launceston General Hospital and Royal Hobart Hospital so the expansion of the internship program with GPs is very important.”

Dr Seidel said nationally there would be an extra 300 places for young doctors to do their internships with GPs and more than 1000 in the coming years.

Currently there are five young doctors doing their internships with GPs in Tasmania.

“For Tasmanian doctors and the health system it is a very positive budget,” Dr Seidel said.

“It is good for our health workforce.”

Dr Seidel also welcomed funding to allow doctors in rural and regional areas to get better training.

“In rural areas we don’t just need doctors, we need excellent doctors who are specialist GPs,” he said,

“Doctors who don’t have qualifications for the city are often sent to the bush and that is not good enough.

“The budget also provided funding for multi-disciplinary GP clinics in rural areas to employ people such as pharmacists, nurses and physiotherapists.

“The details aren’t quite clear but this will be a game changer and huge for regional and rural Tasmanians.”

Dr Seidel said he had met with Health Minister Greg Hunt after Tuesday night’s budget was handed down and was confident details would be available soon on exact funding allocations.

He said the only negative from the budget was that while there was funding for medical research, there was “not a single penny” set aside for GP research.

The Daily Telegraph: Medicare rebates for GPs to rise but knee MRIs, sleep studies and back surgery restricted in budget


The Medicare levy for GP visits will rise, there will be help to get more doctors and health workers in the bush and new Medicare rebates for cancer scans in next week’s budget.

But a series of budget cuts will see patients find it harder to get an MRI scan of their knee and people with sleep problems will face new restrictions on access to sleep studies.

Access to spinal fusion and skin lesion treatments will also be tightened and testing for allergies will be streamlined to save money.

The Medicare rebate for GP visits has been frozen for four years and the budget will fund a rise of around 55 cents per visit from $37.05 to $37.60 from July 1.

Doctors say the rise is not enough and new data shows out of pocket costs to see a GP have risen by over 15 per cent from $30 when the freeze began to almost $35 in 2016-17.

Royal Australian College of General Practitioners president Dr Bastian Seidel says there are 150 million GP consultations each year and this rebate rise will apply to the 110 million standard visits.

Herald Sun: Medicare is keeping health care locked in the past by failing to rebate electronic GP consultations


Fed up patients are demanding doctors get tech savvy and notify them via SMS when they are running late.

In return, general practitioners are demanding a new Medicare rebate be made available to cover electronic consultations as a new survey shows patients are complaining their GPs are behind the times.

Doctors have asked the government’s Medicare review to bring the system into the 21st century and make a new rebate for consultations using email, or Telehealth.

While there is currently a Telehealth rebate available for specialists it does not apply to GP consultations.

Royal Australian College of General Practitioners president Dr Bastian Seidel said doctors want to embrace new technology but Medicare does not provide rebates for electronic GP consultations.

“Currently there is only a telehealth Medicare rebate for specialists; we want it for GPs and it makes sense that is an option, there is no reason it should not be rebated at the same level as an ordinary consultation,” says Dr Seidel.

The Australian: The dope on legal weed


Health regulators have sought to make a clear distinction between medicinal cannabis and recreational marijuana. A line is drawn between those who could obtain health benefits from the part of the plant understood to relieve symptoms of medically diagnosed conditions, and those who simply smoke weed for pleasure — despite the often-repeated health risks. In Australia, this line is determined by medical evidence and criminal law.

At one extreme, there are children managing their epilepsy, while at the other extreme there are adults battling self-inflicted, drug-induced psychosis.

This is a distinction Greens leader Richard Di Natale, a former doctor, also had sought to make and defend in recent years as he pushed for the seriously ill to have greater access to medicinal cannabis. At least, that was the case until last week, when Di Natale launched the Greens’ campaign for the legalisation of marijuana, blurring the lines completely.

Royal Australian College of General Practitioners president Bastian Seidel warned the risks of cannabis use were being lost in the debate over medicinal cannabis.

“It’s really difficult for the public to understand the difference between medicinal cannabis and recreational cannabis,” Seidel said.

“It’s unfortunate timing that we are talking about medicinal cannabis right now and now a new debate about recreational cannabis is being thrown in.”

Seidel pointed to a report last year from the National Academies in the US that sought to assess the evidence for and against cannabis at what it called “a pivotal time in the world of cannabis policy and research”.

BuzzFeed News:  What We Actually Know About Greg Hunt’s “Cannabis Is A Gateway Drug” Claims


Federal health minister Greg Hunt may have evidence to support claims that cannabis use in adolescence can lead to mental health issues, but the evidence behind his belief that “marijuana is a gateway drug” is inconclusive, experts say.

Responding to the Greens plan – announced last week – to legalise recreational cannabis for adult use, Hunt said the risk of graduating to serious illicit substances like ice or heroin from cannabis use is “real and documented”.

President of the Royal Australian College of General Practitioners (RACGP), Bastian Seidel, told BuzzFeed News that a THC-rich, psychoactive form of cannabis “has potential to be dangerous”, but that it should not be confused with the drug’s medical form, which is low in THC and high in cannabidiol (CBD), offering little to no psychoactive effect.

“It’s very confusing,” he said. “My concern is that people will get confused and put medical and recreational cannabis together.”

Seidel said “there might be a link to risk of schizophrenia” in using cannabis, and quoted an extensive report by the National Academies of Sciences, Engineering, and Medicine which reviewed scientific research on cannabis from the last decade.

The same report concluded there was “limited evidence” that cannabis use increases the chance of initiating other drug use, and “moderate evidence” that there was a link between cannabis use and the development of dependence on other substances such as alcohol and illicit drugs.

The Daily Telegraph: What’s up Doc? Try these tricks to save money on medical services


Visiting a doctor can be painfully expensive for people who don’t consider strategies that save money without compromising their health care.

Medical services costs in Australia have climbed three times faster than overall inflation — up 84 per cent in the past decade, according to Bureau of Statistics data.

A report released this month by the Consumers Health Forum says one in five Australians don’t visit a GP because of cost, and one in six fail to fill a script for the same reason.

Royal Australian College of General Practitioners president Dr Bastian Seidel said people should be careful that their healthcare was not too fragmented. “We as GPs want patients to contact us,” he said.

Don’t try to save money by self-diagnosing online. “There’s information overload now. The GP puts this information into context, and the context is you — no one size fits all,” Dr Seidel said.

He said patients could potentially save money by familiarising themselves with the Medicare Safety Net. “The Federal Government to a certain extent will lower out of pocket costs — it’s not really well known.”

ABC News: Decision to stop weekend flu testing at RHH reversed as flu season hits Tasmania early


A decision to maintain the Royal Hobart Hospital’s laboratory testing over the weekends has been welcomed as a common-sense approach as flu season arrives.

The ABC has been told the hospital was considering no longer providing flu testing on weekends due to a lack of staff, but medical staff voiced concerns about the impact of such a delay.

The ABC understands RHH will now take on extra staff to operate seven days a week.

President of the Royal Australian College of General Practitioners Dr Bastian Seidel applauded the move, telling ABC Radio Hobart there had already been 77 cases this year.

He said a seven-day testing was a common-sense approach.

“People don’t only get sick during the week … and we expect services to be available.

“It’s a 24/7 job and that’s what Tasmanians expect.”

Retail Pharmacy: 48-hour access to medicinal cannabis


The Royal Australian College of General Practitioners (RACGP) says the Turnbull government’s proposal to allow easier access to medicinal cannabis products will improve Australian patients’ quality of life.

RACGP President Dr Bastian Seidel said the proposed plan was submitted at the Council of Australian Governments meeting last week and was in line with advice from the RACGP.

“Australian GPs want to see a commitment to a nationally consistent framework for medicinal cannabis access,” Dr Seidel said. “If a specialist GP has decided with their patient that medicinal cannabis is a viable treatment option, then that GP should not be forced to jump through hoops and to have to ask for yet another specialist opinion.

“Patients and doctors should not have to wait months to access a drug that may improve a patient’s quality of life.”

Dr Seidel said the current application process for medicinal cannabis access is onerous, too lengthy and does not value the important role specialist GPs play in prescribing medicinal cannabis products.

“GPs are in an excellent position to prescribe medicinal cannabis, without the need to refer to other specialists for approval to prescribe,” he said.

Dr Seidel said medicinal cannabis was an emerging field and there was still significant confusion about who could access the drug.

“Medicinal cannabis is never the first line of treatment for any medical condition but there is substantial evidence that it might be the treatment of last resort for some patients,” Dr Seidel said. “If I have a patient, who has tried all standard treatment options without success, I should be able to consider prescribing medicinal cannabis as a viable treatment option without having to wait months.

“Prime Minister Turnbull’s proposal is compassionate, logical and the only way forward for Australian GPs and their patients.”

Croakey:  On the COAG health omnibus: mandatory reporting, National Energy Guarantee, smoking age, organ donation…


Australian medical organisations have cautiously welcomed the proposed revision of mandatory reporting laws that compel treating doctors to report the ill-health of other health professionals, but said the changes agreed by last week’s Council of Australian Governments (COAG) Health Council meeting still leave “significant room for doubt and confusion”.

The Royal Australian College of GPs said it was particularly concerned about the retention of requirements for reporting a health professional “practising at a lower standard’.

“Much of the conduct identified as grounds for mandatory reporting is subjective, open to interpretation by both the health professional and their treating practitioner,” said RACGP President Dr Bastian Seidel. “If there is room for doubt on what should or shouldn’t be reported, the fundamental issue of there being barriers to healthcare for all health professionals remains.”

Seidel said health professionals must be exempt from reporting health professionals under their care, in line with the model adopted by Western Australia.

Australian Journal of Pharmacy: Barriers to seeking help to come down


At Friday’s COAG Health Council meeting, the state and territory health ministers agreed to remove barriers for registered health professionals to seek appropriate treatment for impairments, including mental health.

“Ministers agreed to a nationally consistent approach to mandatory reporting which will be drafted and proposes exemptions from the reporting of notifiable conduct by treating practitioners (noting Western Australia’s current arrangements are retained) and subject to other jurisdictional formal approval in certain circumstances,” the COAG Health Council’s communique stated.

“The legislation will include strong protection for patents and will remove barriers for registered health professionals to seek appropriate treatment.

“The legislation will specifically include a requirement to report past, present and the risk of future sexual misconduct and a requirement to report current and the risk of future instances of intoxication at work and practice outside of accepted standards.”

RACGP president Dr Bastian Seidel said that “the announcement today clarifies that mandatory reporting is not required when a health professional has an impairment. This is great news”.

“However, there remains some questions around the other mandatory reporting requirements, which will require careful consideration in order to get this right.”

The Sydney Morning Herald:  Critical drugs could be rationed following EpiPen shortage


Critical medicines could be rationed in Australia in the wake of an EpiPen shortage that left some allergy sufferers without emergency treatment.

The EpiPen crisis, which saw pharmacies around the country drained of stock, is just one of a growing number of shortages of essential medicines, often sprung on patients with no notice.

New laws being considered by the federal government could force drug companies to report all shortages to Australia’s drug regulator as soon as they are anticipated, triggering rationing in serious cases.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, said doctors received no advance warning of the EpiPen shortage, and the same thing often happened with other crucial medicine supply issues.

“We just find out on the hop when the pharmacist or local chemist calls and says ‘I can’t get it’,” Dr Seidel said.

The Sydney Morning Herald:  Plan to tackle endometriosis top of list at COAG health ministers meeting


A plan is being drawn up by federal Health Minister Greg Hunt to tackle endometriosis, a chronic, painful condition suffered by 700,000 women nationally.

Mr Hunt will place a draft national action plan on endometriosis front and centre at the Council of Australian Governments (COAG) meeting of health ministers on Friday in Sydney.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, said Mr Hunt should be commended for trying to tackle what is a significant problem in women’s health.

He said it was difficult to diagnose the condition, because at present it can only be confirmed with a laparoscopy, a keyhole surgery performed in the pelvis.

He said he understood that many women misdiagnosed or diagnosed late were disappointed by their experience, but explained awareness among doctors has been growing over the past 10 years.

“We can’t just yet do another awareness campaign,” he said.

“There’s got to be follow up as well, we need to measure the impact, we need to know what messages work, it has to be a long-term commitment.”

The Mercury:  Tasmanian abortion services: Surgical terminations at the Royal Hobart Hospital only available to women where medically required


The Government says its policy on abortion hasn’t changed, with surgical terminations at the Royal Hobart Hospital only available to women where it’s “medically required”.

Women seeking publicly funded surgical abortions have had to travel interstate following the closure of the state’s last abortion clinic in Hobart on New Year’s Eve.

In January, the State Government extended its patient travel assistance scheme to women referred by their GP to Melbourne for surgical abortions as a temporary fix to the problem.

Royal Australian College of GPs president Bastian Seidel said vulnerable women were being put through unnecessary stress at the hands of the Government’s unclear policy.

“A surgical termination really should be available in Tasmania for Tasmanian women and it’s something the Royal Hobart hospital can easily provide ” he said.

“If the service is available it needs to be made clear, it’s a disaster to send a woman interstate while she’s in a vulnerable position to undergo a surgical termination.

“Tasmanian women and their GPs deserve better than what they’re experiencing now.”

Australian Journal of Pharmacy: 48-hour medicinal cannabis access will help: doctors


The Turnbull Government’s proposal to allow easier access to medicinal cannabis products will improve Australian patients’ quality of life, says the RACGP.

RACGP President Dr Bastian Seidel said the proposed plan, to be submitted at the Council of Australian Governments (COAG) meeting on Friday, is in line with advice from the RACGP.

“Australian GPs want to see a commitment to a nationally consistent framework for medicinal cannabis access,” Dr Seidel said.

“If a specialist GP has decided with their patient that medicinal cannabis is a viable treatment option, then that GP should not be forced to jump through hoops and to have to ask for yet another specialist opinion.

“Patients and doctors should not have to wait months to access a drug that may improve a patient’s quality of life.”

Dr Seidel said the current application process for medicinal cannabis access is onerous, too lengthy, and does not value the important role specialist GPs play in prescribing medicinal cannabis products.

“GPs are in an excellent position to prescribe medicinal cannabis, without the need to refer to other specialists for approval to prescribe,” Dr Seidel said.

Dr Seidel said medicinal cannabis is an emerging field and there is still significant confusion about who can access the drug.

“Medicinal cannabis is never the first line of treatment for any medical condition but there is substantial evidence that it might be the treatment of last resort for some patients,” Dr Seidel said.

“If I have a patient, who has tried all standard treatment options without success, I should be able to consider prescribing medicinal cannabis as a viable treatment option without having to wait months.

“Prime Minister Turnbull’s proposal is compassionate, logical, and the only way forward for Australian GPs and their patients.”

Medical Republic: Concerns grow over new disclosure rules


Australia’s largest medical defence organisation is troubled by the regulator’s new policy to name doctors subjected to legal and disciplinary proceedings.

Under tougher disclosure rules, the Medical Board is now publishing registration conditions imposed on doctors and links to legal cases against them in its register of health practitioners.

RACGP President Bastian Seidel has questioned the Medical Board’s disclosure decision, which came in response to a failure of chaperone conditions imposed in cases of alleged sexual misconduct.

“AHPRA’s decision to link disciplinary outcomes to registered practitioners on a medical register needs to be thoroughly evaluated, and broader discussion on the long-term implications should be held in order to determine impacts on patient safety and the ongoing quality of care,” Dr Seidel said.

“The majority of medical practitioners act in an ethical and professional manner, and disciplinary cases in Australia are considerably low.”

The Maitland Mercury:  Avoid catching flu this season


With winter and the colder weather fast approaching so too is flu season, and after last year’s record flu season it is time to start thinking about prevention.

The timing of an influenza vaccination is critical to ensuring patients have the highest level of protection from the influenza virus when the flu season commences.

The Royal Australian College of General Practitioners (RACGP) is advising Australian patients to receive their influenza vaccination at the right time with a specialist GP, to ensure they are protected.

RACGP President Dr Bastian Seidel said there is no need for patients to rush for a flu vaccination as soon as they are available.

“Typically, flu season affects Australia from June to September, with the peak being August,” Dr Seidel said.

“Recent evidence suggests that protection following flu vaccination may begin to wear off after three to four months, so timing of vaccination is critical.”

ABC Radio Australia: Flu vaccine 2018: Do you need it and when should you get it?


Last month, the Australian Medical Association urged people to hold off on getting this year’s flu vaccine, warning some pharmacies were offering it too early.

Vaccination is a safe and effective way to protect yourself from flu; people who get vaccinated are at lower risk of getting an infection (and developing serious disease) than those who do not.

Bastian Seidel, President of Royal Australian College of General Practitioners (RACGP), said it’s important for people to get vaccinated whether they are healthy or at high risk.

“Every year thousands of Australians are dying or being admitted to hospital for complications of the flu. That is entirely avoidable if people have their flu vaccination,” Dr Seidel said.

If you are in a high risk category or have concerns or questions about the flu vaccine this year, it’s best to speak with you GP, Dr Seidel said.

“They can very specifically give you advice that works best for you.”

WAtoday:  Medical cannabis is legal. That does not mean it works


These days, when Deb Lynch reads that medical cannabis is legal, she just laughs and laughs.

“We used to get annoyed about that,” she says. “Not any more.”

Ms Lynch expected legalisation would mean she could access the drug to treat her autoimmune disease.

But, like many, she has been knocked back and told there is no evidence it would help her.

For medical cannabis, some experts believe the hype has surged way past the science, which is weak, inconclusive and often non-existent for many conditions. When cannabis does work, the effect is often small.

The issue has split the Royal Australian College of GPs and the College of Physicians.

“The problem with medicinal cannabis is we don’t yet have the robust evidence the general public would normally expect if not demand, and the medical profession would normally want,” says the College of Physicians’ Professor Reynolds.

Doctors should only prescribe a drug when there is proof it works, he said.

“Is medicine to remain a scientific endeavour, or is it to become a personal-want-driven endeavour?”

Dr Bastian Seidel, president of the College of GPs, is far more bullish.

“[America’s National Academies of Sciences] made very clear that there is substantial and conclusive evidence that medicinal cannabis is effective for chronic pain, and nausea. They say it’s conclusive,” he said.

ABC News: Royal Hobart Hospital: What is causing the problems at Tasmania’s major health facility?


The Royal Hobart Hospital (RHH) is regularly in the news for the wrong reasons; ambulance ramping, suicides, patients waiting days in the emergency department and low staff morale.

As another flu season approaches, health professionals are again warning the RHH will struggle to cope.

Most of the hospital’s problems stem from a shortage of beds.

But the redevelopment will fix the bed crisis, right?

The completed 10-story K-Block will increase acute inpatient capacity in southern Tasmania by close to 250 inpatient beds. (Remember, Dr Nicklason put the bed deficit at about 200 state-wide).

While the Government says the redevelopment, once complete, will relieve pressure by increasing the number of beds, health professionals and unions say it is by no means a silver bullet.

Royal Australian College of General Practitioners (RACGP) president Dr Bastian Seidel said he was concerned about the notion the completed redevelopment would end overloading at the Royal.

“I think it would be foolish to assume that just because we have a shiny new building at some stage, that our problems in the sector are just going to magically disappear,” he said.

“There is a risk that we have just a building that is not being staffed appropriately, that we still have organisational difficulties that lead to staff leaving and inefficiencies within the RHH.”

Sydney Morning Herald: Pharmacists and doctors trade jabs over the best time to get flu shot


When should you get your annual flu shot?

It is a question that has become the subject of a bitter turf war between doctors and pharmacists, with peak groups offering different advice to the public on when to get their yearly jab.

In the shadow of last year’s big and deadly influenza season, some pharmacies have already started offering vaccines.

But doctors are warning that it could be too early, since the inoculation wears off as the months go by.  They have accused pharmacists of putting their profits before patients.

“If you have your vaccine now it might not be effective when the flu season is at its peak,” said Royal Australian College of General Practitioners president Bastian Seidel.

“For every month it becomes between 6 to 11 per cent less effective.”

Dr Seidel said it was “absolutely unacceptable” that the two groups were not providing consistent advice to the public, and he accused the pharmacy guild and pharmaceutical society of “backstabbing” the chief medical officer by ignoring his advice.

“I don’t understand what the motivation is other than a financial one, which is getting the vaccination out of the fridge and into the patient, whether it’s effective or not,” Dr Seidel said.

Bendigo Advertiser: Half of Aussies won’t vaccinate for the flu this year – will you?


Less than one in two Australians plan to vaccinate against influenza despite the country suffering through one of its worst seasons last year.

About 45 per cent of people are planning to vaccinate for the coming flu season, a poll commissioned by the Pharmacy Guild of Australia has found.

Almost one in two baby boomers were vaccinated last year while less than a third of millennials had the jab, the survey of 1000 people revealed.

The Royal Australian College of General Practitioners president Bastian Seidel said urging patients to receive the vaccination too early in the year could put them at risk.

The college was concerned vaccine providers were already peddling their products, though influenza season typically strikes from June to September.

August is typically the peak time for the virus in Australia.

Australian Journal of Pharmacy: Pharmacy attacked over flu vax fees, timing


The AMA is throwing its weight behind recent calls by the RACGP for Australians to wait until April to have their flu vaccinations at the GP.

National president Michael Gannon told ABC News that timing matters when it comes to flu vaccination.

He said doctor groups were working with the Federal Health Department with an aim of protecting as many vulnerable people as possible, and timing of the release of the vaccine has been part of that discussion.

He also criticised pharmacy over the fees it charges for the service.

“We are concerned when pharmacies are out there advertising early flu shots at a time that might not be clinically appropriate,” he said.

Earlier this month the RACGP’s Dr Bastian Seidel said that the practice of “some vaccine providers” advising vaccination take place in March was putting patient health at “serious risk”.

Medical Republic: What Qoctor wants to do next


Having just celebrated its 10,000th sick note, controversial online GP consultation service Qoctor has set its sights bigger and better things.

As well as medical certificates, Qoctor has been offering prescriptions for almost half a year now, and chief executive Dr Aifric Boylan says business is thriving.

Every treatment currently prescribed by one of the eight GPs working for the service had been “chosen very carefully”, Dr Boylan said, to ensure it was not high risk.

Dr Boylan was well aware of the concerns around her service. RACGP President Dr Bastian Seidel has said the increasing use of online services fragments care and “poses a serious risk to patient safety”.

The college, instead, wants online services offered by the patient’s own doctor or usual practice.

“Completing requests via an online survey can easily result in misdiagnosis due to a range of factors,” Dr Seidel said.

“Without access to the treating GP’s notes, the doctor has no means of otherwise confirming the information provided.”

The AMA has also expressed concern, saying a simple video call would rob clinicians of an opportunity to pick up on body language and less obvious illnesses.

The Advertiser: How hip patients and obesity surgeries are costing big buck as doctors overcharge


Patients who need hip or knee replacements are the most likely to be slugged with out of pocket fees by their surgeons, while obesity surgery patients face some of the highest gap fees.

News Corp has blown the lid on overcharging doctors via a new tool that allows patients to check if their doctor is billing in excess of the AMA recommended fee and today we provide analysis on which doctors are the worst offenders.

It comes as GPs and the Royal Australian College of Surgeons warn patients that doctors who charge the most are not necessarily the best, medicos with the best outcomes tend to charge smaller fees, they say.

Royal Australian College of General Practitioners RACGP president Dr Bastian Seidel says he now has to take into account whether a surgeons large out of pocket fees will harm a patients recovery before he recommends them.

“Before they start treatment doctors must ensure they first do not harm,” he told News Corp.

“That includes first do no financial harm,” he said.

PerthNow:  Getting flu shots too early raises influenza risk, say WA GPs


Pharmacies are exposing people to the deadly flu virus during the peak of the season by encouraging customers to get their vaccination too early.

The push by chemists to “book a flu shot today” contradicts advice from the Department of Health, the Federal Government’s immunisation advisory body, the Royal Australian College of GPs and Australian Medical Association.

Official advice is that people get their flu jabs in May or early June to ensure they have the highest level of protection during the peak of the season between July and September.

RACGP president Dr Bastian Seidel said “urging patients to receive their flu vaccination too early in the year may put them at serious risk”.

“The last thing we want to see this year is patients doing the right thing and receiving a flu vaccination, only for the vaccination to wear off by the time we reach flu season,” Dr Seidel said.

Medical Republic: College’s joint project to mentor returning GPs


The RACGP is teaming up with Primary Health Care in a pilot project to mentor GPs returning to work after a prolonged absence from medical practice.

The Helping Doctors Re-entry to Practice pilot aims to prepare Australian GPs who have been out of practice for an extended period with clinical and educational mentoring and support.

RACGP President Bastian Seidel said the level of need was not uniform and different practitioners might require quite different support structures.

“The longer someone has been away from practice, the greater the challenges that they will face in returning,” Dr Seidel said.

“The biggest hurdle would be coming up to speed with changes in medical knowledge and practice, and particularly so if they have had no involvement with the medical field at all while away.

“This is particularly the case with chronic disease, where guidelines, prescribing and other aspects of management do change.”

Depending on the individual circumstances, there would also be a degree of apprehension about returning to work and how they would cope, he added.

The majority of GPs who take part are likely to organise their own placement, and the RACGP will work with them to determine an individual education plan according to their needs.

MJA InSight: Generalists crucial to tackling complex diagnoses


Embracing generalism is crucial in tackling the complex diagnoses often required in an ageing population and in meeting the community’s priority health care needs into the future, write two experts in this week’s MJA.

Royal Australian College of GPs (RACGP) President Dr Bastian Seidel agreed that a more coordinated and flexible response to medical training was required to meet community health needs. He said, however, that there was a raft of challenges ahead.

“Medical training can take 12 years for a non-GP specialist, and not much less time for a GP; this is important to produce good and safe doctors,” Dr Seidelsaid. “Community needs can change quickly and the response time to produce suitably trained doctors to meet these needs can be very slow.”

Other challenges included increasing specialisation and a bottleneck in clinical training positions.

Dr Seidel said that a greater emphasis on generalism was important to meet the needs of a rapidly ageing population with multiple morbidities.

“As GPs, we are the mainstay of continuous care of multiple diseases in our patients, and the need for generalism among non-GP specialists is becoming increasingly important, especially in very complex patients,” said Dr Seidel, adding that there also needed to be a focus on multidisciplinary and coordinated care.

“While the RACGP welcomes the increasing of generalist skills [among] specialists, the need for constant communication, multidisciplinary and continuous shared care with a GP is the safest way to ensure a patient’s holistic care,” he said. “GPs have been managing and coordinating complex patients for a long time, often when a non-GP specialist only manages one aspect of the patient.”

Bendigo Advertiser: Royal Australian College of General Practitioners highlights lack of protection associated with early flu vaccinations


There is no need for people to rush to get a flu vaccination as soon as they become available, Australia’s peak body for general practitioners has advised.

The Royal Australian College of General Practitioners is concerned vaccine providers are already peddling their products, though influenza season typically strikes from June to September.

“Urging patients to receive their flu vaccination too early in the year may put them at serious risk,” RACGP president Dr Bastian Seidel said.

“The last thing we want to see this year is patients doing the right thing and receiving a flu vaccination, only for the vaccination wear off by the time we reach flu season.”

Recent evidence suggests the flu vaccination’s protective effects can start to wear off after three to four months.

Hence, the RACGP said the timing of vaccination was critical.

“Your GP will know when to provide you the influenza vaccination, to ensure you have the best possible protection when the flu season begins,” Dr Seidelsaid.

The organisation is advising people to consult their GPs to ensure they are vaccinated at the right time and are protected against influenza.

“Specialist GPs are up-to-date on when the flu season will affect Australian patients and will continue to offer vaccinations throughout the flu season,” Dr Seidel said.

Australian Journal of Pharmacy: Non-GP vaccinators accused of increasing flu risk


The RACGP has criticised flu vaccine providers who are encouraging patients to be vaccinated now.

The group’s president, Dr Bastian Seidel, says is concerned that “some influenza vaccine providers” are advising patients to be vaccinated now, which could put them in danger.

“Urging patients to receive their flu vaccination too early in the year may put them at serious risk,” Dr Seidel says.

“The last thing we want to see this year is patients doing the right thing and receiving a flu vaccination, only for the vaccination wear off by the time we reach flu season.”

Dr Seidel is calling on Australians not to be vaccinated early, as this could result in poorer health outcomes. The RACGP is also encouraging Australians to see their “specialist GP” for a vaccination instead of other providers.

“Typically, flu season affects Australia from June to September, with the peak being August,” Dr Seidel says.

“Recent evidence suggests that protection following flu vaccination may begin to wear off after three to four months, so timing of vaccination is critical.”

He says that specialist GPs are “best placed” to advise patients on the timing of vaccination.

Dr Seidel also called again on the Federal Government to provide a government-subsidised influenza vaccination program for all Australians.

“Influenza vaccines should be available to every Australian through their GP this winter,” Dr Seidel says.

“A government-subsidised flu vaccination program would cost far less than the economic losses from the 3000 deaths a year, mounting hospital and health bills, and lost work productivity.

“We are seeing the same story every year – on average 3,000 deaths a year, 18,000 hospital admissions and 350,000 Australians affected by the flu – this is completely unacceptable in 2018 and it is time our political leaders commit to safeguarding Australians from the flu.”

The Examiner: RACGP warns Tasmanians not to vaccinate against flu too early


Tasmanians are being warned against rushing in for a flu vaccination.

Timing for vaccination is “critical” to ensure patients have the highest level of protection from the virus when the influenza season hits, doctors say.

Royal Australian College of General Practitioners president Dr Bastian Seidel, who is based in the state’s South, said there was no need to rush for a flu vaccination as soon as they’re available.

“Typically, flu season affects Australia from June to September, with the peak being August,” he said.

“Recent evidence suggests that protection following flu vaccination may begin to wear off after three to four months, so timing of vaccination is critical.

“Specialist GPs are up-to-date on when the flu season will affect Australian patients and will continue to offer vaccinations throughout the flu season.”

Dr Seidel said he was concerned some vaccine providers were already advising patients to receive a flu vaccination, which “could put them in danger”.

“Urging patients to receive their flu vaccination too early in the year may put them at serious risk,” Dr Seidel said.

Dr Seidel said the college was again calling on the federal government to introduce a government-subsidised flu vaccination program for all Australians.

“Influenza vaccines should be available to every Australian through their GP this winter.

“A government-subsidised flu vaccination program would cost far less than the economic losses from the 3000 deaths a year, mounting hospital and health bills, and lost work productivity.

SBS News:  Why the timing of your flu shot is critical


Timing is everything, especially when it comes to getting the flu shot.

The Royal Australian College of General Practitioners (RACGP) says the timing of influenza vaccination is critical to ensuring patients have the highest level of protection when the flu season arrives.

Rushing out to getting the flu vaccination too early may put people at serious risk, warns RACGP President Dr Bastian Seidel.

“Typically, flu season affects Australia from June to September, with the peak being August,” Dr Seidel said.

“Recent evidence suggests that protection following flu vaccination may begin to wear off after three to four months, so timing of vaccination is critical,” he said.

Concerned some vaccine providers are already advising patients to receive the flu vaccination, Australians are encouraged to consult a specialist GP about when to get the annual flu jab.

“The last thing we want to see this year is patients doing the right thing and receiving a flu vaccination, only for the vaccination wear off by the time we reach flu season,” said Dr Seidel.

ABC News: After-hours medical clinic numbers drop after crackdown on false claims


A Perth after-hours medical clinic says the number of patients using its service has reduced by almost a third since a government crackdown but concedes the system was being abused, including by doctors writing opioid scripts.

The Federal Government crackdown on false claims for urgent after hours care only began on March 1.

A review of the system led to the current crackdown.

It found 63 per cent of the doctors providing after-hours services were not vocationally registered GPs, meaning they were either still in training or not members of the college of GPs.

Royal College of General Practitioners President Bastian Seidel said patients should not get a doctor with fewer qualifications just because they were taken ill in the middle of the night.

“It doesn’t make any sense … (for) a trainee doctor who is on a path to become a radiologist or a pathologist to do any after hours work in general practice, it’s just not his or her area of expertise,” Dr Seidel said.

HempGazette: RACGP: Australian medical cannabis access rules must be uniform


The Royal Australian College of General Practitioners (RACGP) has called for consistency in rules concerning access to medical cannabis products in Australia.

The body wants to see an end to the “highly bureaucratic, time-consuming and expensive” situation, stating that all health ministers must agree to a single-step approval process that acts as submission portal to all relevant authorities.

“While the regulatory and prescribing regime must be robust to ensure only appropriate clinical access within the confines of the legislation, patients and doctors should not have to jump through hoops and wait months to access a drug that may improve a patient’s quality of life,” said RACGP President Dr Bastian Seidel.

Dr. Seidel also said GP’s should also be able to prescribe products, rather than just “specialists” or having to consult them, pointing out that in fact GP’s are specialists and are the first port of call for patients seeking medical assistance.

“If I have a patient, who has tried all standard treatment options without success, I should be able to consider prescribing medicinal cannabis as a viable treatment option without having to wait months,” he said.

ABC News: Cannabis is the only thing easing their chronic pain. Now their father is facing jail


After years watching his daughters Morgan and Ariel suffer from the chronic auto-immune disease Crohn’s, Stephen Taylor decided to research medical cannabis.

After finding no doctor would take on the lengthy Therapeutic Goods Administration (TGA) application process for legal access to medical cannabis, he decided to take matters into his own hands.

He began juicing cannabis to treat his daughters.

Now his home has been raided and he’s facing the serious prospect of going to jail.

Dr Bastian Seidel is the man who represents GPs across the country.

He says the current system is a basket case.

“It doesn’t make sense, your postcode should not determine whether you have access to treatment,” he said.

“We need to have a look at what works best for our patients and what works best for doctors.”

Australian Journal of Pharmacy: RACGP frustrated on cannabis


The RACGP has called for an end to what it calls “the highly bureaucratic, time-consuming and expensive process for prescribing medicinal cannabis products”

RACGP President Dr Bastian Seidel says a consistent national regulatory framework for prescribing medicinal cannabis products would help ensure patient welfare is at the centre of this difficult and rapidly evolving area of medicine.

“The current process of prescribing medicinal cannabis products in Australia differs significantly in every state and territory, which does not make sense,” Dr Seidel says.

“Australia’s state health ministers must agree on a nationally consistent regulatory framework that will create a single-step approval process. This will significantly benefit frustrated GPs and their patients.

“While the regulatory and prescribing regime must be robust to ensure only appropriate clinical access within the confines of the legislation, patients and doctors should not have to jump through hoops and wait months to access a drug that may improve a patient’s quality of life.”

Dr Seidel urged the health ministers to implement the RACGP’s recommendations at the Council of Australian Governments (COAG) meeting next month.

Medical Republic: NSW simplifies medical cannabis process


The RACGP has called for all jurisdictions to follow the lead of NSW and withdraw from the approval process for medical cannabis.

NSW Health Minister Brad Hazzard announced on March 2 that his state would rely on federal TGA assessments alone, ending a two-step process that has been blamed for frustrating doctors and patients with long delays and unexplained refusals for prescriptions.

RACGP President Dr Bastian Seidel said there was no reason all states could not commit to a nationally consistent framework for access.

“I would like to see this happen at the Council of Australian Government (COAG) meeting next month,” he said.

He said medicinal cannabis was never the first-line of treatment for any medical condition, but there was evidence that it might be the treatment of last resort for some patients.

“For too long there has been too much political interference in patient access to medicinal cannabis, which is why we have been calling it ‘political cannabis’.”

MJA InSight: Time to overhaul GP training


Experts are calling for a rethink of general practice vocational training, questioning the educational value of time spent in a hospital environment that was now “poles apart” from the general practice experience.

Dr Bastian Seidel, president of the Royal Australian College of GPs (RACGP), said that the college had been calling for a rethink on GP training for some time, and the impending transfer of training responsibility back to the RACGP and the Australian College of Rural and Remote Medicine from 2019 provided an ideal opportunity to consider these issues.

“There is certainly an appetite here to rethink how we can improve general practice training for it to meet the needs for our future GPs,” he said.

“Realistically, the general practice environment is a very different environment compared to the hospital environment. How can the training that you get in a high-tech, tertiary care environment, which is full of safety nets, be transferred into a low-tech general practice environment? There are some learnings for doctors in the hospital environment initially, but we really need to look at how relevant it is in the scheme of things.”

The RACGP’s 2018–19 pre-budget submission highlighted the potential role for general practice in taking on more interns.

“We are hearing increasingly that interns are missing out on hospital placements, in particular in smaller states,” Dr Seidel told MJA InSight.

“There is no reason why interns can’t be placed in general practice. It would be great exposure early on … that would help them to become confident and capable GPs in the future. And even if [interns] later want to become a cardiologist or a neurosurgeon, the exposure they have to general practice is going to help them understand the complexity we are dealing with on a daily basis. So, it’s going to make them better doctors.”

It was also important to improve the consistency of medical student exposure to general practice, he said, which could vary from just a couple of weeks to a year.

PerthNow: Nurses promoting anti-vax message targeted by new code of conduct


Rogue doctors and nurses who promote anti-vaccination messages are being targeted by their professions, as fresh figures show WA has the lowest rate of vaccinated babies and preschoolers.

A new code of conduct for nurses and midwives from this week states they must help to promote disease prevention including vaccination.

The Royal Australian College of General Practitioners has urged people to seek out vaccination advice from their GP and reiterated that anti-vaccination messages had no place in general practice.

RACGP president Bastian Seidel said preventive health was the core business of general practice and anti-vaccination beliefs were “bad medicine”.

Dr Seidel said people should seek vaccination advice from a GP rather than a medical practitioner without postgraduate qualifications in general practice.

Australian Journal of Pharmacy: Cannabis access change to help ‘frustrated’ doctors, patients


The NSW Government has simplified access to medicinal cannabis by introducing a single application process.

Instead of both the Commonwealth and NSW Health overseeing the approvals, NSW will rely on a single clinical assessment by the Therapeutic Goods Administration.

The RACGP welcomed the decision as an opportunity to move towards a national medicinal cannabis access scheme.

RACGP President Dr Bastian Seidel says it is time sign-off by state bureaucrats was no longer part of the approval process for access to medicinal cannabis.

“NSW Health Minister Brad Hazzard’s changes are welcomed by frustrated GPs and their patients,” Dr Seidel says.

“For too long there has been too much political interference in patient access to medicinal cannabis, which is why we have been calling it ‘political cannabis’.

Dr Seidel says all Australian health ministers must now work together to create and introduce a nationally consistent framework for medicinal cannabis access.

“There is no reason our states cannot commit to a nationally consistent framework,” Dr Seidel says.

“I would like to see this happen at the Council of Australian Government meeting next month.

The New Daily: Codeine ban sends sales of Nurofen, Panadol skyrocketing


Nurofen and Panadol sales have skyrocketed in the month following the controversial ban on over-the-counter codeine, The New Daily can reveal.

The ban has also sent codeine prescription prices skyrocketing, in some cases by more than double.

Data exclusively supplied to The New Daily by Chemist Discount Centre reveals its customers bought 45 per cent more Nurofen (ibuprofen) products in February compared to the same month last year, while Panadol (paracetamol) sales increased by 24 per cent.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, said that while he supported the ban, some of the drugs still available over the counter – such as Voltaren and Nurofen – can be dangerous when taken regularly.

Dr Seidel said GPs had not experienced an onslaught of requests for codeine prescriptions, in neither metro nor rural areas.

Australian Journal of Pharmacy: Docs ‘tearing out hair’ over vaccine refusal

The Australian Research Alliance for Children and Youth has released its 2018 Report Card: the wellbeing of young Australians, which tracks how young people are faring against other nations on 75 indicators of health and wellbeing.

One of these indicators is vaccination, and the report showed that the proportion of children aged two who are fully immunised fell from 92.7% in 2008 to 90.5% in December 2017.

RACGP president Dr Bastian Seidel weighed into the debate, following the introduction of Victorian laws designed to shut down “rogue medical practitioners” who could until recently make false statements about a child’s ability to be vaccinated.

Dr Seidel said that anti-vaccination messages have “absolutely no place” in general practice.

“It is vital all Australians are fully vaccinated,” Dr Seidel said.

Nine News: ‘It’s making changes in children’s brains’: Parents warn of long-term effects of popular asthma drug Singulair


Parents of children affected by the popular asthma medication Singulair have spoken out about what they believe are the long-term side effects of the drug, with several saying they fear the psychological damage done to their children could be permanent.

Royal Australian College of GPs president and National Asthma Council director Bastien Seidel said if parents were reporting long term effects from the drug then more research needed to be done to investigate the claims.

“It certainly would be concerning if that was the case. Realistically if we have more parents, more patients coming forward and saying this is how the medication has affected me, then I think it does warrant a scientific investigation of whether those claims can be validated.”

“I think we need to be careful that scaremongering isn’t taking place. But again we need to thoroughly appraise the medication, particularly when people are talking about irreversible and long term side effects.”

Dr Seidel said Singulair was often used as a last resort option for patients whose asthma could not be controlled by other medications and could be life-saving for severe asthma sufferers.

Medical Republic: ‘Now or never’ for united rural front


After two decades of being defined by their differences over rural health, Australia’s two GP colleges have struck an accord to revive old-fashioned multi-skilled general practice in country Australia.

Under the guidance of Rural Health Commissioner Paul Worley, RACGP President Dr Bastian Seidel and ACRRM President Dr Ruth Stewart pledged to work together to develop a training pathway for rural generalist doctors to meet a 2019 deadline.

The landmark pact comes more than 20 years after disgruntled rural doctors broke away from the RACGP to form ACRRM. The period since has been marked by bickering, notably over the RACGP’s opposition to ACRRM’s bid to have rural generalism recognised as a distinct specialty.

But Dr Seidel, a GP in rural Tasmania, said the two sides had a common mission to restore rural health, and the time was “now or never”.

“This is a once-in-a-generation stellar alignment, and it is now or never to make it work.

“We need to shift from making promises to rural communities, to delivering to rural communities,” he told The Medical Republic.

“Rural GPs and RGs are the centrepieces of rural healthcare. Those practitioners need to be trained, supported and retained in rural communities.

“ACRRM and the RACGP are ready to deliver for our members, funders and patients.”

The Examiner: Experts call on government to prioritise preventative health


Health professionals and advocates are calling for a whole-of-government approach and more investment in preventative health.

The Royal Australian College of General Practitioners said a whole-of-government approach was the “optimal outcome”.

The college also said GPs needed to be better supported to continue their prevention work.

“GPs do prevention well on a one-on-one basis,” president Dr Bastian Seidelsaid.

“They and their teams should be better supported to continue this work.

“We need to highlight the benefits that come from regular GP checks in a more public way.”

ABC News: SMA genetic screening: Couple who lost their baby fighting for others to access free testing


SMA is a rare, inherited, genetic muscle-wasting disease, characterised by a loss of nerve cells called motor neurons.

A test to identify if someone carries the gene for SMA has been available in Australia since 2012, but very few people know it.

Royal Australian College of GPs president Dr Bastian Seidel said the college was about to roll out a new education resource for all GPs about genetic medicine, including screening.

“Expectant mothers and women planning a pregnancy should be provided with information about prenatal screening for chromosomal conditions,” he said.

“GPs should support women and couples to make informed, independent decisions about the utility of prenatal testing and reproductive options.”

He said it was also important to consider non-clinical issues such as costs.

Medical Republic: College calls for broader flu vaccine funding


While the government’s recent decision to fund two superior flu vaccinations for seniors is laudable, this is still a far cry from the far wider coverage Australia needs, the RACGP says.

Two new influenza vaccines, Fluad and Fluzone High Dose, will be made available free of charge for people aged 65 or over from April this year.

The College welcomed the stronger vaccines, but called on the government to fund influenza vaccination for all Australians, not just those older citizens.

The savings made in health bills and work productivity from broader flu vaccine coverage would far outweigh the cost of a government-subsided flu vaccination program, RACGP President Dr Bastian Seidel said.

Croakey: We can now ‘moisten dryness in the triple burner’: here’s why we shouldn’t celebrate


Despite concerted campaigning by health experts, who won some concessions in the Senate, the Australian Government has failed to address concerns that the Therapeutic Goods Amendment (2017 Measures No. 1) Bill that was passed this week has given a green light to pseudo-science.

Royal Australian College of GPs president Dr Bastian Seidel said the new law “makes a mockery” of evidence-informed health policies and health regulation.

Dr Seidel expressed concern about many of the indications. He said: “(…) phrases such as ‘moistens dryness in the triple burner’, ‘replenishes gate of vitality’ and ‘softens hardness’ have no place in any genuine healthcare situation. These types of claims are extremely misleading and could lead to significant harm for patients.”

ABC Radio Australia: Patients falling through the cracks after codeine made prescription-only, experts say


People with acute and chronic pain say they are struggling to get the help they need since codeine-related medication was taken off pharmacy shelves.

The Royal Australian College of General Practitioners said its members had not seen a boost in demand for codeine.

“The run we anticipated, where patients make more and more appointments to get codeine prescriptions now, certainly hasn’t happened,” The college’s president, Dr Bastian Seidel, said.

Mr Seidel also urged patients to turn to their GPs for alternative pain management.

“GPs have upskilled significantly over the past years to meet the needs of our patients,” Dr Seidel said.

“We are always involving pain specialists and allied health professionals when it comes to patients who do suffer from chronic pain.”

Australian Journal of Pharmacy: TV team labelled ‘irresponsible’ over medical checks


Channel Seven’s Sunrise team have come under fire for sensationalising cancer and promoting medical checks which may not be necessary.

Sunrise marketed the “Special event” segments as “the difference between life and death: the medical checks every Australian needs”.

“This week the hosts at Sunrise are undergoing various lifesaving medical tests to spread awareness,” the show’s website states.

The Royal Australian College of General Practitioners has slammed the series, with president Dr Bastian Seidel saying he is “disturbed” that a national TV program could sensationalise a subject as serious as cancer.

“The advice delivered in the Sunrise series ‘The medical checks you have to have’ was not in line with current RACGP guidelines and far from encouraging patients to speak to their GP about prostate checks that could potentially save their lives,” Dr Seidel says.

“Contrary to what was suggested on this show, routine screening without discussion with each individual patient about the benefits and harms of screening for prostate cancer is not recommended.”

Dr Seidel says RACGP guidelines recommend GPs only request a PSA blood test after the patient has been informed about the risks and benefits of testing and has requested a test.

“A digital rectal examination is no longer recommended,” Dr Seidel says.

BuzzFeed News: Medical Cannabis Regulation Might Be A “Basket Case”, But Greg Hunt Says That’s On The States And Territories


The president of the Royal Australian College of General Practitioners (RACGP) has called the country’s medicinal cannabis regulations a “basket case” — but federal health minister Greg Hunt says it’s a problem for the states and territories to sort out.

Last week, Bastian Seidel of the RACGP told ABC News it was almost impossible to get a prescription.

“It’s impossible because of political reasons — that’s why I’ve called it political cannabis rather than medicinal cannabis.”

When asked to respond to Seidel’s comments, a spokesperson for Hunt told BuzzFeed News the minister agreed that the process needed to be simplified, and had written to states and territories asking them to do just that.

“At a federal level, we’ve legislated to allow for the first time pathways for doctors to prescribe medicinal cannabis, for domestic cultivation and manufacturing, and for importation,” said the spokesperson.

“The states and territories play a role in assessing the suitability of the doctor to prescribe, and the patient to receive, all Schedule 8 (controlled) medicines (including medicinal cannabis products).”

The Examiner:  ANMF Tasmania concerned about shortage of nurses


Tasmania faces significant challenges in recruiting and retaining nurses, the head of the nurses’ union says.

While both major parties have promised to employ more nurses, the Tasmanian Health Service currently has 184 permanent nurse vacancies.

Australian Nursing and Midwifery Federation Tasmania branch secretary Emily Shepherd said nurse shortages already existed across maternity, intensive care and theatre areas.

Royal Australian College of General Practitioners national president Dr Bastian Seidel said there was also a shortage of nurses working in GP clinics in Tasmania.

“Nurses working with GPs are indispensable but there are simply not enough of them and it is difficult for them to compete with hospital nurses,” Dr Seidelsaid.

ABC News: Study of big pharma’s education events for doctors raises concerns about overtreatment


Big drug companies are spending thousands of dollars educating doctors about expensive medications for depression, osteoporosis and overactive bladder that are not necessarily considered the preferred treatment, a new report has found.

In one case, researchers found a company spent more than $11,000 on a private dinner for 18 specialists at a top Sydney restaurant to discuss a new drug.

One of the report’s authors, University of Sydney senior lecturer Barbara Mintzes, said attendance at these educational events could potentially lead to overtreatment, or lead doctors to prescribe less effective drugs.

Royal Australian College of GPs president Dr Bastian Seidel said all RACGP members were trained to appraise evidence whether it was presented to them at events, or in journal papers and the media.

“Commercial interests should never inform the clinical decision-making of healthcare practitioners in Australia, including the commercial interest of pharmaceutical companies,” he said.

Medical Republic: Medical cannabis regulation a ‘basket case’


RACGP President Dr Bastian Seidel has lent his support to a coalition of doctors, lawyers and researchers seeking easier access to medicinal cannabis in Australia.

Dr Seidel said GPs were increasingly interested in the promise of medicinal cannabis to treat chronic and painful conditions and he was optimistic that a nationally consistent regulatory framework would be introduced.

“What we have now is a basket case,” he told a meeting organised by the charity, United in Compassion, last week.

Dr Seidel said GPs had seen that medicinal cannabis could be useful for some patients.

“My line would be, I would not consider medicinal cannabis as the first choice of treatment for any medical condition.  But it might well be a treatment of last resort for quite a few of my patients,” he said.

Dr Seidel said there was resistance to medical cannabis in the profession because “we just don’t know enough”.  But he held out hope of new “learning phase”.

ABC News: Hepatitis C drugs not being accessed by thousands of Australians with the disease


Hundreds of thousands of Australians with hepatitis C are failing to access new curative drugs, despite the Government subsidising them at huge cost to the taxpayer.

The trend means the Government is at risk of missing its target to eradicate hepatitis C and of spending far more than necessary on the treatments.

Royal Australian College of General Practitioners president Dr Bastian Seidel said the early symptoms of hepatitis C — which can include fatigue and nausea — could be vague.

He encouraged GPs to test patients for the disease and said patients should also ask to be tested.

“There’s no need [for patients] to go to hospital any more, there’s no need to go to see any hospital specialist,” he said.

“Your GP can assess you and, in cooperation with a hospital specialist, the medication can be prescribed and treatment can be monitored.”

New York Times:  Even Australia’s Medical Marijuana Poster Boy Can’t Get the Drug


Lindsay Carter had his first violent seizure at 14. He toppled face first onto a tiled floor in front of his father.

At 19, Mr. Carter can still have seizures several times a month that can convulse his body and threaten his life. But more often, the recent high school graduate experiences “focal seizures,” which temporarily arrest his ability to speak or comprehend.

When he gets what he describes as “clouds in my head,” he turns to a legal but difficult to obtain remedy — medical marijuana.

Dr. Bastian Seidel, president of the Royal Australian College of General Practitioners, called the country’s distribution system “fragmented” and “not transparent.”

“We don’t have a consistent, regulatory framework that is either efficient or timely,” he said, “and this is what makes it so frustrating for medical practitioners and for patients who are clearly in need of medical treatment.”

ABC News: Medical cannabis red tape forces thousands to turn to black market for pain relief


Medicinal cannabis was legalised in Australia two years ago, but patients and doctors are still struggling to access the drug and say the barriers and bureaucracy are driving thousands of people to a flourishing black market.

The peak body representing general practitioners agreed the application process to obtain medicinal cannabis was far too onerous on the doctor, was convoluted and was different in each state and territory.

“Currently it’s a basket case here in Australia,” said Bastian Seidel, president of the Royal Australian College of General Practitioners and a practicing GP.

“It’s almost impossible [to get a prescription] and it’s impossible because of political reasons — that’s why I’ve called it political cannabis rather than medicinal cannabis.”

The organisation wanted to see the process for prescribing and accessing the drug streamlined across the country.

“There’s complete inconsistency,” Dr Seidel said.

However, he cautioned that medicinal cannabis was not the right drug for everyone and could only be used to treat certain conditions such as epilepsy, severe chronic pain and nausea in chemotherapy patients, after they had tried conventional treatments.

The Examiner: Lilydale Family Health Care opens, replacing closed GP clinic


The former owner of Lilydale’s GP practice is charging patients to have their medical histories transferred back to the clinic, and has reportedly refused to allow the new owners to keep the old phone number.

The Lilydale GP Clinic closed in December, but the town’s pharmacy owners opened Lilydale Family Health Care in the same building in mid-January.

The former clinic owner, Advanced Rural Health, which comes under the umbrella organisation Your Health Connect, has since been charging people to have their full records transferred back. However, it is understood medical summaries are being provided free of charge on request.

Royal Australian College of General Practitioners president Dr Bastian Seidel said the college would speak to the parties involved to see if a better solution could be reached.

“There should be a reasonable solution in the best interest of the patients,” he said.

3AW: Outlandish claims could appear on alternative medicine labels, alarming health groups


Alternative medications spruiking hundreds of bizarre and outlandish claims could soon be approved if a new law passes Federal Government.

Some of the claims, which would appear on labels of complimentary medicines, included ‘replenishes gate of vitality’ or ‘opens body orifices’ in a move that is alarming health groups.

Dr Bastian Seidel, President of the Royal Australian College of General Practitioners, was amused by some of the phrases but said the Therapeutic Goods Administration needed to look at its role as the regulator.

“I started laughing, I don’t know what that means!” he told Ross and John on 3AW Breakfast.

“In all seriousness, it is concerning.

“We are concerned things are being made up that don’t make any sense, that don’t follow any logic or any scientific basis and people are going to fall for it they are going to see the labels stating TGA approved.

“And people are buying it.”

Sydney Morning Herald: ‘Softens hardness’: TGA under fire for health claim list that critics say endorses pseudoscience

Hundreds of bizarre health claims such as “tonifies kidney essence” and “opens body orifices” will be approved by the Therapeutic Goods Administration and appear on complementary medicine labels under new laws being pushed by the federal government, horrifying doctors.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners (RACGP), said some of the indications were a dangerous mixture of “fiction and hope” and, at worst, could interact with pharmaceuticals and be harmful.

“The TGA needs to have a good look at its role as a regulator and realise it should not endorse wannabe indications that are not based on science, logic or common sense,” he said.

“Its role is to protect the public from made-up claims and protect them from spending significant amounts of money on voodoo medicines that only benefit the company selling them.”

The RACGP, along with consumer group Choice, are calling for mandatory disclaimers on all traditional complementary medicines, as seen in the United States, that say the claims are “not accepted by most modern medical experts” and “there is no good scientific evidence that this product works”.

Medical Republic: After hours marketing blitz ahead of ban


After-hours home-doctor services are not going down quietly, with some businesses reportedly staging last-ditch marketing blitzes in state capitals before a ban on direct advertising to consumers takes effect next month.

The government this week revealed new rules for medical deputising services (MDS) that provide home visits, including a ban on direct advertising.  Those that do not comply run the risk of losing accreditation and their ability to employ non-vocationally registered doctors.

RACGP President Dr Bastian Seidel welcomed the ban on direct marketing by MDSs, saying the practice had become “inappropriate and unacceptable”.

“Advertising and marketing campaigns that unnecessarily divert patients from daytime general practice into the after-hours period represent a pathway to fragmented care and potentially poorer outcomes for patients,” Dr Seidel said.

“Banning direct-to-consumer advertising in this sector is a common-sense decision that has been made in the best interest of Australian patients.”

Financial Review:  Australia takes first step to combat opioid addiction with Panadeine, Nurofen Plus ban


One of Australia’s most powerful lobby groups, the Pharmacy Guild, lost a rare battle this week.

For more than two years it fought to overturn a looming government ban on over-the-counter sales of codeine medicines like Panadeine and Nurofen Plus.

But on Thursday the change that means Australians now have to have a prescription for these products came into effect, with federal Health Minister Greg Hunt declaring it would save lives.

“Australia is quite late to make this change,” says Bastian Seidel, president of the Royal Australian College of General Practitioners. “We need to follow the advice and experience of other countries. These medications are not available over the counter in the US, Japan or most European countries.”

Seidel says part of the problem lies in patient expectations for pain management, as people are often not open to alternatives like physiotherapy, massage and exercise.

“It’s difficult to have this conversation with patients. They want a quick fix,” he says.

“We need GPs and pharmacies to be working together … to get people off medication that’s risking harm, to explore less harmful treatments for pain management.”

The Australian: Medicare in bid to curb corporate billing


Hospitals, clinics and other major employers have been billing Medicare on behalf of health practitioners — sometimes without their knowledge — or significantly influencing the services they provide to patients at taxpayers’ expense.

Practitioners have their own Medicare provider number and are meant to take responsibility for all billing, but audits have discovered lax and problematic arrangements, prompting the Health Department to seek new powers to determine who controls the provider numbers and who is to blame for inappropriate billing.

Royal Australian College of General Practitioners president Bastian Seidelsaid an education program was needed so doctors were not caught unaware: “Quite often it’s organisations who are doing the billing for practitioners, and this happened in the after- hours (home visits) space and quite frankly it happens in public hospital outpatients clinics too.”

Australian Journal of Pharmacy: Codeine conversation highlights opioid trouble


Doctor groups today welcomed the upschedule of low-dose codeine, with AMA president Dr Michael Gannon declaring that the Guild stood alone on its opposition to the measure.

The RACGP encouraged patients who are apprehensive about the change to talk to their GP, with president Dr Bastian Seidel suggesting they should use the upschedule as a reminder to find a safer alternative for managing their pain.

“If patients find they feel particularly anxious about the upcoming change perhaps that is a sign it is time they seek alternatives for pain relief,” Dr Seidel said.

“There are many alternatives that provide just as much pain relief in a much safer way.

“Evidence shows that over the counter medicines containing codeine provide little additional benefit in pain relief in comparison to other similar medicines without codeine,” Dr Seidel said.

“Codeine is dangerous and the situation in Australia was leading to severe health outcomes.

“Over 150 codeine related deaths in Australia every year is completely unacceptable.

“If your GP believes codeine is appropriate for you, then codeine is still a viable treatment option.

“But patients cannot self-medicate with it anymore.”

The Canberra Times: Australian doctors ‘disturbed’ by manslaughter conviction against Dr Hadiza Bawa-Garba

In 2015, British trainee paediatrician Dr Bawa-Garba was convicted of manslaughter on the grounds of gross negligence over the “needless” death of six-year-old Jack Adcock. In January, the UK High Court ruled she must be struck off the UK medical register, banning her from the profession for life.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, said it was “inconceivable” that a system designed to support patients and doctors would wholly and excessively lay the blame on a doctor for its failures.

He said it was another reminder for Australia to stop “eagerly copying and pasting” health policies in the UK and instead scrutinise them “with sophistication” and learn from their experiences.

Herald Sun:  Codeine prescriptions: Why you will pay more for pain relief


Millions of Australians may have to pay several dollars more for popular pain medications from today, as fallout from the Government’s new prescription only rule for codeine products begins.

Now the pills are prescription only. chemists will be able to charge a dispensing fee for supplying the drugs that will raise their price.

RACGP president Dr Bastian Seidel says Australians need to start moving away from medication to treat chronic pain and look at physiotherapy, acupuncture, massage, exercise treatment, heat and ice as alternatives.

Medical Republic: Doctors rally behind struck off registrar


Australian doctors are rallying to support a British registrar who faces being struck off over the death of a child, saying she has been used as a scapegoat for staffing and systems failures at a UK hospital.

Former AMA President Dr Mukesh Haikerwal and RACGP President Dr Bastian Seidel are among many Australians speaking out against last week’s ruling that Dr Hadiza Bawa-Garba be stripped of her registration. They say the outcome is not only unfair but could damage medical culture.

Dr Seidel took to Twitter yesterday, saying: “How can one demand excellence from a doctor working in a broken system that only ever allows compromised care. It’s incomprehensible that the regulator does not take the context into account. Wake up #NHS and take note Australia.”

Medical Republic:  Calls grow for unified access to cannabis


More GPs and patient advocates are venting their frustration over state-based rules that are blocking access to medicinal cannabis for conditions such as chronic pain and nausea.

RACGP President Dr Bastian Seidel has come out in favour of a unified system of access, instead of the array of state regulations which require GPs to get endorsements from specialists on top of federal approval.

“It’s time for all health ministers to commit to a nationally consistent regulatory framework that informs access and prescribing of medicinal cannabis. Patients and practitioners deserve transparency. Anything else is politics,” Dr Seidel said.

He was responding on Twitter after federal Health Minister Greg Hunt revealed government hopes to create a world-leading export industry from medicinal cannabis products.

“If I were a patient I would wonder, does the government want me to move countries to access the product?” Dr Seidel said in a media interview.

Townsville Bulletin: Tasmanian state election: Labor promises $560m health boost


Opposition Leader Rebecca White has placed health at the centre of Labor’s election campaign with a $560 million pledge to boost health funding.

She said her party would fund more beds in hospitals and employ up to 500 more doctors, nurses, paramedics and allied health staff.

The Royal Australian College of General Practitioners welcomed the policy announcement, particularly the commitment to preventive healthcare — such a smoking cessation, flu injections and more GP training places.

“Given the clear impact general practice has on health it makes sense that our political leaders invest in preventive medical care delivered by Tasmanian specialist GPs,” said Bastian Seidel, president of the GP group.

ABC News: Tasmanian election: Labor announces half-billion-dollar health pledge


Tasmania’s Labor Party has unveiled a half-billion-dollar health plan in a bid to convince voters it is the only party that can improve the state’s health system.

Labor leader Rebecca White said the six-year spend would include money to recruit 500 extra staff across the state’s health and hospital system, and improve waiting times for outpatients and emergency departments.

Labor’s health policy has been welcomed by health professionals.

Royal Australian College of General Practitioners president Bastian Seidel said there had been a significant underspend in Tasmania.

“As a health practitioner of course I am saying it is about time, because otherwise patients are going to pay for it, literally with their lives,” Dr Seidel said.

“It’s a step in the right direction and it’s a welcome announcement but there’s more to come, we hope.”

Australian Journal of Pharmacy: Could a GP app ease codeine trouble?


Christian Nehme, a medical scientist and former pharmacy assistant, is developing doctoroo, an app which allows patients to see a GP via their phone or other device.

doctoroo is currently being suggested as a solution “to ease the pain, unfamiliarity and inconvenience of travelling to a GP for a codeine script,” it said in a statement today.

Online consultation services – such as Qoctor, which was formerly known as “Dr Sicknote” – have received criticism in the past, with RACGP president Dr Bastian Seidel saying of Qoctor that “the big risk with online services performed outside of the usual patient-doctor relationship is that they fragment care and do not provide continuous, comprehensive general practice care to patients”.

ABC News: (video)

More than a third of all visits to emergency departments last financial year were deemed potentially avoidable. Dr Bastian Seidel says that Medicare rebates need to be increased, to encourage more Australians to see their GPs.

Triple J Hack:  Medicines committee to decide fate of Diane contraceptive pill


The Advisory Committee on Medicines – which informs the Therapeutic Goods Administration (TGA) – will meet on Friday to decide if the guidelines in place for Diane-35 are working.

Dr Bastian Seidel, the President of the Royal Australian College of General Practitioners, told Hack the TGA is clear that Diane-35 should not be prescribed only as a contraceptive.

“I think patients and practitioners need to be aware that there are certain risks with Diane-35.”

“It’s only meant to be used for women who have signs of hyper-androgenisation, in particular, severe facial hair growth and other treatments haven’t worked,” Dr Seidel said.

Contraceptive use can be a positive side effect for those patients, he said.

Diane-35 is also great for patients’ skin, but it shouldn’t be the go-to treatment for acne, Dr Seidel said.

“It’s only for women who have severe acne, and that’s acne that hasn’t improved with other treatments.”

The Australian: Hospitals on alert over rush for codeine


NSW Health Minister Brad ­Hazzard is concerned people will try to obtain codeine from emergency departments after ­tomorrow when it ceases being available from pharmacies without a script.

Royal Australian College of General Practitioners president Bastian Seidel said 85 per cent of people visited a GP at least once a year and could discuss any pain ­issues.

GPs provided at least 150 million services a year, whereas there would be fewer than eight million over-the-counter codeine transactions, which he suggested made any increased workload manageable.

Dr Seidel had expected GPs to experience a significant increase in patients asking for codeine scripts or alternatives, but said that had not occurred. Instead, patients already due to see a GP were discussing codeine in those consultations.

“If the doctor, and you as a ­patient, have decided that codeine is appropriate for you then you will get a prescription,” Dr Seidel said.

“If there are better alternatives, or safer alternatives, they will be discussed as part of proper pain management.”

Australian Journal of Pharmacy:  No GP S8 prescription ban: TGA


There is no substance to reports that GPs could be banned from prescribing S8 analgesics, the TGA says.

Over the long weekend, Fairfax and News media reported that the TGA’s consultation on S8 opioids could lead to a ban on GPs prescribing them, as a measure to prevent a similar “opioid crisis” to that being experience in the United States.

Fairfax reporter Aisha Dow wrote on January 26 that “general practitioners could be banned from prescribing strong painkillers in an attempt to prevent Australia following the United States into an opioid overdose epidemic”.

The article quoted RACGP president Dr Bastian Seidel, who said he felt the TGA was unfairly targeting GPs.

“We need to move away from blaming a particular group,” he said.

Meanwhile news.com.au reported that “the proposal would bar doctors from prescribing painkillers such as morphine, oxycodone, fentanyl and pethidine”.

The TGA made an announcement that “the story today that suggests GPs may not be able to prescribe high dose opioids under a review being done by the TGA is totally incorrect”.

“The medicines’ regulator is not proposing and will not be stopping GPs from prescribing high dose opioids,” it said in a statement.

ABC News: Codeine is coming off the shelves this week. Here’s what you need to know


As of Thursday, codeine-based pain relief will no longer be available over the counter.

To get your hands on painkillers like Panadeine and Nurofen Plus, you will first need to make a trip to your GP to get a script.

“There are other medicines available that are more effective for pain, and certainly less dangerous when compared to codeine,” said Dr Bastian Seidel, president of the Royal Australian College of General Practitioners.

“Nationally, we are seeing 150 people die each year because of codeine overdoses,” Dr Seidel said.

“That is completely unacceptable in the 21st century, and it’s time for us to take action.

“If your doctor believes codeine is appropriate for you, then codeine is still a viable treatment option. But you can’t self-medicate with it anymore, you’ve got to see your doctor first.”

Sydney Morning Herald:  GPs could be banned from prescribing addictive painkillers


General practitioners could be banned from prescribing strong painkillers in an attempt to prevent Australia following the United States into an opioid overdose epidemic.

The idea was criticised by Bastian Seidel, president of the Royal Australian College of General Practitioners, who said that while the review into schedule 8 painkillers was needed, he felt the Therapeutic Goods Administration had unfairly targeted GPs.

“We need to move away from blaming a particular group,” he said.

Although the report suggested that the rules could allow remote GPs to keep their access to stronger opioids, Dr Seidel said city doctors also often performed care that needed schedule 8 opioids, including as palliative care doctors visiting people in the community.

Sydney Morning Herald:  Victoria’s horror flu statistics revealed as stronger vaccine on way


A strengthened flu vaccine could be introduced this year after cases soared by nearly 300 per cent during last year’s horror flu season in Victoria.

Bastian Seidel, president of the Royal Australian College of General Practitioners, called for all Australians to be given access to free flu shots.

Dr Seidel said some people were likely skipping the vaccine because of the cost (about $10 to $15), and argued that the only way to validate the claim that it was a necessary health precaution was to make it available to everyone.

“Every year we have 3500 Australians who are dying of complications from influenza, and we believe that’s preventable,” he said.

“And 50 per cent of the deaths of children are happening in kids who are otherwise well.”

AJP: Docs call for free flu jabs for all


The RACGP is calling for free vaccinations for all Australians, following NSW’s announcement of free jabs for under-fives.

The RACGP welcomed the move but is now calling for a further commitment from the Federal Government – to extend a free vaccination program for all Australian adults.

Such a government-subsidised flu vaccination program is “long overdue,” says RACGP president, Dr Bastian Seidel.

“Far more needs to be done to protect Australians from influenza,” Dr Seidel said.

“Influenza vaccines should be available to every Australian this winter, not only children.

“Our political leaders must commit to this in an effort to avoid a repeat of last year’s flu season.”

Dr Seidel told the AJP that the priority is increasing vaccination rates, though he encouraged Australians to visit their GP regarding vaccinations.

“GPs remain the cornerstone of an effective and timely immunisation program,” he says.

“GPs will be able to offer specific advice suited to parents and their children’s individual needs and circumstances, therefore we encourage patients to see their regular GP to receive their immunisations or to receive further information on immunisations.

“Having said that, the principle of all Australians receiving immunisations to protect themselves, family and vulnerable individuals (aged, children, those who are unwell) is the most important thing in this instance.”

Post Script: Free flu vacs for NSW kids


From April 2018 all NSW children aged from six months to under five years of age will be offered free influenza shots. Parents can access the free flu shot from their usual immunisation provider: their GP, Aboriginal Medical Service, community health centre or local council.

The Royal Australian College of General Practitioners (RACGP) welcomed the New the announcement but called for further commitment from the Federal Government to safeguard Australians from a repeat of last year’s flu season.

RACGP President Dr Bastian Seidel said a government-subsidised flu vaccination program is long overdue.

“New South Wales Health Minister Brad Hazzard’s announcement is a step in the right direction, but far more needs to be done to protect Australians from influenza,” Dr Seidel said.

“Influenza vaccines should be available to every Australian this winter, not only children.”

Dr Seidel said he hopes the Federal Government will follow Minister Hazzard’s lead and carefully consider implementing a vaccination program that provides all Australians with a free flu vaccination.

“We want to see action, not just announcements,” Dr Seidel said.

The Age: New test for STI superbug you’ve probably never heard of


A new test to detect a superbug similar to chlamydia is being rolled out across the nation – and experts are urging those with symptoms including painful urination to get checked.

Mycoplasma genitalium is thought to affect about 400,000 Australians, but many people have never heard of it, unlike other sexually transmitted infections.

The bacterium can cause painful urination, itching and bleeding in the rectum, and in women has been linked to pelvic inflammatory disease, spontaneous miscarriage and infertility.

Royal Australian College of General Practitioners president Dr Bastian Seidel said growing treatment resistance emphasised why it was important to put more focus on prevention and safe sex.

The new Mycoplasma genitalium test involves a urine test or a swab of the genital area. A Medicare rebate of $28.65 is available.

The Australian: New blood-clot alerts added to Diane-35 ED’s product information


A revised set of explicit warnings detailing the increased risk of bloods clots for those taking popular acne drug Diane-35 ED as an “off-label” contraceptive have been added to its production information statement following increased concern about its use.

The Therapeutic Goods Administration and pharmaceutical company Bayer Australia have updated Diane-35 ED’s product information to include several additional pages of detailed symptoms and precautions to avoid the formation of blood clots while taking the drug.

Bastian Seidel, from the Royal Australian College of General Practitioners, said the changes were a positive step in improving patient-consumer education around safe usage of Diane-35.

“The more up to date the information the better it is,” he said.

Medical Republic: College bemoans mixed messages on marijuana


The RACGP is calling for a national approach to the prescribing of medicinal cannabis, which GPs say is near impossible for patients to obtain nearly two years after it was legalised.

RACGP President Dr Bastian Seidel appealed for a national solution on Twitter and in a media interview in his home state of Tasmania.

“It’s time for all health ministers to commit to a nationally consistent regulatory framework that informs access and prescribing of medicinal cannabis. Patients & practitioners deserve transparency. Anything else is politics,”  Dr Seidel said on Twitter at the weekend.

Controversy over the issue flared anew after Federal Health Minister Greg Hunt revealed that his government hoped to create a world-leading export industry from medicinal cannabis products.

Dr Seidel said the focus on exports sent an odd message.

“If I were a patient I would wonder, does the government want me to move countries to access the product?” he told the Hobart Mercury.

“Is this medical cannabis or political cannabis?” he added.

Herald Sun: Grower Hansen Orchards looks to expand free-apple program from schools to workplaces


As doctors call for free fruit to be issued to Tasmanian schools as a preventive health measure, a Tasmanian orchard is already generously leading the way.

Hansen Orchards has given away 75,000 apples to schoolchildren around the state and is investigating how to spread the fresh-fruit buzz in workplaces.

Meanwhile, the Royal Australian College of General Practitioners has called on the State Government to commit to preventive health care strategies.

The group’s president, Bastian Seidel, said the Government should provide free flu vaccines and free fruit to public schools.

Dr Seidel said a focus on preventive health was needed if the state was serious about getting healthier.

Providing schools with fruit helped create healthy habits for the future, he said.

“We are the most overweight state in the country, and if we are serious about becoming healthier we need to start in childhood,” Dr Seidel said.

Herald Sun: Patients driven to break the law as medicinal cannabis remains difficult to access


More than four months after medicinal cannabis ­became legal in Tasmania it has been approved for only two patients — despite an ­“explosion” in demand.

Royal Australian College of General Practitioners president Bastian Seidelsaid Federal Government moves to allow Australian exports of the product sent a confusing message to sick patients.

“If I were a patient I would wonder: Does the government want me to move country to access the product?” he said.

Dr Seidel questioned whether the announcements concerning medical cannabis were motivated more by political spin than patient care.

“Is this medicinal cannabis or political cannabis?” he said.

The GPs organisation is calling for a simpler and ­nationally consistent ­approach to medicinal cannabis, as every state has different requirements for patients and doctors.

Dr Seidel was not surprised that only two patients had been approved for the treatment since it became legal in Tasmania, as the drug needed to be prescribed by a specialist and waiting lists for appointments could be lengthy.

Dr Seidel said he would like to see GPs allowed to prescribe medicinal cannabis, in partnership with specialists, as GPs generally had longer ­relationships with patients and knew what other treatments they had tried.

“We would always look for standard treatments first, but if those treatments have failed then medical cannabis might be an option for patients with a certain sort of epilepsy or ­patients with some chronic pain conditions,” he said.

“It might well be a treatment of last resort for quite a lot of medical conditions.”

The Examiner: Calls for greater access to safe abortion in Tasmania following private abortion clinic closure in Hobart


Tasmania’s primary private abortion clinic is closing its doors due to decreased demand, sparking concerns that women seeking a surgical abortion will be forced to travel interstate.

Royal Australian College of General Practitioners president Dr Bastian Seidel said there were no Tasmanian public funds available for medical or surgical terminations, meaning women needing surgical abortions would have to fly to Melbourne.

A private clinic in Hobart still offers surgical abortions at a higher cost making it unfeasible for many women.

Dr Seidel said no political party in Tasmania had committed to funding accessible abortion within the state’s public health system, and Health Minister Michael Ferguson could immediately provide such access.

“We should all be concerned about how this limits the options for women,” Dr Seidel said.

“There’s no public funds here, whether that’s for medical terminations or surgical terminations.

“For women where medical terminations are not appropriate or not desirable, or where the woman chooses a surgical option, of course that’s no longer available in Tasmania and that means people have to find their own interstate solution.”

Dr Seidel said the RACGP wanted to see more Tasmanian GPs trained up in the safe administration of medical abortions to increase safe, local access for women.

Another option could be for the Tasmanian Health System to cover the cost of transport and surgical procedures for women needing to travel interstate for a surgical abortion, Dr Seidel said.

The Australian:  Health insurers want to pay GPs directly


Australia’s largest health fund wants the federal government to allow insurers to pay GPs for seeing their members, in what would represent a major departure from long-time separation of private and primary care.

In a pre-budget submission, Bupa, which has more members than the formerly government-owned Medibank Private, has recommended insurers be ­allowed to pay GPs directly “for visits on behalf of customers”.

The president of the Royal Australian College of General Practitioners, Bastian Seidel, yesterday said there was scope for insurers to fund more primary care: “We would welcome any move that is going to end up increasing the funding for ­patients going to see their GP.”

Nine Coach:  How staying healthy got so complicated — and how to make it simple in 2018


If you want to maintain good health, it’s easy to fall down a rabbit hole, trying to find the perfect lifestyle to have you looking good and living long.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, says health is becoming an unnecessary minefield for Australians.

“We have learned over thousands of years and millennia how to feed ourselves and unfortunately we have introduced a fair bit of uncertainty in the 21st century when it comes to feeding ourselves,” he tells Coach.

“Often that’s driven by secondary interests, which is really unfortunate.”

Dr Seidel suggests consulting a doctor or dietitian before you attempt a new eating regimen.

“I get patients asking me, ‘What do you think of Gwyneth Paltrow’s diet’ or ‘What do you think of this other diet I’ve heard about?’” he says.

“It’s a great discussion starter and actually opens up the door for me to ask about their health and health needs.”

Herald Sun:  Hospital discharge letters too slow say frustrated GPs


Patients’ lives are being risked daily because of hospitals’ and specialists’ failure to provide timely discharge letters, frustrated GPs say.

The lack of instructions for patients and their family doctors after operations and other hospital stays are leading to thousands of costly readmissions to hospital, and a worsening of Victorians’ health, the Royal Australian College of General Practitioners says.

The College’s president Dr Bastian Seidel said the lack of discharge orders was a major problem nationally.

He said that if patients could see a GP within a week of leaving hospital, armed with effective discharge notes, hospital readmissions could be cut by 23 per cent.

“If the information is not passed on in a timely manner they are putting patients at risk,” Dr Seidel said.

“I am sending a patient a week back to the hospital system just because they attend my practice and I have no idea what happened when they were in hospital.”

Dr Seidel said almost all GP clinics had access to programs capable of encrypting medical records so they could securely be sent electronically, and the hospitals’ failure to use them was “nonsense”.

The Australian: Medicare: MBS review savings reinvested


Almost 99 per cent of ­additional funding provided by the Turnbull government for Medicare since the last budget came from a once-controversial taskforce looking for outdated, inappropriate and wasteful rebate-funded services.

The Medicare Benefits Schedule review taskforce was established in 2015 by then health minister Sussan Ley to examine more than 5700 items on the MBS. In the wake of the GP co-payment proposal, and the Medicare freeze, doctor groups initially feared the taskforce would make cuts and little else.

But the mid-year budget update last month ­revealed the MBS review had not only found $409 million in savings but the government had reinvested the money in Medicare. That is ­despite the review running well behind schedule, according to the Health Department.

Australian Medical Association president Michael Gannon welcomed the progress with the MBS review, while Royal Australian College of General Practitioners president Bastian Seidel called for more transparency over the reinvestment.

The Age: ‘A tsunami of pain’: Changes to codeine availability shed light on hidden epidemic of addiction


When you think about drug addicts, an “upper-middle class” massage therapist doesn’t fit the stereotypical profile.

But just a few months ago, Leah Dwyer was taking at least dozen tablets each day of Mersyndol, addictive codeine pain pills that she was easily able to get from her local pharmacists.

GP and doctor groups have said that they will not prescribe stronger drugs when they begin to treat former over-the-counter codeine users, despite alleged efforts by drug lobbyists to fill the void with other addictive products.

Royal Australian College of General Practitioners president Dr Bastian Seidel​ confirmed that “certain drug companies” had been promoting even stronger prescription opioids, such as oxycodone and endone, as substitutes for codeine.

“It is the last thing we need,” he said.

Dr Seidel said GPs were well aware of the dangers posed by opioids, which in the United States were fuelling the deadliest drug crisis in the nation’s history.

“We can’t follow the nightmare scenario that America is going through now,” he said.

“Opioids are never the first choice treatment for any medical condition. There is a very limited role of opioids for pain management.”

The Examiner: Legislative Council’s inquiry into Tasmania’s acute health system visits Launceston


The Legislative Council’s subcommittee inquiry into Tasmania’s acute health system held hearings in Launceston on Tuesday. Five presentations covering a diverse range of topics across the health system’s successes, failures and progres were heard by MLCs Rob Valentine, Ruth Forrest and Kerry Finch.

The Royal Australian College of General Practitioners brought the need for a greater focus on preventative health to the inquiry, saying general practitioners could generally provide many of the healthcare services often provided at hospitals “at a fraction of the cost” for outpatients.

RACGP president Dr Bastian Seidel said there needed to be a commitment to more mental health beds and facilities, and greater support for GPs who lead the treatment of mental health in the community.

Dr Seidel said he also wanted to see a combination of federal and state funding for $50,000 innovation funding for all GPs to support preventative health practices to keep patients from being readmitted to hospital.

The RACGP also highlighted discharge paperwork from hospitals not being sent to GPs quickly, often taking up to two weeks – Dr Jenny Presser from headspace said this delay “could risk lives”.

The Australian: Acne drug Diane-35 ED clot warning for women


Australia’s drug regulator has been urged to restrict access to popular acne drug Diane-35 ED, amid a mounting push from women who say its “off-label” use as a contraceptive has exposed them to an increased risk of dangerous side effects including life-threatening blood clots.

The president of the Royal Australian College of General Practitioners, Bastian Seidel, has backed calls for increased vigilance around Diane-35, saying its use must be monitored closely.

“The issue in Australia is Diane is still used off-label as a contraceptive pill. That’s the main concern — that although the approval is only for severe acne and hirsutism, Diane still seems to be used as a contraceptive drug and only for that reason,” he said.

“In 2017 we have other options for women and men which are available and less risky to use with potentially the same effects.”

The Canberra Times: ‘Start low, go slow’: Booklets give inside dope on medicinal cannabis for patients, doctors


Doctors who have been reluctant to prescribe medicinal cannabis are getting the inside dope on the controversial drug from the federal government.

Medicinal cannabis information booklets have just been published by the Turnbull government, aiming to make it easier for medical professionals to prescribe the products.

Royal Australian College of General Practitioners president Dr Bastian Seidel​ said a national regulatory framework was desperately needed.

Dr Seidel said the booklets were comprehensive. He said side effects were not known for medicinal cannabis, but this was the same for many treatments currently in use, which was reasonable given the lack of evidence.

“We must be open-minded,” Dr Seidel said.

“Medicinal cannabis has never been the first choice for medical conditions. We need appreciate the treatment with medicinal cannabis is emerging.”

MSN: Why science matters: How to choose the health and nutrition plan that’s right for you


Is it ever okay to ignore the guys in white coats and follow your health intuition, or should you bow down to science and government guidelines even if it doesn’t feel right to you?

Given the way science changes and the fact that not all studies are relevant to all people, Dr Bastian Seidel, president of the Royal Australian College of General Practitioners (RACGP), says your best bet is to talk through your health opinions and concerns with a good doctor.

“There is no one-size-fits-all approach – you need to put information in context,” he says.

Dr Seidel says GPs use the latest evidence as well as their own medical knowledge to treat patients, because sometimes there isn’t enough rigorous studies into particular ailments.

“There are various ways of how we interpret science,” he says.

“We don’t just have medical evidence … we still need a commonsense approach of what makes sense in medicine [so we can treat] emerging problems. It wouldn’t be good enough for me to say, ‘There’s no study investigating your problem, therefore I can’t help you’.”

Dr Seidel says that GPs are forbidden from endorsing products, so you know you are going to get unbiased advice.

“We have celebrities endorsing nutrition products and ways of life and although it may work well for them or for their bank account, it doesn’t mean the information they are putting out there can be uniformly adapted to what individual patients are going through,” he points out.

When it comes to nutrition, Dr Seidel says people don’t have to follow the nutritional guidelines to a tee — so long as they are getting adequate nutrients from substitutes.

ABC News: Tasmanian health system like Muppet Show episode, say doctors


Australia’s peak body representing doctors has labelled Tasmania’s health system a “circus” which looks more like a Muppet Show than a crucial service.

Royal Australian College of General Practitioners’ president Bastian Siedelsaid Tasmanians deserved better.

“It resembles more of an episode of the Muppet Show, it’s just less entertaining but just as silly,” he said.

“Health doesn’t deserve to be a chaos scenario, it deserves to be tackled head on, that’s what our patients expect and that’s what or doctors and nurses expect as well.

“Quite frankly it’s been a circus for the last 12 months.”

Dr Siedel slammed the Government for admitting changes to the THS were needed but waiting until re-election to deal with them.

“I’m concerned that health services are again going to be politicised, but we have to be careful there, politics should stay right out of health.”

RACGP President commends push for pokies ban


The Australian Medical Association has thrown its support behind Labor and the Greens push for the removal of pokies from pubs and clubs by 2023, calling it a bold and courageous plan.

What do the Royal Australian College of General Practitioners think of the plan? Dr Bastian Seidel is President of the RACGP, he speaks with ABC’s Sarah Gillman on Statewide Mornings.

The Examiner: RACGP calls for commitment to preventative health in pre-election submission


Tasmanian general practitioners are calling on the state government to urgently review the health system and recommit to preventative health measures.

Royal Australian College of General Practitioners Tasmania submitted its pre-election submission to the state government on Tuesday morning.

College president Dr Bastian Seidel said keeping Tasmanians healthy and out of hospitals had to be a priority if the government wanted to improve the health system.

“Given the clear impact general practice has on health it makes sense that our government invests in preventive medical care delivered by Tasmanian specialist GPs, to avoid overcrowding in the expensive hospital system,” he said.

“Committing to improve preventative healthcare services is a ground level approach for a multilevel issue.”

In its submission, RACGP Tasmania proposed four key strategies to encourage investment in primary healthcare:

  • Increasing funding to smoking and gambling cessation programs including free nicotine replacement to people with low incomes and a transparent commitment to cease acceptance of political donations from the tobacco or gambling industry.
  • Setting a 72-hour target for all THS hospitals for the delivery or provision of discharge summaries to general practice, with a firm commitment to full interoperability with general practice systems by 2020.
  • Supporting healthy communities by providing free influenza vaccinations to those visiting their GP to be vaccinated and free fruit to public schools.
  • Implementing general practice internships for postgraduate year 1 and 2 medical practitioners as a state sponsored program to keep our best graduates in Tasmania.

The Timaru Herald: Doctors warn of deteriorating health conditions of Manus Island asylum seekers


While New Zealand sits and waits to see whether Australia will have a change of mind, or heart, over the Manus Island situation, Australian doctors warn the asylum seekers’ health is deteriorating.

RACGP president Bastian Seidel said the level of care available to these men was a serious concern.

“As medical practitioners, we cannot sit back knowing the standard of care received by those seeking asylum in Australia is anything but acceptable,” he said.

Many of the men would be experiencing significant trauma, and needed immediate care to improve their health and wellbeing.

“This is not about politics. This is about the health and safety of a group of very helpless people.”

The New Daily: Doctors defend popular contraceptives after some women report side effects


Medical groups have moved to reassure the public on the safety of two popular long-acting contraceptives following reports of serious negative side effects in some Australian women.

The Royal Australian College of General Practitioners (RACGP) president Dr Bastian Seidel recommended women talk to their GP if they had any concerns about their contraceptives.

“All contraceptive choices have benefits and risks, and it is important to have contraception suited to each woman,” he said in a statement.

“Your GP will offer specific advice to your individual needs and circumstances.”

Star Weekly:  Photographer heartbreak at asylum seeker plight


No Australian could support the indefinite offshore detention of asylum seekers and refugees after meeting these people in person, according to a Yarraville photographer recently returned from Manus Island.

The Royal Australian College of General Practitioners (RACGP), the Royal Australasian College of Physicians (RACP) and the Royal Australian and New Zealand College of Psychiatrists (RANZCP) are calling for more to be done to ensure they have access to the healthcare they need.

RACGP President Dr Bastian Seidel said on Tuesday they are “extremely worried about the health and safety of these vulnerable people”.

“As medical practitioners, we cannot sit back knowing the standard of care received by those seeking asylum in Australia is anything but acceptable.

“This is not about politics. This is about the health and safety of a group of very helpless people.”

ABC Radio Australia: Pacific Beat morning headlines


Health concerns remain for Manus asylum seekers; reports that only half of the PNG governments allocated funding to the provinces actually gets there; and a former Hunters captain gets dropped for missing training.

Australian doctors continue to lobby for better healthcare for Manus asylum seekers: Australian College of General Practitioners president, Bastian Seidel

Nine.com.au: Why science matters: How to choose the health and nutrition plan that’s right for you

Is it ever okay to ignore the guys in white coats and follow your health intuition, or should you bow down to science and government guidelines even if it doesn’t feel right to you?

Given the way science changes and the fact that not all studies are relevant to all people, Dr Bastian Seidel, president of the Royal Australian College of General Practitioners (RACGP), says your best bet is to talk through your health opinions and concerns with a good doctor.

“There is no one-size-fits-all approach – you need to put information in context,” he says.

When it comes to nutrition, Dr Seidel says people don’t have to follow the nutritional guidelines to a tee — so long as they are getting adequate nutrients from substitutes.

CathNews: Government urged to provide care for Manus detainees

The presidents of the Royal Australian College of General Practitioners, the Royal Australasian College of Physicians and the Royal Australian and New Zealand College of Psychiatrists, have sent a letter to Immigration Minister Peter Dutton expressing their concern for the health of hundreds of refugees and asylum-seekers recently transferred to new transit centres on the island.

Bastian Seidel, head of RACGP, said he was “extremely worried” about the wellbeing of the men.

“We cannot sit back knowing the standard of care received by those seeking asylum in Australia is anything but acceptable,” Dr Seidel said.

The Examiner: Legislative Council’s inquiry into Tasmania’s acute health system visits Launceston


The Legislative Council’s subcommittee inquiry into Tasmania’s acute health system held hearings in Launceston on Tuesday.

The Royal Australian College of General Practitioners brought the need for a greater focus on preventative health to the inquiry, saying general practitioners could generally provide many of the healthcare services often provided at hospitals “at a fraction of the cost” for outpatients.

RACGP president Dr Bastian Seidel said there needed to be a commitment to more mental health beds and facilities, and greater support for GPs who lead the treatment of mental health in the community.

Dr Seidel said he also wanted to see a combination of federal and state funding for $50,000 innovation funding for all GPs to support preventative health practices to keep patients from being readmitted to hospital.

The RACGP also highlighted discharge paperwork from hospitals not being sent to GPs quickly, often taking up to two weeks – Dr Jenny Presser from headspace said this delay “could risk lives”.

The Guardian: Top doctors ‘extremely worried’ about Manus Island asylum seekers


Australia’s top medical colleges are demanding the Turnbull government to immediately provide care and treatment to the asylum seekers and refugees recently kicked out of the decommissioned Manus Island detention centre and likely experiencing trauma.

Dr Bastian Seidel, head of RACGP, said he was “extremely worried” about the wellbeing of the men.

“We cannot sit back knowing the standard of care received by those seeking asylum in Australia is anything but acceptable,” he said.

“Many of the men … will be experiencing significant trauma. This is not about politics. This is about the health and safety of a group of very helpless people.”

Insurance News: Industry urged to account for mental illness care advances


Life insurers must change their thinking on mental health as treatments advance, a doctor has told a parliamentary joint committee hearing on the industry.

Royal Australian College of General Practitioners President Bastian Seideltold the committee mental health is now the most prevalent condition in Australia, overtaking cardiovascular disease and, more recently, dementia.

“I have patients who’ve been diagnosed with bipolar disorder,” he said.

“I would say 30 years ago the prognosis of bipolar disorder probably wasn’t as good as it is now, but we have more modern medication available, better support networks, [and] we have psychologists out there.”

“[If a person was] to be penalised because of a diagnosis of bipolar disorder, this would be entirely inappropriate, because we know their life expectancy is probably much better compared to what we expected when they were first diagnosed decades ago.”

Dr Seidel says insurers must consider advances in care and treatment.

Australian Journal of Pharmacy: An unscheduled dilemma


There’s no doubt that the looming upschedule of codeine has been one of the year’s most controversial issues.

Just before Christmas 2016, the TGA announced that it would change the schedule of over-the-counter preparations containing codeine, including analgesics and cough medicines, to prescription-only.

Access to medical services is an issue, the Guild argues. By October, it was still encouraging politicians to think about the “Prescription – except when” model.

New NSW Guild president David Heffernan was on hand to explain the “Prescription – except when” model.The response from doctors was swift and angry. The AMA issued a statement in which it called the Guild “irresponsible and unprincipled” for lobbying politicians to “sneakily” use State legislation to avoid the upschedule, while social media accounts erupted.

On Twitter, RACGP president Dr Bastian Seidel accused the Guild of “policy by chequebook at its worst,” while Chair of the RACGP Expert Committee – Quality Care Evan Ackermann declared on Twitter that “a corpse lies deeply buried in the backyard of the pharmacy Guild (sic) – its name is ‘pharmacy credibility’.”

Financial Review: Doctors asked to not include ‘grief reactions’ in medical records


Doctors say patients are asking them to exclude “ordinary grief reactions” from medical records because they don’t want this information passed onto insurers as the insurance industry seeks to deal with what it describes as a ‘tsunami’ of mental health related claims.

The president of the peak body for general practitioners, Dr Bastien Seidel, said patients asking doctors to omit instances of grief, anxiety and other mental health information from their medical record is “not an issue for insurers” but is a significant problem for GPs.

Dr Seidel said patients are concerned they “are surrendering their rights of that information to insurance companies when they are going to make a claim and this is just ridiculous.”

Dr Seidel said there was “no way” doctors are going to have two separate records; one that is used for insurance purposes and another for health purposes.

Instead, Dr Seidel said, insurance companies should ask for treating doctors’ “professional opinion” about a patient’s prognosis rather than rely on records or documents regarding a diagnosis.

The Daily Telegraph: After-hours doctor service probed over theme park incentive

A home-doctor company is under investigation for offering 10,000 tickets to Dreamworld as an incentive to use the taxpayer-funded service designed for those needing urgent medical care.

Dial a Home Doctor executive chairman Zaffar Khan ­denied that the Dreamworld giveaway was an inducement.

But Royal Australian College of General Practitioners president Bastian Seidel slammed the promotion, saying the money should be allocated for better health services.

“This kind of inappropriate direct advertising is unfortunate,” he said. “Money should be allocated for better health services for patients, training and education of doctors, not for joy rides. It’s healthcare, not a ­circus,” he said.

Junkee: This MP Is Trying To Ban A Contraceptive Pill That Gave His Daughter A 64cm Blood Clot


Federal MP Julian Hill has called for a contraceptive pill known as Diane-35 to be banned in Australia, claiming it caused a blood clot that nearly killed his 20-year-old daughter.

Hill’s calls for the TGA to investigate Diane-35 and review its status in Australia were backed by the Royal Australian College of General Practitioners, the peak body for GPs in Australia.

RACGP President Dr. Bastian Seidel told Junkee that while doctors are well aware of the risks involved and are well placed to communicate them to patients, “what we are looking for is the concept of radical transparency — we need to be sure patients understand the risks of any drug”.

BuzzFeed News: Top doctor backs call for contraceptive ban from Aussie politician whose daughter almost died


Australia’s peak body for GPs has backed calls from federal Labor MP Julian Hill to ban the anti-acne and contraceptive pill which he says almost killed his daughter.

Royal Australian College of General Practitioners (RACGP) president Bastian Seidel said the most concerning adverse effect caused by the drug was blood clots.

“In the case of Julian’s daughter’s DVT, if this blood clot had travelled up into the lung area it would cause a pulmonary embolism and it would have been potentially fatal,” Seidel told BuzzFeed News.

“The side effects we are talking about are not a bit of an itch or a rash, we are talking about people dying.”

“Diane-35 is often prescribed to improve skin conditions and as a contraceptive, but there are various other options out there that are far better and safer for women to consider in the 21st century,” he said.

“There must be a push to take this legacy medication off the market and to ensure there are better options out there for women.”

Financial Review: Mental health claims challenge insurers


ANZ Bank’s head of compliance has warned the quality of medical evidence supporting mental health claims is one of the biggest challenges for insurers dealing with an explosion of such claims and mounting losses.

ANZ’s Caroline James said insurers need to “take advice” from medical professionals in how to assess claims.

But Bastian Seidel, president of the Royal Australian College of General Practitioners which represents 90 per cent of all practicing GP’s in the country, said it and other stakeholders remain concerned about how patients with mental health issues experience the life insurance process.

“GPs are concerned that patients may not disclose significant information regarding their mental health or other health-related issues for fear they might affect a future insurance application,” he told Friday’s parliamentary joint committee..

“This represents not only a barrier to disclosure but also, most worryingly, treatment.

ABC News: Psychiatrists, psychologists and counsellors: Who to see for your mental health issues


Nearly half of us will experience a mental illness at some point in our lives. And all of us will go through periods of stress, sadness, grief and conflict.

If you’re feeling stressed, anxious, depressed, or having difficulty coping, your GP can be a good first port of call.

Figures suggest Australians see their GPs for mental health issues more than any other health concern.

“It is not musculoskeletal problems patients are presenting with most often, or cardiovascular disease — the stock standard medical presentations we always hear about,” Dr Bastian Seidel, the president of the Royal Australian College of General Practitioners, said.

“It is psychological issues GPs are dealing with most of the time.”

ABC News: What happens when you ring your doctor in the middle of the night?

Bastian Seidel, the president of the Royal Australian College of General Practitioners, says there is no rational explanation for a sudden increase in urgent medical conditions only in the after-hours period.

Dr Seidel says some doctors are not billing appropriately and when the Health Department sent letters to the highest urgent after-hours billers, billing rates dropped 20 per cent.

ABC PM: Victorian doctors, hospitals to decide where they stand on VAD


Hospitals and medical organisations are deciding whether to allow their doctors to prescribe euthanasia drugs, following the passage of Victoria’s voluntary assisted dying scheme.

Dr Lorraine Baker, president of the Australian Medical Association’s Victorian branch, says some doctors may also have different viewpoints.

The Royal Australian College of GPs president Dr Bastian Seidel says doctors and their employers should have a frank discussion about their stance on the scheme, and their patients’ needs before it is implemented in 2019.

Australian Doctor: RACGP will fight any ‘discriminatory screening’ of GPs

The RACGP has responded to the Medical Board’s plan for mandatory health and competency checks for older doctors by pledging to fight any “discriminatory screening” of GPs.

With more than 1000 GPs in clinical practice aged 70 or over, the RACGP is wary.

“Our members dedicate their lives to general practice and the Australian community and do not deserve to be subjected to any form of discriminatory screening,” president Dr Bastian Seidel said in a statement on Wednesday.

“The RACGP will urge any health checks of GPs to be carefully trialled, appraised and evaluated before a potential compulsory roll out.

“The Medical Board of Australia is already aware that there might well be insurmountable legal obstacles to taking mandatory actions to investigate and address any potential risks from doctors over the age of 70.”

Medical Republic:  Doctors welcome MBA’s competence checks

Doctors have welcomed a plan to impose health and competence checks on clinicians over the age of 70 to assure patient safety, despite reservations that it might be open to challenge on discrimination grounds.

“We think this proposal gets it right,” AMA President Dr Michael Gannon told The Medical Republic.

RACGP President Dr Bastian Seidel said the report vindicated the RACGP’s move this year to adopt the controversial CPD program known as Planned Learning and Need (PLAN).

“The MBA’s new framework does not go beyond the continuous professional development program currently followed by RACGP members.”

But Dr Seidel said the MBA’s plans for compulsory health checks required further explanation.

“The RACGP will continue to advocate strongly against any discriminatory profiling of GPs,” he said.

“Our members dedicate their lives to general practice and the Australian community and do not deserve to be subjected to any form of discriminatory screening.”

SBS: Fears older GP checks are ‘discriminatory’


Peak medical body the Australian Medical Association is backing moves to require older doctors to undergo mandatory health checks to prove their competence.

All Australian practitioners aged 70 or over must have their work peer-reviewed and undergo health tests every three years, including cognitive screening, under the Medical Board of Australia’s Professional Performance Framework announced on Tuesday.

However RACP President Dr Bastian Seidel has raised concern about the MBA’s proposed plans for older doctors.

“The RACGP will continue to advocate strongly against any discriminatory profiling of GPs,” said Dr Seidel.

“Our members dedicate their lives to general practice and the Australian community and do not deserve to be subjected to any form of discriminatory screening.”

The Sydney Morning Herald: Health checks for older doctors to prove they’re fit to practise


All Australian doctors aged 70 or over will have to undergo regular health checks to prove they are fit to practise, as part of a new plan to weed out dangerous medical professionals.

Those who work in isolation, such as solo GPs, will also face additional scrutiny, as will those who have received multiple proven complaints against them.

Dr Bastian Seidel, president of the college of GPs, said he was concerned about tests for older doctors.

“A heavy-handed approach would fail the public and it would certainly fail practitioners who have given decades of their lives to the profession,” Dr Seidel said.

“It would send quite a significant message to society to say once you are over a certain age, you’re not contributing anymore.”

Medical Republic: College calls for graduate GP internship training


The RACGP is calling on the government to invest in a national scheme to create up to 1600 general-practice internships for doctors in training.

“Junior doctors, regardless of intended specialty, will benefit from exposure to general practice,” RACGP President Dr Bastian Seidel said.

“Australia is also facing a medical training crisis due to the disparity between increasing numbers of medical graduates and available medical training placements.

“The federal government can address both those of these issues by establishing a natural general-practice placement program for junior doctors.”

In other core demands, the College is seeking funding for general-practice research and support for an antimicrobial stewardship program for GPs.

ABC News: Manus Island: Top Australian doctors offer free medical treatment asylum seekers


A group of Australia’s most senior doctors, psychiatrists and surgeons have written an open letter to the Federal Government offering to fly to Manus Island and treat asylum seekers and refugees for free.

The 18 clinicians include leading psychiatrist and former Australian of the Year Professor Patrick McGorry, editor of the Medical Journal of Australia Professor Nick Talley, and the president of the College of GPs, Professor Bastian Seidel.

“We are senior Australian clinicians who write in our individual capacity to express our concerns about the ongoing health and wellbeing of the former detainees still based on Manus Island and now in alternative accommodation,” the group said.

“We believe that there should be an immediate, independent review of the health status of those still on Manus.

“We are willing to conduct this review pro-bono, arranging the appropriate mix of clinical specialties.”

ABC News: Fentanyl crisis: Figures show 1,800pc rise in overdose deaths from potent painkiller


Deaths from the potent prescription drug fentanyl have rapidly increased in Australia, with a senior doctor calling the trend a “national emergency”.

A report from the National Coronial Information Service (NCIS), commissioned by Background Briefing, shows 498 fentanyl-related deaths occurred between January 2010 and December 2015.

Dr Bastian Seidel, the president of the Royal Australian College of General Practitioners, said the figures were a “national emergency” and should prompt concern.

“Those deaths are entirely avoidable,” he said.

Dr Seidel said some GPs, emergency doctors and specialists were overprescribing the opioid, as they wanted to make sure they were not introducing harm.

“Certainly, the opioids that are out there now are causing more harm than any good. In some cases they’re causing death — and that’s completely unacceptable,” he said.

The Examiner: RACGP calls for independent inquiry into health system


General practitioners say an upper house inquiry into acute health will not paint a full picture, calling for an independent review into all aspects of healthcare in Tasmania.

Royal Australian College of General Practitioners president Dr Bastian Seidel, who is a GP in the state’s South, said stories continued surfacing “over and over again” about how the health system was “failing patients”.

“We hear about long waiting lists for elective surgery, we hear about long waiting lists for acute procedures as well, and patients even having to go interstate to access urgent treatment,” he said.

“That’s certainly concerning for us, because if we as GPs can’t refer patients for hospital treatment, what are we going to do with them? We’ve already said they have to go into hospital or they need to have treatment in a hospital setting and we GPs can’t deal with them anymore.”

Dr Seidel called for a “genuinely independent inquiry” into the health system, saying the upper house inquiry dealt with acute health only.

ABC News: GPs seek independent review after Tasmanian woman travelled interstate to save eyesight


Doctors are calling for an independent inquiry into Tasmania’s health system amid concerns about long waiting times for specialist care.

On Monday, the ABC revealed concerns by frontline staff about access to neurosurgical treatment with a 20-year-old woman forced to go interstate to save her eyesight.

Royal Australian College of General Practitioners’ president Dr Bastian Seidel said there needed to be an independent, non-political inquiry into health care in the state.

“We need to depoliticise this issue … only an independent inquiry with broad terms of reference can achieve that,” said Dr Seidel.

“The health system is failing our patients and the system is failing Tasmanians.”

“Quite frankly, we just can’t take it any longer.”

“There really comes a point we should have a hard look at the system to actually find out what works and what doesn’t work and how we can make it better.”

Tasmanian Times: Review of waiting lists urgently needed as Tasmanians battle for basic health care

The Health Minister must stage an immediate and wide-ranging review of outpatient waiting lists as more and more Tasmanians face unacceptable delays in receiving basic health care.

Labor Leader Rebecca White said the Royal Australian College of General Practitioners had revealed increasing numbers of Tasmanian patients were being forced to seek treatment interstate for basic procedures because they feared getting sicker on waiting lists.

RACGP President Dr Bastian Seidel told ABC radio the availability of basic health care was lacking in Tasmania.

“What we are talking about is the bread and butter of health care. Patients who need hip replacements, patients who need knee replacements, patients who need rehabilitation after they’ve had a stroke ….  Basic health care, the needs of ordinary Tasmanians – it’s just not available on a regular basis in a timely way here.” Dr Seidel said.

ABC: Specialist shortage in Tasmania drives patients interstate to avoid ‘unacceptable’ wait times


A Tasmanian woman says she faced permanent eye damage due to a shortage of specialist medical services in the state, a problem the AMA and frontline health staff say is causing patients to slip through the cracks.

Royal Australian College of General Practitioners president Dr Bastian Seidel questioned why Ms Pearce had to wait so long for another opinion.

“It is just not good enough that this patient was put on a three-month waiting list for a second opinion,” Dr Seidel said.

“Clearly, a surgical option should have been considered from the start.”

Dr Seidel said he sometimes recommended patients go interstate because he believed the system was not equipped to meet their needs.

“I, at times, have to send patients interstate as well because the waiting times here for surgical procedures or for medical assessments are just too long.”

Get to know your GP well


Tracking your health information is possible as your life changes, according to the Royal Australian College of General Practitioners president.

Dr Bastian Seidel, who runs a general practice in regional Australia, said data can be transferred to other locations if your doctor or circumstances change.

He said there are many health benefits to keeping with the same doctor during your life.
He cited a study in the Netherlands published in the British Journal of General Practice in August 2016 that found people who saw the same doctor lived longer than those who did not.
Dr Seidel encouraged people to develop a relationship with their GP.

“They become your specialist in life, they’ll help you manage your health,” he said.

Mamamia: This online doctor service means time-poor mums can skip the clinic. But is it a good idea?

Qoctor (as in, quick, online doctor) provides medical certificates with just a few clicks and a Skype chat, plus prescription medication delivered to your door.

Is Qoctor the answer time-poor consumers in an increasingly busy world have been looking for, or a potential threat to patient’s safety?

Royal Australian College of General Practitioners president Dr Bastian Seidel says he’s concerned patient safety could be compromised when a doctor prescribes medication for a patient they don’t have any prior knowledge of. In the case of Qoctor, there is no personalised doctor involvement required to order prescriptions, but a series of questions compiled by a team of doctors.

“Completing requests via an online survey can easily result in misdiagnosis due to a range of factors,” Dr Seidel says. “Without access to the treating GP’s notes, the doctor has no means of otherwise confirming the information provided.”

The Daily Telegraph: Codeine crackdown: Why one of the nation’s favourite painkillers will soon be off limits

If you take Panadeine Extra, Nurofen Plus or Mersyndol, prepare for big changes.

On February 1, all codeine-containing medicines sold over the counter will become prescription only.

With about one million Australians taking medicines that contain codeine, the effects will be far-reaching, with greater demand on GPs and pain specialists, and thousands of people rethinking their relationship with this powerful drug.

Some people may not even know that a product they take contains codeine, and Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, says that’s why pharmacists have started talking to customers: “They’re explaining that a prescription will be needed soon, so GPs are already getting patients wanting to talk about codeine and their conditions.”

The Canberra Times: NSW Coroner’s Office clogged up with deaths from natural causes

The NSW Coroner’s Office is clogged with deaths from natural causes that may have been unnecessarily reported, causing undue distress to grieving families, delaying funerals and diverting resources from genuinely perplexing cases.

State Coroner magistrate Michael Barnes is concerned doctors might be reporting these deaths instead of issuing their own certificates out of a fear of litigation, but there are knock-on effects for families and other coronial inquiries in the pipeline.

Royal Australian College of General Practitioners president Dr Bastian Seidel said doctors were driven more by the need for clarity than their own aversion to risk.

“If as doctor you don’t know what the cause of death is, then under the law you need to run this past the coroner’s office, whether you like it or not.” Dr Seidel said.

MJA InSight: Health insurance reform: the good, the bad and the ugly

Last month, with some ballyhoo, the federal government announced what it claimed was the biggest shake-up of Australia’s private health industry in over 15 years.

Are the proposed reforms the right ones, and what do they mean for doctors and patients?

“It’s been billed as this huge reform, but if you look at the details, there are some adjustments there, but I wouldn’t necessarily call it a major reform,” Royal Australian College of GPs President Dr Bastian Seidel told MJA InSight.

Dr Seidel zeroed in on out-of-pocket expenses as a key issue.

He said that doctors need to be aware that financial toxicity is a genuine side effect of treatment now.

Dr Seidel cautiously welcomed reforms regarding mental health, which will allow patients to upgrade their policies to include access to mental health services without a waiting period.

9News: The balloon blowing up obesity surgery

 

Swallowing a balloon could be the key to overcoming obesity thanks to a revolutionary device set to make its mark in the weight loss industry.

The tiny device, which is the world’s first “swallow-able, non-operative device for permanent weight loss” is being described as a gastric band, without the surgery and costs.

President of The Royal Australian College of General Practitioners, Dr Bastian Seidel, says there could be significant risks.

“For a stomach balloon to stay in your stomach long term, that really hasn’t been tested yet and I think the risk could be quite significant,” he said.

Australian Journal of Pharmacy: ‘Qoctor’ on its way to becoming a verb: Founder

Qoctor, the online medical certificate and prescription provider, has been named a technology innovation winner.

Qoctor, which was formerly known as Dr Sicknote, attracted criticism by the RACGP and Pharmacy Guild after it announced in September that it was expanding its services.

When this expanded service was announced, RACGP president Dr Bastian Seidel said that patients should not be able to get scripts, referrals and medical certificates online unless they were provided by the patient’s usual GP or a GP in their usual general practice.

He said services such as Qoctor fragment care and provide prescriptions, referrals and medical certificates without “sufficient understanding of their medical history and social context”.

The Herald Sun: Children aged under five would get a free flu jab under a plan being pushed by state health ministers

 

Children aged under five would receive a free flu vaccine every year under a push by the states to have it included in the national immunisation register.

Victoria’s Health Minister Jill Hennessy, due to attend today’s COAG meeting, will ask Health Minister Greg Hunt to fund a national flu immunisation program for children in the wake of the worst flu season on record.

The Transcontinental: Dr Amanda Bethell named GP of the Year

 

Port Augusta residents can rest easy knowing their healthcare is in the hands of Australia’s number one general practitioner, Dr Amanda Bethell.

Dr Bethell was crowned the 2017 General Practitioner of the Year by the Royal Australian College of General Practitioners (RACGP) at the GP17 Conference in Sydney.

RACGP President Dr Bastian Seidel, who presented the award, said Dr Bethell demonstrates exemplary levels of integrity and professionalism.

“Dr Bethell has devoted her career to enhancing the lives of her patients and their family members,” he said.

“She has been an outstanding advocate for rural general practice and a leading light in the delivery of primary healthcare to the Port Augusta community.”

The New Daily: Doctors call for flu vaccine delay to better guard against ‘damaging’ peak season

 

Doctors say improving the timing of influenza immunisations and making the vaccine freely available to all Australians is key to saving lives next flu season.

This year’s flu season has been labelled the “worst on record”. It impacted 217,000 Australians – more than double the previous record of about 100,000 in 2015 – and killed at least 73 people.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, said one of the main issues is timing the administration of the vaccine to maximise its protection.

“For every month after having a flu shot, the vaccination becomes up to 10 per cent less effective,” he said.

Herald Sun: Call for stronger vaccines to be made available

 

Stronger and better flu vaccines will be available for next year’s flu season with vaccine manufacturers now working to get them approved for use in Australia.

The moves come as the president of the Royal Australian College of General practitioners Dr Bastian Seidel called for the vaccine to made available free for everybody.

News Corp revealed on Monday Australia had 217,000 confirmed flu cases this year, double the previous record, and reported that experts had called for stronger vaccines available elsewhere in the world to be used here.

News Mail: Top gong for Bundaberg doctor’s support of rural GPs

 

A Bundaberg doctor has taken out one of the top accolades in the rural medical field.

Denise Powell of Millbank Medical Practice was named the winner of The Royal Australian College of General Practitioners’ Brian Williams Award.

Dr Brian Williams was a rural GP and medical educator and advocate for rural general practice and education at all levels.

The award is presented each year to a GP who has made a significant contribution to the personal and professional welfare of rural doctors.

RACGP president Bastian Seidel said Dr Powell was a doctor whose guidance and support had enabled other rural GPs and GP registrars to dedicate themselves to their patients, families and communities.

AJP: It’s now up to the states

 

The Pharmacy Guild has reversed its position on the codeine upschedule – or so says the Health Minister.

Speaking at the Royal Australian College of General Practitioners’ conference in Sydney on Friday, Greg Hunt said that “the Guild has reversed its position and has accepted the upscheduling in full,” the Sydney Morning Herald reports.

“So they’re not the only ones that can be strong. On this, they have now come around and made it absolutely clear that they will work us and support the upscheduling,” the Minister reportedly told the conference.

“The final implementation of this scheduling is a matter for each State and Territory as to whether they adopt the decision in their own jurisdiction,” Mr Hunt said.

RACGP president Dr Bastian Seidel said on Friday that there would be no “tsunami” of patients going to see their GP for prescription codeine after 1 February 2018.

“What we will see is a shift to safer, more effective pain relief,” Dr Seidel said.

The Daily Telegraph: Doctors blame our discount flu vaccine for record flu season 

 

Australia suffered the worst flu season on record because we used a cheap vaccine that did not protect the elderly, doctors have warned.

As the virus finally recedes it can be revealed more than 217,000 Australians had laboratory confirmed cases of the flu this year — more than twice the previous record of just over 100,000 in 2015.

Doctors are blaming the $6 budget version of the flu vaccine used in the national vaccination program for the problem.

It is used even though it does not work well in the elderly, said Immunisation Coalition chair Professor Paul Van Buynder.

The president of the Royal Australian College of General Practitioners Dr Bastian Seidel is also calling on the government to fund the stronger vaccine.

He wants the government to provide free flu vaccines for everybody.

Bendigo Advertiser: Human lie detector can tell when a pleasant person is really a serial killer

 

“I’ve interviewed serial killers who are some of the most pleasant people you’ll ever meet,” Steve van Aperen said.

“They’re very good at maintaining a false facade.”

The former Victorian police officer dubbed the “Human Lie Detector” has honed his deception detecting skills with the FBI, LAPD, US Secret Service and conducted behavioural interviews on 76 homicide and two serial killer investigations.

But on Saturday the untruth sleuth-cum-conference circuit speaker will be ministering to GPs.

RACGP president Dr Bastian Seidel said the session was a chance for GPs to finesse “the subtle art of picking up nonverbal cues”.

“This is not about manipulating patients, but identifying early on what’s really going on in people’s lives. The information we need is often hidden,” Dr Seidel said, especially when patients are increasingly less likely to see the same GP regularly over their lifetime.

The Sydney Morning Herald: Pharmacy Guild backs down on codeine changes, Health Minister says

 

Federal Health Minister Greg Hunt is standing firm on new rules banning over-the-counter codeine products, in defiance of some party room colleagues, state counterparts and the vocal pharmacy lobby.

He revealed the Pharmacy Guild, which has been lobbying heavily for exemptions so that some codeine products can be easily accessible to some patients, had backed down in its fight to water down the new regulations.

“The guild has reversed its position and has accepted the up-scheduling in full,” he said at the Royal Australian College of General Practitioners’ (RACGP) conference in Sydney on Friday.

At the conference, RACGP president Dr Bastian Seidel urged the guild to clarify its position immediately and make it “crystal clear” it would stop seeking an exemption.

“We want to see an absolute commitment the only codeine being dispensed will be prescribed,” he said.

“They just need to give the statement otherwise it’s just semantics.”

SBS News: Adelaide GP named doctor of the year

 

An Adelaide doctor has been named the GP of the year.

The Royal Australian College of General Practitioners on Wednesday named Dr Adelaide Boylan as the general practice registrar of the year for 2017.

College president Bastian Seidel said Dr Boylan was a standout nominee for her exceptional patient care and enthusiastic approach to her tutorials and clinical meetings.

“Although in the early stages of her career in general practice, Dr Boylan is already highly respected for her inspiring, intelligent, considered and enthusiastic approach to her role and her education,” Dr Seidel said in a statement.

“She serves and advocates for her patients with grace and care, often visiting her patients outside of her allocated hours.”

News.com.au: GPs ramp up effort to reduce opioid abuse

 

Efforts to reduce opioid and other prescription medication-related deaths in Australia have been boosted with the release of new prescribing guidelines by the Royal Australian College of General Practitioners.

RACGP President Dr Bastian Seidel said pain management has significant benefits for patients but painkilling medications must be prescribed and used responsibly.

“For many people, good pain management can transform their quality of life, allowing them to work, be active, and participate in the community rather than being functionally disabled,” Dr Seidel said.

Unfortunately, there has been an “exploitation of painkilling medications”, says Dr Seidel.

The Sydney Morning Herald: anti-euthanasia campaign targets wavering MPs

 

Victorian MPs are being “bombarded” with emails and calls as opponents of assisted dying legislation make a last-ditch attempt to stop the state legalising voluntary euthanasia.

One legislator has reported receiving “abhorrent” messages from “no” campaigners as the final hurdle of the legislative process approaches.

Meanwhile the GPs group’s president,  Dr Bastian Seidel said the “ethical and professional issues associated with voluntary assisted dying” had been well covered by the bill and he called on other states to follow the Victorian approach.

“The RACGP is satisfied that appropriate safeguards for patients, relatives, and medical and health practitioners have been put in place in the legislation,” Dr Seidel said.

MJA Insight: Support for GPs weaning off antibiotic prescribing

 

Leading GPs are calling for an urgent national strategy to curb antibiotic prescribing in primary care, which could include antibiotic prescribing targets, audits of GP scripts and greater use of point-of-care tests.

Professor Christopher Del Mar, a GP and professor of Public Health at the Centre for Research in Evidence-Based Practice at Bond University, this week warned that the global problem of antibiotic resistance was approaching “apocalyptic” proportions, such that by 2050 more people would die from currently treatable infections than cancer.

Without effective antibiotic prophylaxis, there would be “a return to the pre-high-tech medicine of the 1930s and earlier,” Professor Del Mar said in an MJA InSight podcast, with procedures such as coronary catheterisations, joint prostheses and chemotherapy potentially becoming no longer safe to perform.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, said that the college broadly supported the recommendations from Professor Del Mar’s group.

“Tackling antibiotic resistance needs to be a priority for the Australian Government and for our profession,” he said.

“As a GP, you need to deal with the acute situation of the patient in front of you, but also know that with each and every prescription you give out, you are worsening antibiotic resistance,” he said. “Patients are potentially being put at risk either way.”

The Daily Telegraph: Home GP overhaul on ads

 

Home-call doctor companies could be banned from running mega-advertising campaigns after concerns they are promoting taxpayer-funded convenience rather than urgent medical care.

Health Minister Greg Hunt said he would seriously consider calls from GPs to bring advertising of the private-equity-backed house-call companies in line with the rest of the health industry, which cannot, under the law, advertise health services in a way that encourages its unnecessary use.

The Royal Australian College of GPs President Bastian Seidel said there was no valid reason for after-hours doctors to use mass marketing and advertising to encourage parents to use their fully bulk-billed services.

“This type of advertising encourages the excessive and unnecessary use of afterhours health services, which is inappropriate,” he said.

The Mercury: US nutritionist Patrick Quillin spruiks nutrition and attitude to beat cancer

 

A nutritionist visiting from the US will today deliver a talk in Brisbane on how patients can beat cancer “with nutrition and attitude”.

Patrick Quillin, who holds a PhD in nutrition, believes all cancer treatment should include an aggressive nutrition component but said he would never assert that food and a positive attitude could replace medicine.

“I am very firm on the subject that a well-nourished cancer patient can better tolerate the therapies and the disease and has a great chance of longer, higher quality life and complete remission,” he said.

Royal Australian College of General Practitioners president Bastian Seidelsaid he was concerned about generalised statements in the fight against cancer.

Australian Medical Association Queensland president Bill Boyd said patients should be wary of anyone who claimed they could beat cancer through special diets.

AJP: Voluntary assisted dying a step closer

 

Victoria’s Voluntary Assisted Dying Bill has been passed through the state’s lower house following an emotional debate.

The introduction of the Bill followed a report by the Ministerial Panel on Voluntary Assisted Dying, headed by former AMA president Dr Brian Owler, which included 68 safeguards, all of which the Andrews Government accepted when drafting the legislation.

Under the legislation, pharmacists would supply lethal medication in a “locked box” following a strict procedure which would be self-initiated by the person living with a life-limiting illness.

Victoria’s Health Minister, Jill Hennessy, said that this was a “historic” day for the state.

RACGP president Dr Bastian Seidel said that he is satisfied that ethical and professional issues associated with voluntary assisted dying have been appraised appropriately in the Bill, which he welcomed.

But AMA president Dr Michael Gannon has received negative feedback after taking to Twitter to criticise the Bill.

AJP: What will the 2018 flu vaccine include?

 

The TGA has accepted committee recommendations for next year’s flu vaccine, which brings a new virus strain into the fold.

While this year’s flu season – one of the worst on record – is only just slowing down after surpassing 200,000 confirmed cases this month, the Australian Influenza Vaccine Committee recently met with the TGA to discuss which viruses should be used in the composition of next year’s influenza vaccines.

An expert committee reviewed and evaluated data related to epidemiology, characteristics of recent influenza isolates circulating in Australia and the Southern Hemisphere, serological responses to 2016-2017 vaccines, and the availability of candidate vaccines viruses and reagents.

Bastian Seidel, Royal Australian College of General Practitioners president, recently said that if the Government subsidised such a free vaccination program, the $250 million spent would significantly offset the cost of death and illness from the disease.

“Every year we have the same story; a new flu outbreak, the public hospitals and ambulances so stretched they can’t cope any more and, on average, 3000 deaths every year from influenza, 18,000 hospital admissions and 350,000 Australians affected by the flu,” he said.

WA Today: After-hours home doctor industry should be stopped from exploiting Medicare, says taskforce

 

The booming after-hours home doctors industry has been slammed for deploying under-qualified doctors, disrupting a regular GP’s continuity of care and demonstrating a “pricing failure”, and may soon face new restrictions.

In a scathing report, the Medicare Benefits Schedule Review Taskforce concluded the after-hours industry was a drain on the health system and recommended changes that would stop it from exploiting four Medicare items.

But the industry has warned such changes would “shut it down” and “leave patients stranded”.

The Royal Australian College of General Practitioners “applauded” the findings, but described them as a “first step in a larger process” of ensuring high quality after-hours care.

“We [want] to ensure any changes made do not have unintended consequences,” said its president Dr Bastian Seidel.

AJP: Guild to doctors: stop hurling abuse

 

The Pharmacy Guild has rejected claims it’s putting profits ahead of patient safety

“Chemists are putting profits ahead of patient safety as they try to fight new rules that will make Panadeine and Nurofen Plus prescription only, doctors claim,” writes health reporter Sue Dunlevy in an article which appeared in News Corp media today.

“The powerful Pharmacy Guild of Australia has rejected claims by the nation’s peak GP group that it is trying to buy a change in the policy through $340,000 in donations to political parties.”

RACGP national president Dr Bastian Seidel told Ms Dunlevy that the Guild is “trying to introduce policy by chequebook by donating large amounts to state and federal parties to gain open access to decision makers”.

SBS: Doctors pen open letter on codeine battle

 

Doctors have reinforced the potentially deadly impact of codeine overuse, as pharmacists deny putting commercial interests ahead of patient safety.

In an open letter to health ministers, medical and health consumer advocates warn codeine is not an effective treatment of chronic pain and overuse can lead to death.

The letter has been written in response to reported lobbying by the Pharmacy Guild of Australia to alter a decision made by the Therapeutic Good’s Administration to make codeine containing medication drugs prescription only from February.

Signatories on the letter include: Carol Bennett, CEO of Pain Australia; Dr Bastian Seidel, President of the RACGP; and Dr Catherine Yelland, President of the RACP.

My Sunshine Coast: Open letter to Health Ministers on codeine upscheduling

 

Medical and health consumer advocates have published an open letter to state and territory Health Ministers, warning that any changes to the Therapeutic Goods Administration’s (TGA) plan to make codeine prescription-only will put health and lives at risk.

In the open letter, experts reiterate key findings from the TGA’s review of codeine use:

  • Codeine is not effective for treatment of chronic (long-term) pain.
  • There are serious risks of harm associated with codeine use, including death, toxicity and dependence.
  • There are over-the-counter alternatives available that are a combination of ibuprofen and paracetamol that have been found to be a more effective analgesic than over-the-counter codeine containing analgesics.
  • Multidisciplinary pain management is the most effective way to treat chronic pain.

Signatories to the letter include:

  • Carol Bennett, CEO, Painaustralia
  • Dr Ewen McPhee, RDAA President
  • Dr Bastian Seidel, RACGP President
  • Leanne Wells, CEO, Consumers Health Forum of Australia
  • Dr Catherine Yelland PSM, RACP President

The scheduling changes are due to commence on 1 February 2018.

The Medical Republic: DHS ‘underestimated’ Medicare fraud threat

 

A Senate committee has rapped the Department of Human Services for failing to address potential identity fraud involving stolen Medicare details.

The Finance and Public Administration References Committee inquired into the circumstances in which Australians’ Medicare numbers were allegedly stolen and put up for sale on the dark net.

In response to the breach, a separate report has recommended the government tighten controls on health professionals’ access to Medicare numbers, including a phase-out of telephone services over two years.

The Senate committee said it was not known how the Medicare numbers were appropriated. Some experts had said the breach most likely arose from an authorised user of Health Professional Online Services (HPOS), or from the theft of HPOS authentification credentials.

But the committee suggested the department had underestimated the threat.

“The submissions from the department do not indicate that this risk is fully understood, or has been addressed,” the committee said in its report, released this week.

The committee noted “with great concern” that the issue of potential identity fraud involving Medicare numbers had arisen before, and the department had been questioned about it at a Senate Estimates hearing in October 2015.

In the 2015 hearing, the department confirmed that the Medicare details of 369 individuals had been appropriated over a two-year period and rebates had been diverted to fake bank accounts.

In the “dark net” affair, revealed by The Guardian in July, the committee also noted that it was a media organisation rather than government monitoring that brought the security breach to light.

“The committee is also concerned by the department’s failure to promptly notify affected individuals once the breach was notified,” it said.

It said responsible data management required prompt disclosure when security breaches occurred.

The criticism comes on the heels of an independent report from former public service chief Sir Peter Shergold, which recommended health professionals should be encouraged to use HPOS as the primary means of accessing or confirming a patient’s Medicare number.

The report said telephone channels should be phased out in two years, in all but exceptional circumstances. In 2016-17, health providers made 500,000 calls to the Medicare-provider inquiry line.

In the interim, security checks for phone access should be strengthened with additional questions to be answered by health professionals or their delegates.

Health professionals should also be required to take “reasonable steps” to confirm the identity of patients when they are first treated.

Authentification for HPOS should be moved from Public Key Infrastructure to (PKI) to Provider Digital Access (PRODA) system within three years, the Shergold report said.

The report, issued last weekend, recommended delegations within HPOS should need renewal every 12 months, and HPOS accounts should be suspended after being inactive for six months, to reduce the risk of unauthorised use.

The review, assisted by RACGP President Dr Bastian Seidel and Dr Kean-Seng Lim, Deputy Chair of the AMA’s Council of General Practice, also backed stronger patient-privacy rules and concluded that Medicare cards should remain in use as a form of secondary evidence of identity.

In submissions, the RACGP and the Pharmacy Guild supported a proposal to require patients to show proof of identity when they first visit a health service.

But the AMA, the Northern Territory Health Department and the National Aboriginal Community Controlled Health Organisation argued against the step.

“It would place an unnecessary administration burden on practices and put in place an unnecessary barrier to care for patients,” the AMA said.

Daily Telegraph: Chemists accused of putting profits ahead of patient safety in codeine prescription row

 

Chemists are putting profits ahead of patient safety as they try to fight new rules that will make Panadeine and Nurofen Plus prescription only, doctors claim.

The powerful Pharmacy Guild of Australia has rejected claims by the nation’s peak GP group that it is trying to buy a change in the policy through $340,000 in donations to political parties.

And five expert health groups have written to state health ministers pleading with them to reject the Guild’s bid to change the policy.

RACGP president Dr Bastian Seidel says codeine should not be used for tension headache or period pain.

In fact, evidence shows codeine causes headaches when people become addicted.

“They are trying to introduce policy by chequebook by donating large amounts to state and federal parties to gain open access to decision makers,” he said.

ZD Net:  Australian government details Govpass digital ID

 

The federal government has detailed what its digital identification solution will look like, outlining how citizens can apply for an optional Govpass in a video posted on YouTube.

The Govpass platform is currently in testing phase, with a beta version “soon” available for opt-in.

To register for a Govpass, citizens will need to enter a handful of personal details, starting with their email address. Once an address is entered, the user will receive a code via email, with the second step requiring that code to be entered into the account creation screen.

Following a review into heath providers’ access to the Health Professional Online Services system, and in particular access to Medicare card information, the review panel – headed by professor Peter Shergold, and comprising also the president of the Australian Medical Association Dr Michael Gannon; Dr Kean-Seng Lim, also from the Australian Medical Association; and president of the Royal Australian College of General Practitioners Dr Bastian Seidel – dismissed requests to suspend a Medicare card from being a valid form of ID in Australia.

The Medical Republic: Focus sharpens on obesity care plans

 

Two major Australian medical societies have officially defined obesity as a “disease”, and experts are urging GPs to utilise care plans to help patients manage the condition and access treatment.

Obesity was originally prohibited from funding under GP Management Plans, but the eligibility criteria was changed, largely unnoticed, years ago.

“Historically, when the Department of Health described which health conditions were eligible for chronic disease plans, they listed various eligible diseases,” Dr Georgia Rigas, chair of the RACGP’s obesity management network, said.

“Way back then, obesity was specifically named as an excluded health condition.”

Since then, a list of inclusions and exclusions have been dropped, meaning patients with a BMI of 30 or more and no “apparent comorbidities or complications from their excess weight” were eligible, considering the chronic and progressive nature of the disease, Dr Rigas said.

For years, debate has raged over whether obesity should be considered a disease or simply a chronic condition, with proponents of the disease label arguing it would give the problem gravitas in the community and among policymakers.

Now, joining the Australian and New Zealand Obesity Society which issued a media release earlier in the month, the RACGP has also officially labelled obesity a disease.

Dr Rigas hoped this would have a “ripple effect”, prompting other medical groups such as the AMA to follow suit.

College President Dr Bastian Seidel made the call, urging GPs to act early, noting that obese and overweight children had a quality of life as poor as those with cancer.

In Australia, two in three adults and one in four school children are overweight or obese.

If nothing changes, 2.7 billion adults globally will be overweight or obese by the end of the decade.

“Sadly, there is a real risk that these children might not outlive their parents,” Dr Seidel said.

“There is a serious sense of urgency, and the time to act is now.”

For Dr Rigas, recognising obesity as a disease should help change its perception in society, improving health outcomes for people who “suffer significant degrees of stigma, discrimination and weight bias and as a result may be reluctant to access healthcare”.

“Very few understand that the causes of obesity are multiple and complex including epigenetics, and alteration in the gut microbiome,” she said.

“While the heritability of obesity has been shown in twin studies and clinical practice, there are only a small percentage of patients who have a purely genetic cause.”

Dr Rigas has been a long-time critic of the inequitable treatment available to patients with obesity, highlighting the vanishingly small capability of hospitals in the public sector to offer bariatric surgery, and the dearth of any obesity medication covered by the PBS.

Funding did not come close to that available for other serious medical conditions that represented a significant public health concern, she said.

Along with the change in label, the College is also suggesting a shift in health messaging from “lose weight” to “gain health” in recognition that obesity is about more than body weight.  In addition, the College is promoting weight screening to become routine in general practice.

“Start screening ALL patients in [general] practice, young and old,” Dr Rigas said. “For children, their parameters need to be plotted on a BMI-for-age chart; for adults BMI and waist circumference, taking into account their ethnicity (as different cut- offs for different ethnic groups) and physical activity levels (if they are muscular or not) are important.”

As a baseline of care, the RACGP says waist circumference and BMI need to be taken every two years in the general population and annually for those with diabetes, cardiovascular disease, stroke, gout or liver disease, or if they are from high risk groups, such as Aboriginal and Torres Strait Islanders or Pacific Islanders.

These measurements are recommended twice a year for patients who are already overweight or obese.

In Daily: Cost of treating obesity set to soar

 

The annual cost of treating obesity-related diseases is estimated to cost Australia $21 billion by 2025, according to new expert estimates.

Obesity is one of the leading causes driving the high rates of heart disease and diabetes and has been linked to many types of cancer.

Without action on obesity, the annual global medical cost of treating these serious health consequences will reach $US11.2 trillion per year within the next eight years, warns the World Obesity Federation (WOF).

Its a call echoed by the head of the Royal Australian College of General Practitioners (RACGP), Dr Bastian Seidel.

“We’ve been very clear in terms of what we need to be doing. Firstly we need to actually talk about how we advocate for better treatment options for treating obesity,” said Seidel.

Triple J Hack: What it’s like living with Chronic Fatigue Syndrome

 

Andrew Bretherton was 26 when he caught glandular fever. Even after he shook off the disease, his body hasn’t yet fully recovered.

“I can’t even get out of bed to go to the toilet or brush my teeth or have a shower. Just doing basic, everyday tasks is like a marathon,” Andrew told Hack.

“I felt I would constantly be tired or my legs were in constant pain and I had a lot of digestive problems as well. Doctors couldn’t really pinpoint what was causing it.”

President of the Royal Australian College of GPs, Dr Bastian Seidel, said doctors need to listen to their patients to make sure their health needs are being met.

“Dismissing symptoms is inappropriate. We need to take those symptoms seriously.”

ABC News: Private health insurance premiums will not rise as much under industry shake-up, Greg Hunt says

 

Health insurance costs will keep rising — but Health Minister Greg Hunt says the increases won’t be as high under changes he has announced today.

The most clear-cut change is for people under 30, who would be eligible for a series of discounts up to 10 per cent.

For other people, Mr Hunt said that over the next three years “we want to take out some hundreds of dollars out of the costs that they would otherwise be paying”.

The Royal Australian College of General Practitioners president Dr Bastian Seidel said he was worried people will get caught out if they choose a higher excess.

“If you can afford it that’s great, but if you can’t afford it you want to be really careful before signing up,” Dr Seidel said.

ABC Radio Australia: Private health insurance premiums to be cheaper under industry shake-up, funds and doctors say

 

Private health insurers and doctors welcome a major shake-up of the industry that looks set to curb premium rises over coming years, but the Government comes under attack for not banning “useless” policies.

Soaring private health insurance prices are set to be slowed by a major industry overhaul.

More than a dozen changes will be formally announced today, including a discount on premiums of up to 10 per cent for younger Australians.

The Royal Australian College of General Practitioners praised the Government for removing the coverage of some natural therapies such as homeopathy, aromatherapy, pilates and yoga.

“That’s a reasonable approach because private health insurance should only cover evidence based treatment,” Dr Seidel said.

Huffington Post: Obesity-Related Diseases Expected To Cost Australia $21 Billion

 

The annual cost of treating obesity-related diseases is estimated to cost Australia $21 billion by 2025, according to new expert estimates.

Obesity is one of the leading causes driving the high rates of heart disease and diabetes and has been linked to many types of cancer.

Without action on obesity, the annual global medical cost of treating these serious health consequences will reach $US11.2 trillion per year within the next eight years, warns the World Obesity Federation (WOF).

It’s a call echoed by the head of the Royal Australian College of General Practitioners (RACGP), Dr Bastian Seidel.

“We’ve been very clear in terms of what we need to be doing. Firstly we need to actually talk about how we advocate for better treatment options for treating obesity,” said Dr Seidel.

Triple J Hack: ‘The scariest moment of my life’

Under different state and territory Mental Health Acts, doctors can involuntarily admit patients to hospital if they are a risk to themselves or others. It’s called being scheduled or sectioned.

But as President of the Royal Australian College of GPs, Dr Bastian Seidel, told Hack, it’s not a decision doctors take lightly.

“Sometimes it happens when patients are under the influence of medication or certain drugs for example, and certainly are not capable of making a decision and then it would require an involuntary admission,” he said.

“But that happens very, very rarely.”

The Medical Republic: About addictive painkillers and backdoor deals

 

It is concerning that those who have been given responsibility to look after the health of Australians take decisions influenced by commercial interests instead of sound evidence and common sense.

As I have said before we have an opiate problem in Australia and it is the responsibility of doctors, pharmacists, consumers and governments to solve it.

One of the opiates that are harmful is codeine. Codeine is closely related to morphine and can cause dependence, addiction, poisoning and, in high doses or in combination with other drugs, death. That’s why in many countries this painkiller, like other opiates, is only available via a doctor’s prescription.

The independent Therapeutic Goods Administration has decided to do the same in Australia after extensive consultations with stakeholders including doctors, pharmacy groups and state health departments.

From 1 February 2018, medicines containing codeine will no longer be available without prescription in pharmacies. There will still be safe and equally effective alternatives available through the pharmacy without a script.

Unfortunately some of the stakeholders are undermining this process, putting patients at risk.

Wheeling and dealing

Publicly the Pharmacy Guild of Australia states that it is not seeking to overturn the decision by the TGA. It has, in fact cashed in a large sum of money from the federal government to develop and deliver education, information and communications for community pharmacies and patients to enable a smooth transition to the upscheduling of codeine.

However, behind the scenes it seems other things are happening.

For example, shortly after Pharmacy Guild representatives spoke to NSW Deputy Premier John Barilaro, he made the following statement: “(…) the Nationals are calling on the Federal Government to reverse their decision in relation to the way customers can access codeine products over the counter.”

The Guild’s approach was clever: They picked a pharmacy in a town with no doctor, invited Barilaro, took a picture with him and issued a press release thanking the Deputy Premier for his support of the Guild’s ‘common sense’ proposal to allow pharmacists to continue to supply codeine, stating: “What are patients with headache, toothache or period pain meant to do in Harden when there is no doctor within a hundred kilometres for a week at a time? The AMA has no answer.”

The AMA reiterated the concerns around codeine, including that 75 per cent of recent painkiller or opioid misusers reported misusing an over the counter codeine product in the previous 12 months and that these products were even more likely to be misused by teenagers.

The AMA also expressed concern about the Guild’s lobbying of State and Territory Governments to undermine the independent TGA ruling.

The Guild immediately responded on social media saying this was ‘overblown self-serving nonsense from the AMA’.

President of the Royal Australian College of General Practitioners (RACGP) Dr Bastian Seidel reminded Guild representatives that opiate painkillers including codeine are not normally recommended for tension-type headaches.

A good explanation of some of the problems with codeine can be found in this article written by a pain specialist from Deakan University: Over the counter codeine gives as many headaches as it fixes.

Substandard rural solutions

Sales of codeine-containing medications without script represent a revenue of $150 million per year for pharmacies.

The Guild has been busy lobbying State Health Ministers – successfully, it seems.

This weekend the Australian newspaper reported that all State Health Ministers, except for South Australia, have written to Federal Health Minister Greg Hunt “relaying unnamed stakeholder concerns about the unintended consequences of requiring a script” for codeine. NSW Health Minister Brad Hazzard was one of the signatories on the letter according to the Australian.

Here’s a screenshot of (part of) the letter to Minister Hunt in which the State Health Ministers explain why they are worried about the upscheduling of codeine:

If it is true that people in regional areas are indeed “managing chronic conditions with codeine medications” bought from a pharmacy than that is of course a concern as codeine should not be used for this purpose.

The State Health Ministers seem to implicate in the letter that it is preferable to treat chronic conditions by self medicating with over the counter codeine purchased from pharmacies instead of going to a doctor to get appropriate treatment.

This would indicate a lower standard of care for people in rural and regional areas. The upscheduling decision by the TGA could actually help regional patients receive more appropriate treatment via a doctor and cut out-of-pocket medicine costs.

Cash for access unethical

The Australian also revealed that Queensland Health Minister Cameron Dick, who also signed the letter, failed to disclose seven cash-for-access meetings with Labor donors. One of the donors was the Pharmacy Guild of Australia.

Queensland’s Premier Ms Annastacia Palaszczuk had earlier announced she had a moral responsibility to ban certain donations.

The Guild gets high level access to politicians in all states via significant donations. Their political donations are on the rise. Concerns have been raised for a while now that the Pharmacy Guild is able to influence healthcare decisions based on commercial principles instead of sound evidence.

The Guild regularly negotiates a massive agreement with the Australian Government to the value of $19 billion for dispensing PBS medicines. This begs the question how ethical it is that the Guild, at the same time, transfers money into the bank accounts of the political parties it is negotiating with.

Political donations (Australian dollars) by the Pharmacy Guild Australia 2012-2016. Source: AEC.

The Guild’s solution is weak

The Pharmacy Guild said on their website: “When we put our solution to the politicians they think it makes sense, particularly when we explain how up-scheduling alone will mean a loss of convenience and higher costs for patients, as well as the clogging up of GP practices.”

Although the medical profession and health consumer organisations can see through this rhetoric, it appears some politicians have more difficulties and I don’t blame them – at first glance the arguments by the Guild sound convincing.

The recent Health of the Nation report showed that most Australians can see their GP when they need to and are able to get an appointment for urgent medical care within four hours. The argument of ‘clogging up GP practices’ as a reason for over the counter opiates is deceptive and it is probably not the Guild’s place to comment on this.

So let’s look at the Pharmacy Guild’s preferred solution. They believe that pharmacists should continue to sell codeine without a script for acute pain and state pharmacies would monitor misuse via their real-time monitoring software called ‘MedsASSIST’. The Guild continues to remind everyone that they are the only one with this pharmacy software package.

The problem here is first of all that medications issued without a script in a pharmacy must be substantially safe and without risk of misuse.

Clearly codeine is not safe and there is unambiguous international evidence of harm and misuse. So it makes no sense for codeine to be freely available in the pharmacy on the one hand but on the other be subject to real-time monitoring.

There are also serious problems with MedsASSIST. It is not an independent tool but owned by the Guild. Not all pharmacies use it so it is easy to get around for those who use codeine for the wrong purposes.

The Therapeutic Goods Administration has considered the evidence around MedsASSIST and found that it did not lead to a significant number of people being denied codeine medications in the pharmacy.

The TGA mentioned an example where an individual was able to receive 660 codeine tablets in one month despite their purchasing behaviour being tracked by the software. This raises questions about the efficacy and safety of the Guild’s preferred solution. Is it just smoke and mirrors?

The Guild continues to accuse others that they have done nothing to monitor the use of  drugs of dependence. This is also incorrect as many groups, including the AMA, RACGP and coroners have repeatedly asked for an effective national real-time prescription monitoring system, accessible by doctors and pharmacists.

What do consumers say?

The Consumers Health Forum has raised concerns about the Guild’s solution and said in their press release: “We do not support the proposal from the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia to allow pharmacists to dispense codeine products without a prescription for people with one-off acute pain under certain conditions.”

“CHF supports the role of TGA as the regulator; we believe overall it does an excellent job of ensuring Australians have access to safety and high-quality medicines. We also note that this decision brings Australia into line with most other developed countries. As recently as July 2017 France has moved to make codeine products prescription only. The evidence for harm from codeine and other opioids is growing and their efficacy in assisting with pain management is coming under more and more scrutiny.”

Other groups also expressed concerns about the Guild’s undermining of the TGA. Pain Australia, the RACGP and the RACP have issued a joint press release. Painaustralia CEO Carol Bennett said:

“Chronic pain is a major health issue in Australia – we need to do much better than offering medications that are often both ineffective and potentially harmful in responding to chronic pain. Providing appropriate pain management should be a much higher priority, particularly in rural locations where reliance on opioids is a significant issue.”

“Painaustralia supports a co-ordinated, whole of sector strategy to address the issue of access to optimal pain management, including public and clinical education programs, linkages between rural health care clinicians via Telehealth with specialist city based services.”

And addiction specialists?

Last month, addiction specialists from the Royal Australasian College of Physicians (RACP) reaffirmed their support to make codeine-based medications available only with a prescription because of the many reports about misuse, addiction, and secondary harm.

The RACP said in a press release: “Addiction is a serious medical condition which should be avoided at all costs. (…) Addiction alters life choices, life chances and life trajectory. Addiction specialists have seen the number of patients with addiction to over the counter codeine grow at an alarming rate.”

“People with persistent pain should talk to their doctor to develop an appropriate treatment plan. This may include a referral to see a pain specialist or pain management clinic to manage their condition on an ongoing basis.”

The response from the Pharmacy Guild: “doctors are missing the point on codeine.”

Conclusion

The Pharmacy Guild of Australia is increasingly becoming a disruptive factor in healthcare. Protection of their significant commercial interests drives behaviour that is not always in the interest of the health of Australians. Feedback or criticism is met with aggressive counter punches. Working with the community pharmacy sector is becoming difficult for other health groups.

It is sad to see because the Guild represents a respectable profession. It appears that the Australian healthcare system, which makes pharmacies dependent on commercial activities, is partly to blame for this situation. I am not accusing anyone of backdoor deals but this whole codeine saga is not a good look. Political donations and cash-for-access programs also seem highly inappropriate, especially in the healthcare sector.

SBS: Calls to limit sugar in Aust soft drinks

 

Australian doctors want soft drink manufacturers to voluntarily limit the amount of sugar they put in drinks.

The head of the professional body representing GPs says it’s time to acknowledge the existing federal government will never introduce a sugar tax so other practical ways of tackling obesity should be considered.

With a “damning” seven out of 10 Australian adults estimated to be either overweight or obese by 2025, Dr Bastian Seidel says its time for common sense solutions to the obesity epidemic.

“The issue of obesity and Australians being overweight doesn’t go away so we keep talking and talking about it and we actually don’t take any action,” said Dr Seidel, the head of the Royal Australian College of General Practitioners.

ABC News: Tasmania’s medicinal cannabis access scheme stalls as doctors remain hesitant, sceptical

 

The first month of the Tasmanian Government’s Medicinal Cannabis Controlled Access Scheme is being bogged down in hours of paperwork and confusion over how it is meant to operate.

Since the scheme started on September 1 the Health Department has received just three applications from medical specialists with none yet approved.

Dr Bastian Seidel of the Royal College of General Practitioners said such anecdotes were not surprising as patients and GPs remain confused over how the scheme works.

“There has been limited information from the Tasmanian Government and the Tasmanian Health Service as to how patients can be referred,” he said.

Nine News: Almost 60 percent of Australians have returned survey forms

 

In an updated statement Dr Seidel said: “it is clear to me- as it is to the RACGP Council – that broader RACGP membership expects an explicit position statement on issues that affect the mental health of our LGBTIQ members, colleagues and patients. This includes marriage equality.”

“As part of valuing diversity and inclusion, RACGP Council supports marriage equality. We recognise the absolute right of all RACGP members to hold and express their own personal views on this matter.”

The Sydney Morning Herald: Royal Australian College of General Practitioners endorses marriage equality after backlash over neutral stance

 

The Royal Australian College of General Practitioners has abandoned its neutral position on same-sex marriage in support of the ‘yes’ vote after suffering heavy criticism from its members and the wider community.

The RACGP published a new position statement on Monday night strongly endorsing marriage equality days after it was lambasted online and by its own membership for not backing the move as other medical organisations and individual GPs have done.

“RACGP council discussed the issue of marriage equality at the August council meeting. Council acknowledged that the organisation has a diverse membership of more than 35,000 GPs with a range of views. Council believes that for this matter members should consider the issues involved carefully for themselves,” College president Bastian Seidel said in a statement to the publication.

Herald Sun: Healthy people are dying from the flu and doctors say it’s time to make the influenza vaccine free

 

The flu vaccine should be provided free for everyone as the death toll mounts from this year’s killer flu outbreak doctors say.

The calls come just days after the death of mother-of-two Jennifer Thew in Canberra to the virus which prompted the remarkable response from a family grieving a similar death.

The head of Australia’s peak GP group Dr Bastian Seidel wants everyone aged over 6 months to get a free flu shot as a record 181,000 Australians are struck by the virus.

Herald Sun: ‘Kickbacks for kids’ in dodgy deal

 

A major private-equity backed after-hours medical service drew up plans for a ‘kickbacks for kids’ scheme where schoolchildren would receive fundraising dollars if they signed up as a member to the service.

The Daily Telegraph has uncovered the National Home Doctor Service, majority-owned by Crescent Capital partners, drew up plans to offer schoolchildren membership in return for giving them fundraising money.

The Royal Australian College of GPs President Bastian Seidel said the plans for a fundraising program for children were concerning.

“There are ethical concerns if the service is only offered for a higher direct or indirect financial contribution via so called fundraising activities,” he said.

AJP: Lib Nat would fund free flu vaccines 

 

Victoria’s state Opposition has committed to free flu vaccines for all kids, should it win the next state election.

Shadow Minister for Health Mary Wooldridge announced that a Liberal Nationals Government would provide up to $7 million over four years for free voluntary flu vaccinations for all Victorian children between the ages of six months and five years old.

The Royal Australian College of General Practitioners welcomed the move.

RACGP President Dr Bastian Seidel says a government-subsidised flu vaccination program is long overdue.

“Shadow Health Minister Mary Wooldridge’s announcement is a step in the right direction, but far more needs to be done to protect Australians from influenza,” Dr Seidel says.

Gears of Biz: Medicinal cannabis about to get green light in Tasmania, but concerns linger over who will qualify

 

Tasmanians will be able to apply to access medicinal cannabis from Friday, but doctors and advocates have concerns about how the scheme will work.

Doctors said in reality, prescribing medicinal cannabis will be restricted to two rare forms of childhood epilepsy.

They’re worried they’ll be left to deal with angry patients, for whom the scheme won’t deliver.

“Doctors feel overwhelmed because the evidence really is very limited, when it comes to medicinal cannabis,” Dr Bastian Seidel said.

ABC News: Transgender medical knowledge among regional doctors in short supply

 

When Holly Conroy first tried to transition from male to female 11 years ago she was talked out of it by family and friends.

“People told me I’d never pull it off as a woman, that I’d never hold down a job, and I can remember my mum saying that if I was ever going to come around I’d have to call first in case they had visitors,” Ms Conroy said.

Bastian Seidel, president of the Royal Australian College of General Practitioners, is also concerned about the knowledge gaps that rural and regional doctors are demonstrating with regard to transgender medicine — especially given the increasing demand for it.

“We’re concerned about this because we want all patients to feel comfortable when they’re seeing their GP,” the Tasmanian-based Mr Seidel said.

“Discrimination is just not acceptable in the 21st century.”

The Daily Telegraph: Preying on taxpayers is just a sick joke

 

Quite rightly, the federal government pays 100 per cent of the medical bill for a doctor to visit your home at night time, on weekends and on public holidays if you have an urgent medical crisis when no doctor’s surgery is open.

The after-hours service at home, at $130 a pop, is bulk-billed and has been part of Medicare since its inception in 1984. It’s a wonderful and important service.

But just five years ago private equity firms entered the market seeking to profit from this potentially lucrative business model.

RACGP president Dr Bastian Seidel slammed many of the doctors for being “unqualified”, saying the industry is “trying to make a mint by creating this urgent call-out market”.

3AW693: Allegations of misdiagnoses from underqualified doctors making home visits

 

Under qualified junior doctors are completing after hours GP home visits, resulting in allegations of misdiagnoses, complications and poor quality of care.

As reported in The Herald Sun, 70 per cent of home visits in 2015-16 were made by non-vocationally registered GPs and GP trainees.

Royal Australian College of GPs president Dr Bastian Seidel, told Ross and John the service is costing taxpayers a quarter of a billion dollars every year.

“These are doctors who have the medical degree but don’t have any further training,” Dr Seidel said.

“It’s actually a huge industry, driven by commercial interest.”

Dr Seidel said it takes a further four years of post graduate study to become a GP.

AJP:  Online GP and pharmacy services ‘second best’

 

Doctor and pharmacy groups criticise websites that offer online consultations, scripts and medication delivery.

Following the announcement that Qoctor – formerly known as Dr Sicknote – is now expanding its services, the RACGP has stated that the increasing prevalence of medical online services fragments care.

Qoctor is an online medical hub that offers medical certificates, specialist referrals and online consultations, and this week announced it is expanding into providing online prescriptions for STIs, contraception and erectile dysfunction, as well as an online pharmacy and medication delivery service.

RACGP President Dr Bastian Seidel says patients should not be able to access prescriptions, referrals and/or medical certificates through online systems unless they are being provided by the patient’s usual GP, or a GP in the patient’s usual general practice.

The Daily Telegraph: Underqualified GPs sent to house calls doing more damage than good

 

House calls by doctors were once commonplace in Australia. Veterans of that era will recall many visits ending with a recommendation for nothing more potent than aspirin.

Still, house calls were a sensible idea. Many illnesses leave victims unable to easily travel. Some maladies can strike outside of hours when medical practices are open. In these cases, the obvious solution was to phone a doctor and have the medical help come to a house.

There has been a recent ­return to the practice of making house calls. Yet the house call services provided by some firms are not quite the same as in ­previous decades.

“Our main concern is there is a loophole in the system that allows doctors who are not qualified showing up to do home visits and charging Medicare $130 and they’re in and out in under five minutes,” Royal Australian ­College of GPs president Dr Bastian Seidel says.

Pharmacy News: GP college calls for free flu vax for all

 

The Royal Australian College of GPs is calling for the $10 influenza vaccination to be made free for all Australians as the number of cases and deaths continue to climb.

The number of notified laboratory confirmed cases of influenza are almost three times higher than last year, according to the latest figures.

Victoria is one of the worst-hit states. There have been 97 fatal flu cases this year so far, largely in nursing home residents.

However, children are also being affected, with eight-year-old schoolgirl Rosie Brealey dying last Friday after a cardiac arrest.

The strain on Victoria’s system has forced the state to enlist private hospitals to help public facilities manage the demand from flu patients.

However, RACGP President Dr Bastian Seidel said a $250 million subsidised preventive program would cost far less than paying for hospital care.

“Every year we have the same story: a new flu outbreak, the public hospitals and ambulances so stretched they can’t cope anymore and, on average, 3000 deaths every year from influenza, 18,000 hospital admissions and 350,000 Australians affected by the flu,” Dr Seidel told the Australian newspaper.

Adelaide GP Professor Nigel Stocks, director of the Australian Sentinel Practices Research Network, backed the college’s calls for a fully funded program.

He said there was good evidence from Ontario in Canada that a free, nationwide influenza immunisation program was feasible and cost-effective.

“Australia has … a very strong primary care-orientated healthcare system. It is potentially feasible. There would just have to be a political will,” he said, adding that the evidence on cost-effectiveness was likely to persuade politicians in their decision-making.

It isn’t too late to vaccinate patients this season, he added.

AJP: Should all Australian get free flu vaccines?

 

Stakeholders are calling for the flu vaccination to be made available without cost to all Australians, including children.

Bastian Seidel, Royal Australian College of General Practitioners president, says in The Australian that if the Government subsidised such a free vaccination program, the $250 million spent would significantly offset the cost of death and illness from the disease.

“Every year we have the same story; a new flu outbreak, the public hospitals and ambulances so stretched they can’t cope any more and, on average, 3000 deaths every year from influenza, 18,000 hospital admissions and 350,000 Australians affected by the flu,” he said.

Dr Paul Van Buynder, Chairman of the Australian Immunisation Coalition, renewed a call for the influenza vaccine to be added to the National Immunisation Program for children.

ABC Radio Darwin: Push to end high turnover at the doctor’s office 

 

There’s a push to put an end to “six minute medicine” where patients are shuffled in and out at bulk billing clinics with a high turnover.

The Royal Australian College of General Practitioners is leading the charge. College president Dr Bastien Seidel spoke to ABC Radio Darwin’s Adam Steer.

Doctor Portal: GPs on front line of climate change health

 

GPs are under increasing pressure to ensure vulnerable patients are prepared for climate-related events, amid growing evidence of excess hospital presentations and deaths related to heatwaves, periods of heavy bushfire smoke and thunderstorm asthma incidents.

Dr Bastian Seidel, president of the Royal Australian College of GPs, recently told The Saturday Paper that rarely a day went by in his rural practice in Tasmania’s Huon Valley that he didn’t hear about a climate change impact for his patients – prolonged drought affecting cherry farmers and graziers, unseasonably hot weather worrying salmon producers and hay fever cases going all year round.

Dr Seidel said that GPs needed to be bold enough to nominate climate change as a cause of illness and to campaign to have health policies “blueprinted” against climate change effects.

“It looks like climate change has almost become the Voldemort of health impact research and policy – it shall not be named,” he told the paper.

The Australian: Free flu jab could save us ‘millions’

 

Australia’s peak medical body representing doctors has called for influenza injections now costing $10 to be offered free to all Australians as the number of epidemic victims grows.

Royal Australian College of General Practitioners president Bastian Seidelsaid a $250 million government-subsidised flu vaccination program would cost far less than the economic losses from 3000 deaths a year, mounting hospital and health bills, and lost work productivity.

Huffington Post: Public Awareness Has Failed To Improve Australia’s Mental Health

 

One in every five Australians has a mental illness or substance abuse disorder, a large-scale global health study has found.

And while we are world-leaders in treating heart disease, stroke and cancer and our life expectancy is one of the highest in the world, as a nation we’re failing to improve our mental health.

The findings come just one day after the Royal Australian College of General Practitioners (RACGP) announced that mental health is now the number one condition dominating GPs’ time.

“It is not musculoskeletal problems patients are presenting with most often, or cardiovascular disease – the stock standard medical presentations we always hear about,” RACGP President Dr Bastian Seidel said.

“It is psychological issues GPs are dealing with most of the time.”

RACGP: Health of the Nation report launch

 

The Royal Australian College of General Practitioners (RACGP) is Australia’s largest professional general practice organisation, representing 90% of the general practice profession.

The General Practice: Health of the Nation 2017 report draws on specifically commissioned research involving more than 1300 RACGP Fellows from all parts of Australia, as well as information from the MABEL (Medicine in Australia: Balancing Employment and Life) Survey and a range of government publications, to provide a unique overview of the general practice sector.

The report focuses on a range of key areas including:

  • patient access to general practice
  • the role of the general practitioner
  • the general practice workforce

AJP: Anti-vax GP Suspended 

 

Melbourne GP Dr John Piesse has been officially suspended while enquiries into his practice continue, says AHPRA.

Two weeks ago, Dr Piesse was reported to have agreed to an undertaking with AHPRA not to work as a medical practitioner, either paid or unpaid, following allegations that he had helped patients avoid compulsory immunisations.

The doctor’s practice at the Nerida James Natural Healing Centre in Mitcham, Victoria was also reportedly raided by AHPRA with the assistance of Victoria Police one week ago.

The RACGP has responded to reports of anti-vaccination GPs, saying that the GP remains the most trusted source of advice on immunisations and that anti-vaccination messages have absolutely no place in general practice.

“It is vital all Australians are fully vaccinated,” RACGP President Dr Bastian Seidel said.

4BC: Ending “6 Minute Medicine”

 

Ben Davis speaks to Dr Bastian Seidel, the President of the Royal College of GPs about their proposal to help doctors spend longer with their patients and do away with “6 minute medicine”.

Herald Sun: Doctors want a 19 per cent pay rise in exchange for ending so-called ‘six minute medicine’

 

Six minute medicine would end and patients would get to spend at least 20 minutes with their GP under a new funding model rewarding longer consultations.

GPs would get a 19 per cent pay rise under the plan and be paid as much as specialists for seeing a patient.

The Royal Australian College of General Practitioners says the six minute medicine practised by high turnover bulk billing clinics encourages too many prescriptions for antibiotics.

And chronically ill patients don’t get the comprehensive care that keeps them out of hospital with short consultations.

“We believe when GPs are spending more time with their patients that leads to less prescribing, less pathology, less referrals, enhanced continuity and care and that would, or course, mean less hospital presentations as well,” RACGP president Dr Bastian Seidel says.

SBS World News Radio: Immunisation lacking after refugees arrive

 

There are now calls for a national strategy to address what the report says is under-immunisation among the refugees.

Australia has one of the most comprehensive immunisation programs in the world.

But many of the thousands of refugees who arrive each year are under-immunised before they resettle and remain so afterward.

Earlier this year, for the first time, the federal government provided funding for catch-up vaccines to refugees of all ages.

Royal Australian College of General Practitioners president Bastian Seidelhas welcomed the funding.

“This is a really good start, but we need to make sure that the catch-up programs are administered consistently in all states and territories.”

The Medical Republic: Mental health issues now dominate GPs’ time

 

Australia’s GP waiting rooms are increasingly filled with patients seeking help for psychological distress, and overseas-trained GPs have taken the lead in terms of workforce output, according to a new benchmark report from the RACGP.

Psychological problems such as anxiety and depression have become the most common reasons for GP presentations, and particularly dominate the patient lists of female GPs, the report on current and emerging health trends found.

The report, General Practice: Health of the Nation 2017, identified Medicare rebates, mental health, obesity and aged care, in that order, as the leading health-policy issues needing immediate government action to maintain high-quality healthcare.

Psychological conditions were the most frequent reason for patient visits, it said. In a poll of more than 1300 RACGP members, mental health was cited as a top-three issue by 68% of female GPs and 53% of male practitioners.

RACGP President Dr Bastian Seidel said women doctors were taking a lead role in managing psychological issues and obesity, but male doctors were more likely to work full-time.

“When it comes to the general practice workforce, despite the increase in the number of female GPs, the average number of female GPs working full time in a practice is almost half that of male GPs,” he said.

The report showed that women now make up 45% of the 35,000-strong GP workforce but only 36% of the full-time service equivalent (FSE), owing to their higher rates of part-time work.

“The clear difference in male and female FSEs could reduce a patient’s ability to select their preference of a male or female GP,” the report said.

The report also found that, for the first time since records began, overseas-trained GPs in 2015-16 represented a higher proportion of the FSE than GPs who gained their basic qualifications in Australia and New Zealand.

The FSE is calculated by the Department of Health based on Medicare claims information, representing hours worked, volume of services and schedule fees.

Mental health was flagged by RACGP members as the health issue causing most concern for the future, followed by obesity and diabetes.

“This is a clear warning of both the current frequency and future potential impact of psychological ailments on individuals, the community and the broader health sector, “ the report said.

“It is also a stark reminder that the personal and financial health costs associated with obesity and diabetes are expected to escalate.”

AJP: Anti-vax GP to stop practicing as doctor 

 

One of the doctors under investigation by authorities has agreed to temporarily stop working as a medical practitioner.

Melbourne GP Dr John Piesse has agreed to an undertaking with AHPRA not to work as a medical practitioner, either paid or unpaid.

AJP understands that the restriction on his practice will last for two weeks while investigation into Dr Piesse continues.

The RACGP has responded to reports of anti-vaccination GPs, saying that the GP remains the most trusted source of advice on immunisations and that anti-vaccination messages have absolutely no place in general practice.

“It is vital all Australians are fully vaccinated,” said RACGP President Dr Bastian Seidel said.

“While some parents may have concerns stemming from reading misleading immunisation information, anti-vaccination messages are dangerous and are not supported by the RACGP.”

The Guardian: Medicare data breach: government response ‘contemptible’, says former AFP officer

 

The federal government’s response to a Medicare data breach that led to patient details being sold on the dark web was “disappointing, confusing and often contemptible,” according to a former detective who headed the Australian federal police’s investigations into high-tech crime.

Nigel Phair, now an adjunct professor at the University of Canberra’s Centre for Internet Safety, told a Senate inquiry the government’s response to data breach concerns meant “less and less people will trust the government with their health details”.

AJP: Pharmacy urged to back codeine upschedule 

 

The RACGP has used International Overdose Awareness Day to tell pharmacy to support the codeine upschedule.

August 31 is Overdose Awareness Day, held worldwide to raise awareness of overdose, reduce stigma and remember those who have died or been permanently injured due to overdose.

RACGP president Dr Bastian Seidel encouraged Australians to learn the signs and symptoms of opioid overdose.

He cited recent data which showed more Australians are now dying from pharmaceutical prescription opioids than from heroin overdoses.

Australian Doctor: College calls for level E consult fee

 

The Federal Government should boost GP attendance rebates by one-fifth and create a new level E consult worth $163 to end the disparity with specialist fees, the RACGP says.

The college hopes to end the long-running fee gap between GP consult fees and those of other specialists — who attract higher fees because their training is longer.

The recommendations are part of a 19-point wishlist of changes to GP attendance items submitted to the MBS Review Taskforce earlier this year, which was made public this week.

At the top of the list, the college is calling for an 18.5% rise in the scheduled fees for GP attendances, which is the amount it says is needed to bring them in line with funding for other specialist consults.

Related: How much do GPs earn compared with other specialists?

The 18.5% loading would bring the value of a standard level B consult to $43.90, just a fraction over the schedule fee for ‘specialist’ item 105.

Time tiers should be extended, with a new level E consult to allow for GP consultations lasting more than an hour, the college says.

Level D consults make up just 1.3% of total GP attendances, but RACGP president Dr Bastian Seidel says many of these take far longer than the minimum 40 minutes funded by Medicare.

“Patients are presenting with more complex conditions more often and GPs need more than 60 minutes to support them,” he told Australian Doctor.

Dr Seidel said the college was pushing “very seriously” for the attendance fee boost, which would cost at least $1 billion per year.

But it would also go some way towards reducing the pay inequality between GPs and other specialists, he said.

Australian Doctor last month revealed that on average, GPs took home nearly $200,000 less than other specialists in 2015, according to MABEL data.

The college arrived at the 18.5% figure after calculating that GPs claimed an average of $19 less per consult than other specialists, based on MBS statistics for the 2015/16 financial year.

When public health consultations were excluded, the average gap between ‘specialist’ and GP consultation fees rose to 43.3%, the college claimed.

Furthermore, even when the extra training other specialists undertook was factored into the amount paid for ‘specialist’ consultation items 104 and 105, GPs still came out behind, the college said.

Melbourne University health economist Professor Anthony Scott said: “In a world where MBS fees are being partially unfrozen, I would imagine they would have a hard time getting this through.

“But the review has equalised the fees for some procedural items.

“There is a principal there but it depends on the cost, which is likely to be huge.”

Tasmania Talks: GPs want right to prescribe medicinal cannabis under new state plan

 

GP’s believe they should be able to prescribe medicinal cannabis to patients, rather than referring patients to a medical specialist whom they have never met.

From Friday September 1st, patients in Tasmania will be able to be prescribed with medicinal cannabis to treat their illnesses.

The State Government plan says that there are no restrictions on which illnesses can be prescribed the cannabis, however there are regulations around how it will be prescribed.

President of the Royal Australian College of General Practitioners, Dr Bastian Seidel tells Brian Carlton that the GP who understands the patients history should be the one to prescribe the drug.

ABC Radio: Can full body medical scans save time, money… and lives?

 

They are getting more and more popular, but are full body medical scans actually effective?

What if airport body scanners could give you a full health check…. would you want to know?

Ryk Goddard puts these questions to President of the Royal Australian College of General practitioners Bastian Seidel and makes some startling discoveries.

Ryk

ABC News: Medicinal cannabis about to get green light in Tasmania, but concerns linger over who will qualify

 

Tasmanians will be able to apply to access medicinal cannabis from Friday, but doctors and advocates have concerns about how the scheme will work.

“Doctors feel overwhelmed because the evidence really is very limited, when it comes to medicinal cannabis,” Dr Bastian Seidel said.

Croakey: What (more) can the health sector do to end harm to asylum seekers?

 

The Human Rights Law Centre said a Federal Government plan to cut income and accommodation support from Monday for asylum seekers who have been transferred to Australia from offshore detention for medical reasons is “a shocking act of cruelty“.

The plan rejects clear warnings from leading health organisations about the risks to a very vulnerable group of asylum seekers and raises questions about what health professionals can do to convince the government to put an end to ongoing physical and mental harm from Australia’s offshore detention system.

RACGP President Dr Bastian Seidel renewed calls for an independent medical review panel on Manus and Nauru,  saying doctors working at the centres “need to have the authority to advise on medical treatment”.

“If the government doesn’t trust the expertise of doctors on the ground, we should have an independent body,” he told Croakey.

MSN: Melbourne GP accused of helping parents avoid vaccinations reprimanded 13 years ago

 

A Melbourne doctor under investigation for helping parents evade compulsory vaccinations was reprimanded a decade ago for failing to properly treat patients with potentially life-threatening illnesses like cancer and depression.

The Australian Health Practitioner Regulation Agency (Ahpra) is investigating Dr John Piesse after a video was uncovered of him speaking at an anti-vaccination event in August. In the video, he boasts that he can help parents jump through hoops to get their children exempt from Victoria’s “no jab, no play” legislation and the federal government’s “no jab, no pay” legislation.

The president of the college, Dr Bastian Seidel, said it was vital all Australians were fully vaccinated.

“While some parents may have concerns stemming from reading misleading immunisation information, anti-vaccination messages are dangerous and are not supported [by the college].”

AJP: Pharmacies selling ‘snake oil,’ say Kiwi GPs

 

Like their Australian counterparts, doctors across the Tasman are taking aim at pharmacy over complementary medicines

The New Zealand Medical Association had expressed concern in Pharmacy Today over the Pharmacy Council’s revised code of ethics, which it says was not strong enough in discouraging the sale of CMs.

In Australia the RACGP has stated in its response to the King Review Interim Paper that it wants to break the “retail-medicine link” in pharmacy, especially regarding CMs.

“When it comes to complementary medicines and homeopathy we would argue that taxpayers’ money should only be used to support access to evidence based medicines,” said president Dr Bastian Seidel.

The Australian: Cold comfort if you’ve really got the flu

 

It is a big flu season and, with all the coughing and spluttering going on, you may be at risk, especially if you have other health conditions or are very young or very old.

The Pharmacy Guild is lobbying for pharmacists who have received appropriate training to be exempt from the rule to, in certain circumstances, continue to dispense the painkillers to some patients without a script.

However, Royal Australian College of General Practitioners president Bastian Seidel has called on the guild to back the “much needed public safety initiative”.

Seidel suggests pharmacists have a conflict of interest because of their codeine sales but the TGA decision obviously means that GPs would have more customers, too.

Courier Mail: Tragic death of WA man Lloyd Dunham sparks rush for meningococcal jabs in Tassie

 

A spike in demand for a free meningococcal vaccination program has caused a temporary shortfall at some Tasmanian doctors’ surgeries.

Doctors say Tasmania’s higher rate of meningococcal infection, as well as the recent death of a teenager in Hobart, has led to more people wanting protection from the deadly bacteria.

RACGP national president Dr Bastian Seidel, a Huon Valley GP, welcomed the Government’s free program but said demand was stronger than supply in some areas.

“There is a bit of a supply issue for GPs, it has been difficult to get enough of the vaccine,” he said.

“This is because people are obviously asking about the vaccine – which is a positive thing.”

Canstar: Australian patients further out of pocket

 

Australians are paying more out of pocket for doctors visits despite record high bulk billing rates, according to the latest Medicare statistics from the Department of Health.

Australia’s bulk-billing rate increased from 85.1% to 85.7%, the highest rate ever recorded since the inception of Medicare – but the Royal Australian College of General Practitioners says this 0.6% increase is the lowest growth for almost a decade.

“Bulk billing statistics have been used for political spin for too long,” said RACGP President Dr Bastian Seidel.

Perth Now:  Perth mum’s death from excessive protein leads to government probe of sports food supplements

 

Federal Health Minister Greg Hunt has ordered the national food and medicine watchdogs to investigate the regulation of sports food supplements.

Mr Hunt made the request this week after the revelation that protein supplements contributed to the death of Mandurah mum Meegan Hefford.

The 25-year-old’s death made headlines around the world this week and sparked debate about the safety of high-protein diets and use of sports supplements.

Royal Australian College of General Practitioners president Dr Bastian Seidel said an increasing number of Australians were putting their health and lives at risk because of supplements.

“The perception is that it’s safe because it’s marketed as safe … but the opposite is true for a lot of those supplements,” he said.

ABC: Overdiagnosis of medical conditions is causing more harm than good

 

A coalition of Australian healthcare organisations says too many patients are being diagnosed with medical conditions that do not pose a threat to them, leading to unnecessary treatments that cause more harm than good.

Experts say doctors need to do a better job communicating with their patients about their options.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners (RACP), who also supported the statement, said doctors needed to do a “better job.”

The Mercury: Doctors call for free flu shots as confirmed cases rise to 860 this year

 

As cases of influenza continue to rise in Tasmania, the peak body for GPs has called for free flu vaccinations across the community.

Tasmania Health Service figures show the number of confirmed cases of flu has risen to 860 this year, with the peak starting last month.

Royal Australian College of General Practitioners president Bastian Seidel, a GP from the Huon Valley, said free flu vaccinations would create immunity for the bulk of the community.

“I call on state and federal governments to make funding available for preventive health measures, and the flu vaccination is the one that should be funded,” he said.

SBS: Worst ever flu year for NSW

 

A NSW Health report confirms 35,727 cases of the flu have been detected in NSW residents so far in 2017, compared to last year’s 12 month record of 35,538.

With 12,724 flu cases registered already in August – traditionally the worst month for influenza – the NSW opposition is accusing the Berejiklian government of being unprepared.

Dr Seidel, from the Royal Australian College of General Practitioners, says the focus should be on prevention.

He suggests the government should make influenza vaccinations free for every Australian.

“You’re asking me whether we should be spending money to prevent influenza in the first place? Absolutely. It would be key to vaccinate everyone from the age of six months onwards – not only the ones who are at risk, because everybody is going to be at risk. You know, influenza doesn’t ask any questions. It can affect everybody.”

Broadsheet: 2017 Record-Breaking Flu Season Set to be Australia’s Worst

 

Australia is on track to experience its worst-ever flu season, with more than 75,000 cases for the year to date and a record 30,000 confirmed cases reported in July – up from 9000 in July last year.

According to stats from the Immunisation Coalition, Victorian influenza cases rose by 170 per cent for the year to August 6; Queensland Health has deemed this season the worst in five years, as has New South Wales Health; and South Australian flu notifications are at a six-year high. The figures only reflect confirmed cases of flu, so the actual number could be higher.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, encourages parents to get their children vaccinated.

“We need to make an effort to vaccinate everyone over the age of six months,” Dr Seidel says. “Get your flu jab. That’s the bottom line.” Thousands of people are hospitalised with the flu each year.

Australian Doctor: There’s room for private health insurers in general practice, RACGP says

 

The RACGP says private health insurers could take a bigger role in funding general practice.

Current regulations ban health insurers from offering subsidies for any out-of-hospital service covered by Medicare.

But the diminishing value of MBS rebates is forcing general practice to look in new places for the money to cover the cost of quality patient care, according to RACGP president Dr Bastian Seidel.

Extra cash has mostly come from increased out-of-pocket fees and, “within this context”, GPs are willing to examine the role of private insurance in primary care, Dr Seidel said in his submission to a Senate inquiry on private health insurance.

“While motives may differ, private health insurers and general practice share a key purpose: keeping patients healthy and out of hospital,” he wrote.

That goal is financial as well as moral, he added, with insurance companies willing to spend money on GPs in the hope of making savings on expensive hospital treatment in the long run.

Dr Seidel reiterated the college’s longstanding opposition to any change of the law that would allow private health insurers to fund any out-of-hospital service subsidised by Medicare.

But there is room for private health insurers to invest in GP services that don’t receive any Medicare funds, especially in care co-ordination programs for chronic disease patients, nurse servics, team care and telehealth, he said.

Steps would need to be taken to stop the creation of a two-tiered primary care system, he added, where rich or privately insured patients get better access to GPs than everyone else.

Dr Seidel also warned that any change could risk the clinical independence of GPs if it gave private health insurers leverage over referrals to other care providers.

Health insurers have taken tentative steps into funding primary care services in a bid to cut the cost of hospitalisations but with mixed success.

Four years ago, Medibank Private and IPN partnered on a ‘GP Access’ offer that guaranteed Medibank members priority, bulk-billed appointments at the GP corporate.

The two companies abandoned the scheme in June 2015 after protests from then AMA Council of General Practice chair Dr Brian Morton, who said it ran “against the spirit of the law”.

But Medibank, the nation’s biggest private health insurer, has also been working with GP practices offering support services to patients with chronic heart failure, COPD, osteoarthritis, diabetes and coronary artery disease.

Australian Doctor: Doctor prescribing leading to codeine deaths  

 

Pharmacists are claiming doctor prescribing is leading to codeine-related deaths as they continue their fight to bypass the TGA’s decision to make the drug prescription-only.

The Pharmacy Guild of Australia has alarmed many doctors with its push for exemptions on a state-by-state basis that will allow pharmacists to dispense the drug for acute pain without a doctor’s prescription.

The move flies in the face of the TGA’s decision to make codeine an S4 medication from next February in a bid to protect patients from harm.

The guild says patients will be protected under its “common sense” exemption plan because pharmacists will get extra training and all medications sold will be tracked by a real-time dispensing system to cut doctor shopping.

Last week, RACGP president Dr Bastian Seidel called on pharmacists to back the TGA, saying the “consumption” of codeine was “running out of control” with more than 16 million items being sold over the counter in pharmacies every year.

“While these sales represent a lucrative financial return of over $150 million a year for the pharmacy industry, patients are paying for this with their lives,” he said.

Referring to an MJA study published in 2015, Dr Seidel added: “Up to 150 Australians are now dying from codeine-related overdoses each year – double the number ten years ago.

“Many more people are also seeking help for codeine addiction.”

But on Monday the guild hit back, claiming that the majority of codeine-related deaths were the “result of high-strength medicines that are prescribed by doctors and/or the result of a combination of medicines consumed by patients”.

“The statistics cited by the RACGP are eight years old – and they show one codeine-related death for every two opioid-related schedule 8 deaths,” the guild said in a statement.

“What does the RACGP propose to do about doctor-shopping?”

The guild, in its media statement entitled “Putting patients first”, says it is still working with the TGA codeine working group.

But it said that its proposed system can make over-the-counter codeine safe.

It claimed one group of pharmacies that started using the dispensing tracking system MedsASSIST reduced the sale of over-the-counter codeine products by 31% over a six-month period.

“Community pharmacists are voluntarily continuing to use MedsASSIST as a clinical tool to support their patients and refer them where appropriate for more intensive pain management and addiction support, including to their GPs,” it said.

Last week, Australian Doctor revealed the guild had signed up former federal minister Santo Santoro as a political lobbyist, a month after it first announced it wanted to persuade state governments to adopt its codeine plan.

The guild said it hired various consultants to work on a range of issues.

Medical Republic: Chronic disease – the search for a better way

 

The welfare of some 120 chronically ill patients in Victoria could open the way to more primary-care delivery at pharmacies and take the load off GPs in underserviced locations.

An 18-month pilot program will track the progress of patients with at least one of four common chronic conditions, who are under the care of GPs, but using consultant pharmacists for monitoring, follow-ups and medication adjustment.

The commonwealth’s far larger Health Care Homes initiative for chronic disease also seeks to involve pharmacists and other allied-health professionals, but that program has gained little traction due a lack of clear purpose and poor funding. By contrast, the small, narrowly-focussed Victorian trial has struck a chord.

The response from GP-pharmacy partnerships was such that the Victorian government has extended the pilot to four locations, up from three. “Interest has been so strong we have expanded the pilot,” Victorian Health Minister Jill Hennessy told The Medical Republic.

“That means more patients will be able to visit their local pharmacist to monitor chronic conditions and manage medications under the direction of their GP’s care plan.”

The state will give every participating pharmacy and general practice a grant of $21,500 each to compensate them for time spent on the project over the 18-month trial period, beginning in September.

The state will cover the cost of subsidising medications rather than the PBS, so the cost effect on pharmacies and patients will be neutral. The state will also fund the purchasing of relevant point-of-care testing devices.

Nine pharmacists from the four participating pharmacies are midway through a specially designed, month-long training program.

The focus on asthma, hypertension, hypercholesterolaemia and anticoagulation therapy means they will need to prove competence in skills such as spirometry and measurement and interpretation of blood pressure, lipids and INR levels.

The town of Kilmore, 60km north of Melbourne, is one of the four locations where consultant pharmacists will screen, monitor, advise and adjust medications for patients under the direction of GP partners.

Dr Daile Kincaid, principal of Kilmore’s Stepping Stones medical practice, says she jumped at the chance to team up with her local Amcal pharmacy for the pilot program. “I’ve been a GP for 20 years, and there are things that stand out as making good common sense. This is one of them,” Dr Kincaid said.

“It was a simple decision because it wasn’t going to add to my workload; in fact, it’s a really great example of (prioritising) outcomes for patients.”

The great appeal of the trial is its preventative nature, she says.

Under the scheme, up to 30 patients from each practice will have appointments with consultant pharmacists at least once a month according to the care plan.

Dr Kincaid opened her practice two years ago because she wanted to “do things differently” and promote community health.

Kilmore is an idyllic rural community where people get up in the morning and milk their cows, she says.  But like all sites in the pilot, it has high rates of chronic illness and doctors are overstretched.

“We have three GP clinics. T there are a lot of GPs. But it’s difficult to get appointments.”

She says doctors need to be realistic about the need for reinforcement of the education they give patients, one of the roles the pharmacists in the program can perform.

“Asthma is a good example. The technique is completely crucial to the efficiency of the medication.  It’s a serious disease that is often untreated. If we have got the pharmacist trained specifically to deliver the information, it’s a really good idea.

“Education becomes prevention. That’s a really key thing. If we have more education readily available when asthmatics get their scripts filled, we actually will have better management of asthmatics,” Dr Kincaid said.

Dr Kincaid expects to be in closer consultation with her participating pharmacy through the trial, responding to queries and reports while she maintains responsibility for patient outcomes.

“I suspect the training for the pharmacists will cover all the important things. But I guess the reality of how that works in general practice and what actually happens to the patient – I see myself in that role,” she said.

In Kerang, in the state’s far north, pharmacist Simon O’Halloran welcomes the pilot as a “unique opportunity” to close gaps in chronic disease care by having pharmacists and doctors work together instead of communicating through the patient.

“I am already seeing quite a lot of these (chronically ill) patients through the week,” he said. “Rather than them asking questions when something crops up, we are going to be working more proactively, having more formalised patient consultations and documenting and reporting the outcomes directly to the GP, so they have more timely access to any relevant measurements.”

Mr O’Halloran works at Terry White Chemist, Kerang, which has teamed for the pilot with Gannawarra Family Clinic in the Murray River border town. He is also a principal pharmacist at a dispensary over the NSW border and does mobile consulting work.

Among requirements for taking part in the pilot, the GP-pharmacy teams had to demonstrate a strong existing working relationship and the means to relay test results and information instantly using the cloud-based cdmNet system offered by Precedence Healthcare.

“I’d like to see a model where pharmacists and GPs work collaboratively to better manage the patient, as opposed to working somewhat in isolation where the GP sees the patient to assess, diagnose, and manage, and we see them to fill prescriptions and advise on medications,” Mr O’Halloran said.

“A lot can happen between those two points, and if the GPs and the pharmacists are not on the same page there can (be) gaps, and if they’re not working towards a common goal it might fragment care.  That’s where I’d like to see this program bring a distinct advantage, in bringing the patient to the forefront.”

Appointments with the GP-referred patients should be a “manageable workload” on top of walk-in business, as long as management made sure a consultant pharmacist was available at all times, as well as a dispensing pharmacist.

“Effectively, we already have that model of care, with two pharmacists doing professional services such as home-medication reviews, Medschecks and primary point-of-care testing,” Mr O’Halloran said.

He dismissed talk of turf wars with GPs as “silly”, adding many of the functions to be asked of pharmacists in the pilot were things they already did s uch as counselling, triaging and point-of-care tests.

“I think there’s a lot more we can do, and a lot more we can do better. It can’t simply be seen as something that works against doctors. There has to be a distinct benefit to better support doctors and absolutely to support the patient. Patients are the priority.”

As reported in the mainstream media, initial reactions to the Victorian pilot from the AMA and the RACGP a few years ago were prickly.

After the go-ahead was announced in January, RACGP President Dr Bastian Seidel said there were plenty of highly qualified GPs who were capable and willing to manage chronic disease for patients.

The program is also designed to help reduce the workload of overstretched GPs

He said access to doctors did not seem to be much of a problem.

“The concern really is that sometimes patients are not able to afford to see their GP on a regular basis and that’s a direct consequence of the extension of the Medicare rebate freeze,” he said.

“Pharmacists are not going to offer services for free, either.”

More recently, AMA Vice President Dr Tony Bartone told The Medical Republic the important thing was to ensure the GP remained at the centre of patient care.

The aspect held out as controversial in earlier reports was that, under a GP care plan, a pharmacist would be able to adjust a prescribed medication if a target test measurement was not achieved within a stipulated time and if the GP so directed.

This, according to the Melbourne Age newspaper, would give pharmacists the power to “alter prescriptions” and shift patient care away from doctors.

Professor Jill Thistlethwaite, medical adviser at NPS, said it was important to note that all the pharmacists taking part in the trial were highly experienced and had close relationships of trust with their partner GPs.

Their training will consist of a month of online tuition and tests, and three days of face-to-face practical training at the end of August, related specifically to the tests they will be conducting and interpreting, as well as plans for communicating with GPs and what to do if a problem arises. The trainees are expected to be familiar with course components such as medication history-taking and best communication.

Practical training will be followed by an assessment including an eight-station OSCE, similar that taken by medical trainees, to ensure they meet the mark.

A practising GP and an advocate of inter-professional practice, Professor Thistlethwaite said the teaching of pharmacy had evolved over the past decade to put more emphasis on interactions with patients, adding the benefits of cooperation could flow both ways.

“Working as a GP in the UK, we had a pharmacist in our general practice for two days a week who helped us with our prescribing and looked at the efficiencies of our prescribing and best practice. That was exceptionally helpful,” Professor Thistlethwaite said.

She characterised the Victorian pilot as a “conservative” step into patient-centred chronic disease management which could, nevertheless, help inform the future of the commonwealth’s larger scheme.

Debbie Skinner, director of the Alexandra Medical Clinic, a pilot participant some 140km northeast of Melbourne, says the response of patients will be the key to the success of this particular care model.

As a nurse consultant in diabetes and wound management who works across spectrum of rural healthcare – in hospital, community health, aged care and the medical practice – she has seen a raft of projects designed to wring better results from thin resources.

“This is a way of seeing if the pharmacy-GP model is going to work better than the other things they have tried, such as nurse practitioners and medical assistants,” she said.

“Regular screening for INR and lipids could be fascinating for some patients,” she said, going on her long experience of diabetes management.

“It could be a motivating factor for INR and cholesterol patients to become more engaged in their care.

“However, different people need different motivations. The question is whether this type of pathway captures an audience and makes them more concordant with therapy, by engaging with another person as well (as the doctor). It’s a pilot. Let’s give it a try and see what works.”

Her clinic, which is under demand pressures after the death of her GP husband last year, would benefit from added data. For patients, easier access to health checks could lead to earlier interventions, more conversations and more useful clinical information.

She recalled her husband asking a patient, how are you managing your asthma? The patient said, “Good”. “Then I asked him, but how are you managing it? He said, ‘I don’t get out of my chair because I can’t breathe’.”

The story illustrated the need for “layered conversations” to get to clinical information.

The only urban location in the pilot is Whittlesea, in Melbourne’s northern suburbs, where GP services also appear to be in strong demand.

Dr Brian Murphy, principal of Whittlesea Medical Clinic, was dealing with emergency patients on both occasions we called to hear the circumstances of his involvement in the pilot program.

The project has been designed with input from an external panel, including doctors’ and pharmacists’ groups, the National Heart Foundation and the Asthma Foundation.

Harry Patsamanis, clinical strategy adviser at the Heart Foundation, said the care-plan model would give patients confidence the pharmacist knew what the GP wanted them to achieve and could provide practical help for them reach their blood pressure target.

“We know that the more people know they have high blood pressure and have it managed to target will significantly reduce their chance of having a heart attack. So we certainly see this is an opportunity to better manage people with medicines,” he said.

“The other thing that’s really important is that the care plan can include information about, and access to, lifestyle-behaviour programs – such as exercise and healthy eating – that the pharmacist can provide.”

Mr Patsamanis said pharmacists had the skill to trouble-shoot with patients on adherence issues and side-effects, and the expertise to go ahead with a dose adjustment or a second agent to manage hypertension,

But the pilot was inherently cautious.

“The GP sets the care plan, the GP identifies what the patient needs to achieve outcomes under the plan, the GP enlists support of the pharmacist to provide support as part of that care team.

“It’s a very structured way of assisting patients to better meet the outcomes we want to see as evidence-based practice.”

The CEO of the Asthma Foundation of Victoria, Danielle dal Cortivo, said interventions by pharmacists could help tackle the “disconnect” between how asthmatics were managed by GPs and their medication-taking behaviour, such as over-use of reliever medication.

“The pharmacist may see lots of people going in to get reliever medication, because that’s the only thing that works for their asthma. However, we know that what patients using their medication more than twice a week actually need is to engage with their GP about preventer medication that can manage the asthma.

“Certainly, the Asthma Foundation is very excited about these collaborative-type approaches, because it means people with asthma having access to people who can keep reinforcing key messages and better support them.”

GPs taking part in the pilot can claim the usual MBS benefits, and the enrolled patients will continue to cover their usual care and medication costs.

To be enrolled in the trial, patients must have established relationships with a general practice and a pharmacy, live in the community, have stable medications, no recent hospital admissions, and may not be pregnant or cognitively impaired.

Exclusion criteria also apply to each of the chronic illness categories.

AJP:  Doctors fire salvo over codiene deaths

 

The PSA and Guild have expressed disappointment after an RACGP spokesperson said OTC codeine is “out of control”

Royal Australian College of General Practitioners president Bastian Seidelsaid in a statement over the weekend that “codeine addiction has become a serious problem for our community”.

“The consumption of these medications is currently running out of control with over 16 million items being sold over the counter in pharmacies every year,” he said.

The Australian: Medical staff mental illness: getting help with no fear

 

An expert advisory committee will examine how regulatory bodies can seek to protect patient safety without discouraging health practitioners from taking steps to ensure they are mentally fit to practice.

At its latest meeting, the Council of Australian Governments Health Council discussed moves by several states to reconsider the mandatory nature of the notifications process that covers practitioners who may have an impairment.

Royal Australian College of General Practitioners president Bastian Seidelalso welcomes the progress, saying mandatory reporting is “driving issues underground and reducing, rather than increasing, patient safety”.

The Medical Republic: United push to reform mandatory reporting

 

Health ministers have agreed to work towards nationally consistent mandatory reporting rules to support health-seeking by doctors, especially in cases of mental health treatment.

In a breakthrough accord at the Council of Australian Governments (COAG) meeting in Brisbane on Friday, the ministers agreed that doctors should be able to seek treatment for health issues with confidentiality.

“A nationally consistent approach to mandatory reporting provisions will provide confidence to health practitioner that they can feel able to seek treatment for their own health conditions anywhere in Australia,” the ministers said in a communique.

However, a consensus among the states and territories is not a given.

At present, only Western Australia does not require a treating practitioner to report a colleague suffering from an impairment. The exemption was adopted in 2014, only after years of intensive lobbying by the AMA’s WA branch.

In other states, current rules deter doctors from help-seeking because of perception that it could ruin their careers.

AMA Federal President Dr Michael Gannon told The Medical Republic that NSW was understood to favour a tweaked version of the WA model, while Queensland was happy with the status quo and South Australia was uncertain.

“There is a possibility we will end up with a less than harmonised model,” he said.

The COAG ministers will reconvene in November to review proposals for amending the rules.  After a period of consultation, they will meet again early next year for to decide on amendments and invite national discussions.

Protecting the public from harm was of paramount importance, as was supporting practitioners to seek health and in particular mental health treatment as soon as possible, the OAG communique said.

Dr Gannon commended Federal Health Minister Greg Hunt and WA Health Minister Roger Cook for driving the issue.

“It has been acknowledged that there needs to be a change, that there’s a problem,” he said.

RACGP President Dr Bastian Seidel welcomed the COAG accord, saying College faculties had been lobbying their jurisdictions for the adoption of the WA model.

“GPs are the main treating doctors of all medical practitioners – and are currently required to report practitioners who seek help with a health condition that might affect their work,” Dr Seidel said.

Although well intentioned, mandatory reporting laws are having the opposite of what was intended, because doctors were not seeking the healthcare they needed for fear of being reported.

This is driving issues underground and reducing, rather than increasing, patient safety.

NSW Health Minister Brad Hazzard has been an outspoken advocate of change after the issue was linked to a string of suicides by junior doctors in his state earlier this year.

Victorian Health Minister Jill Hennessy has told The Medical Republic she was “very sympathetic” to the need for change.

“Every day doctors prioritise the health and wellbeing of their patients, so it’s only fair they get the same care when the tables are turned,” she said.

“Doctors are human. The pressures of the job are immense and we know there are higher rates of mental health issues and suicide among health practitioners. It makes it vital for us to ensure that everyone – including health practitioners – is able to access care when they need it.”

The Australian: ‘Disincentive’ stops medics seeking help

 

Doctors and other health workers have the highest suicide rate in Australia’s white-collar workforce, according to new data that will reignite the debate over how best to support those in need.

Data released to The Australian from the National Coronial Information System shows that between­ January 1, 2011, and December­ 31, 2014, there were 153 health professionals who died as a result of suicide.

Within the profession, that repre­sented a suicide rate of 0.03 per cent, lower than for some occupations but the highest among white-collar workers.

After several deaths, Royal Australian College of Genera­l Practitioners president Bastian Seidel said he was concerned that doctors with depression were not seeking help out of fear for their professional standing and career prospects.

The Australian: Rewards to reduce crush in hospitals

 

GPs would be paid to prevent chronically ill patients being hospitalised and hospitals fined for readmissions that could have been avoided, under a reform proposal considered so important that Health Minister Greg Hunt is willing to offer the states a ­10-year funding deal for their ­support.

Under the extraordinary proposal, described internally as the “third wave” of reform, the commonwealth would seek to tilt the health system towards paying for better outcomes, not just funding hospital treatment without regard to whether it could have been avoided.

Royal Australian College of General Practitioners president Bastian Seidel welcomed the move to tilt the system in favour of better outcomes, saying “our patients want health, they don’t necessarily want treatment”.

The West: New drug alert system to save addict lives

 

Lives will be saved by a new national system to instantly alert doctors and chemists when addicts stock up on prescription pain drugs, the federal health minister believes.

Greg Hunt on Friday announced $16 million to roll out the real-time prescription monitoring system over the next 18 months, amid calls for action by professional medical bodies and families who have lost loved ones to overdoses.

Royal Australian College of GPs president Bastian Seidel said real-time monitoring was already in place in Tasmania and had become a vital tool, urging other states to follow suit.

AJP: Docs want to ‘break the retail-medicine link’

 

The RACGP has slammed pharmacy professional services and complained that doctors saw no cash back from the risk share solution.

The group is urging the King Review panel to break what it sees as the “retail-medicine link” in community pharmacy, particularly in relation to complementary medicines.

“Our submission focuses on key areas including complementary medicines and homeopathy, breaking the retail-medicine link, the role of pharmacists and access to pharmacies for Aboriginal and Torres Strait Islander people,” says Dr Bastian Seidel, RACGP president.

The Medical Republic: Hunt pledges real-time prescription monitoring

 

Federal Health Minister Greg Hunt has promised to roll out national real-time prescription monitoring by next year and support a further expansion of pharmacists’ scope of practice.

Mr Hunt also pledged to dump a sunset clause on store location rules which protect pharmacies from undue competition, saying the sector needed certainty to stay viable.

The minister announced the commitments at the Pharmaceutical Society of Australia’s annual conference in Sydney today.

He said it was utterly unacceptable that 600 Australians a year died from the misuse of prescription drugs such as morphine.

“We will now move immediately to real-time monitoring.”

A system to track dispensing records across state borders would mean a pharmacist asked to fill an Endone script in Albury, for example,  could find out immediately if the patient had had the drug dispensed over the border in Wondonga an hour or a day before, he said.

“The fact that we don’t have that in Australia is a legacy and an error which we will address.”

He said the commonwealth would contribute $16 million to the scheme.

RACGP President Dr Bastian Seidel welcomed the commitment to real-time prescription monitoring, noting accidental overdoses of pharmaceutical prescription opioids now killed more Australians than heroin overdoses.

“GPs and pharmacists are on the front-line of this crisis and we desperately need a real-time tool to help us identify and support patients experiencing addiction to prescription drugs,” he said.

“Real time monitoring is already in place in Tasmania where I work as a GP. It’s a vital tool for me and every GP and pharmacist in our state.”

Mr Hunt also announced a move to have pharmacists take a proactive role in asthma management, following the success of pharmacy-based trials to detect and manage diabetes.

With more than two million Australians suffering some form of respiratory condition, in many cases it was the incorrect administration of asthma medications that was causing problems, he said.

“You are the front-line and we will develop the trial, supporting you, which I want to see to be fundamental to the next pharmacy agreement.

“We will work with the Willcock Institute, the society and the (Pharmacy) Guild to develop a major trial across the country to complement what ‘s been done with the diabetes trial.

“We want to translate that to asthma.”

Mr Hunt revealed a personal insight into the role of pharmacists, saying his grandmother, Phyllis Grant, had stressed to him the community aspect of her work as a pharmacist in country Victoria in the 1930s.

“Much has changed since the 1930s, but the fundamentals are the same.  You are still the front-line of  services along with GPs.”

Going forward, he spoke of a vision for an expanded role for pharmacists “as medicines providers, as community leaders and primary carers”.

The minister said the “compacts” he signed with the PSA and other peak health groups, including the RACGP, had created a “strong basis of trust for going ahead”.

The threat that the pharmacy location rules could be taken away was affecting the viability of pharmacies, he said.

In his keynote address, PSA President Dr Shane Jackson said he wanted to banish the description of pharmacists as the “most under-utilised” health professionals.

He flagged a 10-year action plan to deliver expanded  roles for pharmacists in professional services.

Australian Doctor: No need to revamp GP training, says College

 

The RACGP has poured cold water on suggestions that GP supervision needs revamping following claims that registrars may be “over-ordering” pathology tests.

The study, published in the Medical Journal of Australia, found that registrars increased their rate of pathology ordering by 11% for each of the four GP training terms.

The authors noted that registrars had a “large degree of clinical independence” and perhaps they needed greater access to supervisor advice in the later stages of their training.

“As seeking in-consultation information or advice is associated with lower rates of ordering, structural changes to the supervisory model … may be indicated,” they concluded.

But RACGP president Dr Bastian Seidel said GP training was “designed to decrease direct supervision as the registrar increases competency and confidence”.

“They are the first point of specialist contact for the patient and take on the responsibility of undifferentiated diagnosis.

“So given these increasing levels of autonomy, it is hardly surprising that the ordering of tests increases.”

Dr Seidel said the level of supervision in the latter terms was appropriate based on “a very low level of patient complaints and supervisor reports”.

General Practice Registrars Australia president Dr Melanie Smith agreed, saying registrars had adequate access to supervisor advice when required.

“Supervision depends on the accessibility of the supervisor, especially with corridor advice … and GP registrars are perhaps transitioning to how a fellow GP will seek advice from their peers and seniors,” she said.

The higher rates of pathology testing found in the study might also reflect the registrars’ patient cohort, she said.

“Registrars are often seeing new patients to the practice with new presentations. It is not unexpected that they may be ordering more tests than their supervisors who are seeing patients that they’ve known for 20 years.

“There may also be an increased awareness of what testing is available. There may be tests that they are ordering later on which they didn’t know or didn’t understand earlier in their training.”

The Medical Republic: AMA warns after-hours crackdown may backfire

 

The AMA says a proposed crackdown on urgent MBS claims by home-doctor services could backfire on “genuine” GP deputising services and imperil critical after-hours patient care.

The MBS Review Taskforce in June said the soaring growth in urgent claims for after-hours home visits did not reflect clinical need and could be solved by changing workforce rules.

In a preliminary report, the taskforce said use of the four urgent item numbers (597, 598, 599, 600) should be restricted to GPs in regular daytime practice who are called out for an urgent patient assessment.

Specifically, it recommends a business established to routinely provide care in the after-hours period (including a medical deputising service) should be permitted to claim only on non-urgent items for after-hours calls.

The AMA says those curbs are a step too far.

It says there should be a place for a “collaborative” model, including services that operate exclusively after hours, to complement the care provided by a patient’s regular GP or through their regular general practice.

In their current form, the recommendations “will potentially undermine the viability of genuine medical deputising services and significantly impact on access to care for patients”, the submission says. “While we agree that there is scope for some MBS savings through the better targeting of funding for urgent after-hours GP services, the extent of the likely financial impact of the taskforce’s approach is significant and this is not recognised or well addressed in its report.”

The AMA submission urges more work to explore different funding arrangements for “genuine” medical deputising services linked to general practice.

These could include a revised MBS item number structure for deputising doctors or, as suggested by the 2014 Jackson Review of After-Hours Services, the adoption of a blended funding model.

The taskforce’s interim report fails to strike the necessary balance between infrastructure and activity-based funding for a sector with unpredictable and uneven service demand, as recommended by the Jackson Review, the AMA submission says.

The AMA also appears to leave the door open to wider participation by doctors in after-hours calls, a field that has attracted many emergency and hospital clinicians.

As reflected in the taskforce report, the RACGP has been adamant that after-hours deputisers should be restricted to using vocationally registered GPs and GP registrars under supervision.

RACGP President Bastian Seidel said earlier this year that patient care could be compromised by junior doctors performing after-hours work.

But the AMA says only that the deputising services should have access to, and utilise, an “appropriately skilled workforce”.

While the taskforce has been limited by its terms of reference to a review of existing MBS item numbers, the AMA urges that a broader package of reforms is required to ensure high quality and appropriately targeted services.

The reforms should include:

  • MDS workforce skills, training and supervision;
  • MDS accreditation arrangements;
  • Patient triage processes;
  • Direct-to-consumer advertising; and
  • The necessary link between an MDS and a patient’s usual GP or regular general practice.

The taskforce investigated use of urgent after-hours item numbers in response to doctors’ concerns and Medicare data showing the number and cost of home visits was far in excess of population growth.

In the five years to 2015-16, the number of “urgent” after-hours MBS services, grew by 150% to more than 1.87 million a year, while standard GP services grew 15%.

The AMA response also emphasises that any savings from after-hours reforms should be re-invested in general practice, calling attention to significant funding pressures on GPs.

Sky News: Govt must stem flow of foreign doctors

 

Doctors are urging the federal government to stem the flow of overseas-trained doctors, arguing many are being sent to rural communities without the skills needed to care for patients.

The Royal Australian College of General Practitioners says many of the doctors working in rural and regional Australia do not have the appropriate skills, qualifications or support.

Dr Seidel says Australia should stop spending money attracting overseas-trained doctors and focus on training local graduates to care for rural patients, who are typically older and have more chronic conditions such as heart disease.

Australian Doctor: Plan to give patients more power over referrals

 

Patients will be encouraged to shop around for a different specialist to the one named in their GP referral, under a push to boost healthcare competition.

The idea — strongly condemned by the RACGP — is one of several presented in a draft Productivity Commission report exploring ways inject greater user choice by weakening existing referral networks.

The report says patients should be given greater scope to “independently choose” a public outpatient clinic or private specialist “after leaving the GP’s office”.

“This would give patients the opportunity to do their own research, consider their options and perhaps consult family and friends before making a decision.”

Under the Health Insurance Regulations 1975, which details the conditions under which specialist referrals qualify for Medicare payments, GPs are not required to name a particular clinic or specialist on a referral.

The rules also allow any doctor in the relevant speciality to accept a referral, regardless of whether they are named on the referral.

The commission claims these rules are poorly understood by doctors and should be amended to clarify that patients can choose their own private specialist after receiving a referral and advice from their GP.

“This could increase competition among private specialists, by reducing the importance of established referral networks,“ it states.

“There are risks to greater choice, but their likelihood is low.”

But the RACGP says the plan compromises the GP’s duty of care, especially if the patient chooses their own specialist without informing their GP.

Patients do not necessarily have the required health literacy to choose an appropriate specialist, the college wrote in its submission to the commission.

“Without the knowledge of specialists’ roles, patients may choose the wrong subspecialty for their condition. This will result in waste of patient and practitioner time, as well as health resources.”

GPs already support patient choice by discussing referrals in consultations based on their medical expertise and strong working relationships with other specialists, RACGP president Bastian Seidel said.

“Completely removing the ability for the GP to nominate a particular medical specialist would reduce the opportunity for a patient to benefit from these existing relationships.”

Dr Seidel also said referral letters could be adjusted to include a named medical specialist “or appropriate alternative provider” so patients had the option of changing specialists.

“There is no evidence the proposed change is necessary or that it addresses an existing problem,” the RACGP said.

“The RACGP cautions the Productivity Commission about the unintended consequences of promoting patient choice at the expense of appropriate use of health resources.”

The final Productivity Commission report is expected to be published in October.

Doctor Portal: Are GP registrars ordering too many pathology tests? 

 

Concerns have been raised about GP registrars’ potential over-use of pathology tests, as new research shows that registrars request increasingly more tests as they progress through their training.

Conjoint Professor Parker Magin of the Discipline of General Practice at the University of Newcastle and colleagues analysed the number of pathology tests ordered by GP registrars during their first 18–24 months of clinical general practice. They used data from 876 registrars involving 114 584 consultations from the multicentre cohort study, Registrar Clinical Encounters in Training conducted in 2010-2014.

Royal Australian College of General Practitioners president Dr Bastian Seidel said that the study’s findings needed to be put in the context of complex general practice, where the end goal was not necessarily a reduction in pathology testing but improving the health outcomes of patients through evidence-based medicine.

The Mercury: ‘Rudeness’ denies sick Tasmanians chance to see a doctor

 

An estimated 3000 sick Tasmanians a month are being denied prompt appointments at their doctor because patient no-shows are failing to notify clinics of their cancellation.

The Huon Valley Health Centre, south of Hobart, has even taken the step of tallying the failed patient cancellations on a whiteboard in its waiting room, showing 169 such cases in four months to May.

Mr Hancock said tallying the figures on the whiteboard in the clinic’s waiting room, the idea of Royal Australian College of General Practitioners president Bastian Seidel, a doctor at the Huonville practice, had surprised many patients.

Doctor Portal: Call to curb antibiotic prescribing for respiratory infections

 

New measures are needed to curb antibiotic prescribing rates, say experts, after researchers reported that GPs were prescribing the drugs for acute respiratory infections ( at four to nine times the recommended rate.

In research published in the MJA, it was estimated that 5.97 million ARI cases in general practice were managed annually with at least one antibiotic, far exceeding the 0.65–1.36 million prescriptions recommended by the Therapeutic Guidelines.

The authors compared general practice activity data over 5 years, from 2010 to 2015 – sourced from the Bettering the Evaluation and Care of Health program – with the estimated prescribing rates recommended by Therapeutic Guidelines.

Royal Australian College of General Practitioners president Dr Bastian Seidel said the MJA research showed antibiotics were still being overprescribed in general practice, but he noted that the data included delayed or “wait-and-see” prescriptions that may never have been dispensed.

The Australian: Medicare’s 45,000 daily hits under scrutiny

 

The federal government will launch a high-powered inquiry into Medicare security to review the way doctors check up to 45,000 records every day, after a damaging privacy breach sparked fears about the sale of personal data to criminals.

The Health Professionals Online Services web portal is used about 45,000 times every day to check details when patients offer their name and date of birth, ensuring they are not turned away because they do not have their card.

Dr Shergold, who was the head of the Department of Prime Minister and Cabinet when John Howard was prime minister, will conduct the review with Australian Medical Association president Michael Gannon and Royal Australian College of General Practitioners president Bastian Seidel.

The Sydney Morning Herald: Australian GPs prescribing antibiotics at up to nine times recommended rates, study finds

 

Australian GPs are prescribing antibiotics at up to nine times recommended rates, a new study has found, in a trend that could see the emergence of deadly superbugs and put common medical procedures at risk.

Antibiotic resistance could also undermine the basics of modern medicine, by making it dangerous to perform chemotherapy and major surgeries such as caesareans and hip replacements.

“We need to take action now if we don’t want this to be a complete disaster in the decades to come,” Royal Australian College of General Practitioners president Bastian Seidel said.

Australian Doctor: RACGP warns against ‘one size fits all’ rural generalism after Parliament vote 

 

The RACGP is warning against “one size fits all” approach to creating a new generation of rural generalists after Parliament voted to establish a Rural Health Commissioner tasked with creating a national training pathway.

The legislation to create the position passed both houses on Wednesday, making good on a promise the Coalition took to the 2016 election.

Increasing the numbers of rural generalists — usually seen as GPs with additional training in areas like obstetrics, emergency medicine and surgery — is being sold as one way to fix the rural health workforce shortage.

But the vexed questions of who should be called a rural generalist, where they should work and how they should be trained have long been bones of contention between the RACGP and ACRRM.

The RACGP is nervous about anything that creates national standards based on the rural generalist program in Queensland, where doctors get hefty pay packets and secure hospital credentialing, but allegedly have limited focus on GP care.

RACGP rural chair Dr Ayman Shenouda said: “A rural generalist is a rural GP working to the full scope of their practice with skill sets informed by the needs of the community they serve.

“While we support a national generalist pathway, we also acknowledge that states and territories need flexibility within this and the pathway can’t be one size fits all.”

ACRRM president Professor Ruth Stewart said the first job of the rural health commissioner would be creating a national rural generalist program, replacing the hodgepodge of programs created around the country, where hospital doctors, obstetrics specialists, and private GPs all worked under the title of “rural generalist” despite having little in common.

“Each jurisdiction has different priorities and a national program will need some flexibility, but the curriculum and the level of support that rural doctors receive would need to be consistent across the nation,” she said.

She is calling for a single national pathway based on the ‘Cairns Consensus’ which is seen as heavily influence by the Queensland program. Significantly, the RACGP has consistently refused to back the summit’s recommendations.

“It is fairly obvious that ACRRM and the RDAA are committed to the consensus definition of rural generalism and it seems that the RACGP has a dissenting view,” said Professor Stewart.

“The new commissioner will need to broker that space.”

The Medical Republic: Rural commissioner needs to be a doctor

 

The federal government will soon invite applications for the new post of National Rural Health Commissioner to fix inequities in health outcomes and health workforce shortages in the bush.

After the Senate passed enabling legislation on Wednesday night, doctors groups stressed the need to have one of their own in the inaugural role.

Dr Ewen McPhee, president of the Rural Doctors Association of Australia, said the commissioner could bring “significant, positive reforms” in rural health.

“He or she will play a particularly important role in rebalancing the maldistribution of doctors and other health professionals between urban and rural Australia,” he said.

The second major priority would be in implementing the government’s promised National Rural Generalist Pathway, to help to deliver the next generation of doctors with advanced skills to rural and remote communities, he said.

RACGP president Dr Bastian Seidel said the new commissioner should be a GP who championed the cause of rural general practice.

“The RACGP believes this role should go to an experienced rural GP with a good understanding of national rural workforce issues,” Dr Seidel said.

This person must also understand and promote the benefits that digital health can bring to rural communities and promote participation in the rural health workforce across medical specialties and allied health, he said.

ACRRM President Dr Ruth Stewart said the new role would help bring along states that were lagging behind in the development of versatile rural doctors who were prepared to make careers in rural and remote Australia.

“Queensland’s rural generalist program has 10 years of data showing 85% of graduates continue to work in rural and remote areas,” she told The Medical Republic.

Dr McPhee said the rural doctors movement would also help the development of other strategies to build the rural health workforce, not only for doctors but also for nursing and allied health.

“Additionally, this role will play a crucial role in the wider challenges facing rural healthcare, including improving health outcomes for Aboriginal and Torres Strait Islander people and boosting mental healthcare access in the bush,” Dr McPhee said.

The government has budgeted $4.4 million to establish the new commissioner, who will have a brief to work with communities, the health sector, universities, specialist training colleges and all levels of government to champion the cause of rural practice.

“The very first task of the commissioner will be to develop a National Rural Generalist Pathway, to improve access to training for doctors in regional, rural and remote Australia,” Assistant Health Minister Dr David Gillespie said, outlining the statutory position in February.

“Appropriate remuneration for rural generalists, recognising their extra skills and longer working hours, will also be under consideration,” he said.

Croakey: Training and access must be major priorities for Australia’s new rural health tsar

 

Reducing cost of living pressures for Australians living outside the major cities and improving training pathways for rural generalists ought to be major priorities for the new National Rural Health Commissioner, the RACGP urged Thursday following passage of the legislation.

“More than 30 per cent of Australians live and work in rural Australia yet rural Australians receive far less than 30 per cent of health funding,” said RACGP President Dr Bastian Seidel.

ABC Lateline: Lateline goes inside Australia’s first legal cannabis growing facility

 

With oversight from the Therapeutic Goods Administration now gone, the College of GPs is warning its doctors not to import medicinal cannabis from overseas.

“The risk would be solely with the GP or the medical practitioner and it’s a significant risk.” said Dr Bastian Seidel, RACGP President,

“If something goes wrong with the patient, with the medication, it’s the GP, the medical practitioner who is solely responsible for this.

“Now this can’t be in the best interests of our medical profession. It can’t be in the best interests of our patients and it can’t be in the interests of the community at large.”

Australian Doctor: What the Senate’s cannabis vote means for GPs

 

Terminally ill patients will gain easier access to medical cannabis products following a Senate vote to relax TGA restrictions on the product.

How has this come about?

A motion raised by Greens Senator Dr Richard di Natale and passed on Tuesday 13 June allows medical cannabis to be prescribed for people with a terminal illness under category A of the Special Access Scheme rather than category B.

The Greens motion also allows patients to personally import up to three months’ supply of medical cannabis products into Australia.

What does this mean for GPs and patients?

Under category A, GPs will no longer need to obtain TGA approval to prescribe medical cannabis, and instead only need to inform the TGA about a prescription within 28 days.

According to the Greens, this means patients with terminal illness will no longer need to wait weeks or even months to access to medical cannabis, and their wait time should be cut to less than a day, as for a prescription for any other pain medication.

How does the scheme work?

The Special Access Scheme Category B process requires the GP to fill out paperwork nominating the product to be used and show evidence the patient has tried all other treatments without success or has endured intolerable side effects.

The application must then be approved by the TGA, and every application is done on a case-by-case basis.

Under the Category A process, doctors do not require the approval of the TGA to directly supply medical cannabis products to patients “who are seriously ill with a condition from which death is reasonably likely to occur within a matter of months, or from which premature death is reasonably likely to occur in the absence of early treatment”.

Doctors must sign a Category A form, which they send to the supplier of the medical cannabis products and to the TGA for proof of legal authority.

What’s the catch?

Access to medical cannabis products will still be restricted in most states and territories by state-based regulations over the supply and prescribing of S8 cannabinoid products.

The makers of medical cannabis products are urging states to adopt the South Australian model, which treats medical cannabis in the same way as other S8 medications.

How have medical groups reacted?

The RACGP has expressed concern about the changes, saying there is not enough evidence for the efficacy and safety of medical cannabis to justify instant access.

“This change undermines the reporting and monitoring processes to the detriment of patients and their doctors,” says RACGP president Dr Bastian Seidel.

“The current TGA application process features a turnaround time of 2 days. This is a strong model that guides GPs and ensures safety for patients.

“This efficient, tested and appropriate process has now been undermined by political point scoring … [it] means the risk of prescribing now lies solely with the medical practitioner.”

The AMA has also expressed disappointment at the move, saying it creates a double standard in regulation for medical cannabis vs other therapeutic products.

“The Australian community would be outraged if prescription medication was rushed in, if someone said that it was okay to use,” says president Dr Michael Gannon.

“The Australian people would be outraged if new operations got brought in or, for that matter, new foodstuffs were brought in without appropriate care and safety.

“Why would we possibly have a different rule when it comes to cannabis?

“We can’t put the cart in front of the horse; the TGA’s got a process in place, let’s support that careful process to make sure what is used is perfectly safe,” he says.

How have politicians responded?

Federal Minister for Health Greg Hunt has called it a “reckless and irresponsible decision” and said the vote was done in defiance of advice from medical and regulatory bodies and was inconsistent with the views of Palliative Care Australia.

However, Shadow Health Minister Catherine King said it was “a win for dying Australians”, who struggle to access medical cannabis for pain relief.

Tasmanian Senator Jacqui Lambie said it was a vote “to see terminally ill people be treated with dignity and respect”.

What is the background to this change?

When medical cannabis was legalised in November 2016, former health minister Sussan Ley amended the TGA regulations to disallow it from being prescribed through the Category A process.

The rationale was that there was a need for clinical oversight from the TGA for medical cannabis that would not be available under the Category A process.

However, patient groups claimed the changes unfairly denied terminally ill patients the right to access medical cannabis products that could ease their pain or chemotherapy-induced nausea symptoms.

On 11 May 2017, the Greens introduced a motion in the Senate to make two changes to the Therapeutic Goods and Other Legislation Amendment (Narcotic Drugs) Regulation 2016.

The motion was voted down with the support of Pauline Hanson’s One Nation senators.

However, following an outcry from patients, the motion was revived and successfully passed with the support of One Nation and Senator Lambie on 13 June.

The West: Senate scraps rules on medicinal cannabis

 

Terminally-ill patients waiting months to access medicinal cannabis could have that slashed to just hours after a backflip by crossbench senators.

The Greens have succeeded in scrapping rules which made it harder for dying patients to access medical cannabis after a failed attempt in May.

Doctors warn the move will undermine the existing, safe process for the sake of political point-scoring.

“When it comes to medicinal cannabis we need to keep politics needs out of healthcare,” Royal Australian College of GPs president Bastian Seidel said.

“This change undermines the reporting and monitoring processes to the detriment of patients and their doctors.”

Nine News: Senate scraps rules on medicinal cannabis

 

Terminally-ill patients waiting months to access medicinal cannabis could have that slashed to just hours after a backflip by crossbench senators.

The Greens have succeeded in scrapping rules which made it harder for dying patients to access medical cannabis after a failed attempt in May.

Doctors warn the move will undermine the existing, safe process for the sake of political point-scoring.

“When it comes to medicinal cannabis we need to keep politics needs out of healthcare,” Royal Australian College of GPs president Bastian Seidel said.

“This change undermines the reporting and monitoring processes to the detriment of patients and their doctors.

The Daily Telegraph: Why queues at hospital emergency departments are about to surge

 

Hospital emergency departments could be flooded with one million extra patients if Medicare rebates for after-hours GP care are cut, doctors have warned.

An after-hours care provider says bulk billing of the service could end and patients could face a $25-$30 fee when a doctor visits the home.

And consumer and carer groups say parents with young families, the elderly and chronically ill will face greater difficulties getting the in home medical care they need.

However the Royal Australian College of General Practitioners is backing the pay cut for doctors and says the increasing use of after hours doctors is interfering with the continuity of care by a patient’s regular GP.

Lithgow Mercury: Home doctor services deemed ‘poor value for money’

 

Home doctor services that provide after-hours visits face stricter conditions on their Medicare billing practices after a government review found they did not represent value for money to the taxpayer.

As part of a broader review of Medicare items, the Medicare Benefits Schedule Review Taskforce examined after-hours services in response to concerns they were increasing far in excess of population growth.

The Royal Australian College of General Practitioners president Bastian Seidel said it was appropriate that only GPs who normally worked during the day were eligible for the higher rebate.

“This would deliver better outcomes for patients because the healthcare provided would be based on the GP’s deeper knowledge of the patient’s circumstances, better access to their health records and better follow-up to ensure continuity of care,” Dr Seidel said.

ABC News: Crackdown on ‘urgent’ after-hours doctor visits recommended by Federal Government taskforce

 

Medical groups have largely welcomed a shake up of after-hours doctor visits recommended by the Federal Government’s Medicare Benefits Schedule Review Taskforce.

Under the proposed changes, Medicare rebates would continue for home visits and after-hour visits provided by general practitioners or after-hours doctors services.

Royal Australian College of General Practitioners president Dr Bastian Seidel said the report was a positive step towards better supporting continuity of care between patients and their regular GPs.

Australian Doctor:  Make ‘urgent’ after-hours items GP-only, says MBS review

 

Medical deputisers should be banned from claiming lucrative “urgent” after-hours items, according to a long-awaited report from the group tasked with overhauling the MBS.

The recommendation by the MBS Review Taskforce’s after-hours working group is just one of several outlined in its draft report which could transform the deputising industry.

GPs and other medical practitioners who normally work in-hours but are providing urgent after-hours services should still be able to claim the 597-600 items, which attract fees of up to $153 for attendances in “unsociable” hours, the report says.

But in an attempt to curtail the boom in corporate after-hours services, doctors working for deputising services would be limited to billing Medicare for non-urgent consults, such as item 5023.

It means these after-hours doctors would be able to claim maximum Medicare rebates of $74.95 for home visits and $49 for attendances in a doctor’s rooms.

In the five years to June 2016, the number of urgent after-hours MBS services has increased by 150%, from 734,000 to 1,869,000 per financial year.

That rise, the taskforce argues, has been driven by direct marketing to patients and no out-of-pocket fees rather than clinical need.

“It appears that major drivers of the growth in urgent after-hours services are convenience and because they are free at the point of care – 99% services bulk-billed,” the taskforce notes.

“Recent marketing and campaigns by after-hours medical deputising service providers across Australia targeted at consumers often emphasise these two factors—convenience and no cost to the consumer.”

The report also criticises the deputising industry for the high rate of dubious urgent claims.

“Many urgent after-hours services claimed as urgent are not truly urgent, as intended when the items were created, and the distinction between ‘urgent’ and ‘non-urgent’ appears to be not well understood by many medical practitioners.”

The taskforce also condemns the business tactics of some after-hours corporates and calls for the Federal Government to ban booking “urgent” calls in the two hours before deputising services come on call.

“Urgent after-hours GP services should only be provided in genuinely urgent situations,” the report says.

However GPs claiming urgent items would be affected by the revamp. The taskforce says that the Medicare item descriptors should be rewritten to provide a clearer definition of what is considered “urgent”.

Under the expanded definition put forward by the taskforce, only patients whose assessment cannot be delayed until the next in-hours period would be able to claim the “urgent” items.

RACGP president Dr Bastian Seidel has praised the taskforce’s recommendations, which will now go out for further consultation.

“This would deliver better outcomes for patients because the healthcare provided would be based on the GP’s deeper knowledge of the patient’s circumstances, better access to their health records and better follow-up to ensure continuity of care,” he says.

But the after-hours sector is already gearing up for a fight.

The National Association for Medical Deputising Services (NAMDS), the peak industry body, warns that any rebate cuts will result in a “flood” of new emergency department visits.

NAMDS president Dr Spiro Doukakis says the inevitable result will be a repeat of the 1996 emergency department crisis that inspired the expansion of after-hours services in the first place.

“A cut to Medicare after-hours home visits would result in rolling service closures across the country leaving people with no alternative but to visit an emergency department.

“This would mean emergency departments would be flooded with new patients putting people with genuine emergencies at risk.”

However the taskforce says in its report that it is “not convinced” that the growth in after-hours services had reduced pressure on hospital emergency departments.

A final report will be released later this year after considering stakeholder feedback. The Federal Government will then consider what action, if any, should be taken.

Daily Telegraph: GPs continue to absorb gap in Medicare payments

 

Local GPs are absorbing the rising cost of Medicare just so they don’t have to charge patients.

But the problem with the Liberal Government’s Medicare freeze for another 12 months is reaching the pointy end. One GP said if it continued he’d have to start charging people who were already reluctant to visit their GP.

Royal Australian College of General Practitioners president Bastian Seidelsaid Australia’s health system was too hospital centric.

“While hospitals in Australia are of the highest standard they are extraordinarily expensive to run,” Dr Seidel said.

ABC News: How do you choose a good GP?

 

The right GP can make a big difference to how healthy you are and may ultimately save your life.

As well as diagnosing illness, a good GP can draw your attention to problems you never knew mattered, decide if you need certain tests, refer you to the right specialists, monitor your progress, offer reassurance or advice, and keep you out of hospital or limit the care you need there.

President of the RACGP, Dr Bastian Seidel, said looking out for that qualification in your doctor ensures they’re up-to-date with the latest developments in general practice.

Pearls and Irritations: Patients want health not necessarily treatment

 

Achieving recognition of general practitioners as medical specialists in our own right has been an uphill battle  for decades. We only achieved vocational recognition as specialists in the 1990s.

For many years we were seen as #JustaGP, a term that symbolises the academic and professional discrimination our members are still subjected to today.

Australian Financial Review: Doctors searching for more optimal results

 

When general practitioner Linda Mann needs to refer someone for elective surgery, she relies on the experience of colleagues and patient feedback rather than data.

“If they elect public, I need to know whether this week the local health area is only taking people in their geography or whether they are being a bit more generous,” she says. “I don’t give them information about waiting times because that is not something that I am privy to.”

Dr Bastian Seidel, who is based at Huon Valley Health Centre south-west of Hobart, has access to only one hospital for patients who want to see a public hospital specialist.

“There is a high through-put of medical doctors there, so even if I referred to a named consultant it doesn’t mean that named consultant is still there in three months’ time,” he says.

“If you then say patients will be given a choice, well, you know the next choice is for this patient to fly interstate and often that is not an option.”

The Medical Republic: What can doctors actually do about climate change, really?

 

It was about 4pm when the weather changed. Thunderclouds rolled into Melbourne and strong northerly winds shook the rye grass pastures ringing the city, sweeping pollen into the air.

On the evening of 21 November 2016, people who had never previously experienced asthma symptoms developed severe respiratory distress.

Ambulance calls increased by 20-fold. There were 8,500 asthma presentations over the next 13 hours. In terms of health impact, this was the worst thunderstorm asthma incident to be recorded internationally.

“No one saw this coming,” Dr Stephen Parnis, a consultant emergency physician, told the Doctors for the Environment conference in Melbourne last month. While the emergency response was admirable, Victoria was underprepared for an asthma outbreak on this scale.

Pollen levels were not being monitored closely and there was a 13-hour delay in the state emergency response mechanisms, Dr Parnis said.

“I don’t have the evidence to say that this is directly related to climate change,” he said.

“[But] climate-related disasters are increasing in frequency and impact. There is no doubt about that. We can’t prevent climate change. It’s here.”

While a single weather event cannot be attributed to anthropogenic global warming, the increase in weather extremes has been linked to higher carbon dioxide levels in the atmosphere.

“It’s obviously an extremely large change to be having [weather] events that probably came along once every 30 years happening every summer, or more than once a summer,” Dr Karl Braganza, the Bureau of Meteorology’s manager of climate monitoring, said.

The current spike in atmospheric carbon dioxide concentrations – which hit 410 parts per million in April – is the largest rate of change in around 50 million years.

“These events are generally associated with planetary outgassing events or asteroid strikes,” Dr Braganza said. “So what we are really doing, as humans, is mechanically replicating that process.”

Analysis shows that human activity has increased the risk of experiencing extreme heat in Australia by up to three-fold. And around 50% of the record heat anomaly of October 2015 could be attributed to increasing carbon dioxide levels, one study estimated.

“Heatwaves are the most lethal of the natural disasters,” Dr Parnis said. “They are also the most insidious. They don’t have the drama factor that [other natural disasters] have, but they kill far and away more people and cause major morbidity.”

During Melbourne’s 2009 heatwaves, ambulance callouts increased 46% and 374 heat-related deaths were recorded. Subsequent bushfires on Black Saturday killed 173 people and destroyed 2,133 houses.

Climate change is believed to have contributed significantly to recent droughts, coastal flooding, extreme rainfall, bushfires and heatwaves around the globe.

And with warmer, wetter climates the incidence of mosquito-borne diseases such as dengue fever, as well as water and food-borne diseases, is expected to rise.

“Ross River fever is now able to be contracted in suburban Melbourne,” Dr Parnis said. “Not that long ago it was confined to northern Victoria. There is no doubt in my mind that increased humidity and the change in the climate is contributing to that.”

In the light of this evidence, many doctors, among others, argue the threat climate change poses to public health can no longer be ignored. But can doctor advocacy really make a difference?

Data: National Oceanic and Atmospheric Administration. Some description adapted from the Scripps CO2 Program website, “Keeling Curve Lessons.”

YES, WE CAN

Despite climate change being a grave environmental and humanitarian issue, it is often seemingly shuffled to the back of the political agenda.

Either the science is too complex, or the threats too remote, to provoke urgent action.

This is where doctors can really help, says Dr Maria Neira, director of the Department of Public Health, Environmental and Social Determinants of Health at WHO.

Having doctors drawing attention to the health impacts of climate change could be very powerful because, by doing so, a complicated piece of science could be reduced to an immediately relatable and visceral problem that people actually cared about, she told the conference.

“In my opinion, if we have been able to change a little bit the attention [directed towards climate change] it is because we started to talk about air pollution,” she said.

WHO estimates that air pollution kills around 6.5 million people each year from ischaemic heart disease, stroke, chronic obstructive pulmonary disease, acute respiratory infection and lung cancer.  Australians fare better than those living in the smog-clogged cities of China and India, but long-term exposure to air pollution still accounts for 1.5% of all deaths in Australia.

WHO argues that reducing the particulate matter from power plants and vehicle emissions can significantly cut premature air pollution-related deaths, while also reducing warming.

“The day we made that link, people started to click,” Dr Neira said.

“It was magic. Because people see it. Ask the people living in Beijing. They understand very well the connection between air pollution and their health. Maybe they don’t have a scientific explanation, but they feel it. They know it’s not good for their lungs.”

Doctors can act as a conduit for these ideas, Helen Szoke, the CEO of Oxfam Australia, says.

“The general community see the medical profession as evidence-based. And the evidence is pretty compelling in terms of climate change being one of the biggest barriers to people actually realising a truly healthy life,” she said.

“That should be what is driving the medical profession to take some activism here.”

Assisting humanity was part of the mission that people signed up for when they chose to become a doctor, Szoke said.

Dr Neira argues that doctors “have the right to be influential”.

“[The health sector] needs to be able to influence urban planners, energy sectors, transport sectors – whoever will have a decision that will impact the health of our people.  There are no limits on public health,” Dr Neira said.

“Human beings have really become a force of nature.” – Grant Blashki, a GP and associate professor at The University of Melbourne, speaking at the Doctors for the Environment conference in Melbourne.

NUTS AND BOLTS

If doctors are to weigh in on the climate change debate effectively, they must leverage their unique relationship with government in a smart and organised way. But are conservative elements within doctors’ associations holding this back?

A general consensus from the medical associations panel at the conference thought yes.

“There’s this idea that colleges are there to do the same thing they’ve done for the last 25 years,” Dr Simon Judkins, the president-elect of Australasian College for Emergency Medicine (ACEM), said.

“We need to look at how we can reinvent the role of colleges.”

Conservative ideas had prevented medical associations from banding together to form a united front on climate change, Dr Judkins said.

“We haven’t been as prepared to – for want of a better term – piss people off and make this (climate change) a number one priority.”

Although the AMA, ACEM and RACP each have position statements on climate change, there is resistance to environmental activism within
each organisation.

For example, AMA President Dr Michael Gannon recently appeared to contradict that association’s own climate-change policy. Speaking with The Guardian media group, Dr Gannon said he was not convinced that closing the Hazelwood power plant in Victoria’s Latrobe Valley in March was the right call, arguing the health impacts of unemployment in the community also needed to be considered.

The brown coal used for power production at Hazelwood has been linked to a significant burden of cardiovascular, respiratory and neurological diseases, as well as lung cancers, according to the Climate and Health Alliance.

And AMA policy states that active transition from fossil fuels to renewable energy sources should be considered to mitigate the negative effects of air pollution on health. Dr Parnis, who led the review of the AMA policy on climate change in 2015, said he was “quite taken aback” by the remarks, saying  they were a “wilful distortion of the AMA policy”.

“There is no doubt that the health impact on the people in the Latrobe Valley has been a difficult one over decades. When you are the loudest medical voice in the country, you have an obligation to respect the evidence,” Dr Parnis said.

The RACGP, on the other hand, does not have an official policy position on climate change and that situation is unlikely to change, according to President Dr Bastian Seidel.

“I wish I could give you a good news story but I can’t,” he said. “Climate change is not a top priority within the RACGP, which is a shame. We are just fighting for survival to get funding.”

Ideally, the Council of Presidents of Medical Colleges would place climate change on the agenda in meetings with the Minister of Health, Dr Seidel said.

“The general community see the medical profession as evidence-based. And the evidence is pretty compelling in terms of climate change being one of the biggest barriers to people actually realising a truly healthy life.”

The message doctors conveyed to politicians must be carefully crafted, Alessandro Demaio, a medical officer at WHO, told the conference.

“People don’t want to hear about the problems, they want to hear about the solutions,” he said.

Lobbying efforts from doctors needed to match those coming from big business, he said.

“Another strategy to broaden support base for climate action is to show how climate-change solutions might tackle lifestyle diseases, including obesity and diabetes,”  Demaio said.

“A low-carbon city is a low-cardiovascular disease city, it’s a low-obesity city,” he said. “A low-carbon food system is a low-obesity food system.”

Climate change and health issues often overlapped, with the greatest burden falling on the world’s poorest, Demaio said.

“If you put a heat map of the fastest-rising rates of child obesity and climate change on top of each other, they align in the world’s most vulnerable populations – lower, middle-income countries that have literally just pulled themselves out of poverty.

“And we risk doing a huge amount of human damage if we don’t get both of these issues right very soon. Why not work together?”

REAL CHANGE

Money often speaks louder than words, and health industry divestment in fossil fuel would send a clear message about climate change, Pablo Brait, a campaigner at carbon divestment group Market Forces, told the conference.

And while there was force in numbers, doctors should not underestimate the difference one person could make, he said.

Health insurer HCF’s decision to become the first Australian insurer to divest its fossil fuel investments was largely due to a single member inquiring about the company’s strategy. A letter sent by HCF to this member was then circulated by Market Forces, putting pressure on the company to act.

In announcing the decision, HCF said it would not keep funding activities that could threaten the health of its 1.5 million members. Fossil fuel investments comprised around 1% of its $1.39 billion investment business.

Market Forces is now turning its attention to Medibank, Australia’s largest health insurer, as well as BUPA and NIB.

On 22 May, Market Forces presented the case for divestment to Medibank at a meeting with the company’s Chief Medical Officer, along with a delegation from Doctors for the Environment Australia, Australian Medical Students Association, Victorian Allied Health Professionals Association, and Healthy Futures.

“Our main argument is that it makes no sense for a company whose interest is in keeping the population healthy, to be invested in the industries driving the ‘biggest global health threat of the 21st century’, according to The Lancet,” Mr Brait told TMR.

According to the Australian Prudential Regulation Authority, Medibank have around $443 million in equity investments, of which some unknown proportion will be in fossil fuels, he said.

The delegation campaigning for Medibank to divest in fossil fuels.

In a campaign launched in April, Doctors for the Environment urged Australia’s 600,000 health workers to divest any investments they had that were related to fossil fuels.

While the RACP has sold out of all its fossil fuel investments, lobbying efforts by Doctors for the Environment for the AMA to similarly divest have met resistance.

But Doctors for the Environment is planning to organise more face-to-face meetings, open letters and campaigns to put pressure on health organisations over their investment strategies.

Tim Buckley, director of the Institute for Energy Economics and Financial Analysis, said public statements about divestment coming from multiple organisations at the same time could have a powerful influence on the market.

If the balance is tipped far enough, divestment could even create a “stampede effect” where a critical number of investors exit, causing fossil fuels to become a stranded asset.

And while politicians in Australia were fixated on future which still focused on coal, the biggest electricity markets in the world were swiftly moving towards renewable energy sources.

China was diversifying its electricity grid and was now three years beyond its peak use of coal, despite earlier projections that coal use would continue to rise there until 2030, Buckley said.

“India is equally impressive,” he said. India, the third-largest energy consumer in the world, had earmarked billions for solar energy projects with the Indian government forecasting that non-fossil fuel sources would supply 57% of that nation’s electricity by 2027.

“[The transformation] is happening so fast that our Australian government is going to look like idiots,” Buckley said.

“They are trying to make us a coal exporter. It is a flawed strategy. It fails rule number one of economics, which is that the customer is right. If India and China don’t want our coal, we won’t be exporting it.”

“Economics and finance will drive an inevitable technology transformation of our energy markets,” Buckley said.

“Will it happen fast enough? That’s a separate question.”

The Medical Republic: Plan to tackle cognitive biases

 

A professional reflection process is crucial if clinicians want to overcome the common cognitive biases that drive the provision of low value care, the RACGP president says.

The president was commenting on a review published in the MJA, in which Australian researchers found doctors were often advocating treatments, investigations or interventions that had little or no evidence of benefit, but they believed were worthwhile based on their own biases.

Without recognising and addressing these biases, campaigns such as Choosing Wisely will not achieve their potential, the review authors said.

The researchers including lead author Associate Professor Ian Scott, director of the department of Internal Medicine and Clinical Epidemiology at Princess Alexandra Hospital, analysed the effect of bias on clinical decision-making in over 25 years of research.

The most common biases held by doctors were found to be:

– Commission bias, where clinicians have a strong desire to avoid experiencing a sense of regret at not administering an intervention that could have benefited at least a few recipients;

– Attribution bias, when the perceived beneficial effects of treatment are based on anecdotal and selective situations;

– Impact bias, where clinicians overestimate the benefits and underestimate the harms of interventions;

– Availability bias, when previous vivid and emotionally charged cases lead clinicians to overinflate the likelihood of that scenario being repeated;

– Ambiguity bias, where the lack of certainty around the disease or outcomes drives clinicians to over-investigate;

– Extrapolation bias, where benefit in a small group of patients is generalised to a broader set of patients, often seen in off-label prescribing;

– Status-quo bias, the reluctance to stop interventions, sometimes because the discussion around the pros and cons of discontinuing medication can be confronting;

– Sunken-cost bias, when clinicians continue with potentially inappropriate care due to the amount of time, effort and resources already invested in it;

– Groupthink bias, where the human impulse to be like, and belong to, a group may quell dissenting opinions about the value of care, or override policy mandates.

Because day-to-day clinical decision-making was largely intuitive, relying on mental short-cuts and internalised tacit guidelines, decision-making was vulnerable to common errors, the authors of the review said.

“While accurate and efficient for many decisions, this intuitive decision-making is vulnerable to various cognitive biases … which can distort both probability estimation and information synthesis, and steer clinicians towards continuing to believe in, and deliver, care that robust evidence has shown to be of low value,” the authors said.

RACGP president Dr Bastian Seidel said that the review authors’ recommendation to introduce strategies such as ‘reflective practice’ vindicated the college’s much-maligned introduction of PLAN.

“We know that reflective learning is the most evidence-based way of improving us as professionals and improving outcomes for our patients,” Dr Seidel said. “That’s based on what international evidence suggests.”

Dr Seidel pointed out that the authors of the study were primarily physicians and researchers, and said that GPs working in more of a “real-life” environment were likely to be a bit more pragmatic.

“But I might be slightly biased there.”

Australian Doctor: RACGP chief defends budget pact with govt

 

The RACGP is denying bungling the numbers as it defends its controversial budget pact with the Federal Government.

Under the “compact”, unveiled on the night of the budget, the RACGP gives the government the green light to wait until July 2018 to lift the freeze on Medicare rebates for GP consultations.

Under the deal, the rebates will rise based on a government indexation formula.

However, the formula, which will lift a level B consult by around 55 cents, has long been criticised by doctor groups for being below the actual rate of CPI (see box below).

Despite this, RACGP president Dr Bastian Seidel has defended the agreement.

Describing it as a major win, he said it ensured rebates would be reindexed in line with “wages and inflation” from July and secured an “ongoing guarantee of the same funding each year in real terms”.

“While this [guarantee] may seem like a step back to where we were before the big freeze, it’s a clear win for over 85% of Australians who receive preventative health services from their GPs each and every year,” Dr Seidelsaid in a media statement on Tuesday morning.

“Our agreement with the Australian Government to help strengthen Medicare recognises the essential role of GPs in a system that touches every Australian.”

The AMA made a similar deal with the government, without agreeing to how rebates will be indexed once the freeze is lifted.

But AMA vice president Dr Tony Bartone said: “If funding is less than CPI, then, by definition, it is not in real terms.”

On Monday, former AMA secretary general Dr Bill Coote warned it would add to the already heavy financial pressures on practices.

“The RACGP part of the ‘compact’ notes that indexation for these items will continue annually, on an ongoing basis, using the calculation which has formed the basis of indexation of MBS items by successive governments since 1995,” he wrote.

“This is the very formula that has led to the erosion of MBS fees, threatening the economic viability of many practices.”

Dr Seidel’s comments come amid growing anger among GPs about the college’s “memorandum of understanding” with the government.

But Dr Seidel is refusing to back down, saying the agreement is “unprecedented”.

“The compact is an unprecedented move by the RACGP to secure a planned strategy to addressing the challenges we face now and into the future,” Dr Seidel wrote in a message to college members.

“Whilst verbal agreements have previously been the norm in negotiations with government, the compact represents the first step towards formalising meaningful written agreement between the profession and government.”

But Dr Seidel also recognised the deal was not a perfect one for the profession. It should be seen as the first step, and not the end-point, he wrote.

“Our end-game is not just lifting of the freeze, but genuine and meaningful recognition of the value of general practice care.”

The Medical Republic:  Are the RACGP/AMA compacts meaningful? 

 

If media commentary is any measure, the GP community isn’t at all impressed.

Dr Bill Cootes, a former AMA secretary-general who served as an advisor to Sussan Ley, describes the compacts between the RACGP and the AMA with the federal government, announced last week on budget night, as “the most extraordinary documents I have seen in 30 years around this stuff”.

Writing in Medical Observer, he says they are little more than an “odd charade” and a “few trinkets” designed by the government to “ calm the restless natives”.

He sees virtually no substantive gains on the many serious issues facing general practice and is annoyed that pharmacists continue to do so well in the lobbying stakes, compared with doctors, for apparently little effort.

“The RACGP compact echoes that cosy, soothing rhetoric about general practice and primary care that has excited federal bureaucrats and GP dreamers for decades …” Dr Cootes said.

Paul Smith, writing for Australian Doctor, is even more blunt. He describes the compacts as “this is the gratitude you offer an abusive partner when they decide to no longer hit you”.

The Medical Republic hasn’t written specifically about the compacts but does note that if we were in a lobbying competition with most of the other professions, the only one we would have beaten in this budget is the banking sector probably.

$9m in year one, versus $200m for pharmacy, and $180m for the Australian Digital Health Agency to spend on the MyHR, which hasn’t saved us a red cent to date, does beg a few questions of anyone suggesting  the compacts are are significant step forward.

As pointed out by Paul Smith in Australian Doctor, it feels like our GP leaders are just happy to be back in play somehow in what ever minor way. It’s certainly minor . And even when the thaw becomes better next year, it’s still putting the sector behind in true indexing terms, and doesn’t contemplate any catching up the lost years.

And what of true funding reform for measures like Health Care Homes? Amid the pleasantries of the compact, there is virtually nothing on how the country could meaningfully transition to this better patient funding model. Instead, we learned the  that the lion’s share of the trial money would be going to IPN and Primary.

After budget night, the  Sydney Morning Herald quoted AMA NSW president Brad Frankum saying the freeze would be an “ongoing problem for specialists and the patients who need their care in this state.”

And Crikey went on a rant about the $375m for the roll out of the MyHR which wasn’t really connected to the compact at all.

So we know what the leaders think. We know what the press thinks. But what do the rank and file really think.?

The medical press and some social media activity appear to have sent the the RACGP into defensive mode. In a statement this week, President Bastian Seidel said: “While this [guarantee] may seem like a step back to where we were before the big freeze, it’s a clear win for over 85% of Australians who receive preventative health services from their GPs each and every year.”

In a statement to members, Dr Seidel attempted to portray the agreement as a step forward, saying: “We recognise that not everything the profession is seeking is contained within this first Compact. It should be seen as the first step, and not the end-point. Our end-game is not just lifting of the freeze, but genuine and meaningful recognition of the value of general practice care.”

Among the 50 or so comments in the columns of the GP press, we could not find one that backed the RACGP on the compact. Rather, doctors vented their annoyance over:

  • Pharmacists getting a lot more cash in the coming year(s)
  • General practice receiving only $9m in year one
  • The MyHR project receiving $375m over two years for what many perceive is an unproven or failing government intitiative
  • The lack of a meaningful commitment to Health Care Homes
  • Major corporates getting the majority of funding for Health Care Homes

The Courier Mail: Medicinal marijuana hotline for doctors

 

A medicinal marijuana hotline will be set up to help doctors who feel pressured to dispense the drug as patients demand easier access.

As patient groups mount political campaigns for easier prescriptions, the Therapeutic Goods Administration will hold meetings in Queensland, Victoria and South Australia in the next few weeks to give doctors and patients a better understanding of when it should be prescribed. It will also run the 1800 phone line for medicos and patients.

Royal Australian College of General Practitioners president Bastian Seidel said GPs were feeling pressured to prescribe marijuana oil for conditions that could be treated by acupuncture, excise or other drugs.

The Australian: Budget ‘back on track with doctors’

 

The Turnbull government’s second budget “signals a pivot” in the Coalition’s commitment to preventive health and has “reset” its relationship with doctors, the Royal Australian College of General Practitioners declared.

The president of the key health lobby group, Bastian Seidel, also suggested the increased 2.5 per cent Medicare Levy — 1 per cent of which will go towards fully funding the National Disability ­Insurance Scheme — could be ­renamed the “NDIS levy” to prevent confusion about the purpose of the tax.

Doctor Portal: Health Care Homes postponement welcomed

 

PEAK medical bodies have welcomed the postponement of the rollout of stage one of the Health Care Homes (HCH) trial, announced in last week’s Federal Budget, but concerns remain about the funding model and the practice representation in the first stage.

The federal government announced that the implementation of stage one of the HCH project would be delayed from the planned commencement date of 1 July to 1 October 2017, when 20 selected general practices and Aboriginal Community Controlled Health Services would begin to provide services under the new HCH model. A further 180 selected practices will provide HCH services from 1 December 2017.

Dr Bastian Seidel, President of the Royal Australian College of General Practitioners, also welcomed the delayed implementation of the HCH model, but said that a capitation funding model was unlikely to provide improved clinical outcomes in primary care.

“We need to put more funding into general practice to provide comprehensive care, rather than capping funding,” he said.

The Medical Republic: IPN and Primary snap up Health Care Homes

 

The government has stumped up some $50 million for the Health Care Homes trials and delayed the roll-out, apparently taking on board doctors’ concerns. The surprise, however, is that it has awarded 50 per cent of the trials to the two biggest corporate chains.

“Working closely with GPs and other health professionals, the government is progressing the implementation of the Health Care Homes trial with 20 practices to commence 1 October 2017 and the remaining 180 to commence 1 December 2017,” the government said in its budget announcement.

But about half of the 200 practices selected belong to two major corporates – Primary Health Care and IPN, part of the Sonic Health Care group.

“This is quite a problem in terms of a range of practices taking part in the trials. The corporates are only a small part of the landscape,” a source close to the project told The Medical Republic.

With the two corporates winning such a large slice of the tenders, many independent practices that have been actively developing patient-centred “medical home” models had missed out.

The Health Care Home concept has been embraced by the government as the way to deal with a rising burden of chronic disease with greater efficiency and better health outcomes.

The RACGP was initially enthusiastic but, to the Health Department’s fury, it withdrew its support from the trials months ago, complaining the government’s version was half-baked and underfunded, relying on inadequate capitation payments.

The government abandoned the original start date of this July for the two-year trial.

It has allowed $22 million for the trial in the current year, followed by allocations if $2.6 million in 2017-2018 and 25.5 million in 2018-19. An additional $30 million is allocated for community pharmacy to support the trial.

RACGP President Dr Bastian Seidel said last night the government had stated it would use the additional time allowed for the Health Care Homes trial to collaborate with the profession to get the concept “right”.

“I’m also pleased Minister  (Greg) Hunt has agreed to extend the Medicare Benefits Review for three years with a view of permanency,” Dr Seidel said.

“When I called for an Independent Medicare Authority in my speech at the National Press Club in March this year, I argued that we need to continuously assess the value of Medicare item numbers to patients, clinicians and the public.”

Dr Seidel was also pleased that the government had heard the college’s call to fund practice-based research networks.

“The initial $5 million funding to kick start these networks signals a pivot towards preventative health research that will build a knowledge base for the profession and help us build a healthy Australia.”

Perth Now: Damage done to health already, Labor says

 

Labor has dismissed the health profession’s backing for federal government budget measures, saying doctors and specialists would have welcomed anything that “left them alone for a while”.

The indexation freeze on Medicare rebates – a huge sticking point for doctors – will be lifted in stages over the next four years at a cost of $1 billion to federal coffers.

The Royal Australian College of General Practitioners said it was “a good start”.

“It will take the pressure off our patients and will put money back into health…where the health dollar works best,” president Bastian Seidel said.

AJP: Medicare freeze to be lifted

 

Health Minister Greg Hunt has earned praise from doctors’ groups for the “well overdue” move, which will be staggered over four years at a cost of $1 billion.

Australian Medical Association (AMA) President Dr Michael Gannon said that while it would have preferred to see the Medicare freeze lifted across the board from 1 July 2017, the decision to unfreeze the rebate is a step in the right direction.

The Royal Australian College of General Practitioners (RACGP) has also welcomed the lifting of the Medicare rebate freeze, saying it represents the first step towards a commitment to reinvesting in preventative health.

“The patient rebate had been frozen since 2013 putting pressure on patients and their GPs as out of pocket fees increased,” said RACGP President Dr Bastian Seidel.

Australian Doctor: Medicare freeze to continue for another 12 months

 

This is a budget of less than nothing for General Practice with the continuation of Medicare cuts.

The widespread rumours of the end of the rebate freeze this year all proved false.

Yes technically there is a thaw of sorts – indexation will be applied from July but only to the GP bulk billing incentives.

You may expect the government to declare this a product of a concern to protect the poor and vulnerable, to ensure they can still access GP care.

But not even this government is that cynical.

A measure of its significance is that it will “cost” just $9 million during the coming financial year.

Rebates for actual GP standard consults will be lifted in line with indexation from next July – along with the attendance items for specialist consults.

So patients rebates will be left to erode for another 12 months (ie the real terms cuts continue).

When it comes to items for specialist procedures and allied health services, they will only be indexed from July 2019.

The media release put out by Federal Health Minister Greg Hunt refers to a “partnership having been struck” with the nation’s doctors, its GPs and specialists.

But you could be forgiven for asking for written evidence of when and where doctors signed their names to this patnership.

GP groups should be disappointed but their words tonight about Treasurer Scott Morrison’s (pictured) budget seem up beat.

RACGP President Dr Bastian Seidel hailed the delayed thaw as a victory.

“The lifting of the freeze was exactly what the RACGP’s #youvebeentargeted campaign was aiming for,“ he said.

“If we are serious about focusing on a preventative GP health care we need to end the inequality of GP Medicare rebates compared to other clinical specialties.”

To be fair to ministers, if you look back at the words falling from their mouths in recent, they have done no more than drop hints the freeze will end.

The truth is they let the media run with its speculations.

What is in the rest of the budget:

There is no crackdown on Medicare after hours funding.

The RACGP wanted the urgent items made GP only to curtail the boom in corporate after hours. That has not happened.

Health Care Homes roll out will be delayed.

The alleged funding revolution in GP care for chronic disease patients was meant to start in July.

This was went 200 practices would register patients in return for receiving block funding (capitation).

But now only 20 practices will become Health Care Homes in October. The other 180 practices – whoever they are, we still don’t know – will wait until December.

It’s a win for the RACGP. It called for the delay having turned its back on the reform which is now warning GPs against.

The MBS Taskforce is a winner. When it was first launched its was meant to spend a couple of year modernising the schedule – is now in the long haul.

It will get $44.3 million over three years to continue its existence.

And the crackdown on GP rents being paid by pathology corporate for co-location collection centres?

Its looks like it will go ahead – but how hardline the crackdown will be is unclear.

There is money – $18 million over four years  – for audits and compliance programs to ensure that GPs practices are in line with the law.

From Australian Doctor’s understanding, the current law demands that no payments are made for rents that are above 20% of the so-called market value.

There is no detail in the budget papers the impact on GP practice revenue this crackdown will have.

The Pharmacy Guild of Australia has secured a compensation package for its members, who have been affected by savings to the PBS.

The headline is that there will be $600 million over three years for pharmacists “to continue and expand existing community pharmacy programs”.

It is not clear from the budget papers what it means by “expansion”.

It has been suggested (again by the media rather than ministers) that it could include the roll out of in store diabetes checks – something that would cause alarm among GPs.

But presumably programs will be left pharmacy sector to develop as it sees fit.

If you want to see the protection that pharmacy owners get from government that has not been extended to general practice, it’s worth looking at the budget papers fineprint.

They says pharmacies will get paid $225 million to compensate for lower than expected script volumes.

The MyHealth Record is also something ministers don’t shy away from when it comes to funding.

It will become opt-out for all Australians (as previously reported). It will cost a further $380 million over two years. But the government claims it will save $305 million in efficiencies from its use.

The reaction from the AMA to tonights budget has, like the RACGP response, been measured.

President Dr Michael Gannon claimed the government has begun to win back some of the goodwill it lost after the 2014 bloodbath health budget.

“The AMA would have preferred to see the Medicare freeze lifted across the board from July [this year],” he said.

“But we acknowledge that the three-stage process will provide GPs and other specialists with certainty and security about their practices, and will help address rising out-of-pocket costs for patients.”

“Lifting the Medicare rebate freeze is overdue, but we welcome it.”

ABC Budget 2017: Medicare rebate freeze to be unwound, but cuts expected elsewhere

 

The four-year freeze on Medicare rebates is likely to be lifted in the budget.

It is a move that many health and consumer groups including the Australian Medical Association, Royal Australian College of GPs and Consumers Health Forum have been calling for.

The RACGP’s Dr Bastian Seidel said he hoped the budget would shift the focus from tertiary care to primary care.“We want the system to focus the health dollar on where it works best and that’s primary care,” he said.

The Saturday Paper: Health and climate change

 

Groups such as CAHA say a big struggle on climate change has been to persuade people that it’s not just an environmental issue, and that the health urgency is personal and immediate.

That’s where Dr Bastian Seidel sees a role for GPs as “climate witnesses”. Seidel moved to Tasmania a decade ago from Germany and was recently elected president of the Royal Australian College of General Practitioners, Australia’s largest medical organisation.

He says not a day goes by in his rural Huon Valley practice that he doesn’t hear about a climate change impact for his patients. Seasons are now pretty much unpredictable. He sees cherry farmers struggling to get crops out at Christmas, graziers dealing with prolonged drought, salmon producers worried about unseasonably hot weather. Hayfever cases now seem to go all year round.

Croakey: making plans to renovate the house

 

Dr Seidel told Croakey it was unfortunate that the Building better foundations for Primary Care report had been released before the budget, as the easing of the freeze was a separate issue to the need for collection and funding of data for General Practice.

He also pointed out that rebates for General Practice consultations are for patients, not doctors.

ABC RN Drive: Your stories about healthcare in Australia

 

Confusion around the merits of private health insurance. Surprising out-of-pocket expenses. Concern for elderly family members in an ageing population.

These were some of the stories listeners shared about healthcare in Australia, when RN Drive asked for your experiences.

Our expert panel looked at what healthcare policy could look like in next week’s federal budget, and how those policies impact people’s lives.

The Sydney Morning Herald: GPs despair as work pressures on the rise

 

Family doctors may become harder to find as higher patient expectations and lower financial returns dissuade medical students from becoming GPs.

A new report by the University of Melbourne has seen a drop in job satisfaction, work-life balance and private practice ownership since the Medicare freeze of 2013.

Dr Bastian Seidel, chief of the Royal Australian College of General Practitioners, is worried the pay gap will deter young women in medicine.

“If you are a medical student and you’re coming out of university with significant debt, you have to make a decision” he said.

The Medical Republic: More money can’t buy happiness for GPs

 

The Medicare rebate freeze appears to have caused a dip in morale for GPs, even though hourly earnings for the profession rose at double the national average.

An ANZ-Melbourne Institute Health Sector Report shows job satisfaction and work-life balance plateaued then tapered off after the freeze was first introduced in 2013.

Job satisfaction fell by 1.5% over three years, while work-life balance dropped 1.2% over the same period – a decline that could lead to difficulties in retention and recruitment, the report warned.

“Though it is not possible to say that the fee freeze has caused the fall in job satisfaction, there appears to be an association,” the report said.

The findings come as little surprise to doctors’ groups, which warn that the downwards trend could be hard to reverse.

“Once morale is down it is really quite difficult to get it back up again,” RACGP President Dr Bastian Seidel said.

GPs were being “blamed, attacked and targeted all the time” by government and pushed to the periphery of health policy. “If you target the GP workforce … then don’t be surprised if the system falls apart,” Dr Seidel said.

AMA President Dr Michael Gannon said he was both unsurprised and saddened by the low level of job satisfaction.

“GPs often feel greatly aggrieved that it seems policy after policy from the government unfairly targets them even more than their fellow doctors,” he said.

Despite increased financial pressure, GP salaries have actually increased, the report said. Personal hourly earnings before tax rose 4% since 2013, which is double the rate of real wage growth in the economy.

Although hourly rates were up, Medicare revenue per GP fell around 2% per year in real terms.

GPs might be reducing practice costs or seeking other sources of revenue to maintain their salaries, the report said. But there was no evidence that GPs were reducing bulk-billing rates and charging higher out-of-pocket expenses.

Without an increase in government funding, GPs faced the tough choice of discontinuing unprofitable services to the community, Dr Seidel said.

“When I go to a nursing home I am not going to take my eftpos machine with me to ask for a co-payment,” he said. “It’s just not something I would consider doing.

“[GPs] have to consider whether we are still offering this service and the answer is most likely not. “So somebody else has to do it. And, of course, it is going to be even more expensive, in particular, when the patient ends up going to the emergency department or calling out the ambulance.”

Dr Gannon said the change in take-home earnings was not often what troubled doctors.

“If you talk to doctors across the system … you will rarely hear them talking about how much they are paid,” he said. “They will more talk about their ability to get the job done.”

If the government’s remuneration model squeezed funds from general practice clinics, GPs might move to communities with lower bulk-billing rates or stop providing services, he said.

The Guardian: Greg Hunt hints at Medicare breakthrough as Scott Morrison workshops ‘good and bad debt’

 

The health minister, Greg Hunt, has strongly hinted at a “big breakthrough” on Medicare, suggesting the government will unfreeze the Medicare rebate in the May budget.

This comes as the treasurer, Scott Morrison, has intensified the government’s pre-budget positioning, discarding years of anti-debt rhetoric from the Coalition to promote a new concept of “good and bad debt” on Thursday.

With the budget just 12 days away, the Turnbull government has been keen to promote its healthy relationship with doctors, particularly the Australian Medical Association and the Royal Australian College of GPs.

“We’ve done tremendous work, and I want to thank the AMA and the Royal Australian College of GPs for their cooperation so far, I think we’re making real progress,” he said.

“I won’t pre-empt any announcements, but I couldn’t be more thankful for the work of Michael Gannon at the AMA, and Bastian Seidel at the College of GPs.

The Age: Malcolm Turnbull to forge ahead on GP reforms, despite doctors’ funding fears

 

The Turnbull government is forging ahead with reforms to GP care despite fears its policy is rushed and underfunded.

The government is set to announce 200 trial sites for Health Care Homes – described by Prime Minister Malcolm Turnbull as one of the biggest health system reforms since Medicare – in the coming days, Fairfax Media can reveal.

Royal Australian College of General Practitioners president Bastian Seidelsaid the government’s policy was falling well short of its revolutionary billing, and the government may need to “go back to the drawing board”.

“It’s very clear it’s simply not designed to make a major difference to patients or practitioners,” he said.

The Guardian: Medical bodies say politicians causing falling job satisfaction among GPs

 

The “constant” and “unfair” targeting of general practitioners by politicians is one of the reasons behind a decline in job satisfaction within the profession, the heads of Australia’s peak medical bodies say.

A report from the University of Melbourne’s Institute of Applied Economic and Social Research published on Wednesday found general practitioners are experiencing lower job satisfaction and a decline in work-life balance.

The Royal Australian College of General Practitioners represents more than 80% of general practitioners and its president, Dr Bastian Seidel, said the findings from the report were unsurprising.

Pharmacy News: Inhaled steroids claim upsets asthma experts

 

Claims that inhaled steroids may increase pneumonia risk in people with asthma should be treated with caution, respiratory experts say.

A Canadian cohort study of more than 150,000 people with asthma found current use of inhaled steroids was linked to an 83% increased risk of hospitalisation for pneumonia.

RACGP president Dr Bastian Seidel, who is also the director of National Asthma Council, questioned the quality of the study, warning that the findings could pose a serious risk if patients overreact and cease steroids without consulting their GP.

Australian Doctor: 7 medication classes GPs want streamlined

 

The PBS should lift the red tape burden for GPs and extend its Streamlined Authority for increased quantities of seven classes of medications, the RACGP says.

In 2016, the PBS successfully moved to allow high quantities of topical steroids to be prescribed without authority.

This showed that GPs were responsible prescribers, the college says in a submission to the Pharmaceutical Benefits Advisory Committee.

The move was a great help for time-poor GPs wanting to prescribe repeat quantities of topical steroids and should be implemented for other medications such as SSRIs and antihypertensives, the college says.

The RACGP wants a similar move to streamlined authority for medications whose quantities were still restricted, and require phone or written approval prior to prescribing.

The medications include:

  1. Antidepressants (including SSRIs and amitriptyline at 50mg strength)
  2. Antihypertensives
  3. Antipsychotics
  4. Anticonvulsants
  5. Antibiotics
  6. Anti-reflux medications
  7. Antiemetics

“The potential productivity gains achieved from further streamlining the authority system from an administrative and clinical care perspective are large,” says RACGP president Dr Bastian Seidel.

“At a minimum, GPs will be able to redirect the time savings resulting from these changes to further enhancing patient care and increasing access to services.”

In July 2016, the PBS lifted the Authority restrictions on the quantities of topical steroids such as mometasone.

This allowed GPs to prescribe several tubes at a time and with five repeats. Previously, they had been required to obtain phone authorisation when prescribing more than one tube at a time.

The RACGP also called for GPs to be allowed to prescribe acne medications, such as isotretinoin, and dementia medications, such as donepezil, without the need for referral to a specialist.

“These medications can be commonly prescribed in general practice; providing safe, efficient access to medications for patients at reduced cost to the health system,” the college said.

The Medical Republic: Squishy and uncertain, or shiny and cutting-edge?

 

Senior lecturer and Fremantle general practitioner, Dr Brett Montgomery, likes to conduct a time-travel experiment with his third-year medical students at the University of Western Australia.

He begins by painting the picture of a person collapsing with a likely heart attack, who’s rushed to a hospital emergency department where doctors and nurses dash to his aid. He’s in VF and fortunately, defibrillation is successful. The patient slowly opens their eyes, and another life is saved. Dramatic stuff worthy of depiction in a hospital-based TV series.

It’s here that Dr Montgomery pauses and takes students back in time, to a period five years before the patient’s life-changing episode occurred.

“What if we had a time machine?” he asks.

His students are metaphorically transported back to an occasion when the same patient saw their GP.

After a thorough history and examination, the GP calculated a high risk of the patient suffering a myocardial infarct in the next five years. She prescribed antihypertensives and cholesterol-lowering medication.

Now the time machine returns the students to the day of the patient’s almost fatal arrhythmia. This time, the day passes without incident for the patient because of a decision made five years earlier, and subsequent continuous care in the GP’s hands.

“The image of the patient being saved makes for a very dramatic story,” Dr Montgomery told The Medical Republic.

“But if you knew that person was going to have an arrest and could prevent it from ever happening … in a sense, that is even more amazing and impressive.

I use this for my students to explain how general practice is so important.”

The reality, however, is that we can’t predict the future, at least not with certainty. So prescribing pills in a suburban clinic for something that has yet to happen does not set the pulse racing or fire the imagination. Hence Dr Montgomery’s time-travelling experiment.

Therein lies one of the inherent issues around the perception of primary care, as grossly unfair as it may be. General practice contains a fraction of the drama, commands fewer headlines and has none of the political currency that accompanies the “heroic” hospital and emergency intervention end of town.

In short, the work of a GP can often fly under the radar, undervalued in comparison to the more celebrated areas of the healthcare system.

“I think a lot of GPs would probably agree that we sometimes struggle to have our expertise or importance in the healthcare system recognised,” Dr Montgomery said.

“Look at the Medicare rebate freeze and the proposal to introduce co-payments a few years ago. That would appear to indicate a government not valuing in financial terms and in other senses of the word, the role of GPs.”

A recent article in The New Yorker, penned by renowned US surgeon and medical writer Atal Gawande, contained acknowledgement from the author that prior to his exploration of the issue, he had regarded primary-care medicine as “squishy and uncertain”. He regarded the role of a surgeon as the “real work of savings lives”, with surgery the “definitive intervention at a critical moment in a person’s life, with a clear, calculable frequently transformative outcome”.

If a prominent and respected member of the healthcare community could hold such a view, little wonder that others – governments and politicians among them – are sceptical about the role of GPs in genuinely saving lives and reducing morbidity.

“Unfortunately, GPs are seen as the second cousin in the medical fraternity,” observed Professor Chris Del Mar, professor of public health at Bond University and a GP at Robina on the Gold Coast. “They earn less money, and are looked down upon, not just by the rest of the profession but also by patients.

“It’s a case of ‘just a GP’, which is why it’s so great the college has been moving hard to overcome that,” referring to the RACGP’s campaign and slogan, “I’m not just a GP, I’m Your Specialist in Life’, launched late in 2016.

Now more than ever, RACGP President Dr Bastian Seidel is convinced general practice must be better supported by those decision-makers holding the purse strings. Health should be funded not from the viewpoint of “what we think might make a difference”, but what actually worked, he said.

And that meant continuity of care from the highly-skilled generalist.

“We need a change of mindset,” he told TMR.

For years, mountains of research, most notably from the late US pediatrician and primary care advocate Professor Barbara Starfield, has demonstrated the worth of primary care. But more recent trials have provided the strongest evidence yet that continuity of care in general practice can save not only lives but billions of dollars in expensive, avoidable and, at times, unnecessary hospital admissions. It’s also a better experience for the patient.

One study from the Netherlands, published in the British Journal of General Practice, found adults over 60 who had multiple GPs were 20% more likely to die over the 17-year study period than those who consistently visited the same doctor.

I think a lot of GPs would probably agree that we sometimes struggle to have our expertise or importance in the healthcare system recognised.

Furthermore, UK researchers found patients with the same GP were 12% less likely to be hospitalised with conditions that could have been managed successfully in primary care.

“We’ve had soft data around patient satisfaction and comfort and so forth, and that’s all great but often not good enough to inform health policy,” Dr Seidel said.

“It’s not really about what we like, it should be about what makes a difference to patients and health outcomes. And what works is general practice. We are now getting hard outcome data and that is what we need when writing evidence-based health policy.”

Health policy must include far greater support for primary care from governments who, doctors uniformly agree, are too short-sighted and blinded by the higher-profile, and voter-friendly, world of specialist and hospital care.

According to Dr Seidel, only 5% of Australia’s annual health expenditure of $145 billion goes to general practice, a figure that includes Medicare, practice incentive payments and Primary Health Networks.  With 85% of Australians visiting their GP at least once a year – there are 104 million consultations annually – funding was a “measly” $30.40 per person per month, he said.

“That’s how much the federal government spends on GP care,” Dr Seidelremarked witheringly in a recent speech, saying that amount was less than a subscription to Foxtel or The Australian.

Over the same period, hospital funding has climbed 19%.

As Dr Gawande said in The New Yorker, as a surgeon “I have a battalion of people and millions of dollars of equipment at hand when I arrive in my operating room”. GPs on the other hand, “are lucky if they can hire a nurse”.

Furthermore, the respective salaries of surgeons and non-GP specialists appear to mirror that funding disparity.

“We call it almost professional discrimination. The rewards are for fixing up a problem, not for preventing it in the first place and that is the mindset we are dealing with,” Dr Seidel said.

“What we do in general practice is prevent conditions from getting worse. We fix things early. But you don’t hear about this, there is no recognition for it.

“If a patient comes to see me and I diagnose ischaemic heart disease and they are at risk of having a heart attack, I am preventing this by taking action early. But the prevention aspect is just not sexy.

“Politicians are playing to the masses. It’s always a good news story to fund a new hospital or list another expensive drug. If that drug fails five years down the line, well, the money has already been spent when it should have been spent on preventative measures. But unfortunately, that is not politically palatable to a lot of those guys.”

Michael Kidd, a professor of global primary care at Southgate Institute for Health, Society and Equity at Flinders University, said Australia had built a successful healthcare system “on the basis of strong primary care and strong general practice”. Even a cursory glance at markers such as life expectancy, infant mortality and rates of immunisation illustrated that assertion, said Professor Kidd, a past president of RACGP and the World Organisation of Family Doctors.

“We have excellent health outcomes. But there are times when the government takes this for granted,” he said. “What we often see in a time of increasingly scarce health resources, is that resources drift towards that dramatic, heroic emergency intervention and neglects the important role of primary care.”

Among the reasons for the financial skew towards emergency intervention was, Professor Kidd suggested, the weight of “community expectations” where the public, particularly in wealthy countries such as Australia, expected to have access to all the best and latest cures and surgical interventions.

“There is a lot of community pressure, and that is felt by our politicians,” he said.

“Look at the backlash when a political party suggests closing a hospital.

“For those who work in primary care, there are times when they must feel less valued than other parts of the health system.

“That is very unfortunate because they are not less valuable. They are absolutely critical to keeping our population well for as long as possible, and for preventing the need for heroic dramatic emergency treatment.

“We must look very closely at every person who receives that type of intervention, because many will be a result of failures in the health care system that could have prevented the events from occurring in the first place.”

Keeping patients out of hospital is, naturally, one of the fundamental aims of the primary-care system and for GPs individually.

And knowing your patient, establishing a relationship over time and accruing information about their life and circumstances has long been known by GPs as the critical ingredients of succeeding in this aim. It can shape the judgment, treatment and the overall approach to any given problem.

“This is the fundamental part of a GP’s work. It’s that personalised care for a person who through the increments of time you have developed a knowledge of,” Professor Kidd said. “You know their health and well-being, their responses to treatment. You have become their trusted GP. But in primary care there are also heroic dramatic emergency interventions. It’s part of what we do.

“At other times, we’ll be providing incremental treatment to someone with a chronic disease, or providing one-off treatments and cures for those with acute diseases. The primary-care role is complex. It provides comprehensive care and co-ordinated care with other parts of the healthcare system.”

According to another former RACGP president, Dr Liz Marles, a GP in Hornsby on Sydney’s upper north shore, it is this rapport, this long-term continuity of care, that can be undervalued by the wider health community.

But for patients it’s a different story, with the consistency and trust that comes with the familiarity of a single doctor anything but under-estimated.

“They want to have those relationships and want to keep seeing the same GP,” Dr Marles said.

“If I’ve looked after someone for five years I might have spent many hours talking to them about personal issues and circumstances, so when they come in with a problem I’ve got a context for it.

Understanding the whole person makes it easier to determine what’s going on. It becomes a very efficient way to deliver a service.

“I’ll have all the background. I’ll know if they are someone with high anxiety levels or whether they are a stoic who rarely complains. We’ll know what investigations and tests have previously been carried out, what illnesses they have had.

“Understanding the whole person makes it easier to determine what’s going on. It becomes a very efficient way to deliver a service.”

High quality continuity of care at a general practice brought “efficiency of diagnosis”, Dr Marles continued, which was free of duplicate tests and unnecessary medications “because we don’t bark up the wrong tree”.

Non-GP specialists have, of course, unparalleled expertise in their respective fields, but by the very nature of their narrow focus, rarely approach a patient from a holistic viewpoint – a strength of the generalist.

If a specialist finds nothing of concern in their own area of expertise, it is entirely possible the patient could be shunted to another department and, according to Dr Marles, at risk of “having a whole lot of inappropriate” tests.

“They are not really trained in that broad initial work,” she said. “Most diagnoses take place in general practice. If someone comes in with a headache or abdominal pain, the GP will be thinking broadly and be able to ask the appropriate questions, do the appropriate tests and narrow it down.”

One of Dr Brett Montgomery’s students told him she was almost in awe of the extraordinary depth of knowledge required by a GP, telling him it was just too hard and she needed to narrow herself to a certain field, in her own case anaesthetics.

“It was one of the nicer things to hear,” he said.

Professor Del Mar echoed the thoughts of Dr Marles, arguing that continuity ensured “the right things are being dealt with” while at the same time preventing cases of polypharmacy by weaning patients off drugs that might have outlived their usefulness.

“We deliver care that keeps people away from expensive high tech medicine that very often they don’t need,” he said.

He tells the story of a patient who had seen him the previous day complaining of chest pains, his anxiety heightened by the recent death of a relative from a heart attack.

In his case, a visit to an emergency department, unfamiliar with his history, may have led to an ECG, X-rays and even a precautionary hospital admission – all at significant cost and additional stress.

Professor Del Mar examined his patient, found little of concern, and offered gentle reassurance that nothing serious was amiss. Within half an hour, his patient had departed, relieved and comforted and without a needless visit to a coronary-care unit.

“What GPs are good at is communication. One of the things we are taught is the patient-centred communication system. In other words, make sure you understand what makes your patient tick, what are they frightened of, what concerns them. If you know these things you can address them.”

Yet all this was at risk of being undermined by funding issues, exacerbated by the long-standing Medicare rebate freeze which, said Dr Marles, had piled pressure on already-stretched GPs.

With some practices financially struggling, the pressure to see more patients has intensified, leading to shorter consultations and, ultimately, less time to effectively manage the patient. This in turn can lead to an increased number of referrals.

In New South Wales alone, 20,000 extra patients descended on emergency departments in the October to December quarter compared with the same period in 2015, although how much of this increase can be attributed to the freeze cannot be ascertained.

“We have had a fantastic system in this country. Primary care has been really well developed … the skill set of GPs is very high, but I think the issue has been the system has not supported them to work to that skill set. We are getting more and more care shunted, at cost, to the specialist end of things rather than allowing GPs to use their skills to keep the costs down.”

As you might expect, Dr Seidel said GPs were the most trusted of all health professionals. Patients, he said, “want health, not necessarily treatment”, with a strong doctor-patient relationship likely to result in fewer medications, less diagnostic testing, fewer pathology tests, and ultimately, fewer hospital admissions.

In addition, if all patients saw their GP within a week of hospital discharge, readmissions would be reduced by 23%. This could be easily achieved if there was the political will, said Dr Seidel.

Flinders University’s Professor Kidd said while a strong healthcare system could be taken for granted, governments around the world, including Australia, had “rediscovered” the importance of high-quality primary care, which was pivotal to meeting the challenges posed by the rise of non-communicable diseases such as diabetes and heart disease.

Primary care held the solutions through early detection and appropriate management, he said, to prevent these conditions reaching the point where they become life-threatening.

And so it circles back to Dr Montgomery and his students in WA, attempting to travel back in time to the day his patient was saved from his future.

We need to change the mindset. We can’t afford the shiny treatment stuff anymore. It is costing us so much.

Consultants, surgeons and emergency intervention may grab the attention, plaudits and the lion’s share of resources, but primary care is where the real difference can be made, as more hard data seems to confirm.

“We need to change the mindset,” Dr Seidel said. “We can’t afford the shiny treatment stuff anymore. It is costing us so much. We should be focusing on what works, and what works is general practice and we have the track record to back it up.”

Whether performing in-practice procedures, identifying warning signs of potential future ill-health through opportunistic or continuous care, offering reassurance and guidance, or managing conditions over a long period of time, GPs are as much at the cutting edge as emergency intervention, probably more so.

As Dr Marles concluded: “I get a lot of satisfaction from the longer-term nature of the doctor-patient relationship and I get to see some fantastic outcomes in terms of people getting better and better. It’s a one-on-one relationship, and my patients are often incredibly grateful.”

The primary care sector must hope more people – in particular those in influential positions – soon become similarly appreciative.

Sydney Morning Herald: Address vaccination concerns to keep immunisation rates up

 

Doctors and the medical community need to take vaccination hesitancy seriously, or risk seeing immunisation rates fall, researchers have found.

While nationally, the immunisation rate has remained largely stable, sitting between 91 and 93 per cent, it is not uniform, with some regions, including northern New South Wales and inner city Melbourne and Sydney dipping into the 80s.

Royal Australian College of General Practitioners president Bastian Seidelsaid 86 per cent of Australians visited their GP at least once a year.  He said visits to the doctor should be an opportunity for people to address any concerns they had about vaccinations.

Australian Doctor: Asthma expert irked as study links preventers to pneumonia

 

Claims that inhaled steroids may increase pneumonia risk in people with asthma should be treated with caution, respiratory experts say.

A Canadian cohort study of more than 150,000 people with asthma found current use of inhaled steroids was linked to an 83% increased risk of hospitalisation for pneumonia.

The risk appeared to be greater with higher doses of inhaled steroids and was seen for both fluticasone and budesonide, said the researchers from McGill University in Montreal.

They said the magnitude of pneumonia risk seen with inhaled steroids in asthma was comparable to that previously seen in patients with COPD.

“Our study suggests the risk may be present in asthma, although pneumonia in patients with asthma remains unusual and inhaled corticosteroids remain the best therapy available,“ they concluded.

RACGP president Dr Bastian Seidel, who is also the director of National Asthma Council, questioned the quality of the study, warning that the findings could pose a serious risk if patients overreact and cease steroids without consulting their GP.

He noted that previous data from randomised control trials had found inhaled steroid use decreased asthma patients’ risk of developing pneumonia.

And even if the study findings were valid, the risk of “out of control” asthma was far more serious than pneumonia, he told Australian Doctor.

It was vitally important for asthma patients to be on inhaled corticosteroids, which are “safe medications that are going to make a difference to clinical outcomes,” he said.

Australian Doctor: Concerns axing of 457 visas will hit IMG recruitment

 

Scrapping the 457 visa will have an “immediate and potentially significant impact” on doctor recruitment, rural and remote health organisations warn.

The scheme will be abolished from March 2018 and replaced by new Temporary Skills Shortage Visas with tighter conditions, Prime Minister Malcolm Turnbull announced on Tuesday.

Migrants will find it harder to become permanent residents under the new system, which will be open to fewer occupations. The new visa will also include tighter English language requirements and mandatory criminal checks.

Doctors have been spared from the list of more than 200 occupations that will no longer be able to apply to work in the country.

But while details of the new program remain scarce, medical bodies fear the changes will make it even harder to provide healthcare to the bush.

“Without overseas-trained health professionals, many rural and remote communities would simply be without access to healthcare,” said National Rural Health Alliance CEO David Butt.

“Whatever replaces the 457 visa must ensure we do not put the health of these seven million people at further risk.”

Mr Butt was joined by RDAA CEO Peta Rutherford in urging the government to guarantee the flow of overseas-trained doctors to the bush, where they make up about 40% of the health workforce.

“Communities have been heavily reliant on doctors coming in on 457 visas, and while we are pleased about the government’s efforts to improve workforce distribution, we are at least five years away from seeing any real change,” she told Australian Doctor.

Ms Rutherford pointed out that overseas-trained doctors were already required to apply for a 19ab exemption and could spend years making plans before migrating.

“If they are going to require more than that, we will see further delays to what is already a lengthy process,” she said.

AMA president Dr Michael Gannon cautiously welcomed the new visa arrangements but echoed the rural health organisations’ concerns about workforce shortages outside the cities, despite a projected oversupply of locally trained doctors.

“Many communities would not have doctors if it were not for the excellent work of IMGs,” he said.

The new Temporary Skill Shortage Visa program will be split into short-term and medium-term streams, which the government says will be underpinned by focused occupation lists that are responsive to genuine skill needs and regional variations around the country.

Short-term visas will be issued for two years with no pathway to permanent residency, while medium-term visas will be issued only for more critical skills shortages and for up to four years.

It is understood that doctors will be listed in the revised visa arrangement’s ‘medium category’, with permanent residency applications eligible after three years — a change from the two year requirement under the current 457 visa.

Allied health workers and researchers — including clinical coders, dental hygienists and therapists, pathology collectors and exercise physiologists — will not be eligible for the replacement visas.

Thousands of overseas trained doctors including RACGP president Dr Bastian Seidel have worked in Australia on 457 visas, which were first introduced by the Howard Government in 1996.

The Medical Republic:Thumbs up for GP training exam plan

 

Medical students have voiced their support for the RACGP’s move to introduce a two-part examination to screen aspiring GP trainees.

The RACGP has been given control of the selection of 90% of next year’s intake of 1500 GP registrars, with ACRRM responsible for the remaining 10%, under the Australian General Practice Training (AGPT) program.

“We welcome the transfer of the selection process from the Department of Health to the two colleges,” Douglas Roche, Vice President of the Australian Medical Students Association, told The Medical Republic.

The association agreed the new arrangement would allow the two colleges to create a GP workforce that was more tailored to community needs, both in terms of ACRRM’s rural focus and the skills that their respective GP training programs would provide, he said.

While ACRRM will stick with an interview-based selection process, the RACGP is introducing a two-and-a-half-hour exam which will be held on July 22 in capital cities around the country, plus Townsville, the Gold Coast and Newcastle. Both colleges are charging application fees for the first time.

The RACGP’s exam will consist of a clinical-knowledge test focusing on serious conditions and emergency care, and a separate section to assess “situation judgment” pertaining to professional and ethical matters.

“From what we know, (the test) seems to be based on international best practice,” Mr Roche said.

The AGPT, the agency that oversees the nine regional training organisations, had already required applicants to sit a situation-judgment test.

Applications for the 2018 registrar intake for both colleges opened last week and will close on May 8 at 10am.

The exam will make it easier for the RACGP to choose its allotted 1350 candidates for the AGPT program from more than 2000 expected applicants.  It is looking for applicants that align with the “knowledge, skills and approach required of an RACGP fellow”.

The RACGP is developing sample questions to help candidates prepare.

“Often there are people who apply but might not have a particular interest in general practice,” RACGP President Bastian Seidel told The Medical Republic after the selection transfer was announced formally in late January.

“We don’t want to come second best. We want to compete with other medical colleges for the best candidates out there.”

In its interview process, ACRRM will seek candidates with the right stuff for rural practice, that is, junior doctors who are excited about a career in rural or remote practice and committed to becoming rural generalists.

The smaller, country-oriented college will hold webinars for prospective applicants on consecutive Thursdays from April 20 to May 4.

Australian Doctor: GPs welcome $54m rural training announcement

 

GP leaders have welcomed the announcement of new rural training hubs that aim to expand vocational training outside big cities.

The Federal Government has allocated $54 million over four years to set up 26 regional training hubs to be run by 14 universities.

The hubs will work with local health services to enable doctors to remain rural through undergraduate and postgraduate training, says Assistant Minister for Health Dr David Gillespie.

NSW will get nine hubs, Queensland six, Victoria four, WA three, SA two, and the NT and Tasmania one each.

RDAA president Dr Ewen McPhee says the move is “a step forward” for encouraging aspiring rural GPs or rural generalists to train in regional areas.

“It’s taking them to the next level, from medical students just passing exams to defining their career pathway into rural medicine, and mentoring and supporting them.”

ACRRM president Dr Ruth Stewart says the hubs will help fund infrastructure and support, and work with the colleges to get training posts accredited in rural areas.

“That means a student who has a commitment to a rural practice doesn’t have to disappear to a big city to be trained. What happens is that the likelihood of them returning rural practice is small,” she says.

RACGP president Dr Bastian Seidel says the RACGP’s rural arm will partner with each training hub to share teaching resources.

“Most of all we’d like to bring a national perspective to help build networks between the hubs and support their long-term regional workforce goals”.

The move follows the government’s bill to establish a National Rural Health Commissioner to help oversee rural training, which is still being debated by Parliament.

There will also be three Departments of Rural Health set up by the University of Notre Dame (WA) in Broome and the Kimberley, Charles Sturt University in southern and central NSW, and University of Queensland in South-East Queensland.

Sydney Morning Herald: How the controversial PSA test for prostate cancer is making a comeback

 

David Mullen is a textbook case of a potentially life-saving medical test done badly.

Barely a blip of ill-health interrupted Mr Mullen’s first 62 years before his GP suggested he start having yearly PSA tests, the blood test that measures levels of the prostate-specific antigen, an early warning marker for prostate cancer.

President of the Royal Australian College of General Practitioners, Bastian Seidel said doctors needed to move away from applying a blanket approach to screening and instead have a discussion with men about their individual risk.

“This is not about ‘to screen or not to screen’, but rather identifying the men most at risk,” he said.

Australian Doctor: The future of general practice – how should we pay for GP care?

 

Where is the money for general practice going to come from?

Last month, Australian Doctor revealed that most GPs believed a standard consult should cost at least $65 — far short of what most GPs actually receive for their work.

And while the Federal Government is apparently soon to axe its rebate freeze, it will make no difference to the long-term underfunding of the specialty, which has been left to stagnate for a decade.

Here, we ask four policy obsessives the hard questions about the real-world options.

They are RACGP president Dr Bastian Seidel, former RDAA president Dr Paul Mara, AMA vice-president Dr Tony Bartone, and Terry Barnes, the former health advisor to Tony Abbott whose ideas to increase funding for general practice led to the GP co-payment policy.

Judge for yourself whether you think they have the answers.

Australian Doctor: It costs around $110 million every time the government increases the Medicare rebate for a GP attendance item by just one dollar. The truth is that the Federal Government is not going to increase rebates to anywhere near where GPs say they should be.

Mr Barnes: Yes. My estimate is that raising MBS rebates for general practice and related services (non-referred attendances for Medicare purposes) by the amount of the proposed 2014 GP co-payment, $7, would cost around $1.1 billion a year or almost $5 billion over four years.

That’s a heck of a lot of new money to find, and in pure budgetary terms, it’s almost impossible for governments to pay what GP services are worth, especially while they obsess on boosting bulk-billing rates.

AD: So where will the money come from to fund general practice?

Mr Barnes: There must be offsets from elsewhere, ideally at least dollar for dollar … Clamping down
on cost-shifted MBS rebates for public hospital patient services and private patients in public hospitals is one place I’d be looking.

Dr Seidel: The Victorian Government released data prior to the federal election last year, indicating that the MBS freeze would cost it $220 million per year as more patients would attend EDs.

Consider that re-indexation of GP MBS item numbers only costs $160 million nationally. It is a no-brainer to fund general practice.

Dr Bartone: It’s up to the government to determine its spending priorities, although it is critical we don’t debate taking funds from one part of the health sector to fund another.

This is divisive and fails to recognise that there are funding pressures across the whole health system.

Sadly, the government [under Tony Abbott] also mismanaged its approach to encouraging patient co-payments, so that any discussion about patients who can afford to contribute to the costs of their care is now political poison.

AD: When rebates are as inadequate as GPs say they are, what impact is that having on the quality of patient care provided?

Dr Seidel: The RACGP is concerned about poor continuity of care, shorter consultations, and therefore more referrals, more prescribing, and more initiation of pathology and diagnostic imaging.

Dr Mara: Practices compensate. Initially, GPs simply charged their non-bulk-billed patients higher fees. The history of this suggests that we have reached the brick wall of how this can occur.

Dr Bartone: We know GPs are giving very good care for patients and getting world-class outcomes. However, we know that the viability of practices is being increasingly threatened.

There is pressure on GPs to work longer and to see more patients, and we continue to see strong growth in certain MBS items.

Practices have been restructuring to drive more efficiency, but it is hard to see how much longer this can continue before these gains are exhausted. At the end of the day, something will have to give.

Mr Barnes: GPs will continue to try and do more with less. They always do.

AD: What sales pitch should be made to government to increase funding? If they increase rebates, what do they get in return from general practice?

Mr Barnes: The AMA and RACGP’s message to government should be that the full range of our work matters to the wider health budget. If GPs do their job right, there are real downstream savings in terms of demand and cost.

‘Spending a penny on increasing GP rebates can save two downstream’ is the essence of their message.

The money spent on the soft-focus RACGP ad campaign would have been far better spent giving some empirical evidence to government to help it both make and defend a rebate-increasing decision.

Smiling GPs on posters plastered on the sides of buses are all very well, but they don’t impress treasury and finance bean-counters in government, let alone persuade MPs of the value of general practice.

Dr Seidel: The federal contribution to public hospitals has increased 19% over the past few years, now almost at a level of $20 billion per annum.

That’s just the federal contribution. ED presentations cost at least $200 each — and even when patients are not being seen, it still costs the government $70. Clearly this does not make sense.

We need to ensure continuity of care: this is a significant money-saver and it also improves outcomes.

AD: Given most GPs in the Australian Doctor survey say rebates are inadequate and that more patients should pay out-of -pocket costs, why are bulk-billing rates so high?

Mr Barnes: While the political debate about GP fees and the MBS rebate is the result of tunnel vision about bulk-billing — wrongly and stupidly — that’s what the public has been conditioned to demand, including those members of the public who have the education and the means to think and behave otherwise.

Those morally smug but irresponsible middle-class moaners on very good incomes and in good health themselves, who claim to be acting in the cause of Medicare and universal access, are effectively undermining its future viability by their own short-sighted selfishness.

GPs and practice operators are forced to respond to the prevailing view, when the mindset should be universal fair access to Medicare, not free access.

Dr Seidel: There are ethical considerations to why GPs bulk-bill.

I don’t take my EFTPOS machine with me when I see a patient in a nursing home, and I won’t be taking it when I do home visits for my elderly patients and palliative care patients. I just won’t.

That means those visits need to be cross-subsidised via other means and that’s why we see out-of-pocket costs increasing as above.

Dr Mara: In economic terms, GPs have very little price elasticity.

A small increase in fees in the context of very high bulk-billing rates and workforce competition would lead to a significant loss of patients, and immediate huge loss of income.

This is why many practices think co-payments are a good idea, but want the government to mandate them.

GPs have compensated for the decline in rebates in a number of ways. All these strategies are self-limiting and ultimately self-defeating, economically, professionally and clinically.

Many, but not all, other specialties have much greater price elasticity and this is leading to a growing gap between specialist and GP incomes.

AD: The Health Care Homes reforms are being sold as the alternative to fee-for-service for chronic disease care. Does that provide a mechanism for GPs to be adequately funded for their work?

Dr Seidel: Health Care Homes have nothing to do with improved patient outcomes.

It’s a capitation-funding model, which may work very well for corporate practice owners who outsource chronic disease management to practice nurses or non-GP health professionals.

Ultimately, it is going to be a race to the bottom as funding will not be increased either, in the same way as MBS rebates have not been increased.

Mr Barnes: You mean NHS-style GP budget-holding in disguise, don’t you?

AD: What is the politically viable solution to the long-term underfunding of the specialty?

Dr Bartone: There is no simple solution. The government needs to lift the freeze, and genuinely engage with general practice and have a mature discussion about its long term future.

The Commonwealth will need to do more heavy lifting on the funding side, and we need to have an intelligent debate about how we make care accessible and affordable for disadvantaged patients, while at the same time recognising that patients with means need to make some sort of contribution to the costs of their care.

Mr Barnes: Simple. Rebase MBS rebates for general practice and related services, and focus bulk-billing on the financially disadvantaged and the chronically ill.

But as I well know from the debate on GP co-payment two years ago, that’s politically high risk to say the least.

Dr Mara: There is no simple answer. Governments will not pay doctors any more than what they are prepared to charge themselves or where it can see solid returns on its investment.

You can’t bake a cake without the flour. All ingredients must be used.

My schema would include: independent indexation of the schedule by a tribunal in a way that will allow for input from professional bodies under strict terms of reference.

Also, we should free up the bulk-billing requirements so that market-driven co-payments can be charged. You can do this without legislation.

And through block grants or other blended payments, there should be protection for the chronically ill, socially disadvantaged, young and old.

Dr Seidel: General practice is the shining light of a functioning system and should be used as an example for providing sustainable world-class care.

Allow GPs to practise, stop twisting and turning funding models all the time. Commit to shifting funding from the tertiary care sector to primary care.

Commit to the principle of subsidiarity: if it can be done in general practice, it has to be done in general practice — not in a hospital.

Medicine Today: Continuity of care in general practice reduces elderly hospitalisations

 

Better continuity of care in general practice is associated with a lower rate of hospital admissions for certain conditions in the elderly, British researchers have reported.

Their study of the linked primary and secondary care records of 230,472 individuals aged 62 to 82 years showed that patients with a higher continuity of care tended to have fewer hospital admissions for ambulatory care-sensitive conditions such as asthma, influenza, pneumonia and gangrene.

Commenting on the study, RACGP President Dr Bastian Seidel said the findings tie in with other research suggesting that better continuity of care is also associated with reduced mortality and reduced readmission rates after hospital discharge.

Australian Doctor: A first look at the RACGP’s draft constitution

 

The RACGP has released the draft of its new constitution, detailing contentious plans to strip key powers from the GP-dominated college council.

With 349 deletions and hundreds of new lines, the document contains a dizzying array of changes.

Controversially, the all-powerful RACGP council will be demoted to providing guidance on clinical affairs, leaving strategic decisions to a seven-member corporate board.

The board will include up to three non-GPs, and control the finances and long-term direction of the college.

Supporters of the reforms claim the changes are necessary to bring the $60 million organisation into line with modern corporate thinking.

If the new constitution passes, the college council will be charged with providing leadership on clinical matters and ratifying fellowship appointments.

Yet the seven-member board will retain the right to review any council decision that may conflict with “strategic directions, advocacy efforts, or budgetary or other risk measures set by the board”.

The board will be required to exercise their powers over the council “judiciously” and return their decisions to the council for further consideration where possible.

The college’s 30,000 members will have the chance to vote on the proposals in an online poll on 30 May.

“The buck stops with the board and so it should, and that reflects what contemporary governance models recommend,” says RACGP president Dr Bastian Seidel in a video posted to the college website.

“Decisions can’t be made over the dinner table anymore. We need to move on with the times.”

Some senior college figures past and present have voiced concerns that the new model will restrict the influence of groups such as Indigenous doctors and registrars on the decision making process.

Dr Liz Marles, RACGP president from 2012 to 2014, says she supports improving college governance, but fears the change will widen the gap between members and RACGP leadership.

“I would be really concerned about losing the registrar voice, the academic voice and the member voice that comes through the faculty chairs.“

Also among the dissenters is Conjoint Professor Diana O’Halloran, who, as a past councillor, seconded the original motion for a governance review proposed by Dr Eric Fisher in 2013.

Professor O’Halloran supports adding fresh skills to the board, but says the college’s proposed board makeup won’t be up to the job of navigating the challenging political environment of the Australian health system.

“It is as though they have gone half way, but not completed the job.”

Australian Doctor: Here’s what’s involved in the GP selection exam

 

Thousands of junior doctors will have to pass a two-and-half hour test to be considered for the GP registrar training program this year.

The new requirement has been introduced by the RACGP after it was handed back control of the selection process for the Australian General Practice Training program.

Candidates will sit the online exam, known as the Candidate Assessment Applied Knowledge Test, on 22 July at assessment centres across Australia.

RACGP president Dr Bastian Seidel explains why the exam is being introduced and the sorts of questions aspiring GPs will face.

Australian Doctor:  Can you explain what the test will involve?

Dr Seidel: It comprises of knowledge test questions and situational judgment test questions.

Knowledge test questions are multiple choice questions that aim to test clinical knowledge.

These questions do not focus on a broad range of medical knowledge but specifically on acute emergency situations and potentially serious conditions.

These are pitched at pre-vocational candidates seeking to enter general practice training.

Situational judgment test questions aim to assess candidate’s judgment in a range of professional scenarios, often with a focus on ethical, moral, legal issues and professionalism.

These questions seek to assess reasoning in these scenarios.

The questions are partly derived from the RACGP’s competency profile of the GP at the point of fellowship. In preparing for the test, candidates should review these selection criteria and consider how their experience relates to these criteria.

The RACGP is at present developing exemplar questions to provide insight to candidates.

AD: Why has the RACGP chosen to select registrars using a test rather than just an interview?

Dr Seidel: Our central premise is that the selection process should focus on the potential for candidates to achieve the RACGP Fellowship rather than the current focus of selection into training.

The combination of an assessment (knowledge test and situational judgement test) is robust and valid and does not rely simply on the use of referees, which is known to be inadequate.

While the international literature also notes the favourable use of mini clinical evaluation exercises or objective structured clinical examinations, these were not adopted because of cost and logistic factors.

AD: Has the selection test been developed just for the RACGP selection process, or has it been used in other settings?

Dr Seidel: The Candidate Assessment Applied Knowledge Test has been formulated for the RACGP selection process.

It should be noted, however, that variations of this approach (the combination of knowledge tests, situational judgement tests and interviews) are used extensively in specialist medical selection around the globe.

AD: How many assessment centres will be based in rural or remote areas?  

Dr Seidel: The assessment centres will be located in Adelaide, Brisbane, Canberra, Darwin, Gold Coast, Hobart, Melbourne, Newcastle, Perth, Sydney and Townsville.

The locations were selected to ensure a broad distribution nationally and allow choice for candidates, while taking into account the fact that increased locations lead to an increased fee for candidates.

AD: How did the RACGP come up with the $725 application fee as an accurate measure of cost-recovery for selecting GP registrars?

Dr Seidel: The RACGP has sought to keep the fee low while taking into account the costs associated with developing a robust selection process.

This includes costs associated with question writing and development of an item bank, test construction, IT and infrastructure required, marketing and communications, administration and the delivery of the test through a third-party test provider.

AD: Will the RACGP consider financial circumstances in waiving or minimising the $725 fee charged?

Dr Seidel: An option for an extended payment period will be available to candidates who are suffering from financial hardship.

It is also worth noting that, unlike other specialist medical training programs, Australian General Practice Training (with the exception of the entrance fee) does not have any tuition fees or ongoing costs associated with the training program, apart from exam fees at the end of the process.

The Age: Why low-calorie sweeteners are making us fat

 

When you opt for a diet drink, chances are you think you’re making the better choice.

However, while such beverages may not contain sugar, that doesn’t mean they’re good for your waistline.

In other words, artificial sweeteners “may be directly responsible for increasing fat cells in humans”, explains Dr Bastian Seidel, president of the Royal Australian College of General Practitioners.

Over Sixty: Does fear of bad news stop you from visiting the doctor?

 

There are many reasons people put off seeing the doctor. From time constraints to cost, from the the stereotypical Aussie (“she’ll be right”) attitude to plain embarrassment.

Now a new report from Britain has shown that a third of people who consciously put off seeing their doctor do so for fear of finding out bad news.

Aussies may harbour the same worry, though it’s not as common here, says Bastian Seidel from the Royal Australian College of General Practitioners. He says people who have a genuine fear of bad news feel so bombarded with “scary” health information, they assume they’re automatically “doomed”.

The Medical Republic: No ‘rift’ over rural training

 

The last thing anyone wanted during parliament’s last sitting week was the suggestion of a rift between the RACGP and ACRRM.

After years of policy work, doctors dedicated to bridging the health gap between metro and country Australia were elated by the lower-house passage of a bill to pave the way for a more rural-specific health workforce.

Dr Ewen McPhee, president of the Rural Doctors Association of Australia, said it was gratifying that all sides of politics had got behind the bill to create the role of Rural Health Commissioner.

“We’ve made a good case and politicians of all colours have embraced it,” he said. “I really hope people recognise the work of people in both colleges in making this happen.” The RDAA, in fact, has a majority of RACGP members.

Assistant Health Minister Dr David Gillespie said the appointee would be a “fearless champion” for rural health whose top task would be to develop national rural generalist pathways for GP training.

“The aim of these pathways will be to address the most serious issue confronting the rural health sector – the lack of access to training for doctors in regional, rural and remote Australia.”

The bill is now set to sail through the Senate after the May budget.

So it struck an odd note when RACGP President Dr Seidel was quoted as describing rural generalism as “dogma” and saying he was concerned about a “fragmentation” of GP training.

While ACRRM has led rural-generalist training, adding advanced skills in obstetrics, anaesthetics and a number of other disciplines, the RACGP has expanded its FAR GP training on similar lines.

On Twitter, Dr Seidel denied any rift with the smaller GP college: “May I say, there is no rivalry between @RACGP & @ACRRM. We need to bring the profession together.”

He did not clarify the “dogma” remarks, reported in Australian Doctor, but issued a statement expressing hope that the commissioner would work collaboratively with the RACGP.

“Our rural communities need each and every one of us, and we’re hoping the National Rural Health Commissioner will be a strong supporter of rural general practice and the concept of rural generalism.”

ABC: Children exposed to CT scans face increased risk of developing cancer

 

Children exposed to CT scans have a higher-than-previously-thought risk of developing cancer, according to research.

CT scans are used by doctors to get to the core of a problem by creating a 3D image of the most inaccessible nooks of the body.

But the beams of ionising radiation can cause cellular damage.

Bastian Seidel, president of the Royal Australian College of General Practitioners, said GPs generally tried to avoid using radiation when investigating injuries in younger children.

iDea 17: Climate Change & Rural Child Health. Dr Bastian Seidel President RACGP Croakey: What can doctors do to better address climate health impacts? A quick glance at the iDEA conference

ABC: Tasmania has lowest rate of vaccination for cancer-related virus, study reveals

 

National statistics show Tasmania’s vaccination rates are among the lowest for a sexually transmitted infection linked to a number of cancers, a situation doctors have described as completely unacceptable.

The Australian Institute for Health and Welfare study looked at vaccination rates for human papillomavirus (HPV) in the 2014-15 financial year.

The results released today found 67 per cent of girls in Tasmania were vaccinated in that period, the lowest rate in the nation.

Royal Australian College of General Practitioners president Dr Bastian Seidel, who is based in Tasmania, said the results were a wake-up call.

“We need to get the schools involved, we need to get doctors involved and we need to get communities involved,” he said.

Townsville Bulletin: X-rays and doctor visits to cost less as government prepares to lift the Medicare rebate freeze

 

X-rays and scans could become cheaper for patients in the May budget with the Turnbull Government under pressure to honour an election promise to raise the Medicare rebate for the tests.

However, the move could affect patients’ access to after hours in home medical care with cutbacks in this area under consideration to pay for the change.

Royal Australian College of General Practitioners’ president Dr Bastian Seidel has suggested reducing hospital admissions by six per cent and managing more patients in general practice as a way of saving $4 billion.

He wants an independent Medicare authority to review all Medicare items and settle on adequate rebates for each service provided by doctors.

“There are savings to be made and we have to make sure that funds actually go where patients really need them,” he told the National Press Club recently.

Ultra 106.5fm: Low rates of adult vaccinations

 

Dr Bastian Seidel, Tasmanian GP and President of the Australian College of General Practitioners (RACGP) has told Dave more needs to be done to address the low rates of adult vaccinations.

Up to 3.8 million Australian adults are missing out on free vaccinations each year, putting themselves at risk of contracting life-threatening, yet preventive infections, according to a report set for publication in the Medical Journal of Australia (MJA) today (Monday, March 27).

Release of the report will coincide with the launch of the UNSW Vaccine and Infection Research Lab (UNSW VIRL), Sydney – a national centre of excellence designed to tackle the serious issue of low adult vaccination rates, and reduce the gap between infant and adult vaccination.

Mamamia: Why male GPs are opting out of performing Pap smears

 

More and more male general practitioners are opting out of performing Pap smears and inserting IUDs as the number of female GPs is on the rise.

According to the West Australian, several Perth women raised concerns after they were advised that their regular male GP no longer did Pap smears and they should see a female doctor at the same practice instead.

However, the Royal Australian College of General Practitioners believes this is a patient driven trend.

Bastian Seidel, the president of RACGP, told Mamamia that although male GPs are opting out of procedures, it’s only because the number of female GPs is on the rise, and more women are choosing to see them.

Medical Observer: GP consultations are at least 19% undervalued

 

Amid rumours about government plans to end the MBS freeze, we decided to gauge the temperature on the ground. We asked GPs how much they think their time should be worth.

Of the 1217 who responded to our survey, some 70% said the fee for a level B consultation for adult non-concessional patients should be $65 or more.

Here, RACGP chief Bastian Seidel responds to the results.

Are you surprised by the general results?

No, I’m not surprised at all. I believe that the MBS rebates for all GP consultations should be lifted. I’ve been on the public record stating that the recommended AMA fee may be aspirational and therefore would be unrealistic as an MBS rebate, but the RACGP has long argued for a Relative Values Study 2.0. In fact, that’s even part of our pre-budget submission. Based on our calculations, compared to MBS rebates for non-GP specialists, specialist GP consultations are at least 19% undervalued.

I’m interested in your survey methodology though. Can you confirm that respondents are GPs only, and do not include other AHPRA health professionals? Are there regional, demographic differences?

An interesting approach would be the establishment of a ‘citizens jury’ for MBS rebates, maybe that’s something Australian Doctor would consider in affiliation with the RACGP?

It costs around $110 million every time the government increases the GP rebate for a GP attendance item by a dollar. The hard truth is that rebates are not going anywhere near where GPs say they should be. Do you think that assessment is correct?

Your figure is very close. Unfortunately that means that co-payments are increasing (>4.5% last year), and more patients are avoiding to see a GP, and therefore end of in A&E (please have a look at the NSW public hospital data on A&E presentations and admissions released today)

Where will the money come from to fund general practice at the levels GPs says is needed?

The health system at large can’t afford to underfund general practice. There are only three funding leavers available:

  1. Via patients (eg MBS rebate)
  2. Via practitioners (eg GRIP payments)
  3. Via practice systems (eg PIP payments)

For example, the Victorian State Government released data prior to the election indicating that the MBS freeze will cost them $220 million pa as more patient will attend A&E departments, consider that re-indexation of GP MBS item numbers only costs $160 million (nationally!) It is a no brainer to fund general practice. As I mentioned before, the Final Budget Outcome Statement indicated a MBS underspent of $170 million in the last financial year. So, you don’t have to find the money — it is there already. Fully budgeted.

When rebates fall so far from what GPs believe is the real value, what happens in terms of care. Do patients get lower quality care … what are the compromises in terms of what GPs offer as a result of under funding?

We are concerned about poor continuity of care, shorter consultations, and therefore more referrals, more prescribing, more initiation of pathology and diagnostic imaging. We already have the data on A&E presentations as above.

What is the effective sale pitch to government to raise rebates (or increase funding generally?) If they increase rebates, what do they get in return from general practice that they don’t get now? Don’t governments want hard numbers on improved patient outcomes, reduced admissions and they don’t get that at present?

As above: Federal contribution to public hospitals has increased 19% over the last few years, now almost at a level of $20 billion pa. That’s just the Federal contribution. A&E presentations (according to IHPA) cost at least $200, and even when patients are not being seen — it still costs the federal government $70. Clearly does not make sense.

We need to insure continuity of care: this is a significant money saver and it also improves outcomes.

Given the results of the survey, why is bulk billing so high — is it really about doctors wanting to protect patients from out of pocket costs? Surely it’s also a result of competition? GPs don’t raise fees because patients go to the clinic down the road?

There are ethical considerations. For example, I don’t take my EFTPOS machine with me when I see a patient in a nursing home, and I won’t be when I do home visits for my elderly patients and palliative care patients. I just won’t. That means those visits need to be cross subsidised via other means and that’s why we see out of pocket costs increasing as above.

Health Care Homes reforms are being sold as the alternative to fee for service for chronic disease care — funding to practices who can then spend the money on packages of care. Does that provide a mechanism for GPs to be adequately funded for their work. Or will practices simply look to drive down what it spends on GP involvement? The payer changes but the financial dynamics are the same?

Health Care Homes has nothing to do with improved patient outcomes. It’s a capitation funding model which may work very well for corporate practice owners who outsource chronic disease management to practice nurses or non-GP health professionals. Ultimately it is going to be a race to the bottom as funding will not be increased either (same as MBS rebates have not been increased). Practices will cost minimise, therefore patients will be referred early to hospital outpatients, A&Es. It will cost the health system and taxpayer even more.

Health Care Homes is a solution to a problem that does not exist in General Practice. Federal funding for general practice is $30.40 per month per patient (including PIPs, SIPS, grants, and cost for PHNs), that figure has been steady over the last years. Compare that to hospital costs — maybe worthwhile introducing a capitation payment system there to contain costs.

In your view, what is the politically practical solution for the long term underfunding of general practice?

We have provided a comprehensive suite of suggestions to all political parties. General practice only accounts for 7% of health expenditure, but we see >85% of all Australians at least once per year (for $30.40 per month). General practice is the shining light of a functioning system and should be used as an example for providing sustainable world class care. The tertiary care sector should listen and learn. Policy makers should commit to evidence based health policies rather than bizarre initiatives such as health care homes that have missed that target by a wide margin and a clearly not fit for purpose. Allow GPs to practice, stop twisting and turning funding models all the time. Be consistent in the approach, use the funding leavers appropriately. Do not make deals on the back of GPs any more (such as pathology, diagnostic imaging). Commit to shift funding from the tertiary care sector to primary care. Commit to the principle of subsidiarity: if it can be done in general practice — it has to be done in general practice — not a hospital. Support what has been proven to work: continuity of care. This needs to be encouraged.

SeniorAU: Adults missing out on free, life-saving vaccinations

 

Up to 3.8 million Australian adults are missing out on free vaccinations each year, putting themselves at risk of contracting life-threatening, yet preventable infections.

Dr Bastian Seidel, Tasmanian GP and President of the Royal Australian College of General Practitioners said, “Australia has high childhood immunisation rates by international standards, but we continue to have vast numbers of under-vaccinated adults.

The West Australian: More male doctors are opting out of doing Pap smears

 

More male GPs are opting out of performing Pap smears or only doing them in the presence of a female colleague.

Several Perth women have raised concerns after they were advised that their regular male GP no longer did Pap smears and they should see a female doctor at the same practice instead.

Royal Australian College of GPs president Bastian Seidel said there had been changes but not necessarily because male doctors were wary of carrying out intimate examinations.

My Health Career: RACGP president hits back at claims that future doctors may not prepared to provide physical activity counselling

 

The University of Sydney and Exercise & Sports Science Australia (ESSA) collaborated to survey 17 of the 19 medical schools in Australia to assess how physical activity (PA) training is implemented across medical school curricula.

The Royal Australian College of General Practitioners President Dr Bastian Seidel said that physical activity is the number one recommendation for the vast majority of chronic medical conditions GPs see on a daily basis.

Canberra Times: Three medical experts agree modern medicine isn’t living up to expectation

 

The limitations of modern medicine are coming to light now more than ever before as an outdated system means patients are frequently left disappointed by a lack of diagnosis, experts say.

According to three experts, from the Royal Australian College of General Practitioners, the University of Canberra, and the Australian National University, modern medicine is just not living up to expectation.

Royal Australian College of General Practitioners president Bastian Seidel said people expected too much from medicine.

The Australian: Focus on falls needed to cut rate of injury

 

Aged care may be one of the few areas of public policy that enjoys true bipartisan political support in Australia. In 2011, a major review of the sector by the Productivity Commission recommended a raft of changes that have been supported by both Labor and the Coalition.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, says more funding and effort needs to go into keeping older Australians at home as long as possible so families can play a more active role in their care.

National  Club: RACGP Canberra opening address

The Medical Republic: After-hours group hits back over crackdown threat

 

After-hours home-visit services will quit regional towns and cities – starting with Canberra – if the federal government adopts new workforce rules or alters Medicare item numbers to rein-in health spending.

The National Association of Medical Deputising Services (NAMDS) has lashed out ahead of the May federal budget, warning there could be a community backlash if the viability of after-hours services is eroded in regional areas.

The lobby group, comprised mostly of companies in the private equity-backed National Home Doctor Service group, complains it has been shut out of consultations on possible changes and says its doctors are outraged at unfair attacks on their reputations by the RACGP.

In a new TV advertising campaign to be launched next week, NAMDS will characterise medical home visits as an essential community service that saves taxpayers money but is under attack from “vested interests”.

An online campaign is already under way, with ads showing a young mother with a sick child receiving treatment at home.

“As a community we can protect home visits, but we must act now,” the voiceover says.

In a statement on Tuesday, NAMDS President Dr Spiro Doukakis said 74% of Australians polled on the organisation’s behalf would regard a roll-back of after-hours services as a breach of Prime Minister Malcolm Turnbull’s promise not to cut Medicare.

“The government has refused to even guarantee public consultation on the MBS Review which is looking at Medicare home visits, leaving doctors and patients fearing that the service is on the chopping block,” he said.

He said home visits had been a hugely successful health policy, enabling emergency doctors and GPs to treat patients at home at lower cost “for urgent issues that don’t require emergency care”.

Cuts to the service (either through reducing the workforce or cutting the Medicare items) would mean hospital emergency departments would be flooded with new patients (with non-emergencies) and would send the home doctors broke, NAMDS said.

Service closures would start in these areas where the viability of the service is most fragile, including:

  • VIC: Ballarat, Bendigo,  Shepparton
  • QLD: Bundaberg, Cairns, Coolangatta, Gladstone, Hervey Bay, Mackay, Maryborough, Toowoomba, Townsville
  • NSW: Parts of Western Sydney, Armidale, Ballina, Byron Bay, Central Coast, Cessnock, Coffs Harbour, Gosford, Kiama, Lake Macquarie, Lismore, Maitland, Newcastle, Port Macquarie, Tweed Heads
  • WA: Bunbury, Mandurah, Rockingham
  • ACT: Canberra
  • TAS: Hobart, Launceston
  • NT: Darwin

Long-established after-hours providers, which have distanced themselves from NAMDS, want the sector to abandon direct advertising to consumers, which is blamed for stoking demand.

Dr Doukakis said after-hours doctors were “fed up and frustrated by ill-informed claims about their level of training”.

The RACGP has long been adamant that only accredited GPs or doctors on a GP training pathway should be allowed to do after-hours home visits, focusing on the prevalence of IMGs, hospital doctors and registrars in after-hours work.

College President Dr Bastian Seidel last week escalated the debate by telling a national TV news team that patient safety could be at risk because after-hours services employed doctors without GP qualifications.

“Urgent after-hours visits attract a premium Medicare rebate,” Dr Seidelsaid.

“Currently those premium rebates are often being claimed by doctors who do not have any postgraduate or specialist qualifications in general practice, at a cost to the taxpayer and Medicare of over $250 million in the last year alone.”

On the same program, Health Minister Greg Hunt voiced his concerns about alleged rorting of urgent items and suspicions that corporate after-hours services were prospering at the expense of regular GP clinics.

Early last year, NHDS indicated some 80-85% of its claims were billed as urgent.  Medicare figures show lucrative urgent after-hours claims leapt from just over one million in 2014 to 1.5 million last year.

The Rural Doctors Association of Australia is asking the government to tread carefully in redrawing the rules.

“We urge the government to ensure that, in any amendments it makes to stem the blowout in Medicare after-hours billings, it does not unintentionally impact on the much-needed after-hours care services that have been provided in rural communities by local doctors for many years,” RDAA President Dr Ewen McPhee said.

Medical Republic: Debate over shifting drugs to OTC

 

The money saved by making drugs such as proton pump inhibitors and oral contraceptives available over the counter would not be worth the risk, leading Australian doctors say.

Their comments follow a Canadian report showing $1 billion (AU$983 million) could be shaved off the health budget every year by making erectile dysfunction drugs, oral contraceptives and PPIs available OTC.

As Australia’s economy and regulatory environment is quite similar to Canada, comparable savings could be made here, the Australian Self-Medication Industry claimed.

The industry lobby group said the Canadian report lends support its ‘switch agenda’, which calls for more prescription-only drugs to be made available OTC.

Most of the economic gains would be made from PPIs going OTC, with oral contraceptives creating around $200 million in savings and ED drugs freeing up around $100 million in the Canadian health budget, the report said.

“For each drug class, substantial economic benefit would result from increased efficiency and productivity gains due to fewer primary care visits,” the report, created by The Conference Board of Canada, said.

However, both the AMA and the RACGP were quick to criticise the proposal, arguing that taking GPs out of the equation was false economy.

Dr Bastian Seidel, RACGP’s president, said focusing on a perceived cost alone did not do the doctor-patient relationship justice. Patients on these medications needed proper evaluation and regular monitoring.

“Health is not a commodity that can be negotiated between a willing seller and the highest bidder,” he said.

The issue with making oral contraceptives available OTC is two-fold, explained Danielle Mazza, a professor of general practice at Monash University.

Firstly, it takes away the opportunity for GPs to assess the suitability of ‘the pill’, check for contraindications and suggest alternatives, such as long acting reversible contraceptives.

And, secondly, GPs often use consultations for repeat prescriptions as an opportunity to improve their patients’ health literacy in other areas, such as cancer screening and STIs.

However, Professor Mazza said there were some benefits from making oral contraceptives available OTC, including increased accessibility. “It is easier to get to a chemist than a doctor,” she said.

A US study published last week in the Journal of Adolescent Health found that OTC availability reduced the barriers to contraceptives and could further reduce unintended pregnancy rates, particularly in adolescents.

Professor Mazza said that while she still had concerns, the idea was worth exploring in the Australian context.

Making ED drugs available OTC was associated with risks such as missed diagnoses, said Dr Seidel.

“Erectile dysfunction could well be a symptoms of a more severe underlying medical condition such as diabetes mellitus or PVD,” he said.

“This needs to be assessed before initiating symptomatic treatment. Clearly, it would be in everybody’s interest to treat the underlying cause.”

And PPIs also needed to be used carefully and judiciously, Dr Michael Gannon, AMA’s president, said.

“Some patients should have a gastroscopy from time to time to make sure that there is no disease progression,” he said.

“This is part of what GPs and doctors do every day – to keep an eye on these conditions, recognise the risk of long-term medication use, recognise new advancements and new medicines … and take health promotion opportunities in other areas.”

“There are always groups that seek to nibble at the sides of what GPs do,” he added.

“It’s not the first time we’ve heard these calls and it again shows an inability to understand the complexity of medical practice and the need to treat prescription of these drugs carefully.”

Australian Doctor: In moving to Canberra, College wants to have its cake and eat it too

 

The RACGP denies it has turned into a lobby group, saying its new Canberra office is intended to increase the “health literacy” of politicians.

The office, a short walk from Parliament House, will be home to two RACGP staffers and is seen as an attempt by the college to challenge the AMA as the main political voice of the speciality.

But college president Dr Bastian Seidel says the college’s role is “not that of a lobby group”.

Instead, he said in a speech at the National Press Club on Monday, the office is part of the college’s mission “to raise the level of health literacy … amongst political decision-makers and the press”.

“A coherent and comprehensive health policy is a bit like making a cake,” he said. “One needs quality, evidence-based ingredients.

“Of course one needs to add some political flavours, that’s almost inevitable.

“But if it is all about flavours and not about substance, everybody gets sick.”

In recent weeks, both the RACGP and the AMA have been in discussions with the Minister for Health, Greg Hunt, about ending the Medicare freeze.

No details have been confirmed, but there is speculation the policy will be ditched in the May budget.

In his speech, Dr Seidel stressed that general practice remains starved of investment.

“If you do the sums. The total funding for comprehensive GP care, no matter over how many visits, is a measly $30.40 per person, per month. That’s how much the Federal Government spends on GP care.

“It’s less than a subscription to Foxtel, or to the Australian.”

He added: “A minute of theatre time at the Fiona Stanley Hospital in Perth is budgeted at $160. So, the cost of two minutes of theatre time is more than the Federal Government spends on Medicare for a patient seeking GP care. Not per minute – per year.”

He called on the government to set up an independent Medicare Authority, which would be tasked with “pricing of individual MBS items based on the value to patients and clinicians”.

Referring to the college’s future lobbying tactics, he said: “When we point out a problem, we will also offer a solution. This does not need to happen publicly. It’s possible to be an activist for a cause without being an exhibitionist.”

The Australian: Doctors call for Medicare authority as government looks to lift rebate

 

Doctors will increase their presence in Canberra amid a heightened political debate over Medicare and the rebate freeze, calling for the establishment of a new body to review public healthcare services to cut down on waste and potentially deliver the government much-needed savings.

RACGP president Bastian Seidel today proposed a Medicare authority, to be run independently of government, which would incorporate the Medicare Benefits Schedule review of more than 5000 medical services.

Croakey: Primary care essential to Advance Australia Fair

 

Politics is bad medicine when it comes to taxpayer health and Medicare ought to be ringfenced from partisan brinksmanship by an Independent Medicare Authority, Royal Australian College of General Practitioners President Dr Bastian Seidel told the National Press Club on Monday.

In an impassioned defence of primary care, Dr Seidel said the Medicare Authority would entrench the current MBS review in perpetuity and allow for contemporary pricing of items based on value to patients and clinicians.

The Medical Republic: RACGP sees new Medicare body as politics-free zone

 

The RACGP is calling for an independent Medicare Authority to take the politics out of healthcare decisions and stop deals being done “on the backs of GPs”.

RACGP President Bastian Seidel said the proposed new body would incorporate the MBS Review and would make the review process continuous and permanent to maintain relevance.

Dr Seidel said he was confident the landmark review, being overseen by Professor Bruce Robinson, would be extended beyond its scheduled term ending in seven months.

A new authority should also be tasked with contemporary pricing of individual MBS items based on the “true value” to patients and clinicians, Dr Seidel said, announcing the plan today at a lunch at the National Press Club in Canberra.

In addition, it would incorporate the Professional Services Review, an agency within the Health Department that investigates doctors suspected of Medicare non-compliance, and the Medical Services Advisory Committee.

“We’ve got to bring those branches together. Fragmentation here has the same detrimental effect as fragmentation in the delivery in health care,” Dr Seidel said.

In his address, Dr Seidel mapped out a framework similar to the Independent Hospital Pricing Authority, which would routinely review MBS item numbers, introduce new items in a timely fashion, foster clinical innovation and maintain efficiency and fairness.

Stressing the RACGP’s view that health reform should be in the interests of patients first of all, he said the new body would also review the Medicare Safety Net.

“If we do have a safety net, it should be significantly lower for patients who need to see their GP. It would be the right thing to do.”

The luncheon address marked the opening on Monday of the RACGP’s new Canberra office, a move that marks the college’s resolve to become more of a player in political debate affecting patients and the profession.

Dr Seidel said he was determined to raise the health literacy of politicians.

“We are sick of deals being done on the backs of GPs,” he told reporters after the luncheon.

The Professional Services Review function, if working in concert with the other arms of Medicare, would be much more efficient and transparent, he said.

The Age: More than a third of older doctors have no plans to retire

 

Many older doctors are hanging onto their stethoscopes, with more than a third aged over 55 either not sure about retiring, or not intending to, a new study has found.

The research found that mental stimulation, a sense of purpose and being in good health were popular reasons why 398 doctors – out of 1018 doctors surveyed aged 55 or older – stated they either did not intend to retire, or were not sure about it.

Royal Australian College of General Practitioners president Bastian Seidelsaid the study was important.

He said it belied claims by health workforce agencies and medical schools that we face a glut of GPs retiring over the next few years, and that therefore we should increase our overseas-trained doctor intake and boost medical school numbers.

The Advertiser: Medicare rebate freeze to be thawed

 

Patients would pay less to see a doctor under plans to end the Medicare rebate freeze as the Turnbull Government moves to reform the nation’s growing $90 billion-a-year health budget.

Health Minister Greg Hunt is understood to be working on a May Budget blueprint that aims to undo the unpopular 2013 freeze to the Medicare rebate for GP visits and specialist consultations, but also preserves the high rate of bulk-billing ­doctor.

Royal Australian College of General Practitioners president Bastian Seidelwrote to his members last week to advise them that it appeared that the Government would end the rebate freeze.

The Guardian: Malcolm Turnbull delivers ‘outright’ rejection of pension cuts plan

 

Malcolm Turnbull has ruled out pension cuts in the budget after a report that the government was considering cutting welfare for those receiving less than $20.02 a fortnight.

It comes as the health minister, Greg Hunt, gave further signals on Sunday the government would unfreeze the Medicare rebate in the May budget to demonstrate what he called a “rock solid” commitment to universal healthcare.

On Sunday, Hunt told Sky News he had worked “incredibly well” with the head of the Australian Medical Association, Michael Gannon, and the Royal Australian College of General Practitioners, Bastian Seidel, since taking the portfolio in January.

The Australian: Medicare rebate freeze may go in May budget

 

Health Minister Greg Hunt has given strong indications the Turnbull government will unfreeze the Medicare rebate as part of the May budget.

In the wake of Labor’s damaging “Mediscare” campaign in the lead-up to last year’s federal election, Mr Hunt reiterated the government’s “rock solid” commitment to strengthening the scheme.

He said his first and second calls when he became Health Minister in January were to AMA head Michael Gannon and Royal Australian College of GPs head Bastian Seidel.

The Medical Republic: Crackdown looms for after-hours services

 

Federal Health Minister Greg Hunt has turned up the heat on after-hours home-doctor services, blaming “junior doctors and corporate firms” for a blow-out in urgent items costing taxpayers nearly $250 million in the past year.

The minister has pushed investigations into the sector since taking over the health portfolio from Sussan Ley in January, showing his alarm at the rapid rise in claims for urgent items that carry a lucrative premium.

RACGP President Bastian Seidel told the Nine Network the epidemic of after-hours call-outs was unsustainable and put genuinely ill patients at risk.

ABC Radio PM: Unregistered doctor at Melbourne cosmetic clinic

 

Australia’s health practitioner regulator is investigating another unregistered person claiming to be a doctor.

The woman, Phoebe Pacheco, was working at a Melbourne cosmetic clinic for more than three years before she came to the attention of authorities.

It was revealed last week that a Sydney man had been practicing as an unregistered doctor for a decade

But authorities are trying to reassure the public that Australia’s doctor registration process is stringent, and unregistered doctors are unusual.

A Current Affair: GP deregistered for a year following multiple botched skin cancer surgeries

 

A disgraced skin cancer doctor has been confronted over his botched procedures that left his victims scarred for life.

Dr Jeremy Reader was a once highly regarded doctor who inexplicably botched skin cancer procedures time and time again.

Royal Australian College of General Practitioners president Dr Bastian Seidel says people should not be scared off by Reader’s bungled procedures and should continue to see their local GP for skin checks.

“There’s no need to be concerned. There may be other options for you to treat skin cancers that do not include surgical treatment and if you do require surgical treatment, again, ask your GP whether a GP can do it or whether you need a referral to a surgeon.”

The Medical Republic: RACGP’s fighting words … but where’s the dog?

 

RACGP president Dr Bastian Seidel sent off a fiery missive this morning to members indicating that, despite his many meetings with the federal health minister in which the rebate freeze was discussed, he would not be “pushed to disclose the proceedings just in order to grab a cheap headline in the national news”.

Just who is pushing Dr Seidel, and why, isn’t entirely clear. Dr Seidel is pretty worked up though.

“…I still subscribe to the notion that it is perfectly reasonable to be an activist for the profession without being an exhibitionist”, he said.

“True leadership for our members does not require validation by an endless loop of selfies shaking hands with political decision makers in Canberra.”

The Medical Republic is clearly out of that loop. Is he referring to the fact that in most of the national press about the freeze negotiations, the RACGP and Dr Seidel, are either not mentioned at all, or take second place to the AMA, which seems to be more “top of mind” for the national newspapers when ever they write about anyone lobbying for a cessation of freeze?

Dr Seidel certainly seems to be hinting at something he’s said and done while in Canberra, while not taking any selfies.

He goes on to say that the freeze is not everything. That freeze, or no freeze, GPs “are the neglected professionals of the health system”.

“GPs have been sold out to the  benefit of others and that needs to stop once and for all.”

They’re fighting words.

He seems to be pointing out, importantly we think, that the end of the freeze will very likely be a huge disappointment, if that is all the federal government has in store to keep the GP profession placated.

“To focus on the Medicare rebate freeze alone would not do the profession justice,” Dr Seidel said.

As Dr Seidel seems to be suggesting here, the end of the freeze is not the dog in this fight. It’s effectively now a diversion from much more systemic and emerging issues at hand. But where’s he heading with this?

Is this a hint?

“As GPs we know that in order to make a difference to health outcomes, we need to raise the levels of health literacy in our patients,” Dr Seidel said.

Dr Seidel is in Canberra next week to open the RACGP’s first office in the nation’s capital, and while there he will be addressing the National Press Club on the topics above.

Without wanting to be one of those who are seemingly pressuring him to “let go” on the odd breakthrough policy or program, we’re all waiting expectantly now for him to nail someone to wall next week with his speech.

No photos please. We won’t be needing that sort of shallow publicity. Words (and actions) will do it.

Australian Doctor: The vast variations in specialist consult fees

 

The huge variations in what different medical specialties charge for consults have been revealed. Academics from the University of Melbourne have analysed Medicare claims for initial outpatient consultations (MBS item 110) in 11 specialties.

Immunologists top the fee league table, charging $257 on average for an initial consultation. They are followed by neurologists, whose fees average $252, although one neurologist charged more than $350 for an initial consultation, according to the data.

Bulk-billing rates are also relatively low — 10-40% for all specialties — with the exception of haematology and medical oncology, where just over half of consults are bulk-billed.

Medicare rebates have failed to keep in line with fees, exposing patients to significant out-of-pocket costs for specialist care, the researchers write in the Medical Journal of Australia.

“The lack of publicly available data about the range of fees for specific services places patients at a distinct disadvantage when seeking affordable medical care,” they wrote.

“Further, as there are no data on quality of care in the outpatient setting, patients are not only unsure about the range of appropriate fees, but also about the value of the service they receive.”

The findings again raise questions about the funding disparities between general practice and other specialties.

Last year, the average out-of-pocket fee for a level C GP consultation lasting up to 40 minutes was $41.92. More than 85% of the consults were bulk-billed.

A recent Commonwealth Fund survey found that GPs in Australia were among the happiest in the world with their chosen medical careers.

However, 42% said they were somewhat dissatisfied with the income disparities with other specialists. A further 38% said they were very dissatisfied.

RACGP president Dr Bastian Seidel said the average GP earned less than half the income of specialist hospital doctors. “I’m not surprised GPs are not happy with this.”

The Medical Republic: Are you a member of Australia’s underground GP college?

 

Australia has a virtual underground GP college or, if you like, a GP resistance movement. In terms of moving GPs into the 21st century of social digital engagement and learning, it might just be what the doctor ordered.

“Where there is power, there is resistance,” says Michel Foucault in his seminal work on power and knowledge, Defacing Power.

When we think of power in the GP realm we generally think of the RACGP, AMA, ACRRM, Department of Health, (DoH), The Australian Medical Board and so on.

When we think “resistance” these days, it’s not a big leap to Australia’s largest “unofficial” GP social collective, the Facebook group GPs Down Under (GPDU).

GPDU has quietly and without intent, built into the national powerhouse of direct digital GP engagement in Australia and New Zealand. A few years ago that title might have gone to Australian Doctor, the weekly newspaper, the website of which attracts upwards of 6,000 comments a year to its articles from about 8,000 or so registered Australian GPs.

But that’s what happens when technology meets “the people” – in this case “the people” being a group of highly energetic and well-intentioned GPs.

Today, GPDU has about 3,900 GP and GP registrar members, 1,750 of whom engage directly via posting, and has more than 190,000 direct engagements per year. Those who don’t engage are at least likely to be watching and taking things in. To give that some perspective, that’s more than 30 times the engagement levels of Australian Doctor, and GPDU has achieved those numbers in just three years.

On a per-doctor basis, this level of engagement for a peer-to-peer private doctor network is higher than any of the global private-doctor network sites, some of which are commercialised and valued in the tens of millions of dollars and have many staff working for them.  These sites include Sermo and Doximity in the US and Doc2Doc in the UK.

It’s little wonder some of the powers that be in the colleges are worried about where GPDU might be heading. There is a professional social engagement phenomenon happening here and it is, on any global measure, quite extraordinary. In the old worlds of the RACGP, ACRRM and the RDAA you will often see quite a bit of tribalism. On GPDU, doctors from every creed seem to be there – in a neutral virtual forum – solving problems for each other.

VALUABLE DATA

The data that passes across the site daily, would, in a commercial world, be very valuable – to government, to big pharma, to insurance companies and to other groups. Literally within seconds of some interesting clinical event a doctor can get a peer-validated reading from the Australian GP community. And if you’re interested – which the government and various health bodies would be – you can get a very quick read of the pulse of the GP community on political and regulatory decisions affecting the profession. But you have to be a GP, or a GP registrar, to be a member. Strictly.
How did an amateur Facebook group come to have so many members, engaging in such a deep manner, and talking so openly to each other, so quickly? How was this done without any reference to the official powers? And with no money involved?

Why are the established and powerful doctor-based organisations so far unwilling, largely, to engage meaningfully with this group? And why, behind closed doors, is the establishment in these groups quite concerned by GPDU’s rise to prominence?

The answer might lie somewhere in what Foucault talks about.

Foucault regards power as neither an agency nor a structure. “Instead, it is a kind of ‘metapower’ or ‘regime of truth’ that pervades society, and which is in constant flux and negotiation.”

POWER IN FLUX

Power, as we see it in the various colleges and regulatory bodies in medicine, through GPDU, appears to be in some state of flux and negotiation. If responses to the rise of GPDU are anything to go by, this “flux” seems to be quite uncomfortable for the incumbents of power.

The secret to GPDU’s phenomenal engagement levels likely lies in the fact the founders and moderators of the group religiously and voraciously guard the independence and “GP-only” purity of site.

Its not-for-profit mission is to help GPs in their everyday working lives via more effective peer-to-peer engagement. Particularly in solving clinical dilemmas and in clinical learning.

Another secret might lie in the expertise that the group of founding administrators have developed in professional learning, medical education and social media.

“We are trying to make this a safe place for GPs. One they can truly trust for information and learn without fear of any repercussions to what they see and contribute,” says one of the founders and often-time administrator, Dr Karen Price.

Other admins on the site include Drs Lindsay Moran-Jayaram, Tim Leeuwenburg, Nicole Higgins, Kat Maclean, and Kate Kloza.

Like so many of these things, Dr Price and the other founders had no idea what they were starting when they founded the group. They were simply frustrated by how hard it was to communicate with each other around basic clinical issues using the normal lines of communication of the established organisations.

The utility of a modern social-media platform offered them a way around that frustration, efficiently and without cost.

Dr Price and her cohorts didn’t set out to undermine the power bases of groups such as the RACGP and some commercial medical-education groups. And if you ask them today, they are somewhat aghast that The Medical Republic would suggest that some might be seeing them this way.

But they weren’t, and still aren’t, entirely prepared to play by the old rules either.

“Some of us were on an RACGP committee for member engagement but there was no really effective way to engage with members,” says Dr Price. “The College was relying on Friday faxes and then email blasts, but they were very hit and miss and very controlled. When we wanted to do an email to lots of members we were told it was spamming.”

COMPLEMENTING THE COLLEGES

GPDU sees itself as a complement to what most of the established GP colleges and groups do. Something of an infill for some of the deficiencies of being big, slow, bureaucratic and overly political.

“There is a strong desire with GPDU to unite the RACGP, RNZCGP, ACRRM, RDAA and non-vocationally registered doctors. This is a unique space and one that has been expressly stated in many ways on GPDU”, Dr Price told TMR.

But, while  the groups in power will pay some homage to GPDU, and even say publicly it serves a role, there are clear signs they are displeased that some aspects of what they have tried to achieve in GP engagement in the past have been re-imagined in another place, and re-imagined in a manner that is far more functional.

RACGP President Dr Bastian Seidel is a member of GPDU and does occasionally engage.

He told TMR: “I do post and comment, unfortunately not as much as I’d like to. It’s just a time issue for me.”

But when pressed about GPDU and the College competing in some ways for learning and engagement, Dr Seidel plays a dead bat.

“I believe that GPDU has had a presence at our annual GP conference over the years, which I think was well received. I’ve been on panels with some of the GPDU administrators at GPTEC when we talked about social media. I’ve also co-presented with GPDU’s Dr Nicole Higgins on SoMe at that same conference. I have not been approached re other “events in concert” by anybody else.”

Some sense of Dr Seidel’s reluctance stance might be sourced in the RACGP’s decision last year to set up its own version of GPDU, called shareGP. The RACGP will deny that shareGP is in response to GPDU and will tell you that it serves a different function. For instance, it is supposed to be a means by which College committee members can communicate more effectively on tricky issues. But if you read the shareGP objectives, it’s all mostly all the stuff that GPDU already does, and does very well.

So far, shareGP has failed, if net engagements are anything to go by. TMRasked several GPs who had joined what they thought and none were particularly enthused.

Something is fundamentally missing from this new professional space. Something that GPDU offers. That is the ability to have fierce conversations through thoughtful and focused moderation. And the ability to do it and not get pinged by anyone for overstepping the mark, accidentally or not.

GPDU’s administrators work hard to try to provide an environment where GPs will largely be protected from any company, or organisation, repercussions. They also aren’t afraid of a bit of silliness and humour. The group is careful about not taking themselves too seriously.

But you suspect the major reason for GPs using GPDU over shareGP is much more raw. It’s not the RACGP. It’s the place where there are no overseers with agendas, be they good or bad. It’s a place that has some degree of purity. The purity of GP-only conversations, protected from private enterprise, government and the colleges alike.

We are trying to make this a safe place for GPs. One they can truly trust for information and learn without fear of any repercussions.

ANONYMITY HELPS

But it’s not entirely safe. You can get mauled from time to time. But at least that happens under the watchful eye of independent and passionate moderator GPs who have the sole intention of promoting useful peer-to-peer communication.

Part of why this can happen is GPDU sanctions a degree of user anonymity.

Many doctors on GPDU use avatars to help in protecting their identity. Anonymity on website forums is quite controversial. But the GPDU administrators have thought carefully about it.

Says Dr Price: “In some circumstances people will be emotional about an organisation or group, but if we stop that entirely by identification then you will often prevent a debate from even being had. We know that sometimes GPDU is snapshotted [which is against our policy] and used in internal organisational discussions. In some organisations this can be good, but in some it can be used against people.

“It’s not good for the profession to have people vilified or gagged for having an opinion, so in some circumstances, so long as it is properly moderated, anonymity is useful for debate and progressing issues.”

And in the end, the administrators on GPDU, who will only allow a GP or registrar to join after a rigorous checking process, including a peer reference and recommendation, can identify someone if something really goes wrong.

Those who run GPDU are adamant they are there to support institutions such as the RACGP and the AMA. But they aren’t going to sit back and let them get away with things that the “GP community” doesn’t agree with. Nor are they OK to let faster, more efficient peer-to-peer education and communication languish in old-style methodologies and power bases that are largely being funded by paid-for education and other fees.

“A lot of GP learning makes money for organisations and it makes careers,” Dr Price says. “But if you look at the critical care community and organisations like SMACC (Social Media and Critical Care)  and FOAMeD (Free Open Access Medical Education), they have managed to achieve an effective learning environment that is almost all free of charge to their doctor communities.

“It’s leading edge, it’s nearly all free and it’s altruistic. I can’t see why we can’t aim for that.

“Increasingly GPs and other doctors are seeing paid-for education as frustrating and unfair. People are producing content for free, for the altruistic benefit of the community, which is then taken over by a brand [the RACGP included] and they lose control of that content.

“To some extent there is an element [in GPDU] of protecting the intellectual property of the  body of knowledge of general practice from those who seek to monetise it.”

But while her ambition is to eventually see almost all education done free by the community, Dr Price agrees that disassembling the behemoth of paid-for medical education too quickly could cause more harm than good, especially to people’s livelihoods.

Whether Dr Price and her founder partners think so or not, GPDU is “the resistance”. They don’t agree with all that these powerful groups do and how they do it, so they have simply gone around them as they can.

It’s not a deliberate attempt to disrupt. But it is disruptive.

DOCTORS ARE NOT DIGITAL LAGGARDS

Healthcare is one of the last sectors to embrace so-called digital disruption. It has natural and very high market barriers that have slowed down the march of digital technology. Such barriers include things like market information asymmetry (i.e., the doctor vs patient information gap), supply and demand (doctors again) and regulatory risk (life and death in medicine).

Contrary to popular belief, doctors, however, are not digital laggards. All evidence is that your typical doctor is as digitally literate as any other professional.  Medicine is just a naturally resistant digital sector and the ecosystem isn’t there yet for them to go as fast as many would like.

Which may go some way to explaining the surprisingly rapid rise of GPDU.

All of the founders and admins on GPDU were highly engaged in social media before GPDU. And they aren’t all millennials.

In other sectors, such as finance, transport, travel and accommodation, we are seeing light-speed change being caused by disruptors. In each of these industries, entrepreneurs are  deliberately setting out to disrupt, using technology to make fortunes along the way. You’ve got less of them in medicine because it’s a complex market and hard to crack.

In a manner, the GPDU administrators may have stumbled into significant disruption. And it’s feasible they don’t know the extent to which they’ve done that yet.

Take GPDU’s key stated goal: “Accessing medical education and case commentary in a peer-supported environment”.

This seems a suitably harmless statement.

But if you look under the hood and think about GPDU’s ambitions for online social learning, you see some stuff that might end up revolutionising how the profession practices.

This goes some way to explain why groups such as the RACGP are nervous about this emerging “hive” of “do-gooders”.

MEDICAL EDUCATION RAPIDLY CHANGING

GPDU is pushing some very forward-thinking principles in modern professional learning. Principles that the bigger groups, at best, pay lip-service to, and, at worst, do not even grasp. GPDU, and the like-minded groups such as FOAMeD and SMACC, are already practicing what they preach, providing highly effective, low-cost (free) life-long, social digital learning for doctors.

If the RACGP, the AMA, ACRRM  and other medical groups think that they can keep their members competitive with the current formal-learning regimes then they likely have some serious surprises in store.

Today’s system relies heavily on intensive schooling as the key starting point and then topping up with odds and sods of didactic learning modules on the way (many of which GPs pay for). This is on its way out.

Artificial intelligence will be on top of the basics of diagnosis in no time, as it already is for professions such as the law. Some would argue it already is getting there in medicine. If we stood still, patients with a reasonable IQ and a decent self-learning , bot-basedAI system will be able to compete with your average GP on many diagnoses in the not too distant future.

Doctors and GPs will need to change how they learn and eventually how they practice. GPDU seems to be at the leading edge of this change.

But these changes, per se, aren’t the issue. The issue is how much more efficient, effective  and interesting the medical profession might be if it embraces some of these changes a little more seamlessly.

The future of being a GP is exciting. But not if the way GPs currently learn, and continue to learn, doesn’t change.

Arguably, GPDU and FOAMeD, thought by some as disruptive outliers in the learning sector, have their act together far more than any of the colleges or regulatory bodies.  They are the natural progression of GP engagement through new technology.

WORK WITH THE DISRUPTORS

GPDU, at its heart, was set up to help GPs, rapidly and effectively, with immediate clinical questions. And talking to many GPs and registrars it is hugely helpful in this respect. Even a simple rash, quickly photographed and posted for a couple of second opinions, usually gets a rapid turnaround.

The key is that GPs feel safe to be helping each other in this environment. The other key is very sharp and timely moderation, all of which is done by volunteers.

According to Dr Price, there have been instances where a GP has entered a question during a consult and got answers within minutes. Apparently the patients in each case were delighted.

But while the founding principle of the group is around sharing clinical insights, GPDU figures quite prominently in political and policy discussions.

RDAA President Dr Ewen McPhee says: “GPDU is an excellent forum to take the temperature of GPs on the ground about key political issues. Digital disruption brought to you by GPDU is a critical circuit breaker between primary-care clinicians and health-policy leaders.”

Digital disruption brought to you by GPDU is a critical circuit breaker between primary-care clinicians and health-policy leaders.

HOW BIG CAN GPDU BE?

As it keeps growing, as it seems it inevitably will, some question whether GPDU can stay true to its vision and retain its integrity?

When confronted with the “resistance group”  and “underground” analogy, Dr Price said she far more prefers to think of GPDU as a “national park”.

“Technology is changing culture, of course, and that part is the digital disruption to traditional structures and work flows.

“We are pitched [sometimes] as revolutionary or competitive but within this community, radicalisation is just altruism and love for our profession, our patients and our colleagues. Free (as much as possible!) from graft. That’s the part I think many find hard to understand.

“A national park means that everyone is welcome. Unity. Peaceful co-existence and respect for the environment.”

To date, the group has relied on the hard work and passion of a few. And while the ideals are great, it’s hard to see how this sort of dynamic can be carried into a larger organisation over a longer period of time.

With size comes rules, and with rules comes bureaucracy, and so on.

What if the group were to be twice or three times its current size within a couple of years? It might do that, and if it did administration wouldn’t be feasible at the level it is today.

“I don’t know how big GPDU can get,” Dr Price says. “I think it’s like a community of practice though, so you will always have a core of people who will be contributing who will jump in and out, and maybe for a few months it will be a certain group that will contribute with the larger group observing.”

Recently the group has done work on putting together a constitution, complete with policies and aims for the organisation that are designed to provide continuity and guidance over the longer term.

But eventually, there will come a need for money to help with administration.

One source might be a GPDU event. This is how SMACC helps to fund its organisation.

Dr Price says the GPDU is considering events, but not to make money. She says that events are a natural and important extension to a community such as GPDU.

“Events can deepen and enrich a community. They create the opportunity for valuable face-to-face connections that enhance collegiality, decrease the isolation of practice and engender trust.”

In the face of GPDU, it feels as if the large doctor-focused organisations are going to need to have a hard look at themselves and work out where their strengths might be synergistic.

AT THE CROSSROADS

The founders of GPDU are probably are going to arrive at some difficult crossroads in the not-too-distant future.

The trick seems to be how you get the lumbering and powerful incumbents to embrace the innovative, disruptive and agile-thinking that is coming from GPDU and other suchlike groups.

Maybe this is what Foucault was talking about all along. Power will find a balance. That will make for an interesting few years ahead.

Especially now that GPDU has been outed as the upstart disruptor that the big guys might need to embrace, not simply push away as a threat.

The Flinders News: Self-poisoning among the elderly likely to become a “growing problem”

 

Concerns around over-prescribing of drugs, and deteriorating mental health among elderly Tasmanians, have been voiced by health groups.

The comments follow a report predicting self-poisoning among older people will likely become a “growing problem” as the population ages. The Self-poisoning by older Australians: a cohort study report, published by the Medical Journal of Australia, found most self-poisoning was intentional.

Opioids were most commonly associated with fatal self-poisoning among the elderly, the report found.

Royal Australian College of General Practitioners president, Tasmanian GPDr Bastian Seidel, said too many medications were being provided to the elderly.

The Courier Mail: Junior doctors claim top rates for after-hours calls over routine illnesses

 

Junior doctors making after-hours house calls are claiming lucrative “urgent” rates for attending children with runny noses and other routine illnesses.

The cash grab has alarmed two doctors’ groups, which are warning patients to ask doctors for their qualifications.

The Royal Australian College of General Practitioners president Bastian Seidel said the proliferation of after-hours’ home visiting services was unsustainable.

The Medical Republic: Patient advocates: a private affair

 

As health systems and treatment options grow ever more complex, a new kind of support role is becoming increasingly popular in the United States, UK and Europe – the private patient advocate.

Overseas, private patient advocates have been a common part of patient-centred care since the mid-2000s. With just a handful of private advocates operating in Australia to date, their introduction raises many questions, and it remains to be seen how this emerging industry will streamline our patients’ care.

For example, can Australian health professionals and patient advocates work comfortably together? Are private patient advocates necessary to bridge gaps in our own health system? To answer these questions, we need to look at what private patient advocates do, and where they “fit” in an already crowded, multidisciplinary health market.

WHAT DO THEY DO?

Private patient advocates help patients coordinate, translate and communicate the intricacies of diagnoses, treatments, support services and other aspects of healthcare.

Professional experience in the health industry – nursing especially – is common among private patient advocates. Others come from a legal background, or have experience as a long-term patient or carer.

Services provided by private patient advocates are many and various.

Examples include accompanying patients to appointments, taking notes, explaining medical jargon, arranging second opinions or specialist appointments, co-ordinating support services, managing medications and mediating disputes. Private patient advocates do not make any health decisions or legal decisions on the patient’s behalf, but can equip patients with the knowledge they need to inform those decisions.

These advocates are employed directly by a patient or a patient’s family, independent of a hospital, GP practice or any other healthcare organisation. Fees can vary depending on the kinds of services provided, the level of involvement in a case and the amount of travelling required. Clients can expect to pay between $100 and $150 per hour for a private patient advocate, which is not usually covered by health insurance.

Many roles within public health system combine to perform similar functions to those provided by a private patient advocate. Publicly funded consumer advocates, social workers, nurses, interpreters, discharge planners and other non-medical staff are available to most hospital patients. Though they have many names, collectively these roles can often provide all the advocacy services a patient needs.

But there is also recognition in some quarters that it is possible for patients to get “lost in the system”.

Last month, for example, the Minister for Aged Care, Ken Wyatt,  released a draft of a National Aged Care Advocacy Framework, designed to “better empower people to exercise choice and control within the aged care system”.

In days gone by, there was a role of case management by a doctor within the hospitals, and that really no longer exists.

WHY GO PRIVATE?

Anyone who’s had a relatively smooth sail through the health system might wonder why someone would fork out hundreds of non-refundable dollars for services that can be provided collectively by a good GP, a hospital-support team and a committed family member.

But what if the patient is unaware of the hospital services available to them? What if they don’t have a good relationship with a holistic GP? Or the family is busy, disinterested or absent? What if the GP or specialists or hospital team is rushed or sloppy? Or communication is poor?

In the past, the system has been easier to navigate, and relatives were more likely to be available to be effective supporters or carers.

“There’s a big change in the social structure these days,” says Dorothy Kamaker of Patient Advocates Australia.

“The children of these people are often in their 40s, they’re at the peak of their careers, or at least they’re working as hard as they ever will, or they’ve got their own children.

“They’re called the sandwich generation – where they’re bringing up their own children but they’re supporting their parents.”

Other clients prefer to rely on a private advocate’s emotional detachment to help them deal with a distressing diagnosis.

A common selling point for private patient advocates is their independence. The fact that they are not beholden to any particular hospital, practitioner or bottom line, gives them a marketable ability to consider options for their clients that might not be offered by someone employed to represent an organisation.

“Patient advocates in hospitals do a lot of education with patients and that’s all fine,” Ms Kamaker says.

“That’s absolutely wonderful and they do a lot of referring around the hospitals, supporting them, referring them to other facilities in the hospital, and I don’t disagree with that.

“But I do think that what an employed patient advocate within an institution can never be is independent and look at the problem from everybody’s side.”

ARE THERE SHORTCOMINGS?

Imagine a world in which you could spend as long as you’d like with each patient. A world in which communication flows clearly and unfettered between patients, GPs, specialists, allied health professionals and hospitals. Where funding, forms and facilities are simple and freely available.

That’s a world that needs no private patient advocates, and right now, that is a world that doesn’t exist.

There’s no question that our health system is stretched; that population growth, time pressures and funding squabbles put pressure on doctors, nurses, allied health professionals and support staff to achieve more with less. Any canny businessperson would have no trouble finding gaps to fill, and private patient advocates clearly benefit when patients and their families struggle.

But is that all they’re doing? Are they exploiting cracks in the system for personal gain? Or are they a valuable extension of a system that has evolved beyond the comfortable grasp of the layperson?

Unsurprisingly, Ms Kamaker says her role is vital. “There wouldn’t be a need for us if the system got it right.” she explains.

“In days gone by, there was a role of case management by a doctor within the hospitals, and that really no longer exists. A lot of hospitals used to have patient advocate roles, and by and large that has disappeared, and now people have patient representatives or something that is really devolved into a troubleshooting role.”

Ms Kamaker emphasises that the expectations placed on patients to help manage their own care are currently greater than many people are ready to take on.

“In the last five or six years the health-delivery model has changed. It’s written into the Charter of Healthcare Rights that patients have rights and responsibilities. And those responsibilities are something that providers now rely on,” she says.

“I think there is a need for patients these days to be as smart as the people who are delivering the service, and that’s why people realise they need someone on their side and by their side all the time.”

Dr Bastian Seidel, President of the Royal Australian College of General Practitioners, agrees that there are shortcomings in the provision of health services in some sectors.

“I’m hearing from some patients that they are feeling pressured and pushed. When they go and see a GP they only spend a few minutes.

“When they go to a hospital they see a different doctor all the time and they’re in and out within two minutes as well. So it’s very confusing and they really don’t know whether they do receive the best care that they deserve,” he says.

On the question of whether private patient advocates are a suitable long-term solution, Dr Seidel is less certain.

“My feeling is, certainly in Australia, I can’t see it to be a long-term thing. It’s certainly a niche service that may be suitable for some patients. Absolutely. I cannot believe it’s going to be the norm anytime soon.

“That’s actually not what patients want. Patients don’t want more people involved. Patients want more control over the decisions they make, and they want more choice and they want more information. They certainly don’t want to outsource anything there.

“I think that would be a short-sighted approach. That doesn’t help us to raise levels of health literacy or to raise empowerment for our patients.”

Indeed, many of the opportunities for private patient advocates stem from the gap between what patients understand about their diagnoses, treatment and the workings of the health system, and what they need to know in order to manage it all themselves.

Health literacy is the currency of the private patient advocate.

MANAGING EXPECTATIONS

While barriers to seamless healthcare certainly exist, some issues crop up because of the disparity between what patients expect from the health system and what it can realistically provide.

Natalie* works as a consumer advocate in a public hospital in Victoria. She sees patient expectations as a fundamental factor of the healthcare equation.

“I’ve got this really good Venn diagram. (See above)

One bubble is the resources available in the system, another bubble is the expectations of the health professionals, and the last is the expectations of the patients. And right in the convergence, that middle is what we can achieve. But you really need to factor in all those three circles.”

Equilibrium in such a structure is often difficult to obtain. Most practitioners have encountered patients or family members who have pushed for a particular course of action that wasn’t necessarily warranted by the patient’s condition; or who have complained about the way their case was handled when all correct procedures were followed.

Many of these cases can be resolved once the patient understands where their desires are at odds with what’s feasible – in other words, they want what’s outside the convergence of Natalie’s Venn diagram. However, a small number of patients persist with their objectives beyond what might be considered reasonable, and could see a private patient advocate as a valuable champion for their cause.

This isn’t necessarily a bad thing.

A good advocate with health experience will be able to explain why a patient’s complaint or treatment expectations are unrealistic, and be considered a more neutral player by the patient than the people treating them or processing their complaint.

The patient may feel more at ease working towards an effective compromise with a private advocate than they do with people they consider biased or inflexible.

Is there any evidence that patient advocates are improving patient outcomes? I’m not aware of anything, and that probably should be the main driver.

CRUX OF THE ISSUE

There are several studies that suggest patient health outcomes are improved when a support person, patient navigator or case manager is involved.

For example, a 2008 review published in Cancer  found that cancer patients improved their standard of treatment when using a patient navigator.

Its discussion states, “Overall, there was evidence of some degree of efficacy for patient navigation in increasing participation in cancer screening and adherence to diagnostic follow-up care after the detection of an abnormality.”

A 2016 review in BMJ Open concluded:

“Our review suggests that case management could reduce ED visits and hospitalisations as well as cost, but additional studies still need to clearly confirm its effectiveness.”

On the more specific topic of private patient advocates’ effect on health outcomes, documented evidence is scarce.

“Is there any evidence that patient advocates are improving patient outcomes? I’m not aware of anything and that probably should be the main driver – to make sure we are improving patient outcomes.

“Because otherwise, just to pay somebody, why are we doing it?” says Dr Seidel.

Patient advocate Ms Kamaker adds:

“In Sydney and in Australia, in private practice, there are probably only three or four independent patient advocates practising at the moment … there may be half a dozen or so. So there is no critical mass there to do any kind of research.”

CAVEAT EMPTOR

In the fledgling business of private patient advocacy in Australia, there is currently no quality control or standard of qualification. Though many private advocates have a solid background in nursing or law, there is no restriction on who can become an advocate.

The field is equally open to competence and cowboys, and the onus is on the client to ensure the person they hire is suited to
the job.

Patient advocate Natalie maintains her nursing registration even though she works in a non-nursing role.

She sees the lack of regulation in the private advocate space as problematic, as they are dealing with vulnerable people who may not recognise the distinction between registered and unregistered professionals.

“There’s value in having some clinical credibility,” she says.

“I think it’s very similar to life coaches and psychotherapists. Anyone can call themselves a psychotherapist. You don’t have to be registered with AHPRA.”

SUPPLY AND DEMAND

There are some convincing arguments for using a caring and qualified private patient advocate. But in the present health environment, they are only available to those patients who can afford to pay out of their own pocket.

Arguably, the patients who stand to benefit most from the services of private patient advocates are those who can least afford to use them.

These are the patients who need help not only with health literacy, but also with interpreters, financial assistance and access to support services they may not know exist.

“There’s a real imbalance there,” says Natalie.

“I think the people who have the money to pay for a private advocate are already better placed than many of the people who need that service.”

THE FUTURE

Does the Australian health system have a permanent place for private patient advocates? The answer appears to be yes, but with conditions.

Though some health professionals may view private patient advocates as a temporary fix for cracks in a straining health system, it’s plausible they could evolve into a more permanent, complementary fixture.

For that to happen, more work needs to be done to regulate the standard of private patient advocacy, and to allow affordable access to patients who are currently priced out of the independent advocacy market.

RN Drive: Greg Hunt interview with Patricia Karvelas

 

“Look, I have been fortunate to work with Michael Gannon, who’s the really first-class leader of the AMA, and with Bastian Seidel, who is the equally outstanding leader of the Royal Australian College of GPs. I’m only a few weeks into the job. I’ve got to say, I think both sides here believe we’ve made enormous progress.” – Health Minister, Greg Hunt

The Guardian: Call for website to compare doctors’ fees and services

 

Patients would be able to compare medical doctors’ prices and services on a MySchool-style website under a proposed transparency measure being pushed by the national healthcare consumer body.

But the Australian Medical Association has criticised the plan as an “unwieldy” imposition on specialists.

The Royal Australian College of General Practitioners president, Bastian Seidel, said there was no need for a comparison service to cover GPs because professional regulation already required them to publish fees on their websites.

The Medical Republic: We are here to listen, says ALP

 

Labor Leader Bill Shorten has raised the bar for health policy debate, promising to map out long-term investment in preventive health and primary care in partnership with health and medical experts.

Mr Shorten told 150 senior health professionals at Labor’s Health Summit in Canberra last week, he would use the current term of parliament to plan a future for healthcare beyond the demands of short-term election cycles.

“We want to move beyond the boom and bust in healthcare policy in the recent past, the uncertainty created by deep cuts or sudden swerves in policy or funding,” he said.

“I want all of us to look beyond the next Budget, or the next election, and focus instead on the next generation.”

In his opening address to the summit at Parliament House on Friday, Mr Shorten linked public disenchantment with politics to widespread fear that the society was becoming less equitable and the health system was becoming run down.

“I think there is an almost measurable anxiety. Will we be the first generation of Australians to hand on a lesser standard of living, a lesser quality of life, to the next generation?” he asked.

Mr Shorten said reducing fragmentation of the health system and improving continuity of care were two of the best improvements a government could make.

“Because if the last three and a half years of health policy have taught us at all, it’s that the tired old mindset that views every dollar of health funding as a burden to the budget, or a cost to be cut, is totally unsuited to the challenges facing 21st century Australia.”

He said Labor had called the summit to listen to the experts.

Of course, it’s a lot easier to appease stakeholders in (health) from opposition than it is from government.

“We are here to listen to people on the frontline – to the researchers, the policy makers, to the people who see how the system works.”

AMA President Dr Michael Gannon said Mr Shorten’s address was “a fabulous speech” that showed understanding of the importance of prevention and how the different elements of the health system knitted together.

“Of course, it’s a lot easier to appease stakeholders in (health) from opposition than it is from government,” he told The Medical Republic.

“But the greatest challenge at the moment in health policy is the ability to find savings across all elements of spending across government.

“In the room today we have got 150 stakeholders who have got fabulous ideas about how to spend more money on health.”

Dr Gannon said one focus of discussion was that Australia spent only a small amount – 2% of health spending – on public health prevention initiatives, which he said were of enormous value.

“A point I made was the enormous secondary prevention value the Australian public gets from the work GPs do every day. GPs are the public health champions in every postcode,” he said.

However, both sides of politics had failed to invest in general practice over the past 30 years, he said.

The summit meeting was well oversubscribed, with more than 400 applications for the 150 places at the table.

Dr Stephen Duckett, Health Program Director of the Grattan Institute, said it was a remarkable concentration of people from all political persuasions and across the sector, from public health to private hospitals and health insurers.

“The reality is, if they (Labor) want to develop good policy, they’ve got to listen to a range of ideas,” he said.

RACGP representatives at the summit stressed the opportunity to achieve better efficient by putting more weight on primary care, rather than tertiary care, and the need for more accurate health workforce data.

“We really don’t have very good data to underpin our workforce planning to avoid shortages and oversupply of nurses and practitioners. That’s something to focus on,” College President Dr Bastian Seidel said.

Dr Ewen McPhee, president of the Rural Doctors Association of Australia, said he was encouraged by the emphasis on longer-term investment and giving policies time to mature.

“Bill Shorten summarised it quite well by acknowledging it wasn’t about the Labor Party; it was about listening to health professionals and listening to people with lived experience of disease, and communities.

“That would be a positive way for them to move,” Dr McPhee said.

The Medical Republic: Welcome changes to aged-care services funding

 

Older Australians will have greater choice and control over care services to help them to live at home for longer in a major shake-up of provider rules.

The reforms feature “portable” funding, giving consumers the freedom to change providers – and take their funding with them – for services such as personal care, nursing and social support.

Aged Care Minister Ken Wyatt said the changes represented a “major cultural change in the delivery of aged care”.

He said more than 100,000 consumers would benefit from the scheme in the next year. Previously, home-care packages were allocated to providers and any unspent funds were retained by them.

RACGP President Dr Bastian Seidel said the Increasing Choice in Home Care initiative was a positive step that would allow more patients to continue their long-term care relationships with their GPs.

“I think there’s an appreciation that healthcare in the future is going to be more in the community rather than in institutions or facilities.  When we talk about aged care, we talk about going into the community,” he said.

Helping people to remain in familiar surroundings as they aged would also be less stressful for them and far more cost-efficient than sending them unnecessarily to aged-care facilities, he added.

Under the means-tested program, seniors are assessed for eligibility and allocated a subsidised “package” of services on one of four tiers, according to need.  If they want extra services, they pay more.

Ian Yates, CEO of the Councils on the Ageing, welcomed the reform but said the scheme should be redesigned to put more weight on the higher-need levels three and four.

“We believe the mix of packages is wrong. There are always waiting lists for levels three and four, while there are usually level ones and two vacant,” he said.

“Too many people go into residential care now because, although they have been assessed for a level four, there isn’t one available and there’s a long waiting list.”

It would be preferable to add more higher-level care packages, which were more expensive, even if it meant having fewer packages overall, he added.

The largely non-profit home-care provider sector is now obliged to publish information about exit fees, if applicable, and regular accounts showing clients how much their services cost, including administration fees.

A basic fee of 17.5% of the aged pension is charged (currently $139.58 per fortnight for a single person) for a subsidised home-support package. According to the government’s fee calculator, a person with financial assets of $100,000 would attract an added fee of $33.04 a fortnight.

The scheme can offer help with personal activities such as bathing and dressing, preparing meals and eating, shopping and doctor’s visits.  It also provides support for mobility devices, clinical devices and technology items.

Industry experts predict the home-care industry will expand and improve through increased competition and the rise of brokerage-style operators.  They also note possible benefits for the Health Care Home model of integrated care for patients with chronic disease.

To date, however, patients have complained of patchy delivery, such as care services available only on weekdays during business hours, or packages that did not support their needs.

Dr Seidel said he had also raised with Minister Wyatt the issue of the lack of mental healthcare plans for residential aged-care patients and was confident of a “pragmatic solution”.

“We have patients who are suffering from depression and anxiety in the community,” he said.

“If they have to go into a residential facility because of a clinical condition, all of a sudden they can’t see their psychologist any more because the Medicare rebate is not there.

The Medical Republic: RACGP ramps up its Canberra presence

 

The RACGP is establishing a permanent office in Canberra in a sign of its increasingly prominent role as a policy advocate for general practice.

The new office will be housed in one of the best-connected pieces of real estate in the capital – the National Press Club building on National Circuit, Barton, just around the corner from Parliament House.

“We are a national organisation and realistically we should have a physical presence in all states and territories,” RACGP President Dr Bastian Seidel said.

“Particularly, with a stronger focus on advocacy now, we should have a presence close to political decision makers and the Department of Health.

It had got to a point where members would be surprised if the College did not have a foothold in the Australian Capital Territory.

“If we want the voice of general practice to be heard we just have to be here,” Dr Seidel said, speaking to The Medical Republic during one of his frequent trips to the capital.

The AMA and the Rural Doctors Association of Australia have Canberra offices, as do organisations representing pharmacists, pharmaceutical companies and many other health stakeholders.

The RACGP has become increasingly outspoken on political issues affecting GPs and patients, after the AMA initially took the lead in a public campaign against the prolonged  Medicare rebate freeze.

Dr Seidel said the idea of a Canberra office won support after he suggested it during an academic session at the RACGP’s annual conference in Perth last year.

He declined to put a figure on the outlay for the new premises.  TMR has been told office space in the National Press Club building typically rents for $380 to $430 per square metre per year.

Dr Seidel will deliver an address titled “Bursting the health bubble – How your GP is saving the Australian health system” –  at a luncheon to launch the office on March 20.

The Tasmanian GP and practice owner said he was encouraged by his latest rounds of meetings with ministers.

“I’ve now had multiple discussions and meetings with Health Minister Hunt and those meetings have been positive and progressing well.

“The Medicare rebate freeze has now generally become a political problem, so I think that needs to be resolved. That’s something we have advocated for quite a long time now.

“Politicians talk a lot about cost of living pressures.  With bulk-billing rates dropping and out-of-pocket costs rising, lifting the rebate freeze would have a significant positive impact on the costs of seeing a general practitioner for our patients.

“But of course, that’s not the only thing.  There has to be a suite of initiatives and arrangements to ensure general practice is funded properly. Minister Hunt is very well aware of this.”

The Medical Republic: Huge variation in specialists’ fees spark concern 

 

Some patients may be paying over five times more than others do in out-of-pocket costs for their first consultation with a specialist in Australia, prompting calls for greater transparency.

An analysis of 2015 Medicare claims data also revealed that bulk-billing rates varied between location as well, with rates in the Northern Territory nearly twice as high as anywhere else.

Haematology and medical oncology were the only specialties bulk-billing more than half of initial consultations, the analysis found.

RACGP president Dr Bastian Seidel urged specialists to stick to the AMA-recommended fees, saying this kind of variation reflected poorly on the medical profession.

“I’m not saying you can’t charge above and beyond the AMA-recommended rate, but you need very, very good reasons, and you need to disclose that at the start of the consultation with the patient,” Dr Seidel said.

Data from 2013-14 found that almost 8% of patients delayed or avoided seeing a specialist for a necessary consultation because of concerns about the price.

This study showed that at the most expensive end, patients could be looking at a $340 fee for visiting a neurologist, a more than $200 out-of-pocket expense.

Because there was no publicly available information on the quality of care or any other quality measures, such variation in specialist fees was not based on any objective measure of care provided by individual doctors, the authors of the study wrote.

Dr Seidel echoed the calls in the accompanying editorials that were published alongside the analysis, calling for greater transparency to help curtail unreasonable fee-setting.

“Australia has the highest rate of out-of-pocket specialist expenses [in the world] and that is really concerning,” he said.

While there has been a big focus on GP costs over the last few years, “the cost drivers and those charging tremendous out-of-pocket fees are not GPs”, Dr Seidel said.

High specialist fees were particularly troubling when patients had no choice between specialists, such as in rural and regional areas, Dr Seidel said.

And as much as rising fees was a concern for patients, it would be impossible to expect GPs to be able to find the cheapest specialist for those patients, he said.

The Medical Republic: Canberra sees “lite” on rural GP training

 

The government is restoring a “lite” version of a popular prevocational general practice training scheme that it axed in 2014 as a waste of money.

Applications are open for rural clinical schools to pin down 240 intern placements  in rural general practice to be made available under the scheme, budgeted at $10 million a year, the government said.

“It is a step in the right direction,” RACGP President Dr Bastian Seidel said, adding he believed exposure to general practice should be a compulsory part of medical training for all doctors.

Doctor Portal: Let patients shop around for value

 

Consumer advocates are calling for health system reforms to enable patients to shop around for the best value specialists, as new figures reveal huge variations in out-of-pocket costs.

Royal Australian College of General Practitioners President Dr Bastian Seidel condemned excessive specialist fees and supported the call for greater fee transparency; however, he rejected measures such as ratings websites which he said “turn doctors into a commodity”.

Australian Doctor: The vast variations in specialist consult fees 

 

The huge variations in what different medical specialties charge for consults have been revealed. Academics from the University of Melbourne have analysed Medicare claims for initial outpatient consultations (MBS item 110) in 11 specialties.

Immunologists top the fee league table, charging $257 on average for an initial consultation. They are followed by neurologists, whose fees average $252, although one neurologist charged more than $350 for an initial consultation, according to the data.

Bulk-billing rates are also relatively low — 10-40% for all specialties — with the exception of haematology and medical oncology, where just over half of consults are bulk-billed.

Medicare rebates have failed to keep in line with fees, exposing patients to significant out-of-pocket costs for specialist care, the researchers write in the Medical Journal of Australia.

“The lack of publicly available data about the range of fees for specific services places patients at a distinct disadvantage when seeking affordable medical care,” they wrote.

“Further, as there are no data on quality of care in the outpatient setting, patients are not only unsure about the range of appropriate fees, but also about the value of the service they receive.”

The findings again raise questions about the funding disparities between general practice and other specialties.

Last year, the average out-of-pocket fee for a level C GP consultation lasting up to 40 minutes was $41.92. More than 85% of the consults were bulk-billed.

A recent Commonwealth Fund survey found that GPs in Australia were among the happiest in the world with their chosen medical careers.

However, 42% said they were somewhat dissatisfied with the income disparities with other specialists. A further 38% said they were very dissatisfied.

RACGP president Dr Bastian Seidel said the average GP earned less than half the income of specialist hospital doctors. “I’m not surprised GPs are not happy with this.”

Croakey: Colleges welcome change to trainee entry

 

In a what proved a popular move, Assistant Minister for Health, Dr David Gillespie, travelled to Tasmania at the end of last month to announce that his Government was handing responsibility for selecting trainees in General Practice to the two relevant colleges.

From next year’s intake, potential GP trainees will apply directly to the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine, who will be the gatekeepers of entry into the Australian General Practice Training program.

Australian Doctor: GPs sceptical over review finding in support of vitamin D for colds

 

GPs are sceptical about new findings that suggest vitamin D supplementation can prevent acute respiratory tract infections.

The systematic review of 25 randomised controlled trials of vitamin D supplementation involving more than 11,000 people found a relative risk reduction of 12% in the number of patients experiencing at least one acute respiratory tract infection after taking the supplements.

The protective effects were seen in people taking daily or weekly vitamin D, but not with bolus doses, the BMJ review found.

The number needed to treat to prevent one acute respiratory tract infection was 33 people. In those with severe deficiency (<25nmol/L baseline blood levels), only four need to be treated to prevent one acute respiratory infection.

The authors say their results support public health measures, such as food fortification, to improve vitamin D deficiency.

But a related editorial counters that the absolute risk reduction of 2% does not justify population-level supplementation.

“We think that they should be viewed as hypothesis-generating only, requiring confirmation in well-designed, adequately powered randomised controlled trials.“

RACGP president Dr Bastian Seidel says it is an example of how a study can be statistically significant but “clinically highly doubtful and irrelevant”.

“With a 2% absolute reduction, why would you bother? I would say to the patient: don’t go to the next chemist and load up on vitamin D.”

AMA vice-president and Melbourne GP Dr Tony Bartone (pictured) says he wouldn’t suggest vitamin D supplements to people.

“The quantum of the reduction of risk is of low significance to the average patient. It’s about keeping healthy and keeping well, making sure you have a nutritious diet and good enough sleep.“

Dr Bartone says it is also important to ensure people keep their annual flu vaccinations up-to-date.

The lead author of the study, Professor Adrian Martineau, clinical professor of respiratory infection and immunity at Barts and The London School of Medicine and Dentistry, claims the overall benefits of vitamin D supplementation can be seen in the same light as flu vaccination.

“To put these numbers into context, the number needed to treat to prevent one influenza-like illness with parenteral inactivated influenza vaccine is 40 in adults and 28 in children,” he told the BMJ.

“Influenza vaccination programmes are motivated by the principle that, when a disease is common, even minor reductions in incidence can have significant public health benefits; vitamin D fortification programmes might well be motivated by the same principle.”

Sydney Morning Herald: Medicare rebate

 

Prime Minister Malcolm Turnbull has given the strongest signal yet the government may move to head off its politically damaging feud with the medical profession by lifting the Medicare freeze.

President of the Royal Australian College of General Practioners, Bastian Seidel, said he had met with Greg Hunt three times since he came to the portfolio, as well as Mr Turnbull and said he had pressed the urgency of the situation.

The Medical Republic: Caution urged over emergency doc app

 

A new app that promises to save patients a trip to, and a long wait in, the emergency department has prompted concern about fragmentation of care.

My Emergency Dr, an app developed by Sydney Royal North Shore Hospital emergency physician Dr Justin Bowra, promises to give “every Australian urgent video access via your smartphone to an emergency specialist, wherever they live and whenever they call”.

According to trial data from the company, six in 10 patients using the app were able to avoid a visit to the hospital after a video consultation with one of their doctors.

“The doctor will assess you and make a diagnosis, then arrange what is needed, e.g. prescription for medication, referral for an x-ray, or even urgent admission to hospital,” the website said. “The doctor will also email you a summary of the consultation for your GP.”

After the video consultation, doctors also email patients any electronic prescriptions, as well as referrals for x-rays and blood tests.

A company spokeswoman said that all its doctors went through a “extensive in-house training program” and test before they could start working with the app.

More than 40 senior emergency physicians worked for the company, ensuring the wait time was less than three minutes for patients calling day or night, any time of the year, she said.

But RACGP President Dr Bastian Seidel voiced concern the app might lead to fragmentation of care.

At a cost of $100 for the first 15 minutes on a weekday, and $125 per 15 minutes overnight and on weekends, Dr Seidel pointed out it was still more cost-effective to see a GP in person or with a video or phone consultation.

There is no Medicare rebate for consults through the app, although residents of aged-care facilities and those in telehealth-eligible areas can be bulk-billed if the GP has provided a referral in advance.

“Nobody wants to go to hospital for any reason,” Dr Seidel said. “But rather than using an app to get medical advice from an emergency physician who operates on a very limited scope, and typically in a high-tech environment with lots of back up, it would probably be worthwhile having a chat with a GP who is trained to look at a much broader scope.”

There were also limitations in what could be evaluated in a video consult, Dr Seidel said.

“Realistically a huge component, from a GP point of view, and certainly from an emergency physician point of view, is the physical consultation,” he said. “And that is something that doesn’t apply to a video consult.”

My Emergency Dr said the service was “absolutely not” a replacement for a patient’s GPs or the 000 emergency call.

“We simply want to be there at times when your GP can’t be, as our service is available 24 hours a day, seven days a week,” the company’s website said.

The app also warns customers to instead call 000 if the patient is unconscious, has chest pain, difficulty breathing, uncontrollable bleeding, or if they have been in a major accident.

Prescriptions for S4 drugs are sent directly to the pharmacist via the app, and S8 medications are not prescribed at all.

Choice: Is your pharmacist giving you the right advice?

 

If you walk into any pharmacy in Australia you’re likely to be greeted by rows of shelves groaning with herbal remedies, vitamins and other alternative supplements for sale, as well as medicines. And behind every prescription dispensing counter you’ll find a pharmacist.

The Medical Republic: User-pays emergency clinic opens today

 

Doctors behind the launch of a walk-in emergency clinic hope to provide almost immediate care for people with acute but non-life threatening conditions, reducing the burden on nearby emergency departments.

Patients visiting the Walk-in Specialist Emergency clinic, located in northern Sydney, will pay a $200 fee that covers consultation with a senior emergency physician, treatment and diagnostic imaging.

The clinic, which launches today, and is equipped with a CT scanner, X-ray OPG, ultrasound and pathology laboratory to further reduce wait times.

Dr Pankaj Arora, an emergency physician at Royal North Shore Hospital and one of the clinic’s founders, pointed to figures showing more than two in three patients who visited the emergency department leave without being hospitalised.

This indicated a need for an in-between service, that treated conditions beyond those normally covered in general practice, such as heavy concussions, fractures and lacerations, but would not necessarily need hospitalisation, he said.

Dr Arora and his colleagues anticipate that around half of the presentations will come from GP referrals, with the other half mainly accounted for by the clinic’s extended opening hours of 10am to 10pm.

The triage system was simple, Dr Arora explained: “If you are looking sick just go in to see a doctor, or if you are looking well then sit here in the reception”.

“We want only 40 to 50 patients here per day, but we will be geared up to take them straight in,” he said.

If patients arrive in need of urgent hospitalisation, or deteriorate while in care, the clinic has an ambulance bay to help get them to a nearby hospital.

The permanent staff includes around 15 emergency physicians, all of whom will continue to work part-time elsewhere to ensure their skillset is maintained.

The clinic also includes several consultation rooms for specialists such as orthopaedicians, obstetricians and dentists.

So rather than being sent out into the community to organise their own care, patients can return to the clinic to see a specialist, and their GP is notified with a report on the patient’s condition.

RACGP president Dr Bastian Seidel welcomed the clinic’s commitment to communicating with the patient’s general practitioner, but said he was unsure if there was a need for walk-in presentations.

“The first port of call for patients should always be to a general practitioner, who is trained in acute presentations, and to take it from there,” he said.

While it was ultimately the patient’s choice whether to pay the out-of-pocket fee, Dr Seidel said there was some concern already that patients were already being over-investigated with technologies such as CT scans, X-rays, ultrasounds and pathology.

“My concern is that a presentation there may potentially lead to lots of follow-up investigations, that would of course attract a Medicare rebate and be a cost to the taxpayer,” he said.

While variations on this model have been widely rolled out across the US, this is one of Australia’s first such clinics.

Patients returning to the clinic within 24 hours are covered by the initial $200 fee, and pay an extra $100 for any other consultations made within a week of the first visit. After that they are subject to another $200 fee.

The Medical Republic: Continuity of care could save billions

 

Patients who see the same GP are less likely to be admitted to hospital unnecessarily, potentially saving the healthcare system billions, new research shows.

While efforts had been made to improve access to primary care, those efforts might have had the unintended side effect of reducing continuity of care, the authors of the British study wrote.

In fact, continuity of care tended to be worse in larger practices, they found.

RACGP president Dr Bastian Seidel said the research reinforced the importance of what GPs had instinctively known – that the best care was delivered in small, quality, general practices.

“Last year there was a Dutch study indicating when you have a continuous relationship with your GP you live longer, and now this study says that continuity of care actually prevents hospital admissions – and quite significantly,” he said.

This new study, of over 230,000 English adults aged 62 to 82 years, found that patients were 12% less likely to be hospitalised with conditions that could have been managed in primary care compared with those with low continuity of care.

Even a medium level of continuity was associated with 9% fewer admissions for these conditions.

The effects were most pronounced for patients visiting 18 or more times over the two-year study period, they found.

Older patients were the focus because they tended to have the highest healthcare needs, comprising a high proportion of both GP visits and avoidable hospital admissions.

The authors found almost half of patients in smaller practices had high continuity of care, compared to less than a third in larger practices.

This indicated a need to reverse the trend of corporation of medicine happening in Australia, Dr Seidel said.

“We just have to make sure this research is now informing policy,” he said.

“Medicare rebates don’t reflect how a consultation should be reimbursed,  so the corporate model is just about getting more patients through in the same timeframe.

“That is not beneficial to patients, it is not beneficial to the practitioners and it’s certainly not working for the health system either.”

“It is ingrained in our profession to have a whole-of-life and a whole-of-family approach, so it is actually worthwhile looking at continuity of care [as a metric].”

The increased focus on multidisciplinary teams was also something to be careful of, to ensure it did not lead to less continuity and more fragmentation of care, Dr Seidel added.

In the meantime, it was important that GPs allowed themselves to spend more time with patients, he said.

“If we spend more time with our patients it’s going to enhance the doctor-patient relationship.

“Patients don’t want treatment, they want help, and that doesn’t mean sending them off to a multitude of investigations, blood tests, scans, admissions and referrals,” Dr Seidel said.

The RACGP estimated that preventing avoidable hospital presentations would save the healthcare system $2 billion per year in a submission to the government last year, Dr Seidel said.

Sydney Morning Herald: Does fear of bad news stop you from seeing the doctor?

 

There are many reasons people put off seeing the doctor.

From time constraints, to cost; the stereotypical Aussie outlook (“she’ll be right”), to plain embarrassment.

Now a new report from Britain has shown that a third of people who consciously put off seeing their doctor do so for fear of finding out bad news.

Australians harbour the same worry, though it’s not as common here, says Dr Bastian Seidel from the Royal Australian College of General Practitioners.

Doctor Portal: Herbal products need tighter regulation by TGA

 

Experts are calling for greater regulatory rigour around the provision of herbal preparations in Australia, reporting that the risks posed by such products are not well understood here.

The authors of a narrative review published in the MJA said that while many herbal products may be safe, it was worrying that the specific effects and potentially harmful interactions with prescription medication were not well understood.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, said that herbal remedies in Australia were “terra incognita”.

The Examiner: Google installs new health feature, doctors implore patients to still seek professional advice

 

Google has launched a feature providing information, approved by a panel of doctors, for more than 900 health conditions.

When a consumer types in a health condition, reviewed information around the condition will appear in the form on an online card, with an outline of the condition, symptoms, diagnosis and prevalence, with some featuring imagery.

However, if a user simply types in symptoms, the feature won’t appear – it appears when the specific condition is typed in the search bar.

Royal Australian College of General Practitioners president and Tasmanian GP, Dr Bastian Seidel, said the main concern was that Google “really had to lift its game”.

Katherine Times: Doctors not at fault for bulk billing upset

 

Health experts point to the federal government’s freeze on medicare rebates to be the source of the bulk billing debacle in Katherine.

Royal Australian College of General Practitioners president, Dr Bastian Seidel, said the freeze on Medicare patient rebates would see practices stop bulk billing or close their doors.

The Examiner: Data looks at emergency departments and GP access

 

New data has highlighted Tasmanians’ access to care and experiences in the health system.

More than 15 per cent of Tasmanian patients did not report emergency department doctors or specialists always or often listened carefully to them, the second worst result nationally.

Royal Australian College of General Practitioners president, Tasmanian GP Dr Bastian Seidel, said “the concern … is it’s quite expensive to run a medical practice in Tasmania”.

“The Medicare rebate we are seeing now nowhere near reflects the true cost of patient care,” Dr Seidel said.

3AW: Google to launch digital health cards to give verified medical information

 

Medical misdiagnosis by ‘Doctor Google’ could be a thing of the past.

Google is partnering with medical professionals to launch digital health cards which give details of more 900 conditions with verified medical information.

President of the Royal Australian College of General Practitioners, Dr Bastian Seidel, told 3AW Breakfast it’s about time Google did something about it.

Listen here

The Medical Republic: GP training selection handed to colleges

 

The federal government has handed control of GP training selection to the RACGP and ACRRM, splitting the responsibility 90-10 between the two colleges.

Federal Assistant Health Minister Dr David Gillespie announced the decision today in Hobart, saying it was an important part of the health workforce reform agenda and would give the colleges a greater role in the “management and conduct” of GP training.

As of next year, the RACGP will get to choose 1350 of the candidates for the 1500 GP training places, with the rural-oriented ACRRM to select 150.

Both colleges said they had been working hard to take over selection of GP registrars ever since the government flagged its intention to shut down GPET two years ago.

“It makes sense,” RACGP President Dr Bastian Seidel told TMR.  “It is essential for us as an academic medical college to regain control over selection – it is what we are meant to be doing.”

Above all, he said the RACGP would be looking for applicants with “commitment”.

“Often there are people who apply but might not have a particular interest in general practice.

“We don’t want to come second best. We want to compete with other medical colleges for the best candidates out there.”

ACRRM President Ruth Stewart said ACRRM’s selection role would be a key factor in building a rural training pipeline.

She said ACRRM would focus on attracting junior doctors who were “excited” about a career in rural or remote practice and had a commitment to becoming a rural generalist.

The government has said it would apply a ceiling of 1500 GP trainees annually as of 2018.

Dr Gillespie also announced the government would invest $220 million a year in Australian General Practice Training, the government agency that oversees GP training delivered by the nine regional training organisations.

More than 2200 applications were received by AGPET for GP training places in the 2017 intake.

As of next year, applicants will be required to pay the colleges a non-refundable fee of more than $700 to apply to be considered for training.

Australian Doctor: Colleges to charge $700 fee to GP training applicants

 

Doctors applying to GP training programs will face fees of more than $700 after the RACGP and ACRRM take over candidate selection this year.

The selection of registrars has rested with the Federal Department of Health since the General Practice Education and Training organisation was scrapped in December 2014.

Now the task will be handed back to the colleges, but at a cost.

The RACGP says it will charge a non-refundable application fee of $725 and ACRRM will charge $750.

The RACGP will select 90% of doctors for the 1500 available places on the Australian General Practice Training (AGPT) program.

However, it says it is not profiting from the changes, and the fees are about recovering its costs.

Under the reforms, ACRRM will be tasked with selecting the remaining 10% of registrars.

Last year, there were 2277 applicants for the 1500 available places, which, if fees had been in place, would have cost the applicants more than $1.5 million.

The Assistant Minister for Health, Dr David Gillespie, said most non-GP specialist colleges selected their candidates for training pathways and the change merely brought general practice into line with other specialties.

“The charging of an application fee is consistent with the practice of some other specialist colleges,” he said.

The Royal Australasian College of Surgeons selects its training candidates and charges a $770 application fee.

RACGP president Dr Bastian Seidel (pictured) said the college’s approach to selection would aim to increase the proportion of registrars passing its fellowship.

“The RACGP has advocated that the selection process should focus on the potential for candidates to achieve fellowship, rather than the current focus on selection into training,” he said.

“The RACGP’s strong relationship with the Department of Health has been critical in securing the move of selection across to the profession.”

Dr Seidel said capability and professionalism would be components of the selection process.

He promised the process would be “robust and transparent”.

The RACGP will launch a guide for applicants in February.

ACRRM president Associate Professor Ruth Stewart said having the college take over the selection of candidates was a key step towards the government’s promised rural training pipeline.

“It is fitting that in the college’s 20th anniversary year, we reach a milestone that the college has been calling for since the AGPT’s inception,” she said.

The AGPT involves 3-4 years of full-time registrar training, half of which occurs in rural areas.

The Examiner: Federal Assistant Health Minister David Gillespie announces changes to rural general practitioner graduate placements

 

Tasmania’s rural communities are set to benefit from federal changes to the way medical graduates are assigned to their post-graduate general practitioner placements.

Federal Assistant Health Minister David Gillespie was in Hobart on Monday to announce a $220 million per year investment into the selection of medical graduates for the Australian General Practice Training program.

Royal Australian College of General Practitioners president and Huonville general practitioner Bastian Seidel said the move would ​better reflect the needs of the communities.

The Australian: GP training program in latest medical reform

 

Medical workforce reforms have inched ahead, with the federal government offloading management of its general practice training program to two specialist colleges.

Under changes to be announced today, the Australian General Practice Training program will be run from 2018 by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine.

Assistant Health Minister David Gillespie said yesterday the government would continue to invest $220 million annually in the program and the colleges would introduce an application fee to cover the cost of selecting graduates.

The AGPT program gives graduates three to four years of full-time training, with 50 per cent of registrar training in rural and remote areas where shortages remain.

“The transfer of this function to the GP colleges will bring them into line with other Australian specialist medical colleges and the way these colleges select trainees for specialist training pathways and programs,” Dr Gillespie said.

RACGP president Bastian Seidel welcomed the move as ensuring only the most skilled applicants received general practice training in line with the standards expected of RACGP fellows.

Last year, Dr Gillespie announced a national assessment of the medical workforce, including medical schools, and making adjustments for future needs.
Recommendations are expected to go to cabinet in April.

The changes come after the Department of Health was overruled in its bid to remove GPs from the skilled immigration list out of concern that a rising number of domestic graduates would struggle to find training places and jobs.

ABC News: Tasmanian doctors blame surgery delays for high use of morphine-based painkillers

 

Tasmanians are being prescribed morphine-based medications at a higher rate than any other state – and it is directly related to long wait lists for elective surgery, according to the peak body representing family doctors.

The Tasmanian head of the national Royal Australian College of GPs (RACGP), Dr Bastian Seidel, said many people waiting months and months for surgeries were in chronic pain.

Victoria Harbor Times: Change GP? Medical records can go with you

 

Tracking your health information is possible as your life changes, according to the Royal Australian College of General Practitioners president.

Dr Bastian Seidel, who runs a general practice in regional Australia, said data can be transferred to other locations if your doctor or circumstances change.

Townsville Bulletin: Townsville after-hours doctors allegedly misdiagnosing patients

 

Townsville after-hours doctors are allegedly prescribing unnecessary antibiotics and missing uncommon diseases with one local practice treating several misdiagnoses each week.

Royal Australian College of General Practitioners president Dr Bastian Seidel said patients needed to have access to urgent care after hours.

“To ensure the quality of care provided and the most efficient use of limited healthcare funding, it is crucial that dedicated after-hours home visiting services use an appropriately qualified workforce,” Dr Seidel said.

The Medical Republic: Homeopathy fraud gets a free pass

 

Have you ever walked into a pharmacy looking for a homeopathic remedy? The Medical Republic did – but only to prove a point.

An exhaustive search of the vitamins and supplements aisle did not reveal any homeopathic concoctions. It was only at the cold and flu section that we found, nestled between over-the-counter preparations, what we were looking for.

To those who believe in science, homeopathy, by its very definition, can provide no therapeutic benefit whatsoever, besides a placebo effect. In homeopathy, substances are diluted to the point where there is close to zero probability that a single molecule of the original ingredient will be contained in the final product.

The 200-year old principle underpinning homeopathy is the “like cures like” or the “laws of similar”, first propagated by German physician Samuel Hahnemann. One example of homeopathic logic is the use of trace amounts of onion to alleviate allergic rhinitis. Large doses of the chemical irritant in onion causes watery eyes, but in tiny doses it relieves this symptom, according to the Australian Homeopathy Association.

But this is unlikely to be obvious to your average consumer when faced with homeopathic product packaging. Emblazoned across the label of one particular product we found were the words, “Kids cold”. The box contained 10 lozenges for “temporary relief from cold and flu symptoms, headache, fever, stuffy and runny nose, sneezing”. But each ingredient – including Kali Bichromium, Pulsatilla and Allium Cepa, among others – was diluted to 30c. This means that one drop of each substance was diluted in 99 drops of water and this process was repeated 30 times.

There is no possibility that this product – or any similar homeopathic product – could relieve cold symptoms, according to Dr Ken Harvey, an Adjunct Associate Professor at Monash University.

And there is every possibility that a parent might accidentally select this product for their sick child instead of consulting a GP. “It is really magical thinking to think [homeopathy is] going to do anything,” says Dr Harvey.

“People are simply not aware that homeopathy has nothing in it and doesn’t work and is not medicine,” says Rachael Dunlop, post-doctoral medical researcher and vice president of Australian Skeptics. “People presume – and rightly so – that if they walk into a pharmacy and pick up something off the shelf, it is going to work.”

Yet despite claims by homeopathy practitioners that “nanodoses” can be biologically active, this view is not supported by scientific evidence.

In March 2015, the National Health and Medical Research Council concluded there were no health conditions for which there was reliable evidence that homeopathy was effective. The report was based on 57 systematic reviews and 176 individual studies.

The US Federal Trade Commission went further, initiating a crackdown on dishonest advertising of homeopathic products. The commission, which has a similar role to the Australian Competition and Consumer Commission (ACCC), ordered homeopathic companies to state explicitly on product labels that there is no scientific evidence the product is effective.

The move raised the hackles of the American Institute of Homeopathy. Its rebuttal statement, which was mocked as “comedy gold” by one US physician, claimed that homeopathic efficacy had been demonstrated in “hundreds of state-of-the-art double-blinded, randomised, placebo-controlled studies, many in peer-reviewed journals”.

Despite the mounting evidence that homeopathy is ineffective, the market is flooded with homeopathic products. Australians spent around $8 million on homeopathy in 2009, according to the World Health Organisation.

“[If you look up Australian homeopathy suppliers online] you will find hundreds and hundreds of them all making misleading claims,” says Professor Emeritus John Dwyer, president of Friends of Science in Medicine. “The market is awash with very profitable products that do not benefit Australians and actually send them the totally wrong health message.”

The darker side to false advertising by homeopathy companies, of course, is the risk that consumers will forgo standard medical treatment. “We know that the outcomes of homeopathic practice have in some instances had fatal results and there have been extremely sad coronial inquests and, in one case, criminal charges,” says Ian Freckelton QC, a professor of law and psychiatry at Melbourne University.

In 2005, Perth woman Penelope Dingle suffered a needlessly painful death from bowel cancer after spending around $30,000 on homeopathy remedies and forgoing medical care. A toddler named Gloria died in 2009 in Sydney from untreated eczema when her parents replaced homeopathy for conventional treatment. The parents were found guilty of manslaughter.

The regulatory problem

So could, and should, Australia be doing more to prevent similar tragedies occurring?

Unfortunately, false and misleading homeopathy advertising often falls between the cracks in the regulatory framework in Australia.

As therapeutic goods, homeopathy products fall under the purview of the TGA. But the TGA does little to actively regulate the industry because it views homeopathy as “very low risk”. As such, homeopathic goods need not be registered or listed on the Australian Register of Therapeutic Goods, unless they refer to the treatment of any form of a disease, disorder or condition. While homeopathy companies must comply with the Therapeutic Goods Advertising Code 2015, there are “no effective penalties for Code breaches” such as fines, says Professor Harvey.

Regulation is largely complaints-driven. The TGA outsources complaint handling to an independent Complaints Resolution Panel made up of stakeholders and attended by the TGA. This panel deals with complaints on a case-by-case basis and can ask companies to withdraw specific pieces of advertising. The TGA can take further action to enforce advertising controls but, in the case of homeopathy, the market is essentially self-regulated.

“There’s an assumption that if [homeopathy] hasn’t got anything in it, it doesn’t need to be regulated properly because it isn’t a medicine,” explains Professor Harvey, who sits on the complaints panel.

The complaints process is achingly slow, taking an average of 149 days for each issue to be resolved.

“Australia has … an overloaded and under-resourced complaint system,” says Professor Harvey. Last year, the panel received 146 complaints for complementary medicines (62% of all complaints) and found almost all were justified.

Over the past decade, the panel has asked at least 11 individual homeopathy companies to withdraw advertising following complaints. A cursory look at the websites of each of the sanctioned companies revealed that more than half (by our count) were still making misleading claims. The worst examples included suggestions that homeopathy could reverse autism, act as an effective first-line treatment for burns, aid in healing post-surgical wounds, treat fibromyalgia and ear infections, bronchitis, tonsillitis and ringworm in children.

Another internet search revealed that four out of eight companies recommended by the Australian Homeopathic Association as go-to retailers were misleading the public on their websites, including promoting homeopathy for children with ADHD, eczema, colds and flu, as well as one website presenting homeoprophylaxis (homeopathic immunisation) as an option to parents who did not wish to vaccinate their children.

Professor Harvey says this figure matches the complaint panel’s own statistics for 2015-16, which showed that in 40% of cases advertisers simply fail to comply with the requests of the panel.

“In reality, the industry really snubs their nose at the TGA,” says Professor Dwyer. “There have been many situations where product advertising was said to be fraudulent and they just changed the name of the product, they didn’t change the product. And the Complaints Resolution Panel – the TGA – really doesn’t have any teeth to hurt industry.”

Much of these criticisms of the regulatory process are uncontroversial and are, in fact, acknowledged by the government’s own Review of Medicines and Devices Regulation – Stage Two Report, which describes the complaints system as “overly complex and slow”. “The current sanctions and penalties … are insufficient… and should be enhanced to incentivise greater compliance,” the July 2015 report states.

The ACCC

A major obstacle to reining in homeopathy advertising is that two regulators operate in the same space and neither want to make homeopathy their problem. The ACCC, like the TGA, is responsible for making businesses comply with consumer protection laws.

The ACCC has significantly greater powers than the TGA to pursue legal action under the Competition and Consumer Act 2010 and impose substantial. But the ACCC’s portfolio includes a broad range of industries, including banking and telecommunications, and only the “big picture” cases can be launched in the therapeutic goods space, says Professor Dwyer.

The ACCC has only ever successfully enforced penalties on a homeopathy company in one instance. Last year, Homeopathy Plus was ordered by the Federal Court to pay $115,000 in fines for false or misleading claims about using homeopathic remedies as an alternative for pertussis vaccine.

“The ACCC is concerned when representations about medical treatments are unable to be supported by scientific evidence,” a spokesman told TMR.However, “the ACCC is unable to pursue all matters that come to its attention”. The specific regulation of therapeutic products was more aligned to the roles of other agencies, he added.

But the TGA also backed away from any suggestion that it might become more active in regulating homeopathy advertising.

“The TGA is not a generalist consumer rights regulator,” a spokeswoman said. “Where appropriate, broader aspects of product promotion including fraudulent non-therapeutic claims, financial loss or unacceptable business practices may be referred to the appropriate national or state/territory regulator.”

The ACCC and the TGA are handballing homeopathy regulation back and forth between them. No one wants to catch the ball, says Professor Harvey.

There appears to be general agreement that the current system for regulating fraudulent advertising by homeopathy suppliers is completely inadequate. But the wheels of bureaucracy grind slowly. The Review of Medicines and Devices Regulation, which is leading the reform into the advertising complaints system, is now in in its third year. The Review, commissioned by the Government and chaired by Emeritus Professor Lloyd Sansom, will make recommendations about simplifying the regulation of therapeutic goods.

For some, the process is taking too long. “I really don’t think we need another review. It’s really about getting cracking on just putting some robust systems in place,” says Dr Justin Coleman, Queensland GP and commentator. “Everyone agrees the system is broken.”

But there is much disagreement over how the system should operate. One suggestion – which has received wide support – is to follow the footsteps of the US. Placing a disclaimer on homeopathic products to make it clear that homeopathy has no scientific basis is a “step in the right direction”, says Dr Coleman.

“[Labelling] will absolutely help people become aware that these products are actually not medicine,” says Ms Dunlop.

Dr Coleman suggests extending this model to include a set of standard claims that homeopathy manufacturers can make about their products. “Then if the advertiser wants to use more claims than that then they [would need to be] pre-approved,” he says.

Dr Bastian Seidel, president of the RACGP, says more comprehensive reform is required. “Labelling alone is not going to be good enough in my opinion.”

Health professionals, especially pharmacists, must take responsibility for communicating the problems with homeopathy.

“It is your professional obligation to make the customer or the patient aware of what the benefits are and what the pitfalls are,” Dr Seidel says.

The review’s stage two report called for the entire therapeutic goods complaints system to be disbanded and a new, centralised body with greater powers to be established. The TGA’s consultation, which closed in December, revealed strong opposition to this recommendation.

Professor Harvey and Professor Dwyer interpreted the proposal as the TGA positioning itself to take over the role of managing advertising complaints by abolishing the Complaints Resolution Panel and the Code Council and acquiring similar powers to the ACCC.

A TGA spokeswoman confirmed that the TGA taking over the complaints role was under consideration, along with an outsourced model.

Professor Dwyer says the TGA should not take charge of managing complaints as there is very little confidence in the TGA’s ability to protect consumers. “There are no details about how [the TGA] would do a better job and they are very, very close to industry and they appear to be influenced by industry,”  Professor Dwyer says, adding the TGA has an “unhealthy dependence” on registration fees from businesses. “There is also concern that the TGA lacks a consumer protection culture … has failed to address long-standing problems and is not transparent about the outcomes of complaints it currently handles.”

Dr Coleman cautions against disbanding the Complaints Resolution Panel. “It really hasn’t been given a proper go. If the TGA complaint panel was given reasonable resources, I think they could do a good job.”

One example of underfunding is the lack of support for a RACGP member to sit on the panel, which has meant that GPs have not been represented.  “It’s not the RACGP’s job to pay someone to do that job,” Dr Coleman says. “It seems crazy that the national body can’t find even a bit of money to pay a clinician to sit on the panel.”

A radical idea, proposed by Professor Harvey in his submission to the TGA and supported by Professor Dwyer and Dr Coleman, is to send a senior enforcement manager from the ACCC to the TGA to oversee the new system and change the TGA’s culture. This would keep the best of the old system (the code council and the complaints panel) while fixing the flaws, such as the lack of power to enforced determinations, Professor Harvey argues.

The ACCC did not respond when asked whether they would be interested in performing this function. A TGA spokeswoman said, by way of response: “The TGA has an established, productive relationship with the ACCC. This issue is being considered more closely by the TGA in the context of the Expert Review of Medicines and Medical Device Regulation. In the interim, the TGA will continue to work closely with the ACCC as needed to ensure regulatory coverage.”

So in the meantime, there is seemingly no limit to what homeopathy can purport to do.

The Medical Republic: Can Ley’s legacy be Hunt’s glory? 

 

GP remuneration will be a recurring theme on Greg Hunt’s agenda in coming months, both in terms of demands for fresh reforms and repairing faltering projects left behind by Sussan Ley.

Specific work to overhaul rates for GP consultations is getting under way this month as part of a case to be put to the MBS Review working group on GP items.

“There’s no doubt the MBS review is going to be the single most important policy initiative that could benefit general practice,” RACGP President Dr Bastian Seidel told The Medical Republic.

“(The outcome) should reflect the value of general practice to the government, to the taxpayer, and to the nation. I am very optimistic there.”

The College is seeking better remuneration for the conversations GPs have with patients, as opposed to procedural items, and for longer consultations.

“We need to make it fair and equitable,” Dr Seidel said.

As a first priority for the new health minister, doctors’ groups are unanimous in urging an end to the six-year freeze on patients’ Medicare rebates.

The RACGP argues that stopping the freeze for GP visits will cost some $160 million a year but reap far greater long-term benefits by keeping patients out of hospital.

“Lifting the Medicare rebate freeze is financially responsible policy. It’s a simple solution, to take the pressure off patients who see their GPs on a regular basis,” Dr Seidel said.

The AMA, meanwhile, wants the freeze lifted for all specialties, as well as pathology and radiology, but acknowledges GPs suffer the most from the squeeze on patients and incomes.

Minister Hunt, acutely aware of the Coalition’s vulnerability on healthcare among voters after last year’s “Mediscare” election campaign theme, will be warned the unpopular policy carries a political cost.

“We regard the Medicare freeze not only as bad policy but one that is a barrier to cooperation,” AMA President Dr Michael Gannon told The Medical Republic.

“It would be a sign of good faith for a new minister taking the job, or in terms of driving the 2017 Budget, to make those changes.”

Elsewhere, a sense of doom surrounds the Health Care Homes initiative, which was supposed to bring about a general practice-led solution to the growing burden of chronic disease on the Australian health system.

The scheme, launched last year with fanfare by ex-minister Ley and Prime Minister Malcolm Turnbull as a “radical” step to transform Medicare, is now at risk of collapse for lack of funding and policy detail.

The RACGP says the proposed HCH trials are “set up to fail” and has advised members not to take part. It calls for the government to abandon the planned July 1 start date and take a more considered approach.

Dr John Deery, chair of the General Practice Owners Association, which was formed last year, said the proposed trial program, scheduled to involve some 200 practices, was a good example of how not to proceed.

“It lacks the detail of the RACGP’s proposed model,” he added.

“I think the first priority for a new minister is to consult with general practice owners. If you want to get things done, they are the people who can help you do it.”

Ms Ley won praise as minister for her consultative approach, if not for her success in wrangling more investment in health from a government bent on cutting expenditure.

Doctors hope the legacy of consultation will continue.

“A new minister needs to ensure Health Care Homes, and the momentum of the MBS review, but consult more closely with the public and the profession,” Dr Ewen McPhee, president of the Rural Doctors Association of Australia, said.

Rural doctors have a large stake in the success of the Health Care Homes scheme, declining to join the RACGP boycott call.

They are also awaiting the passage of legislation for the appointment of a rural health commissioner, as well as promised action on the maldistribution of doctors around the country.

Dr Gannon agreed the change of minister could bring new headway in health investment.

“It is an opportunity to re-set,” he said.

“Sadly we have to start again with a minister coming to terms with the massive depth of the health portfolio.”

He commended Ms Ley’s achievement in setting up the MBS review with representation from senior doctors across the specialities.

2GB: The Alan Jones Breakfast Show

 

President of the Royal Australian College of General Practitioners Bastian Seidel talks to Steve about the appointment of Greg Hunt as Federal Minister for Health.

9 News: Doctors lobby Hunt to lift Medicare freeze

 

Greg Hunt has declared himself a minister for GPs but he’ll need to lift his government’s deeply unpopular Medicare freeze if he wants to thaw hostilities with furious doctors.

The Royal Australian College of GPs is also seeking an urgent meeting to lobby the minister to end the Medicare rebate freeze, which isn’t due to be lifted until 2020.

Its president Bastian Seidel says he’ll ask Mr Hunt to at least consider lifting the freeze for GP visits only, at a cost of $150 million per year.

The Medical Republic: Greg Hunt named as Health Minister

 

Prime Minister Malcolm Turnbull has underlined the critical significance of the health portfolio in naming Industry Minister Greg Hunt to take over the role.

Announcing the replacement for Sussan Ley, the prime minister praised Mr Hunt’s “policy, analytical and communication” skills.

“He is ideally suited to take on the very important, critically important, frontline portfolio of health and sport,” Mr Turnbull said.

Mr Hunt, 51, joined the cabinet as environment minister in 2013.  He served nearly three years in that role and stepped up to the industry, innovation and science portfolio after the July 2016 election.

During the election, health policy emerged as a vulnerable area for the Coalition thanks to a successful Labor campaign on threats to Medicare as well as a welter of criticisms from doctors.

RACGP President Bastian Seidel said the first priority under a new minister should be the lifting of the Medicare rebate freeze for all GP items.

“Lifting the freeze is financially responsible policy,” he said.

A taskforce under the Medicare Benefits Schedule Review is continuing vital work on general practice items this year.

“There’s no doubt the MBS review is going to be the single most important policy initiative that could benefit GPs,” Dr Seidel said.

The other pressing issue awaiting Mr Hunt will be the Health Care Homes trials, due to start in July, which the RACGP says are disastrously underfunded.

AMA President Michael Gannon told The Medical Republic the ministerial reshuffle could be a chance for fresh momentum in health.

“It is an opportunity to reset,” he said.

“Sadly, we have to start again with a minister coming to terms with the massive depth of the health portfolio.”

Dr Gannon commended Ms Ley’s “positive and consultative” style as minister and said he hoped the same approach would continue.

“One of her achievements was the way she set up the MBS review, ensuring consultation with senior doctors in the specialties,” he said.

Ms Ley, who resigned from the front bench because of a travel expenses scandal, has left an array of health reforms in mid-stream.

To general surprise, Mr Hunt  was  honoured with  the inaugural Best Minister in the World award at the World Government Summit hosted by the United Arab Emirates in July last year, apparently for his work on the Great Barrier Reef.

In the reshuffle, Ken Wyatt has been elevated to Minister for Aged Care and Minister for Indigenous Health, a step up from his assistant minister responsibilities.

The Australian: Doctors call for end to Medicare freeze

 

Doctors are calling for the country’s incoming health minister to reset the government’s relationship with the sector by ending a controversial freeze on Medicare payments.

President of the Royal Australian College of General Practitioners Bastian Seidel said the organisation wanted to see the government adopt evidence-based policy that would endure regardless of who held the portfolio.

Coach: Need a mental health tune-up? Seeking help is cheaper than you think

 

Gone are the days of stigma about seeing a psychologist – many Aussies seek professional help to cope if they’re feeling stressed or blue, and part of it is thanks to Medicare rebates for psychology sessions.

“It’s so much easier and more affordable compared to how it was before,” Dr Bastian Seidel, Royal Australian College of General Practitioners (RACGP) president, told Coach.

Essential Baby: Taking fish oil in pregnancy may prevent childhood asthma

 

Asthma – a condition that leads to narrowing of the airways – is a common health concern in children.

Children are more likely to develop asthma if their mother smoked during pregnancy, if they’re born prematurely, or if there is someone in the family with the condition, among other causes.

Now new research, published in the New England Journal of Medicine in December 2016, sheds fresh light on the topic.

It found that women who took omega-3 fatty acid supplements (fish oil supplements) in pregnancy reduced the risk of their children developing asthma by almost one third.

Dr Bastian Seidel from the Royal Australian College of General Practitioners agrees. As a Director of the National Asthma Council, he says it’s too soon to put these findings into practice.

Currently, Dr Seidel says the World Health Organization recommends women consume at least 2.6 grams of omega-3 fatty acids daily, with the aim of consuming 100-300mg of DHA (a key component of fatty acids).

The Examiner: Concerns for aged care residents as they lose access to mental health care plans

 

Vulnerable Tasmanians in aged care lose access to their mental health care due to a “discriminatory” Medicare loophole.

Aged care residents cannot use the Medicare GP Mental Health Treatment Plan after they move into a facility.

Royal Australian College of General Practitioners president, Tasmanian GP Dr Bastian Seidel, said the loss did “not make sense as moving into residential care is stressful even for patients who do not have a mental illness, never mind for the ones who already suffer from depression and/or anxiety”.

Sydney Morning Herald: Forecast oversupply of doctors to hit this year amid calls to halt imports

 

An oversupply of doctors is expected to emerge in Australia this year after a failed bid by the federal Department of Health to end the importation of all overseas medicos.

The president of the The Royal Australian College of General Practitioners, Bastian Seidel, has urged the government to remove GPs from the skilled occupations list.

The Age: Pharmacists get power to alter prescriptions under controversial trial

 

Pharmacists will have the power to alter prescriptions for patients with chronic conditions like asthma in a controversial Victorian trial that shifts some patient care away from doctors.

The president of the Royal Australian College of General Practitioners, Dr Bastian Seidel, said: “There are plenty of highly qualified GPs out there who are more than capable and willing to do chronic disease management for patients.

Brisbane Times: Nursing home residents denied GP mental health treatment plans and psychological therapy

 

Tens of thousands of elderly Australians are being denied effective public health treatments because they live in nursing homes, with experts labelling it a “disgrace” and “blatantly discriminatory”.

Royal Australian College of GPs president and University of Tasmania clinical professor Bastian Seidel agreed the denial of treatment was “systematic” because “the data is out there” and he called for the removal of the Medicare exclusion.

Star Weekly: GP standards passed on

 

Gisborne GPs Stephen Newton, Rod Guy and Kulbir Gill have spent the past 21 years training Australia’s future family practitioners.

Royal Australian College of General Practitioners president Dr Bastian Seidel said GP supervisors are essential for providing one-on-one teaching, supervision, support and feedback.

The Examiner: Internet lag affecting doctors: AMA

 

Lagging connection in rural and remote areas in compromising medical development, says the Australian Medical Association.

Royal Australian College of General Practitioners president, Tasmanian GP Dr Bastian Seidel, said the issue affected doctors more than patients.

Dr Seidel said speeds of 20 megabytes per second were required for GP video consultations, although there were not many conducted in Tasmania.

Essential Baby: The latest on taking antibiotics for ear infections

 

Ear infections are very common in young children. In fact, by age three, more than two thirds of children will have had at least one episode of acute otitis media (bacterial ear infection), says Dr Bastian Seidel, President of the Royal Australian College of General Practitioners (RACGP).

A Current Affair: Qualifications of after-hours home visit doctors called into question

 

The Royal Australian College of General Practitioners has called into question the qualifications of medical professionals performing after-hours home doctor visits with only 30 percent of such visits being attended by a qualified GP.

Australian College of General Practitioners president Dr Bastian Seidelbelieves Medicare is not always getting what it pays for with approximately 30 percent of after-hours doctor visits being attended by a qualified GP.

A Current Affair: Bulk billing shake-up

 

The proposed shake-up of bulk billed GP home visits that could see families paying for doctors after hours – a service that is currently free.

But while some say the scheme is essential, others say it is just a cash cow for medical providers.

The Medical Republic: Health Care Homes trials facing boycott 

 

The RACGP has disowned Health Minister Sussan Ley’s Health Care Homes scheme, saying it bears no resemblance to the plan it championed to fight Australia’s rising chronic disease epidemic.

College president Dr Bastian Seidel has called on members to boycott trials of the scheme unless the minister puts off the planned July starting date and embarks on a redesign which includes increased funding.

Minister Ley last week extended the deadline for general practices to signal interest in joining the trials, allowing them an extra week until December 22.

Meanwhile, GP groups have demanded the trials be suspended for at least three to six months.

A recent statement from Ms Ley’s office left open the possibility of a postponement, saying the minister would take advice on “key factors” associated with the trials.

But the RACGP has ramped up its criticism, with Dr Seidel suggesting a half-baked effort could end up being damaging to patients.

“The Health Care Homes model is a capitation funding model for treatment of chronic medical conditions.  It does not in any way represent the RACGP’s ‘medical home’, which is an evidence-based clinical model that leads to improved health outcomes – supported by increased funding for general practice patient services,” Dr Seidel wrote.

“There are serious concerns regarding capitated funding for chronic disease management and treatment.  It may harm patients, and it may undermine GP-led care when funding runs out.”

Dr Seidel last week said the scheme was significantly underfunded and poorly planned, and the federal government was not taking the concerns of GPs and their patients seriously.

The program is aimed at dealing with managing chronic disease through patient-centred primary care using a blended payments system with patients divided into tiers according to their condition.

Announcing the initiative in March, Ms Ley said it was a reform to revolutionise Medicare. Then RACGP president Dr Frank Jones called the move “a great win”, praising the government for taking the College’s advice to adopt the medical home model.

But doctors now fear the implementation will be too rushed and under-resourced to develop an evidence base.

The government has allocated a little more than $100 million to support the rollout of stage one, which aims to enrol up to 65,000 patients in 200 medical practices in 10 regions across Australia.

“It is voluntary for medical practices and patients and no doctor is required to participate if they do not want to,” Ms Ley said.

She said the development of stage one of Health Care Homes had included doctors’ views through an advisory group.

Participation is sought from general practices and Aboriginal Health Services in the PHN regions of Perth North; Northern Territory; Adelaide; Country South Australia; Brisbane North; Western Sydney; Nepean Blue Mountains; Hunter, New England and Central Coast; South Eastern Melbourne; and Tasmania.

Ten Eyewitness News: GPs warn against Medicare rebate

 

Doctors are warning some patients could be putting their lives at risk.. by skipping appointments because of skyrocketing medical costs

Medical Republic: Finally, some clarity on bulk-billing

 

Less than two-thirds of patients are being fully bulk-billed for GP visits and the rest are paying sharply higher costs to see a doctor.

For the first time, the federal health department has disclosed bulk-billing data that backs doctors’ fears about the Medicare rebate freeze eroding access to healthcare.

The department revealed last week that only 64.7% of patients were routinely bulk-billed by their GPs in 2015-16.

The information came to light in responses from bureaucrats, including Health Secretary Martin Bowles, who took questions on notice from a Senate committee hearing on October 19.

The answers also revealed a sudden jump in patients’ out-of-pocket costs. Patients’ gap fees leapt by 5.4% in the year to last June, nearly five times the rate of inflation, after years of growth in the 2% range.

RACGP President Dr Bastian Seidel said attention should focus on affordability rather than bulk-billing rates.

“What matters to our patients is whether or not they can afford a co-payment for the clinical care of themselves and their families,” he said.

“We know that financially vulnerable patients will delay seeing their GP if they are faced with increased out-of-pocket expenses, and they will eventually call an ambulance or present to emergency departments at a much greater cost to the taxpayer.”

Frustrated by the lack of transparency around bulk-billing, the College undertook an independent snapshot of GP activity earlier this year and came up with a bulk-billing figure of 69%.

On the official count, only 1.3% of GPs did not bulk bill any services, down from 3.2% in 2005-06. But most GPs (85.5%) bulk-billed more than half their services, up from 74% a decade earlier.

On the same October day as the Senate grilling of her most  senior bureaucrats, Health Minister Sussan Ley said the official 85% bulk-billing rate, based on services rather than patients, was all that mattered.

“The only figure that matters here is the bulk-billing rate. Now that is simply drawn from Medicare data; it is the evidence,” Minister Ley told reporters in Canberra.

“Other figures that swirl around from time to time may be in the interests of those making the arguments. But what I focus on is the bulk-billing rate, and it has never been higher.”

Dr Seidel said bulk-billing numbers had been subject to political spin for too long.

The government had used its statistics to justify the freeze on Medicare rebates, but they were not truly reflective of bulk-billing rates, Dr Seidel said.

“For the first time we now have access to data regarding how many general practice patients – as opposed to services – are bulk-billed every year,” he said.

Dr Ewen McPhee, President of the Rural Doctors Association of Australia, said the debate about bulk-billing was only important in the minds of Liberal and Labor politicians.

“The whole debate about bulk-billing rates is a complete furphy.  It detracts from the important conversations we should be having,” he said.

Politicians on both sides focused on bulk-billing because they were  out of touch and avoiding the hard questions, Dr McPhee said.

“We desperately need to understand where we are going with a whole bunch of things –such as the MBS review and Health Care Homes.

“Is (the agenda) just an effort in cost savings, or are we trying to promote primary care and increase capacity?”

Medical Journal of Australia: Dr Bastian Seidel, President of the RACGP

 

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, talks about the Health Care Homes trial, CPD reform and his vision for the new triennium with MJA news and online editor, Cate Swannell.

Cootamundra Herald: Two in three patients bulk-billed for all GP visits, department of health figures reveal

 

Two-thirds of patients were bulk-billed for all their GP visits, the Department of Health has revealed.

The figures released on Tuesday in response to Senate estimates questions have punctured the Turnbull government’s claim that bulk-billing was at a record high despite its rebate freeze, the Royal Australian College of GPs says.

Australian Doctor: Push to put all asthma patients on preventers

 

A revolutionary treatment model for asthma should replace intermittent salbutamol for mild asthma with long-term, low-dose inhaled corticosteroids (ICS) for all, proponents say.

Professor Helen Reddel (pictured) of the Woolcock Institute  of Medical Research in Sydney has proposed that asthma be managed with a population-based risk reduction approach, similar to the way hypertension and hypercholesterolaemia are treated.

Instead of relying on as-needed short-acting relievers for infrequent symptoms, all patients with mild, intermittent asthma would take a regular inhaled preventer, such as once-daily 400μg budesonide.

Writing in the Lancet this week, Professor Reddel and colleagues said the new approach was based on a study showing that all patients with asthma showed substantial benefits from low-dose, inhaled steroids, even if they only had mild and intermittent symptoms.

In a post-hoc analysis of a three-year study involving 7138 patients with mild asthma, they found that low-dose corticosteroids halved the risk of severe exacerbations, improved symptoms and reduced long-term decline in lung function.

The researchers said their preventers-for-all approach would tackle the current situation, in which almost 40% of asthma ED presentations and 20% of asthma deaths occurred in patients with infrequent symptoms.

“The findings challenge long-standing assumptions about the risks of so-called mild asthma and suggest that decisions about ICS treatment in such patients should be made on the basis of population risk reduction, rather than only on symptom frequency,” they wrote.

However, Tasmanian GP and National Asthma Council Australia director Dr Bastian Seidel said a change in clinical practice would not be made on the basis of a single post-hoc data analysis.

The Australian Asthma Handbook already had a low threshold for initiating preventer use, recommending patients started treatment if they had had symptoms twice or more in the previous month or had a flare in the previous year, he noted.

“So there’s plenty in the Asthma Handbook already that allows patients to consider regular corticosteroid,” Dr Seidel, who is also RACGP president, told Australian Doctor.

It was also recommended to use the lowest dose of steroid and review patients in 6-8 weeks, he added.

Courier Mail: New statistics reveal the truth on bulk billing rates by Australian doctors

 

One in three patients were not bulk billed for all their GP visits, the Department of Health has admitted.

“The real story is how much do patients need to pay out of their own pocket when the doctor does not bulk bill,” says Royal Australian College of General Practitioners president Dr Bastian Seidel.

Australian Doctor: Call for Govt to delay Health Care Homes rollout

 

GP lobby groups are calling for the government’s Health Care Homes initiative to be delayed by six months, warning the policy is being rushed.

From July next year, around 200 practices are expected to register 65,000 patients to the scheme, with the Federal Government paying them up to $1800 to manage each patient’s chronic disease care.

However, United General Practice Australia (UGPA) called on the government to delay the rollout to “allow sufficient time to get this important opportunity to transform the nation’s healthcare system right”.

The group — which is the collective voice of the AMA, RACGP, ACRRM, GPRA and General Practice Supervisors Australia — said the development of the funding model for the scheme, as well as the tools to support practices, had been “rushed”.

“An extended timeline would allow the profession time to ensure the instruments and tools being used are appropriate and validated by evidence,” the UGPA said in a statement released on Tuesday.

The deadline for practices to apply to join the trial is 13 December.

Under the changes, the practices’ most complex patients will receive almost $1800 a year in funding, those with multi-morbidites and moderate needs will receive $1267 a year and those with “largely self-managing” chronic conditions will receive $591.

However, as yet, there is little detail on the assessment tools that practices will be asked to use to determine the funding individual patients can claim.

Australian Doctor has been told the government is angry at the cool reaction its reform has received from the speciality, particularly because the policy was the product of extensive lobbying by the RACGP.

Earlier this month, RACGP president Dr Bastian Seidel said Health Care Homes were “doomed” unless the government invested significantly more cash.

However, the UGPA statement stressed the profession was “prepared and ready” to work closely with the government to make the plan a success.

Australian Doctor: College stands firm in face of after-hours ‘vested interests’ charge

 

The RACGP is standing by its position on tightening access to after-hours MBS items, despite accusations from after-hours groups that its stance is due to “vested interests”.

The National Association of Medical Deputising Services (NAMDS) has launched a community campaign called Protect Home Visits amid fears there is a looming Federal Government crackdown on unscrupulous after-hours MBS claiming.

The campaign website says: “Some GPs and businesses stand to make more money if home visits are removed.

“They are pushing plans to cut the Medicare rebate for home visits; to reduce the number of home visiting doctors and to restrict the promotion of home visit services.”

In five years, Medicare claims for urgent after-hours visits have more than doubled to 1.4 million in 2014/15.

But NAMDS has touted a report it commissioned from Deloitte Access Economics, which states after-hours services save taxpayers $724 million over the four years of the Budget forward estimates by reducing pressure on EDs.

RACGP president Dr Bastian Seidel (pictured) said on Tuesday that after-hours services should be provided by appropriately qualified doctors.

“Only vocationally registered GPs, non-VR GPs, doctors on a pathway to fellowship or GP registrars under appropriate supervision from a qualified VR GP should be eligible to provide services that attract patient rebates for after-hours services,” he said.

There seems to be no national data on how many non-GPs — including IMGs on visas and junior doctors — have been recruited by after-hours providers.

The National Home Doctors Service, the country’s largest after-hours operator, said about 30% of its 650 doctors were RACGP or ACRRM fellows and most of the rest were working towards fellowship.

Claims for “urgent” after-hours items were identified in the Professional Services Review’s annual report as one of a handful of problem areas.

The Medicare watchdog said it had investigated several cases related to the misuse of after-hours MBS items.

After-hours items are being examined by the MBS Review Taskforce, with the possibility they will be restricted or the item descriptors tightened up.

Townsville Bulletin: Government Medicare watchdog threat to GP home visits

 

They are the after hours lifesavers beloved by families and emergency departments alike — but a government crackdown could make it harder for a GP to make a house call in the dead of night.

The Medical Republic: Visit to GP after hospital reduces risk of readmission

 

The RACGP is pushing for a simple incentive scheme to encourage patients to see their GP within seven days of being discharged from hospital.

The proposal, which will form part of the College’s submission to the MBS review, comes on the back of a recent American study, which found that a visit to a GP within seven days of a hospital admission reduced the risk of a readmission within 30 days of discharge by 12% to 24%.

“That’s the evidence policymakers should be taking notice of,” RACGP President Dr Bastian Seidel told TMR.

The study, published in JAMA Internal Medicine, involved more than 71,000 patients.

“[The study] shows if you get patients in very early to see their GP, the chance of getting readmitted is significantly less,” Dr Seidel said. “Again, it fits in nicely with the idea that the more you see your GP, the less likely you are going to end up in hospital.”

Hospital readmissions that could have been avoided cost the Australian healthcare system around more than $3 billion per year every year, according to the RACGP.

“Imagine the cost savings by providing an incentive to see a GP within seven days of a hospital presentation,” Dr Seidel said.

An MBS item for a post-hospital visit within seven days could provide an incentive for patients and GPs to organise an appointment, a practice which is currently not common.

“Why not double the MBS rebate for item 23/36/44 for patients who are seen within seven days?” Dr Seidel suggested.

Better remuneration also would encourage GPs to leave appointments open for post-hospital discharge consultations.

“As a GP you would know [your patient was in hospital] as you get an admission notification,” he said.

“If you know that five patients have been admitted for various reasons per week over the last three months, you just leave five visits per week open in your schedule.

“Patients would probably be quite happy to come in to see the GP within seven days of discharge,” he said.

This policy could be implemented in a very short timeframe because there was no need for any “fancy bureaucracy”, Dr Seidel said.

The US study did not examine the reasons GP visits significantly cut hospital readmission rates.

But the authors suggested the GP consultations were likely to keep patients out of hospital because they allowed for the assessment of clinical status, treatment intensification, follow-up for pending test results and referrals, medication review and patient and family education.

“It is tying up those loose ends. That’s the main thing,” Dr Seidel said. “Making sure patients are within their treatment regime, patients have enough medication, patients are following the discharge advice.”

Medical Republic: Door open to delay Health Care Homes roll out

 

Federal Health Minister Sussan Ley said she would take advice from her department after GP groups renewed their demand for a three- to six-month delay in the Health Care Homes trials.

In response to the call by six GP groups, under the banner of United General Practice Australia (UGPA), Ms Ley said the government would stick to the December 15 deadline for expressions of interest from medical practices to take part in the trials.

However, a statement from Ms Ley’s office late on Tuesday left open the possibility of a postponement in the 2017 stage-one starting date, saying she would receive advice on key factors associated with the voluntary trials.

“If advice was received about the effective rollout of Health Care Homes for commencement on 1 July 2017 she would consider such advice at that time,” the statement said.

Earlier this year Ms Ley hailed Health Care Homes as a reform to revolutionise Medicare.

The scheme is aimed at dealing with an epidemic of chronic disease through patient-centred primary care using a blended payments system with patients divided into tiers according to their condition.

But UGPA warned that the revolution should be postponed or risk fizzling out.

“The implementation of the Health Care Home, including the model, the tiers, and supporting practice tools, has been rushed and risks undermining this vital opportunity to get the model right,” UGPA said on Tuesday.

The group, representing the RACGP, ACRRM, RDAA, GPSA, AMA, and GPRA, called for a three- to six-month postponement.

Doctors are also unhappy with federal funding plans for the HCH experiment.

In recent weeks, senior doctors, including RACGP President Bastian Seidel,have said they feared the scheme was being set up to fail because of the rushed nature of preparations and inadequate funds.

The government has allocated a little more than $100 million to support the rollout of stage one, which aims to enrol up to 65,000 patients in 200 medical practices in 10 regions across Australia.

“It is voluntary for medical practices and patients and no doctor is required to participate if they do not want to,” Ms Ley said in the statement.

“It will not start until mid-2017 and it will be fully evaluated before any future roll-out to the wider community.”

Ms Ley said the development of stage one of Health Care Homes had included the views of the medical profession through an advisory group in the Department of Health.

ABC News: Doctors call for health care vouchers as patients walk out of emergency

 

More than 4,000 Tasmanians walked away from emergency departments without being treated by a doctor in the past year, but the Commonwealth was still slugged about $70 per patient, documents reveal.

It has sparked calls by the Royal Australian College of General Practioners for hospitals to give patients who choose not to wait around a voucher to use on health care elsewhere.

The Canberra Times: ACT after-hours doctor claims rise by 1200%

 

Home doctor visits in the ACT have gone up almost 1200 per cent in just three years at a cost to the taxpayer that GPs have warned is unsustainable.

Tasmanian Times: Bulk-billing rates crash

 

Medicare bulk-billing rates for GP visits in Tasmania have dropped to their lowest level for five years, apparently in response to the federal government’s continuing freeze on Medicare rebates.

Earlier the president of the Royal Australian College of General Practitioners, Dr Bastien Siedel ‒ a Huon GP ‒ said the next quarterly figures were likely to show a more complete picture of what is happening.

‘General practice has been unfairly targeted by the Medicare patient rebate freeze,’ he said last month.

The Examiner: Bulk-bill travel for GP patients

 

The Royal Australian College of General Practitioners’ president Bastian Seidel on Friday warned universal bulk-billing had almost disappeared in the state’s general practices.

The Mercury: Health directory shows universal bulk billing has almost disappeared in Tasmania

 

Universal bulk billing has almost been wiped out of existence in Tasmanian general practices and the situation is likely to worsen, says the head of the Royal Australian College of General Practitioners.

RACGP president and Tasmanian GP Bastian Seidel said billing patterns had changed because of the Federal Government’s continued freeze on the Medicare rebate.

ABC News:  Rebate freeze sees bulk-billed GP visits fall fastest in Tasmania

 

Bulk-billing rates in Tasmania have fallen faster than in any other part of the country, and will continue to drop until the Medicare rebate freeze is lifted, a GP has warned.

Medical Republic: Bulk-billing data ‘flawed, misleading’

 

Bulk-billing figures used to justify the Medicare freeze are so riddled with confounders as to be meaningless, according to an expert analysis.

The true proportion of bulk-billed GP consultations may be as low as half the government’s claimed 85%, said Margaret Faux, a lawyer and CEO and founder of a medical billing company.

Yet the government has continued to use the numbers to defend the freeze, with Health Minister Sussan Ley saying the “only figure that matters here is the bulk-billing rate” when it comes to out-of-pocket costs for patients.

“Other figures that swirl around from time to time may be in the interests of those making the arguments, but what I focus on is the bulk-billing rate, and it has never been higher,” she said.

While the reliability of the bulk-billing figures has long been under suspicion, the new analysis identifies multiple factors that skew the numbers.

“The government statistic has created a false impression designed to mislead Australians into believing they will not have to pay to see a GP 85% of the time, but the statistic, in fact, has very little to do with whether patients are required to pay at the GP,” said the founder of Synapse Medical Services.

RACGP President Dr Bastian Seidel urged policymakers to move away from the focus on bulk-billing figures as a marker of quality in the healthcare system.

“It’s political spin to talk about the bulk-billing number,” he said. “We have no idea what we’re talking about and what the implications are.

“We are more concerned about how much patients are paying when they actually go and see the GP and we are concerned about how much funding has been put towards Medicare for GPs and their patients,” he said.

Instead, a more meaningful analysis of the healthcare system would be Medicare funding for general practice per person, per year, he said.

Earlier this year, the Coalition government claimed there were 17 million more bulk-billed GP attendances in the 12 months to August this year compared with Labor’s last year in office.

But Ms Faux said it was impossible to know how many patients were paying out of pocket, and how much, doubting the statistic was useful “on any level”.

“That figure is basically meaningless. All it’s doing is picking a random group of services and saying 85% of all of these services are bulk billed, which is meaningless,” she said.

Factors such as unreferred specialist and career medical officer use of GP item numbers, as well as attendances with some bulk billed and some non-bulk-billed services, are just some of the examples that distort the data.

“It doesn’t mean GPs are bulk billing them, it doesn’t mean more patients are being bulk billed, it’s just a group of services, and if we want accuracy we need to apply high-level filters to the data.

“Even then, you would get closer to the truth but you still would not know whether patients are handing over money when they go to the doctor because you can’t see it. It’s invisible.

“What we need to do is start understanding that Medicare is part of a really complex labyrinth, that is every bit as complex as family law,” she said.

“I suspect that the government itself does not understand who claims what and how Medicare is actually used at a grassroots level,” she said.

“Perhaps they don’t understand that a GP has a whole host of claiming options available in relation to billing patients. Not so much when it’s a single service, but there is a large percentage of patients that have more than one service, and that opens up a whole range of claiming possibilities and a whole range of options in relation to the way that a GP might structure that claim,” she said.

“No one will ever know. The only people who know are the patients themselves, because they are the people handing over the cash.”

For this reason, she said the RACGP’s study suggesting the bulk-billing rate was closer to 69% was a more accurate reflection of the true numbers – and potentially even too high.

“What we don’t know is whether the impact of the Medicare rebate freeze has actually changed the true bulk-billing figures, because no one has measured that.

“Doctors are regularly blamed for rorting the system, yet there is no empirical evidence to support those claims. None.”

Instead, the dismantling of the Health Insurance Commission 10 years ago led to a loss of corporate knowledge in the system.

“You can call Medicare five times with the same question and get five different answers.”

9 News: Govt figures show fall in GP bulk-billing

 

Australians are paying more to see a doctor as the Turnbull government’s GP freeze takes its toll on bulk-billing rates.

Official figures published by the Department of Health show the bulk-billing rate for GP services fell to 85.4 per cent in the September quarter.

Royal Australian College of GPs president Bastian Seidel says while the figures show a drop in bulk-billing rates, it’ll likely take another batch of quarterly numbers to get a better picture of what’s happening.

The Advertiser: Medicare statistics show bulk billing is falling 

 

BULK billing has begun to decline creating concern the Federal Government’s freeze on Medicare rebates is starting to impact on free visits to the doctor.

The president of the Royal Australian College of GPs Dr Bastian Seidel noted the decline in the quarterly bulk billing statistics but said more data would be needed to see if the drop off was a trend.

“Most GPs started looking at their business models after the election and this won’t be reflected in this quarter’s data,” he said.

“The only trend you can see is an increase in out of pocket payments,” he said.

ABC News: Doctors call for sweet drink levy to tackle obesity in Australia

 

Sugar-sweetened drinks should be taxed and obesity renamed a chronic disease, according to a coalition of Australia’s most influential doctors’ groups.

The Committee of Presidents of Medical Colleges, representing bodies including the Royal Australian College of GPs, the Royal Australasian College of Physicians and the Royal Australasian College of Surgeons, has developed a six-point obesity action plan to tackle what it calls the most pressing public health issue.

Royal Australian College of GPs president Dr Bastian Seidel said the medical profession needed to lead the way on healthy eating.

“We need to live by the advice that we are giving to our patients,” he said.

Australian Doctor: Top GPs take to the streets for refugees 

 

Thousands of doctors took to the streets on Saturday to highlight serious concerns about the plight of asylum-seekers in detention.

Leaders of the profession, including RACGP president Dr Bastian Seidel, joined rallies in Sydney, Melbourne, Newcastle, Cairns and Hobart, calling for a more humane approach to people seeking asylum in Australia.

The marches, organised by Doctors for Refugees, were the latest attempt to highlight the medical profession’s concerns about the government’s hard-line policies on asylum-seeker care.

“Rational argument and evidence-based lobbying has so far failed.

“Australia’s doctors must now show moral and ethical leadership and take to the streets to protest at the appalling ill-treatment of innocent people, who could best be termed ‘Australia’s political prisoners’,” said Dr David Berger, march organiser and executive committee member of Doctors for Refugees.

Among their demands, the marchers called on the government to immediately end the detention of children and also stop the mandatory indefinite detention of asylum-seekers.

They also called for closure of the offshore detention centres, and independent oversight of healthcare and conditions for asylum-seekers, to ensure that the government achieves its claim of providing standards of medical care that are comparable with those for the Australian public.

Joining Dr Seidel, were Brisbane GP Dr Richard Kidd, chair of the AMA Council of General Practice, and Dr Kean-Seng Lim, vice-president of AMA NSW and the college’s 2015 GP of the Year.

Others participants included Dr Stewart Condon, medical director of Médecins Sans Frontières Australia, and orthopaediac surgeon Professor Munjed al-Muderis, a former Australian immigration detainee, who arrived in Australia by boat.

The Sydney rally was estimated to have 4500 in attendance by the organisers.

Speaker Dr Kean-Seng Lim said the AMA would continue to oppose the government’s inhumane treatment of refugees.

“The standard we walk by is the standard we accept. And as doctors and health professionals we have to ensure that first we do no harm — because not acting is an action,” he told the rally.

“Treating the vulnerable without compassion, without respect and without dignity diminises us all.”

Dr Barri Phatarfod, President Doctors for Refugees said the group was honoured to have so many doctors take time out to publicly condemn the appalling conditions imposed on vulnerable people in immigration detention.

“We are … heartened that so many doctors from around the country have been moved to stage similar demonstrations in support. The thousands that turned out across the cities reinforces that his is an issue that outrages a huge number of the medical profession ”

On Friday the AMA said it its efforts to follow up concerns raised about the care of individual asylum seekers had been hampered or ignored by the Department of Immigration and Border Control

“While the department does provide brief responses on some asylum seekers, the AMA is not always able to ascertain whether quality and appropriate health services, management and treatment is being provided as there is no independent, transparent body of clinical experts that can verify or report on this,” it said in a submission to a Senate inquiry into abuse and neglect of asylum seekers in offshore processing centres.

Australian Doctor: Outcry over cash for Health Care Homes 

 

Practices will receive between $600 and $1800 a year to manage each of their chronic disease patients under the Federal Government’s Health Care Homes scheme.

The RACGP has slammed the funding announcement, which was released by the Department of Health “surreptitiously” on Friday evening.

The $600 sum will be given to practices for every patient assessed as being in tier 1 of the scheme’s funding model. This tier covers around 10% of the population who have multiple chronic conditions, but are largely self-managing

Higher-risk chronic diesase patients will fall into either tier 2 or 3 that will attract higher payments (see box below).

The RACGP says the money falls far short of what GPs need to care for these patients.

The college is also taking aim at news that GP visits unrelated to a patient’s chronic disease will be capped under fee-for-service at five visits per year – after which the patient will have to pay.

“Introducing a capitation not only on funding for treatment of chronic medical conditions, but also on visits for unrelated acute medical presentations that do need attention, is nonsensical and sets up the Health Care Homes trial to fail,” says RACGP president Dr Bastian Seidel (pictured).

“It will fail patients. It will fail practitioners. And it will fail to inform health policy development meaningfully,” he says, adding that the college had not been consulted on the funding model.

The model fails to address the needs of a core group of high Medicare users, idenitfied by the National Health Performance Authority who accounted for 41% of health expenditure, the college says.

This group – around 12.5% of patients – require an average of 51 MBS services per year (including GP consults and other services), amounting to almost one service per week.

The department has not released any information about how it has calculated the sums it will give to practices.

However, its latest documents say that funding for allied health professionals services and diagnostic and imaging services will not be included in the practice payments and will continue to be funded through the MBS.

Practice funds for each patient will be paid retrospectively to practices on a monthly basis and reviewed regularly.

The government is working on a tool that all practices implementing the scheme will use to determine eligible patients and to assign patients to tiers.

Practices will also be expected to tallk to patients about contributing to the cost of their own care.

“The determination and management of patient contributions will be up to each Health Care Home and must be agreed with the patient at the time of enrolment,” the documents say.

The government also announced that a one-off $10,000 grant would be made available to practices that signed up to trial the scheme in the 10 primary health network regions already selected as pilots sites

Those practices taking part will be expected to regularly upload all participating patients clinical information to the MyHealth Record.

Stage one of the Health Care Homes reform will deliver services from 1 July 2017 to 30 June 2019.

Medical Observer: ‘It will fail’: Fee structure revealed as health care homes draw nearer

 

A surreptitious dump of new information about the funding and shape of the government’s health care homes trial has doctors convinced that it’ll be little more than a cost-cutting exercise.

The health department quietly published the first detailed blueprint of the trial on its website late on Friday afternoon, outlining a three-tiered system of bundled payments for the care of the estimated 20% of Australians with two or more chronic health conditions.

GPs will be paid an average of about $1800 per year for the care of the 1% of patients with the most complex health needs, who require lots of coordinated care, the document states.

Those in the second tier, who have multiple chronic diseases and moderate needs (~9% of patients) would receive about $1270. The remaining 10%, comprised largely of those who self-manage their care, are eligible for about $590.

The figures are an indicative average and would be made monthly on a pro-rata basis.

The RACGP, which for some time has expressed concerns that the roughly $100 million earmarked for the trial is not enough, says the payment revelations reinforce its concerns.

College chief Dr Bastian Seidel says the sickest 12.5% of patients require an average of 51 services a year. Under the new model, funding for the 1% of patients in the top funding bracket would cover the equivalent of about 48 level B consults per year. For the 9% in the second bracket, it’s about 34 level B consults.

“It will fail patients. It will fail practitioners. And it will fail to inform health-policy development meaningfully,” he says.

Dr Seidel was particularly concerned about a “nonsensical” provision that would have capped Medicare-funded non-chronic disease visits at five annually. It’s understood the proposal has since been dropped

A spokesman for Health Minister Sussan Ley said the cap is an indicative figure, telling Fairfax Media: “no patient’s access to Medicare will be restricted or capped”.

The government is hoping to recruit 65,000 patients in 200 medical practices in 10 regions for the trial. General practices and Aboriginal community-controlled health services involved in the trial with receive a one-off payment of $10,000 to help get things moving.

The Medical Republic: Backflip over Health Care Homes visit limit

 

The federal government has dropped its proposal to cap GP visits for chronically ill patients under its Health Care Homes scheme after a blistering reception from doctors.

The RACGP said the Health Care Home trials had been “set up to fail” because of a decision to put a five-visit cap on benefits for HCH-registered patients seeing their GP for reasons not related to their chronic conditions.

Health Minister Sussan Ley blindsided doctors with an announcement late on Friday revealing the first details of the landmark Health Care Homes trials to start in 2017, including a shift from fee-for-service to monthly bundled payments and the surprise five-visit limit on acute care.

“All general practice health care associated with the patient’s chronic conditions, previously funded through the MBS, will be funded through the bundled payment,” a payment information factsheet said.

“Enrolled patients can still access fee-for-service billing for a small number (up to five) of episodes of care not related to a patient’s chronic conditions.  This will also enable patients to visit different practices, for example when travelling.”

But after an outcry by doctors groups, Ms Ley’s department today backflipped and changed the wording of the fact sheet to say:  “Enrolled patients can still access fee-for service episodes of care not related to a patient’s chronic conditions.”

For the majority of patients, the number of such presentations was expected to be small, and the number of fee-for-service visits would not be capped but would be monitored during the stage-one trial, the amended version said.

RACGP president Dr Bastian Seidel told The Medical Republic the proposed limit was “completely nonsensical,” adding he would not recommend patients at his rural Tasmania practice take part under those terms and it was unclear what benefit it could offer.

“An elderly patient with a heart condition and dementia is also coming in for vaccinations, or they might have had a fall, stomach pain, or skin cancer that needs to be removed,” he said.

The college has also criticised the proposed funding levels and the government’s failure to consult with the profession before coming out with the plan.

AMA Vice President Dr Tony Bartone said the government should consider putting off the trials, due to start in some 200 practices in 10 geographical areas around the country, in July 2017.

The government needed to win doctors’ confidence in mapping out a crucial reform that was “too important to fail”, he said.

“Right from the start we have said this needs to be funded appropriately.  Doctors want to be part of this new approach but if you don’t adequately fund it, they won’t want to play.

“Doctors needed to be taken on a journey,” the Melbourne GP said.

“At the moment, there’s too much confusion and too much rush.  Doctors need time to make their decisions.”

The Health Care Home model for dealing with complex and chronic illnesses was announced earlier this year in a joint press conference by Ms Ley and Prime Minister Malcolm Turnbull, who described it as a revolutionary step that would become the centrepiece of Medicare reform.

Dr Bartone said the implementation needed just as much visibility and attention.

According to Ms Ley’s announcement, doctor have only until December 15 to register their interest in joining the trials.

A webinar to explain details will not be held until November 17.

The three-tiered scheme will require sweeping changes in how participating GPs practice medicine.

HRC-registered patients with high-risk conditions and complex needs – about 1% of the population – would draw bundled payments of $1795 a year.  Those with multiple conditions and moderate needs would attract $1267 in benefits, and people with multiple conditions largely self-managed are eligible for $591.

The RACGP and the AMA have criticised the lack of consultation with doctors and the adequacy of the proposed $100 million funding.

The Consumers Health Forum said the proposed a five-visit cap threatened to kill the initiative before it got off the ground.

“The patient-centred health care home approach offers a long overdue solution to the contemporary issues our health system is facing: growing complex chronic conditions, poor care and service coordination and the need for better service integration,” CEO Leanne Wells said.

“The overriding concern is that a negative response provoked by the prospect of a cap would doom HCH,” she added.

“The success of HCH will clearly rely heavily on consumer confidence as well as  a positive response from GPs and their willingness to discuss the benefits with their patients. From the reaction of the GP community over the weekend, that seems problematic now.

The Medical Republic: Health Care Homes set up to fail, college says

 

The centrepiece of Medicare reform to deal with complex and chronic illness has been set up to fail by government penny-pinching, the RACGP says.

Health Minister Sussan Ley blindsided doctors with an announcement late on Friday revealing the first details of the landmark Health Care Homes trials to start in 2017, including a surprise cap on funded GP visits for chronically ill patients.

The RACGP said it was disappointed with the framework, the lack of consultation with doctors and funding curbs for what was supposed to be a centrepiece of Medicare reform.

RACGP president Dr Bastian Seidel said a major concern was the decision to put a five-visit cap on benefits for HCH-registered patients seeing their GP for conditions not related to their chronic conditions.

“It is completely nonsensical,” he said, adding he would not recommend patients  at his rural Tasmania practice take part under those terms.

“An elderly patient with a heart condition and dementia is also coming in for vaccinations, or they might have had a fall, stomach pain, or skin cancer that needs to be removed.

“It’s completely unclear what benefit there would be for patients compared with what is available now – chronic disease management plans  which have been shown to reduce hospital admissions and to improve outcomes … and patients can see their GPs for unlimited reasons if they have acute problems.”

Under the Health Care Home model, practices will receive bundled payments rather than fee-for-service for patients with chronic illnesses, according to three tiers reflecting the seriousness of their condition.

Those with high-risk conditions and complex needs – about 1% of the population – would draw benefits of $1795 a year.  Those with multiple conditions and moderate needs would attract $1267 in benefits, and people with multiple conditions largely self-managed are eligible for $591.

The proposed cap on acute visits would only lead vulnerable patients to seek care at hospitals, at far greater cost to the taxpayer, Dr Seidel said.

AMA Vice President Dr Tony Bartone said the government should consider putting off the trials, due to start in some 200 practices in 10 geographical areas around the country, in July 2017.

The  government needed to win doctors’ confidence in mapping out a crucial reform that was “too important to fail”, he said.

“Right from the start we have said this needs to be funded appropriately.  Doctors want to be part of this new approach but if you don’t adequately fund it, they won’t want to play.

“Doctors needed to be taken on a journey,” the Melbourne GP said.

“At the moment, there’s too much confusion and too much rush.  Doctors need time to make their decisions.”

According to Ms Ley’s announcement, doctor have only until December 13 to register their interest in joining the trials.

A webinar to explain details will not be held until November 17.

Like the RACGP, the AMA and other prominent healthcare bodies were not informed in advance of Friday’s announcement.

Dr Seidel said the surprise late-afternoon news was like an episode of the US TV series The West Wing (set in the White House) where communications officials would speak of “taking out the trash”.

The Consumers Health Forum said the five-visit cap threatened to kill the initiative before it got off the ground.

“The patient-centred health care home approach offers a long overdue solution to the contemporary issues our health system is facing: growing complex chronic conditions, poor care and service coordination and the need for better service integration,” CEO Leanne Wells said.

“The overriding concern is that a negative response provoked by the prospect of a cap would doom HCH,” she added.

“The success of HCH will clearly rely heavily on consumer confidence as well as  a positive response from GPs and their willingness to discuss the benefits with their patients. From the reaction of the GP community over the weekend, that seems problematic now.”

The Sydney Morning Herald: Radical Medicare revamp will fail patients as Health Care Homes trial funding falls short, says doctors

 

A Medicare overhaul is set to introduce a tiered system for people with chronic diseases that would see the most unwell patients receive $1795 in GP visits to manage their condition.

“It sounds more like a cost-cutting exercise or a defunding exercise, and that’s the last thing we need if we are to have a sustainable healthcare system that provides quality healthcare for patients,” RACGP president Dr Bastian Seidel said.

Coach: Treating your kids with complementary medicine? Be diligent, warn doctors

 

Doctors have warned parents to get their GP’s advice if engaging the services of a complementary medicine practitioner for their child, after a four-year-old with autism was admitted to emergency following treatment by a naturopath.

Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, told Coach that many complementary medicines and remedies are not subject to the same regulation that medication is.

AJP: GPs expect medicinal cannabis request spike

 

Changes to legislation on medicinal cannabis have the potential to be mistaken by patients as official endorsement of its use, according to a position statement released this week by the RACGP.

The RACGP has released the statement, which says there is very little high quality evidence for the medical use of cannabis, ahead of tomorrow’s introduction of Commonwealth legislation that will make medicinal cannabis a controlled prescription drug.

RACGP President Dr Bastian Seidel says GPs may see an increase in requests for medicinal cannabis.

News.com.au: The nation’s sickest patients could be at risk after a massive Medicare shake-up

 

THE nation’s sickest cancer patients and people with diabetes and other chronic illnesses will get a maximum of $1795 worth of GP care a year funded by Medicare under a revolution in the way doctors are paid.

Royal Australian College of General Practitioners president Dr Bastian Seidel was suspicious about the timing of the announcement.

Governments traditionally use that time to “take out the trash” and announce unpopular policy details.

The sickest 12 per cent of patients account for 40 per cent of Medicare benefits and on average they receive 51 services a year, Dr Seidel said.

The West Australian: WA Government to support medicinal cannabis

 

The Barnett Government has thrown its support behind medicinal cannabis in a major departure from its long-held suspicion about the emerging treatment.

Royal Australian College of GPs president Bastian Seidel said he doubted doctors would flock to cannabis because supporting evidence was “very limited”.

But GPs were already under pressure to prescribe it from patients influenced by “hype”. Reclassification had the potential to worsen this by being perceived as official endorsement, he said.

Australian Doctor: College defends lack of consultation over mandatory CPD

 

The RACGP has defended its decision to introduce a mandatory “self-reflection” CPD activity for GPs without consulting its members, claiming the move is a “no-brainer”.

The college unveiled its revamp of the CPD program for the new QI&CPD triennium at its national conference in Perth.

For the first time, GPs will be required to go through a quality improvement activity known as Planning, Learning and Need (PLAN).

Completed online, doctors will have to reflect on their practice, their patients’ demographics, and identify gaps in their skills and learning.

At the end of the triennium, they will then be encouraged to look back and review what they have done.

The category one activity will be mandatory for all GPs when the new triennium starts next year.

College president Dr Bastian Seidel previously said the change was a response to the Medical Board of Australia’s push to introduce a revalidation system to ensure the country’s doctors are fit to practice.

However, it has emerged that the new requirements, which GPs will have to meet to remain registered and access the higher A1 Medicare rebates, were not subject to any formal consultation with the college’s 33,000 members or other stakeholders.

The college defended the process.

“It was discussed and agreed at the RACGP expert committee on post-fellowship education, whose chair is elected by council, and recommended to council, which is elected by the members,” a spokeswoman said.

“So yes, there was consultation, but not directly with 33,000 members.

“As many have said, and as confirmed at the launch [of the new triennium], this was pretty much a no-brainer, and the alternative would be very hard to justify.

“Timing was obviously an issue, hastened by our intention to address the Medical Board of Australia request [on] strengthened CPD. But even without that, we have had learning plans as part of CPD since 2002, but not user-friendly online ones.”

She also stressed that the announcement came three months before the start of the new triennium.

Full-time locum GP Dr Ken-Tze Koh said he was concerned about the lack of consultation with GPs and how the program would evolve.

“They might begin with self-reflection exercises but they might put more requirements on top of that where it becomes something like peer review.”

The Medical Republic: Intensive testing after early breast cancer ineffective

 

Intensive monitoring of asymptomatic women after treatment for early breast cancer doesn’t improve survival or quality of life, guidelines from Cancer Australia stress.

Specifically, imaging such as chest x-ray, PET, CT and bone scans should not be recommended as part of standard long-term follow-up, nor should blood tests such as FBC, biochemistry or tumour markers, the guidelines said.

Rather than being beneficial, unnecessary imaging and testing increased the risk of false positives and could harm the patient via invasive procedures, overtreatment and unnecessary radiation, the group warned.

The recommendation was released for Pink Ribbon Day alongside another 11 policies in the Cancer Australia’s push to improve breast cancer practice.

Professor Helen Zorbas, CEO of Cancer Australia, said while the overall standard of care in Australia was high, the standard of care for women with breast cancer varied throughout the country.

“Patients are at the centre of our efforts to maximise clinical benefit, minimise harm and deliver patient-centred care,” she said.

“The statement encourages health professionals to reflect on their clinical practice to ensure it is aligned with the evidence and delivers appropriate care for individual patients,” she said.

Another area highlighted in the guideline was ensuring the triple test was used to confirm or exclude a diagnosis of breast cancer in women presenting with a breast symptom.

The triple test comprises patient history and clinical examination, diagnostic imaging and a non-surgical biopsy.

The new guidelines also recommend that premenopausal women should have the opportunity to discuss fertility and family planning before undergoing treatment, as well as the potential for preserving fertility for future childbearing.

The RACGP said the guidelines were a great reminder of the absolute and essential role of the GP as the main coordinator of breast cancer care.

“Many trials on breast cancer care have shown that GP-led follow up is a safe and effective alternative to sub-specialist follow up RACGP president Dr Bastian Seidel said.

“There is no difference in survival outcomes, or breast cancer recurrences.”

“The Cancer Australia Statement emphasises that access to a GP is more convenient for patients and reduces the need to attend subspecialist follow up in a hospital setting.”

Other recommendations:

  • Offer genetic counselling to women with a high familial risk at or around the time that they are diagnosed with breast cancer, with a view to genetic testing to inform decision making about treatment.
  • Ensure optimal fixation of breast cancer specimens for accurate pathological examination and biomarker assessment.
  • Offer a choice of either breast conserving surgery followed by radiotherapy, or a mastectomy to patients diagnosed with early breast cancer, as these treatments are equally effective in terms of survival.
  • Offer a shorter, more intense course of radiotherapy (hypofractionated radiotherapy) as an alternative to conventional radiotherapy for patients with early breast cancer who:

o   are aged 50 years and over;

o   have a cancer at an early pathological stage;

o   and have undergone breast conserving surgery with clear surgical margins.

  • Offer patients with early breast cancer the opportunity for their follow-up care to be shared between a primary care physician and a specialist, to provide more accessible, whole-person care.
  • Offer palliative care early in the management of patients with symptomatic, metastatic breast cancer to improve symptom control and quality of life.
  • Consider the pre-operative use of chemotherapy or hormonal therapy (systemic, neo-adjuvant therapy) informed by hormone and HER2 receptor status, for all patients where these therapies are clinically indicated.
  • Do not offer a sentinel node biopsy to patients diagnosed with DCIS (ductal carcinoma in situ) having breast conserving surgery, unless clinically indicated.
  • Do not perform a mastectomy without first discussing with the patient the options of immediate or delayed breast reconstruction.

News.com.au: Flagship bulk billing company Primary Health Care charges patients $100 to see a doctor

 

IT USED to be the champion of bulk billed GP visits — now Primary Health Care is charging patients $100 to see a doctor in one of its clinics.

That fee is $22 higher than the new fee recommended for a standard consultation by the AMA and as a result of the government’s freeze on Medicare rebates it will burn a huge hole in patient’s hip pockets.

Royal Australian College of General Practitioners President (RACGP) Dr Bastian Seidel has been calling on the government to release the latest figures on bulk billing.

Daily Telegraph: GP fees rise to $78 as doctors abandon bulk billing

 

DOCTORS will raise their fees to $78 from November 1 and more patients will be slugged with the charge as a growing number of GPs abandon bulk billing.

“The final budget outcome statement was out on September 30 and if you look at health you will see they are $170 million underspent on health,” Dr Seidel said. 

Cootamundra Herald: Cost of GP consultations to rise as patients wear cost of Medicare rebate freeze

 

Patients will be forced to pay more for their medical consultations from next month after the peak doctors group recommended its members to raise their fees by 2 per cent.

Dr Bastian Seidel​, a GP and president of the Royal Australian College of General Practitioners, said he would continue to bulk-bill pensioners and those who could not afford to pay, but would reconsider his prices for private patients.

Ten News: Doctors being driven away from bulk-billing

 

Not only are a number of practices abandoning bulk-billing, but doctors will also raise their fees for a standard 20 minute visit to $78 from November 1.

Royal Australian College of General Practitioners president Dr Bastian Seidel believes he has found the money that would put an end to the Medicare freeze.

“The final budget outcome statement was out on September 30 and if you look at health you will see they are $170 million underspent on health,” Dr Seidel said.

Australian Doctor: College attacks revalidation proposal to profile doctors

 

The RACGP has described moves to profile doctors to try and identify those most likely to harm patients as “dangerous”.

College president Dr Bastian Seidel (pictured) said he was “extremely concerned” by the concept, which is included in the Medical Board of Australia’s national consultation on the revalidation of the country’s doctors.

At the heart of the proposals is a plan to screen potentially thousands of doctors to determine whether they are practising below acceptable standards.

According to the board’s discussion paper released in August, those considered “at risk” would be doctors who had already triggered multiple complaints, older doctors and solo doctors practising in isolation from their peers.

Speaking to Australian Doctor, Dr Seidel said: “There seems to be a profile that has already been developed for Australia, which suggests that doctors underperforming are typically males, over the age of 35, who work on their own.

“The profiling concept is really quite a dangerous one.

“If we put a nationwide revalidation process in place, how many doctors need to go through it in order to reduce the 3% of doctors [who the board says are underperforming]?

“[Profiling] is absolutely inappropriate for identifying doctors at risk of underperforming,” he added.

Dr Seidel said the only screening tool that seemed to “predict future behaviour” was patient complaints.

In 2013, an Australian study of 19,000 patient complaints found that any doctor with three complaints against them had a 57% chance of another complaint within three years.

The study, published in the BMJ Quality and Safety in Health Care journal, suggested that patient complaints could be regarded “sentinel events”.

But Dr Seidel said: “When we talk about revalidation, we need to talk about models that have evidence [that it works], but when we look at international evidence, there is not evidence for the models trialled like in the UK or Canada.

“If we are introducing something without evidence, we have to ask, why we are doing it?”

The board’s consultation paper also suggested strengthening CPD, with the introduction of mandatory peer review.

In response, the college announced that, from next year, all GPs going through its QI&CPD program would have to go through a “self-reflection” activity to identify potential gaps in their skills and learning via  an online activity called Planning, Learning and Need (PLAN).

Although there has been no consultation on the move with the college membership, Dr Seidel justified the changes.

“We got the [board’s] interim report, and it was very, very clear that a reflective exercise is going to be part of it. What are we going to do as an academic college? We are not going to sit and wait.

“We want to shape and lead the process … so of course we are going to look at the elements that make sense, those proven to make a difference to continuous professional development, and that is the PLAN tool.”

The New Daily: The truth about medical tests: What you really need to know

 

Has your doctor suggested you get screened for vitamin D deficiency based on your age? The Royal College of Pathologists of Australasia recommends you don’t. You’re better off having a conversation with your GP about your lifestyle.

Dr Bastian Seidel, President of The Royal Australian College of General Practitioners (RACGP) told The New Daily there’s too much medicine going on in Australia.

There is, he said, “over-diagnosis, over-investigating and over-treating of patients’’ who present with complaints that aren’t properly evaluated at the first meeting. The net result is money wasted and patients subjected to unnecessary pain and stress.

The Saturday Paper:  Millions of Australians caught in health records breach

 

When she addressed the annual conference of the Royal Australian College of General Practitioners in Perth last week, Health Minister Sussan Ley was already in a hostile environment.

New RACGP president Bastian Seidel says that when the government rebate for taking out private health insurance is above inflation, at more than 4 per cent, it’s not logical that the rebate for visiting a GP in the public system doesn’t move with inflation at all.

The Examiner: RACGP president Bastian Seidel says AIHW report shows alcohol abuse treatment is working

 

The head of Australia’s peak general practitioner body has praised the success of mental health treatment in Tasmania.

It comes after a report by the Australian Institute of Health and Welfare which found alcohol consumption has decreased, but more Australians are seeking treatment for alcohol and mental health related issues.

Australian Doctor: No blowout in healthcare spending, government data shows

 

Federal Government claims that Medicare spending is unsustainable are again under fire, with figures showing the rise in health costs is slowing dramatically

The average increase in the government’s health spending over the past decade has been 4% a year. But between 2013/14 to 2014/15 that increase was just 2.4%.

The amount that Australia as a whole spends on health – including cash from governments, patients and health insurers – was 9.7% of GDP in 2014.

The Australian Institute of Health and Welfare, which compiled the figures, says this compares with 9.4% of GDP in New Zealand, 9.9% in the UK and 10% in Canada.

The US remains the outlier among OECD countries, spending 16.6% of its GDP on health.

Dr Bastian Seidel , the new RACGP president, was quick to tweet that the numbers released on Thursday showed “no massive growth in expenditure”.

The contribution by governments – state, territory and federal — to the health budget fell from 67.8% to 66.9% as private insurers took up a bigger slice of the bill.

Patients’ out-of-pocket costs grew to $29 billion — an increase of 3.7% — the AIHW said.

The figures showed that Australia spends $6657 on health per person – the 10th highest among OECD countries, compared with $13,266 in the US and $9977 Switzerland.

The Age: One in 10 parents do not trust GPs with their child’s healthcare: survey

 

Some parents do not trust GPs to manage their child’s health needs, and many GPs themselves are not confident treating chronic illnesses in children, research suggests.

President of the Royal Australian College of GPs Bastian Seidel said Professor Freed’s research methodology was not strong enough to create doubt about GPs’ confidence and competence in paediatric care. He said the survey of parents was so small and specific to Victoria, its findings could not apply to other parts of Australia.

The Age: Anxious parents and GPs sending children to specialists unnecessarily 

 

Anxious parents and time poor GPs are sending children to specialist doctors for constipation, bed wetting, and concerns about how tall or short they are, contributing to long waiting lists for care in public hospitals.

Dr Seidel said GPs were exposed to many children’s problems during their training, and that they manage paediatric chronic conditions already, so when they refer to specialists, they usually do so for a “shared care approach”. If a parent has been a main driver of a referral, it does not mean it’s unnecessary, he said.

The Medical Republic: GPs angered by Ley’s silence over rent controls 

 

General practice owners are furious that Health Minister Sussan Ley has yet to consult with them over rent controls that could cost the sector as much as $200 million a year.

GP owners group chair Dr Sean Stevens told The Medical Republic that owners were not merely “ropeable” at the unilateral decision to cap the lease fees they could charge pathology companies for collection centres.

The intervention could be the “death knell” for practices that depended on the rental income to make loan payments and stay afloat despite the prolonged Medicare rebate freeze, the Western Australian GP said.

“You don’t go in and crack a walnut with a sledgehammer, which is what they are proposing to do,” Dr Stevens said.

Owners were dismayed there had been no attempt to consult with them on the rent-control measure – scheduled to be introduced in January – despite an earlier promise to enter detailed talks after the July 3 election.

Minister Ley denied last week the government had agreed to intervene in pathology rents in order to have Pathology Australia drop its damaging protest against the Coalition’s bulk-billing policy one week into the election campaign.

Challenged by Dr Stevens after she addressed the opening plenary session of the RACGP’s annual conference in Perth last week, she said she did not agree with that characterisation of events.

Asked when she would sit down with practice owners to hear GPs’ concerns over the rents issue, Ms Ley only reiterated that she would consult.

As of this week, however, still no date for discussions had been arranged.

New RACGP president Dr Bastian Seidel said a solution to the rent-control problem was needed urgently, before leases come up for renegotiation.

“It will just punish smaller practices and favour the big corporate providers. For smaller practices it will be another kick in the guts,” he told TMR.

As it is currently understood, the intervention in GP pathology rents would be a gift to big-business predators buying up general practices, Dr Stevens said.

The measure is intended to limit the amount a practice can charge to within 20% of market “medical” rents.

In most instances, this could mean a doctor’s lease agreements would be constrained by the per-square-meter prices of suburban medical suites in their local area.

The minister is expected to do this by declining to approve new collection-centre leases unless they satisfy the 20% rule, but there has been no explanation of precisely how the “market” benchmark will be determined.

Dr Stevens said pathology rentals were not often discussed, but he believed pathology labs could pay two to four times more than a medical tenant.

“The rents are high, higher than what GPs pay,” he said.

But the outlay was worthwhile for labs to have collection centres located beside quality practices, and GPs used the income to invest in facilities and quality of care.

His own practice, Mead Medical Group, had used its rental revenues to secure finance and buy equipment, helping the practice achieve the honour of being named the 2013 RACGP Australian General Practice of the Year.

In making its case for rent control to government, Pathology Australia would “trot out people who are paying rents that are too high”, he added.

But it was disingenuous for the pathology lobby to complain that rent premiums were unreasonable when they had been willingly negotiated by labs in pursuit of market share, Dr Stevens said.

A Grattan Institute report has supported the GP-owners argument that pathology is a niche rental similar to pharmacies in shopping centres and could not be equated to rents in medical suites.

Practice owners are organising a fighting fund to challenge the proposed restriction, which they say is anti-small business and unfair to practices that have factored rental income into their finances.

Industry analysts are predicting further consolidation of the general-practice sector if pathology rents are cut, especially if the MBS rebate is continued.

Leading business consultancy PriceWaterhouseCoopers has estimated the proposed rent controls would transfer $150 million to $200 million from general practice to the coffers of major ASX-listed pathology groups.

The Medical Republic: RACGP demands proof for bulk-billing rates claim

 

RACGP President Dr Bastian Seidel has challenged the government to prove its claim that bulk-billing rates remain at record highs in light of new evidence indicating a dip after the July election.

“They could easily do it if they wanted to,” Dr Seidel told TMR, calling for the release of up-to-date Medicare data showing the real picture of general practice billing.

“If we are going to talk about transparency, let’s be transparent,” he said.

An RACGP-commissioned national study indicated GPs bulk-billed patients at less than 69% of consultations in August.

The cross-sectional survey involved 10,222 patients who booked consultations in the period from August 1 and September 2.

The government has pointed to data showing a record 85% of all MBS services were bulk-billed to justify its decision in the May budget to extend the Medicare rebate freeze for another two years to 2020.

“The priority was to get a really good idea of what the current bulk-billing consultations are (in response to) the argument by the health minister that we are still dealing with record levels of bulk billing consultations.

“The data the minister has presented always refers to numbers before the 30th of June this year.”

But the college knew GPs under pressure from the rebate freeze had conducted strategic reviews before the end of the financial year and were waiting to see the election result before making changes.

“Our impression was that quite a few practices were changing their billing practices. We tried to get data from the government (after the election was called), but we couldn’t get it,” Dr Seidel said.

“Surprise, surprise. The bulk-billing rate is not at a record high. Among the practices surveyed it has dropped a fair bit.”

Significantly, the survey covered long and short consultations, as opposed to services, which are the basis for Medicare figures on bulk-billing.

It showed the median out-of-pocket cost for non-bulk-billed consults was $40 and the average payment was $48.69.

However, the study could not be used to pinpoint practices or regions where bulk-billing was on the decline.

As more patients were asked to pay for GP services, Dr Seidel said the logical next question was the impact on access to primary care.

“The question is, will they delay GP visits and become sicker or attend hospitals?”

He noted Australian Bureau of Statistics findings that 5% of patients – or one in 20 – were already reporting they did not visit a GP because of cost during the two years to 2015.

The RACGP earlier estimated that 30% of members were revising their business models because they could not stay viable under the rebate freeze.

The latest survey, published last week in the college’s General Practice Industry Report, adds to evidence that patients’ out-of-pocket costs are on the rise.

Australian Doctor: Bulk-billing rates down to 69%, claims college

 

Millions of patients are paying $40 to see their GP despite the Federal Government claiming bulk-billing rates are at record highs.

The claims are made in a RACGP report, which suggests only 69% of GP consults are bulk-billed, and that non-bulk-billed patients are paying a median out-of-pocket cost of $40, or $48.69 on average.

The college’s figures undermine official Medicare figures for last month that show bulk-billing at a record high of 85%.

The numbers are being hailed as significant as they are based on actual GP consults, including short and long consults, rather than GP services, which are used by Medicare and include activities such as ECG, spirometry, wound dressing and diabetes reviews.

Medicare GP bulk-billing rates are being used by the government to argue the ongoing rebate freeze was having little impact on the costs faced by patients.

Incoming RACGP president, Dr Bastian Seidel (pictured), said the college commissioned the report because they believed GPs were being forced to increase their fees in order to continue to offer high-quality care “for next to nothing” under current rebates.

“We felt that practices would change their billing because it’s the end of the financial year, so practices are going to have that meeting about what they are going to do, how they are going to manage,” he said at the college’s annual conference in Perth last week.

The findings, published in the RACGP’s General Practice Industry Report, were based on a survey of 10,222 patients who booked GP appointments between 1 August and 2 September this year – so don’t show if the decline in bulk-billing has been ongoing since the freeze was first introduced in 2013.

Dr Seidel said the college had requested Medicare release its data on co-payments but it had “yet to deliver”.

“It was probably for obvious reasons [that the figures could show a drop in the levels of GP bulk billing,” Dr Seidel added.

An Australian Doctor survey of 510 GPs carried out in May, a week after the government said it would continue the rebate freeze until 2020, found that the majority believed bulk-billing rates would collapse as a result.

Some 37% said they would increase their own fees for all their patients in the following 12 months.

A further 29% said they would increase their fees for patients except children and concession card holders. Only 18% of GPs said their billing would remain unchanged.

News.com.au: The health care revolution that will see Aussies enrol with a GP for all their medical needs — but not everyone is happy about it

 

DOCTORS will be paid just $8.90 extra per patient per month to deliver a revolutionary new system of care that will see patients enrolled with a single medical practice.

The health care home model being touted as the solution to Medicare’s woes is so underfunded GPs will need an extra $100,000 per practice per year to make it work, doctors say.

Royal Australian College of General Practitioners president Dr Bastian Seidel says the $21 million budgeted for the program isn’t even new money, it is being taken from other GP payments.

The Advertiser: GP bulk billing only applies to two out of three consults: survey

 

One in three GP consultations are not being bulk billed and these patients are paying an average $48 out of their own pocket to see the doctor a startling new survey shows.

RACGP president elect Dr Bastian Seidel said many doctors changed their billing after July 1 when they knew the Turnbull Government had been re-elected and the freeze would continue.

The Medical Republic: Rule guides antibiotic prescribing

 

A team of GPs has developed a way to identify which children with respiratory infections can safely be  treated without antibiotics

Using clinical characteristics, the authors say they can classify children into those at low, medium and high risk of hospitalisation for respiratory tract infection.

The rule, called STARWAVe, could also reduce antibiotic prescribing in primary care for children at very low risk of complications from their respiratory illness, said the authors of the trial published in the Lancet.

Dr Bastian Seidel, former chair and current RACGP board representative of the National Asthma Council, said the study had the

potential to influence prescribing habits with regards to antibiotics in children and teenagers.

“We can now safely identify a group that does not benefit from antibiotics at all. And we now have a tool that allows GPs to communicate that with carers much better,” Dr Seidel said.

Antibiotics were often prescribed to mitigate the perceived risk of future hospital admission and complications, but this study directly addressed the likelihood of these outcomes, Dr Seidel said.

The study looked at 8394 children aged between three months and 16 years old who presented to a general practice with acute cough lasting 28 days or less, or with a respiratory tract infection.

“Our previous systematic review suggests that this is the largest and most rigorous prognostic study of children with respiratory tract infections in primary care,” the authors wrote.

The UK and US researchers identified seven clinical symptoms and examination findings that were directly associated with a higher risk of hospitalisation.

These are short illness duration (≤3 days); temperature of 37.8C; age (<2 years); chest recession; wheeze; asthma; and vomiting – hence the mnemonic STARWAVe.

Each factor is worth one point, stratifying children into very low (0 or 1 point), normal (2 or 3 points) or high risk (4 or more) of admission. Of the 78 children hospitalised, most were for lower respiratory tract infection, bronchiolitis or viral wheeze. Only one quarter suggested a bacterial cause that would have been helped by antibiotics, the authors wrote. A third of the very-low risk group received antibiotics.

“The main value of our results is to reduce clinical uncertainty and antibiotic use in children least likely to benefit from them, namely those at very low risk of future hospital admission,” the authors said.

Because most children in the study were very-low risk (67%), even halving antibiotic prescribing rates in this group and increasing antibiotic prescriptions to 90% in the high-risk group would reduce overall prescribing by 10%, they said.

A no-antibiotic strategy would be safe in the low risk group, and those in the normal-risk group were best treated with no antibiotic or delayed antibiotic prescribing, the authors said.

The high-risk group should be monitored closely for signs of deterioration, “with consideration given to proactively arrange same-day or next-day follow-up and prescribe an immediate antibiotic”, they wrote.

“The interesting part is that they did not incorporate laboratory tests (swab results, CRP), which makes it much more practical and valid for real life application in an Australian general practice setting,” Dr Seidel said.

“The lead research team consists of GPs, the setting is general practice. The cohort recruited is representational. The exclusion criteria are limited. It’s a real-world study,” Dr Seidel said.

Blacktown GP, Associate Professor Michael Fasher, said while the research was interesting, more work would need to be done to validate the STARWAVe rule.

Professor Fasher said he agreed with the authors’ conclusions that at this stage, “this rule should supplement clinical decision making and not supplant it”.

9 News: Review reveals Medicare wastage gripes

 

The interim report of a review into the Medicare Benefits Schedule ordered by Health Minister Sussan Ley has identified unnecessary surgeries and diagnostic imaging and pathology tests as areas of concern for patients and health professionals.

They’ve also pointed to low-value administrative GP consultations for things such as repeat prescriptions, test results or sick leave certificates.

Royal Australian College of General Practitioners president-elect Bastian Seidel said it was “ridiculous” to suggest GP consultations were one of the main cost drivers in health.

But he agreed there were inefficiencies in the paperwork GPs have to do, such as documentation for hospitals or to fulfil Centrelink requirements.

ABC News Breakfast: Medicare report

 

A new report has found Doctors want to streamline appointments for administrative tasks like writing sick certificates, repeat scripts and providing test results.

RACGP: Tasmania’s Bastian Seidel is the RACGP President-Elect

 

President-elect Dr Bastian Seidel wants the RACGP to continue its advocacy for members and maintain its place as the voice of Australian general practice.

Can you tell us about yourself?

I grew up as the youngest of three children in a small place in the Ruhr Valley, in Germany’s industrial heartland. I went to the local primary and high school, graduating in 1994, and then spent a year in the medical corps of the German army before moving to Leipzig to study medicine.

The University of Leipzig was established more than 800 years ago and I just loved the tradition and history. I then spent my final year of medical studies at the University of Pretoria and the University of The Free State in South Africa.

The medical profession in Germany was very competitive back in those days, with unemployment rates among junior doctors as high as 50%. But I was lucky enough to be offered a (pretty poorly paid) position as an intern at the University of Leipzig’s Children’s Hospital.

The internship period in Germany was 18 months and I spent the last year in internal medicine at a regional district hospital in Germany’s wine region in the country’s south-west. I was happy to learn that it was customary that patients in this area would give their treating doctors bottles of the lovely local wine upon discharge, which made me appreciate German Rieslings very quickly.

General practice training in Germany at the time was rather unstructured, so I applied for a training position in a GP voctional training scheme in the UK. The Plymouth Training Scheme proved to be excellent and that was really when I fell in love with the general practice specialty.

During that time I also completed my research doctorate in paediatric immunology, wrote a small book on clinical classification systems (Medical Classifications – Pocket), and undertook clinical attachments at the New York Medical College and the Chinese University of Hong Kong.

I was then awarded a scholarship to conduct research at the University of Adelaide, so I moved to Australia in January 2007.

I met my late wife in those early days in Australia. She was living in Tasmania at the time, so I decided to leave research and Adelaide and moved once again, and I’ve been living and working in Tasmania’s Huon Valley since 2008. It’s a great community and my colleagues at the Huon Valley Health Centre are fabulous. I can’t see myself ever moving from here.

How will your personal and professional experience help in your role as RACGP President?

I have lived and worked in a variety of places and positions, which have all contributed to who I am and what kind of President I will be. I’d like to think that moving around and meeting new people has helped to develop my communication skills and my ability to engage with patients, colleagues, politicians and even journalists.

I’ve been involved with the RACGP in various capacities since 2009 and I understand that experience and corporate knowledge are important when one is representing an organisation.

As an international medical graduate (IMG) who has worked under the Australian moratorium, I also understand what that situation is like for incoming IMGs, many of whom are members of the RACGP

I have a solid background in research, particularly in primary care research over the last few years, and I found the loss of the Bettering the Evaluation and Care of Health (BEACH) program funding to be an affront to general practice.

Given I have worked as a contractor and am now a practice owner, I understand the importance of advocacy – not just for owners, but for contracted and other types of doctors. In the last two years I’ve become more involved in advocacy and health policy and have had media training on the run, which has contributed to my further engaging with health policy experts and politicians.

I am a general practice supervisor and have an appointment with the University of Tasmania, as I not only enjoy teaching but want to encourage and instil in the next generation of GPs the knowledge and enthusiasm that I have for general practice.

I believe having this broad range of experiences will help me, as RACGP President, appeal to and engage with members and external stakeholders, particularly our members, who are a fascinating and heterogeneous bunch.

What is your vision for the RACGP over the next two years and beyond?

I am a firm advocate for evidence – whether that’s evidence-based medicine in the practice, or evidence-based health policy. The RACGP has really come into its own in the last couple of years, particularly under the leadership of Dr Frank R Jones, and I’d like to continue this momentum.

The core business of the RACGP will always be education and standards, so it will be important for us to lead the conversation with policy makers regarding general practice training and rewarding quality and evidence-based practice.

The challenge lies in getting the message across. General practice has to be in places left, right and centre.

What are some of the greatest strengths of the RACGP?

The greatest strength of the RACGP is its members, particularly those who put in time and effort behind the scenes to make things work within the college and the profession.

The RACGP is first and foremost a learned institution. As we move further into the advocacy space, it is important to continue to reinforce evidence-based policy and decision-making. I do think the RACGP is in a stronger position to influence health policy since the ‘You’ve been targeted’ awareness campaign, and the momentum that we have only allows us to become a stronger presence in working for our members.

What are the biggest challenges facing the RACGP and the general practice profession?

One of the biggest challenges for the RACGP, and for me as President, will be to continue to represent the interests of members. By its very nature, general practice is a diverse profession and, at times, those of us in it have wildly differing viewpoints. Luckily, the RACGP has an excellent Council, expert committees and dedicated staff members who will be there to support and guide me as President.

As I stated during the presidential election campaign, the role of President is not an imperial one and I do not see myself making unilateral decisions. Member consultation will always be important and decisions on direction and policy will be made by member representatives on Council for me to then communicate to stakeholders and others.

General practice as a profession is facing many challenges – the Medicare rebate freeze and underfunding of primary care, those who wish to do ‘general practice light’ and funding cuts to research, to name a few. One of the most important messages that the RACGP will consistently be sending out is that general practice remains the most cost-effective form of healthcare in the country, and that it should be funded and respected as such.

The challenge for me is to make sure that message is heard loud and clear.

How has general practice changed in the last decade and how will it change in the future?

Much has changed since I started practice in Australia in 2007.

We have seen the emergence of corporate companies and private equity firms becoming involved in the business of medicine. Private health insurers want their slice of the primary care pie, as do allied health professionals. I really hope that we can continue to improve the evidence base for general practice through primary care research.

I am an avid Twitter user and have found that social media is an effective tool for information-sharing and engaging in discussion. Technology and social media will continue to advance and impact on how we practise medicine and how we learn. Patients will want different ways of communicating with their GP, and the RACGP will need to be at the forefront of setting the standards.

I do not believe GPs will ever be replaced by medical robots, but we may start using more algorithms for diagnostics. Computer-aided decision-making is the next frontier.

In any case, it’s a fast-moving world and I am proud to be representing the RACGP as the leading general practice organisation in Australia.

The Mercury: GP chief warns Tasmania needs more health funding to avoid costly hospital admissions

 

Tasmania needs more investment in general practice in order to avoid costly hospital admissions, says the incoming president of Australia’s leading general practice organisation.

Medical Republic: Continuity saves lives – here’s proof

Research has proven what Australian GPs have long been saying about the importance of continuity of care

A prospective study proves what Australian GPs have long known – having a regular GP saves lives.

The Dutch study, published in the British Journal of General Practice, provides the strongest evidence yet that continuity of care in general practice is associated with a lower mortality rate.

The trial of 1712 adults aged 60 or over found those with multiple GPs were 20% more likely to die over the 17-year study period than those who attended a single doctor.

On the other hand, people with the greatest continuity of care, calculated by an index based on the number of GPs consulted over time, had a significantly lower risk of death over the same period.

Almost half (43.3%) of participants had the same GP during the study.

While previous studies have shown the benefits of continuity of care, most have been based on patient experience, had a limited sample size and were of shorter duration.

“The beauty of this study is that they have used a hard outcome – which is mortality – rather than a proxy marker,” RACGP president-elect Dr Bastian Seidel told TMR.

However, despite the substantial evidence supporting continuity as a principle of general practice, Australian GPs were increasingly struggling to maintain long-term patient relationships, Dr Seidel said.

“What we are seeing in Australia, of course, is fragmentation of care,” he said.

The corporatisation of general practice, after-hours care and the aged-care sector has promoted providers that have limited contact with, and knowledge of, the patient.

“In particular, allied health practitioners, like physiotherapists and chiropractors, are actively trying to get in a space where GPs typically are. We see the same from pharmacists,” Dr Seidel said.

The implications of the study were very clear.

“What we should be doing for the Australian setting is looking at how we actually support GPs to have those long-term relationships with their patients.” The key to this was increased funding, Dr Seidel said.

“If the GP is meant to be the gatekeeper of the system then this function needs to be supported and realistically funded.”

Supporting a system that encouraged continuity of care, strong clinical governance and a gate-keeping function would deliver the same amount of care at a lower cost, or more care that achieved better clinical outcomes, he said.

The study provides further evidence supporting the Health Care Homes initiative, which focuses on the long-term care of patients.

The RACGP has been lobbying the government to accelerate the initiative, and hosted a roundtable in July, which arrived at 22 recommendations for the Federal Government to improve the Health Care Homes initiative.

Australian doctor: After-hours targeted after sharp rise in claim

 

A Medicare crackdown on after-hours billing is underway, with doctors being told to review whether their claims for urgent home visits are genuinely urgent.

The Department of Health has sent letters to a number of doctors, asking them to acknowledge services that may have been incorrectly claimed in the 18 months prior to December 2015.

The department said it had taken action because of the sharp rise in both the claims made and the number of doctors making them.

Michael Wade, a lawyer with the medical defence organisation Avant, said formal audits could follow.

He stressed that the definition of ‘urgent’ under current regulations relates to whether the treatment itself is urgent — rather than the assessment.

“The important point we are trying to make is that whatever service a doctor provides, they are required to make an adequate record of the service, such that another practitioner would be able to understand their decision-making,” he told Australian Doctor.

“Be sure to record the specific facts and circumstances in your medical notes, which go to the urgency of treatment in each case.

“If treatment is not urgent, use the non-urgent after-hours items.”

As Medicare tightens the screw on after-hours service providers, the agency could also use controversial powers granted in 2011, which allow authorised Medicare officials to go through medical notes.

A health department spokeswoman said it would only audit individuals “if there is strong evidence of noncompliance”.

The RACGP has argued that the blowout in urgent after-hours home visit claims — which has risen from $68 million to $153 million within five years — could be contained by banning claims by non-GP doctors working for deputising services.

RACGP president-elect Dr Bastian Seidel said there had been a rapid increase in claims for urgent visits in his own state of Tasmania.

He said he was not sure whether the rise — a threefold increase between 2014 and 2015 — was “supply or demand driven”.

Dr Seidel said he worked for the state’s after-hours GP hotline for seven years, where, on average, he would refer around five of the 25 calls he took each night to an ED or for a home visit.

“I was very surprised to see this epidemic of urgent visits. I could not understand where the urgency came from, which made me a little suspicious of appropriateness of the visits and the triage.”

The justification for these services was that they reduced ED admissions, however, Dr Seidel said data for southern Tasmania suggested Royal Hobart Hospital’s non-acute cases were 8% before deputising services but had now increased to 9%.

Ben Keneally, president of National Association for Medical Deputising (NAMDS), said Tasmania’s case could be because people needed care they were not getting before, and any rorting of the Medicare items was at the extreme margins of the profession.

The Mercury: As long as you have your health

 

“Both political parties knew well in advance that not only health, but in part Medicare would be the number one issue in the electorate. That certainly applies in the Tasmanian context,” said Dr Bastian Seidel.

“I think it’s a concern particularly in rural and regional areas where people are financially disadvantaged already and for them to have access to medical services is absolutely key.”

The Examiner: Tasmanian doctor heads GP group

 

General practitioners throughout Australia will soon be represented by Tasmanian doctor Bastian Seidel. 

“My priority will be to communicate effectively that we need to fund general practice in Australia properly,” Dr Seidel said.

“We can’t be the gatekeepers of the health system without funding of any form.”

Australian Doctor: RACGP announces next president

 

Tasmanian GP Dr Bastian Seidel is to become the next president of the RACGP.

The result of the vote announced on Tuesday will see Dr Seidel take up the college’s top job in October.

His election comes as general practice faces an overhaul of Federal Government funding for chronic disease care and the transformation of GP clinics into so-called ‘Health Care Homes’.

Asked to name the biggest challenge facing the specialty, Dr Seidel told Australian Doctor it remained the urgent need to shift health investment into GP care.

“We have significant funding for hospital services, and general practice seems to be missing out,“ he said.

“We, as GPs, are meant to be the gatekeepers, but we are not funded to do that despite that fact that when [rising] costs of health are discussed, we get blamed for it.

“The total cost of the health budget is $145 billion and yet the money spent through the MBS on general practice is around $6 billion,” he said. “That is next to nothing.”

He said he wants the Medicare rebate freeze reversed.

And he also backs the college’s current media campaign — which includes running TV commercials estimated to have cost in excess of $2 million — warning the public about the impact the policy will have on patients.

However, as voters in the Federal Election head to the polls this week, he stressed the college would never offer endorsement of individual parties.

He said he would remain politically agnostic rather than running “campaign after campaign”.

Dr Seidel polled 38% of the 3316 first preference votes cast in the college election.

His nearest rival was Sydney GP Dr Harry Nespolon, who polled 22% of first preference votes.

Dr Seidel will succeed current RACGP president Dr Frank Jones in October at the RACGP’s annual conference in Perth.

Chair of RACGP’s Tasmania faculty and a partner at the Huon Valley Health Centre, 40km outside Hobart, Dr Seidel studied medicine in Germany and South Africa before completing his vocational training as a GP in the UK in 2006.

Medical Republic: Focus on primary care policy is hitting home

 

The RACGP’s next president, Dr Bastian Seidel, says the new national focus on primary healthcare policy driven by GP activism will have a lasting effect.

The Tasmanian rural doctor, who came to prominence as national spokesperson for the RACGP’s #CoPayNoWay and #You’veBeenTargeted campaigns against attacks on GP funding, says the shift has been evident in the current federal election campaign.

“In the lead-up to this election, we’ve talked a lot about general practice and the role of general practice and the problems that GPs face.  If you think about previous elections, that didn’t quite happen,” he told The Medical Republic.

“That’s quite a shift within a very short timeframe, and I believe it is a direct result of the RACGP’s advocacy campaign that really started when the co-payment was floated two years ago.

“That’s what we want – to make general practice left, right and centre when we talk about health and health policy.”

Dr Seidel was the clear choice as president in online voting by RACGP members, taking nearly 40% of the primary vote in results announced earlier this week.  He will take over the college leadership from Dr Frank Jones in October.

Despite continuing uncertainty over sustainable funding for general practice and the Medicare rebate freeze, Dr Seidel said the college’s evidence-based views were gaining currency.

“I have no doubt political decision makers have taken notice of what the RACGP has advocated,” he said.  “And if you look at the policy announcements by Labor, The Greens and some independent candidates, they were strongly informed by the RACGP’s vision of a sustainable healthcare system.”

Asked what he’d like to achieve in the next two years, Dr Seidel said he was committed to the RACGP’s “medical home” model for chronically ill patients and using it to promote electronic communications between GPs and patients.

“I’m not an IT geek in any way.  For me, it’s a pragmatic thing.  But if it makes my life easier and it makes a difference to my patients, I am going to use any form of digital health or e-health.”

Practising since 2008 in rural Tasmania’s Huon Valley, he was an early adopter of telehealth for patients with transport or mobility problems and has had elderly and deaf patients who preferred to consult their GP via email.

But e-health interaction does not attract a Medicare rebate and perhaps never will. Dr Seidel thinks the proposed medical home – which the federal government has rebranded as its “Health Care Home” and plans to trial next year – could be the answer.

“It should be part of the medical home, where communications with patients should be remunerated and the means of communications should be completely up to the practitioner and the patient.   So whatever they feel is the most suitable and safest way for them can be remunerated accordingly,” Dr Seidel said.

Dr Seidel opposes the compulsory quota imposed on GPs in the My Health Record roll-out, which means doctors face a financial penalty if they don’t upload a set proportion of their patients’ records.

“This puts GPs in an ethically very difficult situation, because you will potentially ask patients to sign up to the health record, which is meant to be patient-controlled,” he said.

“Of course, I will load up a health summary if a patient asks me to.  But the discussion really should be patient-initiated, not initiated by the GP, particularly when there is a financial incentive to do so.”

The German-born doctor said his years of study, research and work in different health systems around the world had formed his pragmatic approach.

“I think that has shaped me a fair bit.  It’s about not trying to re-invent the wheel all the time, but looking at what other health systems do really well.”

After studying medicine in Germany and South Africa, he did an internship in Germany and completed his GP training in the UK in 2006, with stints on scholarships in New York and Hong Kong, before travelling to Adelaide for a GP research role.

Dr Seidel is a part-owner of the Huon Doctors Surgery, current chair of the RACGP Tasmania faculty and a clinical professor at the University of Tasmania.

He captured 1291 votes in the RACGP poll, of 3316 votes cast. Second in the field of four candidates was Sydney GP and practice owner Dr Harry Nespolon.

Medical Observer: Dr Bastian Seidel elected RACGP President

 

Tasmanian GP Bastian Seidel has been elected the next president of the RACGP.

He will take the reins when Dr Frank Jones steps down in September.

Dr Seidel is vowing to bolster the organisation at a difficult time.

“I am absolutely delighted and honoured to have been elected by our members to this important role and look forward to making a positive impact on behalf of Australia’s general practitioners, our college and our patients,” he said.

“With general practice funding increasingly under threat the role of the RACGP in representing and communicating the interests of members and patients has never been more important.”

“I will endeavour to be as passionate and vocal in advocating for primary healthcare as Dr Jones but he will be hard act to follow.”

Dr Seidel triumphed over three strong contenders – former GP of the year Dr Ayman Shenouda, GP Synergy chair Dr Harry Nespolon, and Primary Health Care bigwig Dr Bruce Mugford.

In his candidacy statement, he vowed to make political decision-makers aware of the strong evidence behind the cost-effectiveness and patient benefits of general practice.

“General practice remains vulnerable, and the viability of high-quality general practice is at risk. Erosion of funding for clinical care, postgraduate education and vocational training in general practice are just the start. Research in general practice has already been defunded.”

He said he would remain politically agnostic and uphold the academic credentials of the college, rather than running “campaign after campaign”.

Dr Seidel has over 10 years’ clinical experience and is a partner and co-owner of a rural general practice in the Huon Valley in southern Tasmania.

He is chair of the RACGP in Tasmania and studied medicine in Germany and South Africa before completing his vocational GP training in the UK in 2006. He holds a doctorate in paediatric immunology.

Pulse IT Magazine: RACGP presidential candidates on eHealth: Bastian Seidel

 

Pulse+IT has asked the four candidates vying to become the next president of the RACGP their thoughts on eHealth and health IT.

“Priority is and always needs to be, that we improve patients’ clinical outcomes, whether by eHealth or non-eHealth really does not matter. eHealth has to be a value proposition, and funding needs to follow the evidence.”

Federal funding reduction threatens Tasmanian mobile rural health service

 

Bastian Seidel from the Royal Australian College of General Practitioners said discontinuing funding could cost the health system more.

“It’s a false economy absolutely, we are not saving any money but even more importantly we are not improving any patient outcomes,” he said.

“It’s a complete disaster, I call it a double whammy on top of the Medicare rebate freeze, you will not be finding any private allied health practitioners who are more into rural areas.”

The Mercury: Medicos rally against Federal Government’s Medicare rebate freeze

 

Huon Valley GP Bastian Seidel said he was very concerned about basic healthcare becoming unaffordable for people on low incomes.

Dr Seidel said people who most needed to see GPs were often the poorest because of chronic conditions.

“Fairness should be reflected in the way we care for the sick and those in need,” he said.

“General practice is at breaking point.”

News.com.au: Labor vows to stop GP ‘co-payment by stealth’

 

“In general practices, we are looking after patients who can’t afford hospitals,” Bastian Seidel told news.com.au.

“It’s patients on concession cards, pensioners, those assessed to be in financial need who would have been hit the hardest.

“Now we should have a chance of meeting that need and being able to continue not to charge a co-payment.

“It’s the right policy at the right time for the right reasons.”

News.com.au: Turnbull makes powerful enemy in GPs, as doctors rally patients to fight spiralling health costs

 

The Medicare rebate covers only about 50 per cent of the consulting fee recommended by the AMA, and “that’s just not sustainable for GPs,” Dr Bastian Seidel told news.com.au.

“It’s just a punch in the face,” he said. “It’s a massive problem for our patients. Medical practices may not be viable.

“Patients say it’s ridiculous. They get tax breaks, but pay more. It doesn’t make sense.”

The Examiner: Labor makes $12b general practice pledge

 

Royal Australian College of General Practitioners councillor Bastian Seidelsaid Labor’s announcement made sense.

“It’s a step in the right direction and it’s certainly overdue because GPs couldn’t do it any more,” he said.

“The rebate freeze has to be undone, otherwise we can’t practise safely.”

The Medical Republic: Big Medicine Inc

 

“Patients with diabetes may be seeing an ophthalmologist every year for eye check-ups,” Dr Seidel noted.

“Yet even if their diabetes has no changes and they remain on the same medication, the specialist is still able to charge this initial consultation fee repeatedly.”

Doctors have reported a drop in patient visits because people are worried about $7 GP co-payment.

Dr Bastian Seidel of the Australian College of GPs speaks to ABC News 24.

ABC News 24: 22/05/2014

Australian Doctor: GPs cheaper than car insurance, Senate told.

 

GP services cost taxpayers only $250 per person a year — cheaper than car insurance — a high-profile Tasmanian GP has told a Senate inquiry.

But the ongoing Medicare rebate freeze will make practices unviable and push patients towards more expensive hospital services, warned Dr Bastian Seidel (pictured), chair of the RACGP’s Tasmanian faculty.

Dr Seidel made his comments on Monday at a hearing of the Inquiry into the Health Insurance Amendment (Safety Net) Bill 2015 by the Senate Community Affairs Legislation Committee.

He told senators that general practice was great value for money because the $6 billion annual Federal Government funding into the sector amounted to only $20 per person a month, based on data presented in the Medicare review consultation paper.

“It doesn’t get much cheaper than that — it’s cheaper than car insurance. And while we are doing this, we have actually improved outcomes in patient care; we have reduced the death rate from heart disease by 30%,” he said.

Dr Seidel warned that GPs were already struggling financially and that the indexation freeze would make practices broke unless they dropped bulk-billing.

“If we keep the Medicare index freeze going the way it is now, providing a bulk-billing service or waiving a charge to patients is just not going to be possible.

“I would have to tell my palliative care patients, when I am doing a home visit, that I have to charge a fee for coming out to see them. Dying people will be asked to pay up; otherwise, no doctor is going to come out,” he said.

Dr Seidel said his practice had already become a not-for-profit social enterprise.

“We pay our bills, and that is pretty much it.”

Hospital services cost four times as much as primary care, and patients would be pushed towards EDs by higher out-of-pocket costs from upcoming changes to the Medicare Safety Net and index freeze, he told the Senate.

Dr Seidel cited the example of GPs having to charge fees for wound dressings, where patients might go to the ED instead.

He said changes to the threshold meant it would take longer for patients to reach the Medicare Safety Net, and this would also mean some could no longer afford specialists and ancillary services that did not bulk-bill.

“If a patient comes back to me and says, ‘I can’t afford the diabetes educator’, guess who is going to provide diabetes education? That will be me.”

Dr Seidel said the RACGP supported reform and simplifications of the safety net, but not at the expense of creating financial barriers to clinically necessary care for vulnerable groups.

However, Department of Health officials told the hearing that private hospital specialists had been gaming the safety-net system through creative billing, such as charging high initial fees and inflating their fees.

They said safety-net funds were being paid out disproportionately to affluent patients and to specialties such as obstetrics, psychiatry and radiology.

“The safety net was never implemented with a consideration that it was a tool to support the income of clinicians. The safety net was implemented with the view that it was a tool to prevent excessive cost to patients,“ said Andrew Stuart, acting secretary with the Department of Health.

“The real problem about where we are now and why we are here now with this legislation is that it has become a tool which is about income for clinicians, and that is corrupting the purpose of the safety net, and we now have a significant problem to solve.”

The government said its Single Medicare Safety Net system, which comes into effect on 1 January 2016, would produce savings of $267 million.

ABC News: Tasmanian AMA boss rejects claim one third health budget is being wasted

 

“It’s actually a commonsense approach to review the Medicare rebates, the RACGP has been calling for this for a very long time now,”  says Bastian Seidel.

Medical Observer: ‘General practice lite’: Pharmacist MBS proposal panned

 

A CALL by the Pharmaceutical Society (PSA) to expand MBS item eligibility to the profession has been slammed as “double-dipping” by the RACGP.

In its submission to the MBS Review Taskforce, the PSA calls for a practice incentive payment for pharmacists in general practice and the expansion of existing MBS items so rural and remote Australians can use pharmacists as primary health care providers.

The group also wants to extend the eligibility of MBS payments for after-hours care to pharmacists.

In the submission, PSA National President Joe Demarte says Chronic Disease Management is an example of an MBS-funded service which is under-utilised because pharmacists are excluded.

But Dr Bastian Seidel, head of RACGP Tasmania, says the recent Sixth Community Pharmacy Agreement, which gave the PSA and the Pharmacy Guild of Australia $600 million for new and extended community pharmacy programs, is already “a lot of cash for something GPs do much, much better”.

While the idea of pharmacists contributing to a team centred around a medical home, possibly with in-house non-dispensing pharmacists, is potentially attractive, anything more would not reflect the evidence base the PSA itself cites, he says.

“We don’t support… expanding the MBS [so] that pharmacists are suddenly a workforce solution and offering ‘general practice lite’ in a pharmacy environment from their premises.

“It’s going to lead to a fragmentation of patient care, it would not be safe to practice healthcare from those premises.

“There’s no privacy, no confidentiality, no back-up in case something happens, no responsibility for information being passed on to the regular GP – there are endless problems.

He quoted the recent report that a pharmacy had uploaded six prescriptions to the PCEHR attaching to the wrong patient as an example of the problems that can arise.

Medical Observer: GPs unfairly targeted in waste row

 

Rather than making general practice a scapegoat, Dr Bastian Seidel says the spotlight should be on the tertiary sector and the MBS reform efforts should be based on science without political interference.

“My concern, which is shared by many general practitioners, is that GPs are being blamed as the main reason why there is a significant overspend in healthcare,” he said.

A Four Corners program on ABC TV on Monday attacked fee-for-service as a main driver of waste and contended that 30% of the country’s health spending was wasted on unnecessary tests and treatments.

“It’s very clear that the total cost to the federal government of general practice actually has been steady over the past 10 years, when, in fact, it is the hospital costs that have quadrupled,“ said Dr Seidel, chair of the RACGP’s Tasmanian faculty.

“We have to be mindful that general practice in Australia has a track record of not costing a significant amount of money to the federal government – whereas hospitals certainly do, without taking into account the fact that the states and private health insurance also fund the hospitals.

“It is probably worthwhile asking how many Medicare rebate items apply to general practice and how many apply to tertiary care and other practitioners such as psychologists and physiotherapists. But I am not hearing much discussion there.“

The program’s claims led the RACGP president Dr Frank Jones to defend fee-for-service, saying descriptions of the system as broken are “extreme”.

“One of the drivers of inappropriate care is what’s called ‘fee-for-service’. That’s where every individual visit, test or procedure has a separate fee attached to it,” program host Dr Norman Swan told viewers.

Professor Robyn Ward, chair of the Medical Services Advisory Committee, then described imaging for low back pain as a “huge problem”.

“I think once again fee-for-service encourages the wrong sort of clinician behaviour,” she said.

In its response, the RACGP warns against pointing fingers.

“This cannot be about assigning blame or fighting over ownership,” it says. “There is no international evidence that ‘pay-for-performance’ systems improve health outcomes or reduce health spending.

“We do not need to import failed health systems from overseas. We need our own solutions for our own health system.”

The Four Corners program reiterated a claim that 30% of Australia’s entire spending on health is wasted on unnecessary and possibly harmful tests and procedures.

But Dr Stephen Duckett, director of health programs at the Grattan Institute, says there’s no evidence to support the figure in the Australian context.

“The 30% estimate of waste in the Australian healthcare system is derived from the United States. It was imported uncritically into Australia and has since gained credence without any evidence,” he told Medical Observer.

Elsewhere in the Four Corners program, Professor Ward said “very little of the MBS has evidence attached to it”.

Responding to the program on Twitter, AMA president Brian Owler said: “Lots of sweeping statements. V little balance on #4corners with a clear agenda”.

The government has been accused by the AMA and the Labor opposition of intending to use the MBS review to slash health spending.

At the weekend, Professor Owler said Health Minister Sussan Ley had lost the goodwill of the medical profession “in a rush to cut health funding and services”.

Professor Owler was angered by Ms Ley’s suggestion that doctors would ignore patients’ best interests by sending them for unnecessary tests.

The minister has called for public consultation on the MBS review, inviting people to come forward if they have undergone any Medicare-funded service they considered “unnecessary, outdated or even potentially unsafe”.

The RACGP says it is willing to embrace the MBS review on the proviso that primary health care does not lose out and any savings are returned to health.

“While the RACGP accepts that government will be reviewing Medicare with best practice contemporary care, the review cannot be about cost-cutting or budget balancing,” Dr Jones says.

“And if the review finds that there are efficiencies that can be found in certain patient services or procedures, the savings must be directly reinvested into the health system.”

The Mercury: Small-town doctors and those new to town most likely to leave for the city

Huonville GP Bastian ­Seidel says the issue of GP mobility is topical in Tasmania’s southern communities.

ABC News: Doctors set to tell Government to stop attacks on Medicare

 

Dr Bastian Seidel from the Royal Australian College of General Practitioners said GPs were concerned the Government was still planning to reduce the overall rebate to doctors by $5 and freeze indexation on Medicare rebates.

BBC News: Australia Medicare changes: GPs warn of practice closure

 

Doctors could shut their practices and their patients could flood hospitals as a result of changes to Australia’s public healthcare system, critics say.

The Mercury: GPs hit out over Medicare changes

 

“Dr Wilkins is the typical country doctor who does home visits, he bulkbills patients who can’t afford to pay, he has worked for over 30 years, he is retiring, not because he doesn’t enjoy it any more, he is fed up with the system which pun­ishes GPs,’’ Dr Seidel said.

The Mercury: GPs revolt against Federal Government’s $7 co-payment fee

Bastian Seidel said GPs were deeply concerned that the co-payment had been introduced for ideological reasons and not for the benefit of patients.

The Mercury: Tasmanian voters put health at No. 1 on their list of election priorities

Bastian Seidel said the poll results did not come as a shock as Tasmanians are acutely aware of problems in the health system.

The Drum: Stop politicising health care

Dr Bastian Seidel, one of the doctors who will review nearly 6,000 medical tests and services that receive Medicare and health insurance rebates, fears that expert advice will be drowned out by politics.

The Drum: 29/09/2015

The Examiner: Budget does not impress Tasmanian health groups

 

RACGP councillor Bastian Seidel said bulk-billing would be unsustainable by 2020 as the cost of providing medical services would continue to rise while the amount given to GPs would not.

The Medical Republic: Will Health Care Home fail on the back of MyHealthRecord’s fail?

 

Dr Bastian Seidel, current chair of RACGP Tasmania, cautioned against overstating the influence of the mere $21.2 million earmarked for the four-year project.

“It’s very easy to do something that underfunded and set it up to fail,” he said. “So you just over-promise and under-deliver, and if we have a look at the funding now we are talking about $100,000 per practice roughly.

“Now you could argue that’s a lot of money, but realistically it’s not that much.”

The Examiner: GPs question home doctor service need

 

Dr Bastian Seidel said data showed most low acuity emergency department presentations were between 8am and noon weekdays and that those patients could be seen by a regular GP.

The Examiner: GPs reject ‘simplistic’ report

Bastian Seidel, chairman of Tasmania’s Royal Australian College of General Practitioners, labelled the report “simplistic” and said it was based on modelling that had failed in the UK.

Dr Seidel said the researchers chose to look at a select number of clinics, as opposed to examining general practice as a whole.

Pharmacy News: Pharmacists and GPs pioneer new ways of working

 

A Tasmanian pharmacist will be breaking new ground in the state when he takes up his position in a GP practice next week.

In Penrith, western Sydney, a Bloom’spharmacy is about to welcome its first resident GP. And nearby, a GP practice is embarking on a funded trial in which a non-dispensing pharmacist will sit in on prescription-review consultations.

These are three examples of how pharmacies and doctors are working together to future-proof themselves in a rapidly changing world for both professions.

Tasmanian Andrew Ridge (pictured) came from community pharmacy, had hospital experience and had been doing home medicines reviews when the ad for the Huon Valley Health Centre pharmacist role caught his eye.

Looking for something that was “more than retail” he jumped at the non-dispensing role at the twelve-GP, three-nurse practice 45 minutes south-west of Hobart. He starts next Monday.

The practice’s most notable doctor is Professor Bastian Seidel, who is a Clinical Professor at the University of Tasmania and Chair of the Tasmanian RACGP.

Prof Seidel is also a high-profile cheerleader for more integration between GPs and pharmacy in primary care – often to the chagrin of the wider GP community. Notably as RACGP representative on the National Asthma Council, he has advocated for possible OTC dispensing of corticosteroids.

Mr Ridge said it was Seidel’s “forward-thinking” attitude that captured his imagination.

He will primarily be doing medication reviews, but will also have face-to-face contact with patients in tandem with a nurse or a doctor.

“I think it’s a very clever step and certainly a good thing for pharmacists,” he says.

“If you’re going to deliver good care to your patients it needs to be a collaborative approach. I think this is a very efficient way of doing it. It’s the way it should be.”

The Bloom’s move is the ninth similar partnership with MedClinic.  The GP will be on site from 9.30am till 2.30pm on week days.

The doctor was not available to speak to Pharmacy News, but pharmacist Rachel El-Fawal said the service would suit elderly patients, allowing them to see a GP and pharmacy in one visit.

Down the road at the Mt Druitt Medical Centre, clinical pharmacist Radhika Somasundaram has embarked upon a three month trial funded by WentWest Primary Health Network.

She will undertake medication reviews and sit in with GPs and patients to finalise the patient’s medication plan and help with patient education for eight hours per week.

Though Ms Somasundaram has been with working ad hoc with local GP Dr Kean-Seng Lim for two years unremunerated, it’s only now the relationship has been formalized into a trial, which will be used to make a case to Medicare for permanent funding.

Medical Observer: Specialists urge ‘radical’ change to asthma treatment

 

A GROUP of respiratory specialists has called for change to the way patients access asthma medications, including corticosteroids, in a bid to improve control of the disease.

In an MJA commentary, three Melbourne specialists say a million Australians have uncontrolled asthma, based on figures from a 2015 survey of more than 2600 patients.

A quarter of those in the survey did not regularly use preventers, despite having uncontrolled asthma. Another 20% had uncontrolled symptoms even while regularly using preventers.

“The logical solution to this problem is to re-design access to asthma medications,” they write. “Preventers must be made more accessible.”

They say they welcome discussions about making low-dose inhaled corticosteroids (ICS) available OTC, as floated in the draft new National Asthma Council (NAC) strategy.

They also propose other “radical” measures including monitoring reliever medication dispensing, setting up dedicated “difficult asthma” specialist centres and the introduction to the market of a combined short-acting reliever and preventer puffer.

Co-author Associate Professor Mark Hew, head of respiratory medicine at the Alfred Hospital, Melbourne, says as yet there is no combined low-dose ICS plus short-acting reliever product in Australia.

“The MJA article aims to highlight the need for conceptual changes … in the way we manage asthma, over and above improving guideline implementation,” he says.

“The ideas are just examples of how we might proceed, and reduce the risk of high frequency reliever use without concomitant preventers –  a practice which increases the risk of exacerbations and asthma death.”

Tasmanian GP Dr Bastian Seidel, the RACGP’s representative on the NAC, has doubts about the benefits of specialist centres and of the combination product.

He says a study quoted in the commentary on the benefits of a combined ICS and short-acting beta-agonist is from 2007 and has been superseded by 2013 Cochrane review.

Dr Seidel does, however, see value in a trial of OTC preventer medication to gather evidence.

With regard to “difficult asthma” centres, he says primary care with referral to specialists in managing chronic illness such as asthma is still the best way to go.

“It needs to be tackled in primary care and that has been internationally proven to make a difference,” he says.

Medical Observer: Asthma linked to abdominal aortic aneurysm for first time

PATIENTS older than 50 who are newly diagnosed with asthma should be checked for signs of an abdominal aortic aneurysm (AAA), researchers say.

This follows a large observational study that, for the first time, links the two conditions.

The Danish population-based study, involving more than 34,000 people, has found those who had been diagnosed with asthma in the past six months were twice as likely to have a ruptured AAA than those without asthma.

“Older patients, especially men, with a recent asthma diagnosis should be checked for signs of aortic aneurysm,” says the lead author of the study, published in the journal Arteriosclerosis, Thrombosis and Vascular Biology.

“Patients with a diagnosed aneurysm who later develop asthma should also be monitored for changes in the size and strength of the aorta.”

But experts in Australia are divided about the robustness of the study and whether asthma is a stand-alone risk factor.

Cardiologist Professor Garry Jennings, chief medical adviser to the Heart Foundation, says the link between asthma and AAA shown in the study is “pretty tight”.

“It’s something for GPs to think about and bear in mind,” he says.

“If there’s a history of atherosclerosis and recent asthma, it’s a sign that GPs need to take a closer look.”

A physical examination and abdominal ultrasound may be appropriate, he says, with a small AAA monitored over time.

National Asthma Council director and GP Dr Bastian Seidel says he would consider asthma alongside traditional risk factors to keep “a closer eye on” patients already diagnosed with AAA.

“I would be much more mindful then of the risk of any existing aneurysm progressing or rupturing,” he says.

However, Dr Domenic Robinson, a vascular and endovascular surgeon at the Epworth Hospital in Melbourne, says he is concerned about how smoking is accounted for, and how asthma is diagnosed, in the study.

“It’s quite possible there is a link between asthma and AAA] but it’s not conclusive,” he says.

So, he advises GPs to focus on traditional risk factors, including smoking, vascular disease, COPD, a family history of AAA and age as stronger predictors than asthma.

Mr Jason Chuen, director of vascular surgery at Austin Health, Melbourne, agrees that the study is flawed.

He says there’s not enough evidence to warrant a screening program based on asthma diagnosis, but adds that there’s no harm in a physical exam.

Mr Chuen adds that the proposed link between asthma and AAA underlines the inflammatory nature of this type of aneurysm.

Professor Jennings says the proposed asthma-AAA link may be explained by mechanical forces.

“All that unfamiliar abdominal mechanical strain with coughing, smoking and wheezing might lead to twisting or torsion of the abdominal wall,” he says.

The study authors concede a lack of information on smoking may confound their conclusion. But they note that users of broncho­dilating drugs smoke less than non-users.

Medical Observer: Why worsening asthma symptoms could actually indicate reflux

 

APPARENTLY worsening asthma may be gastro-oesophageal reflux symptoms (GORS), US researchers say.

A study of 56 children with asthma found GORS is closely associated with asthma symptoms, with obese children seven times more likely to report reflux symptoms compared with leaner children.

GORS are also strongly associated with shortness of breath and short-acting beta-agonist (SABA) use in obese children, but these patients often have surprisingly better lung function, the researchers say.

Their study suggests GORS negatively affects perceptions of asthma control by obese children, who are more likely to experience oesophageal reflux that leads to throat clearing and coughing.

“Helping patients decipher GORS from true lower airway symptoms is critically important and will also reduce medication overuse and side effects,” they say.

But Tasmanian GP Dr Bastian Seidel, chair of National Asthma Council Australia, says it’s unlikely that SABAs are being overused to treat reflux.

“You have to look inside the oesophagus to see if the reflux does damage to it and that may not be the case,” he says.

“Symptoms are one thing but whether it causes harm to your body is a completely separate issue.”

The Australian Asthma Handbook calls for reflux to be managed in accordance with age-appropriate guidelines, he says.

Reflux should be treated but parents need to know that it will not make any difference to asthma symptoms or outcomes, he says.

“If we know a child has reflux disease, we should be treating the reflux disease appropriately but we should not be hoping it would make any difference to asthma symptoms or outcomes.”

National Asthma Council: 1 in 10 children with asthma experience an increase in symptoms and attacks when a new school year begins.

National Asthma Council Chair Dr Bastian Seidel speaks to ABC News Breakfast.

ABC News Breakfast: 27/01/2016

(Source: youtube.com)

Australian Doctor: GPs are still bulk-billing at record levels

 

GPs are still bulk-billing at record levels, new figures show.

Despite ongoing political turmoil in general practice, with the Federal Government’s failed co-payment plan and fears over the future viability of general practice, the bulk-billing rate for GP attendances in 2014/15 was 84.3%.

The figure, the highest on record, was up 0.9% on the previous financial year. One decade ago the bulk-billing rate was 73.2%.

The numbers come amid the long-running Medicare rebate freeze, which will remain in place until 2018.

A new report released on Monday by the National Health Performance Authority (NHPA) also shows that Medicare spends on average less than $300 per patient per year on GP care.

Dr Bastian Seidel, chair of the RACGP’s Tasmanian faculty, said this week that GP services were cheaper for most taxpayers than their ‘car insurance’.

Related News: GPs cheaper than car insurance, Senate told

Covering 2013/14, the NHPA report also found:

  • Across metropolitan and regional communities in the ACT, people saw a GP on average 4.5 times in 2013/14, compared with people living in South Western Sydney, who saw a GP on average 7.6 times
  • People living in Murrumbidgee in rural NSW saw a GP after hours least often, compared with those living in Western Sydney who saw a GP after hours most often.
  • The average amount spent by Medicare on after-hours GP visits ranged from $5 per capita in Murrumbidgee to $49 per capita in the Gold Coast.
  • Across metropolitan and regional communities, the average amount spent by Medicare on GP visits ranged from $203 per capita in the ACT primary health network area to $339 per capita in South Western Sydney

Medical Observer: Seidel defends over-the-counter ICS trial

PATIENT self-management will be an increasingly important element of Australian healthcare in future, whether doctors like it or not, a GP says.

Professor Bastian Seidel (pictured), the RACGP’s representative on the National Asthma Council Australia (NAC), responding to comments from Medical Observer readers on a draft proposal to trial OTC supply of inhaled corticosteroids (ICS), says a more pragmatic approach is needed.

“The status quo is not going to cut it. We have avoidable asthma deaths and we need to find ways to reduce them,” he says.

Appreciating comments and criticisms about some elements of the NAC’s new five-year draft strategy, Professor Seidel nevertheless says that the only way to have evidence-based healthcare is to generate evidence.

The NAC’s draft strategy for 2016–2020 aims to cut the rate of suboptimal asthma control from 45% to 30%.

It outlines several proposed reforms, including a review of incentive payments, and calls for a focus on self-management practices, workforce development, system reform and research.

Controversially, it suggests a trial of OTC low-dose ICS “with a view to large-scale implementation if successful”.

This led to comments on the Medical Observer website that it was a “crazy approach”, with GPs expressing concern about lack of patient review and pharmacists “entering the realm of primary care through the side door”.

Professor Seidel pleads for patience.

“We’re not talking about changing legislation, we’re talking about running a trial.

“Let’s see what the evidence is,” he says.

But, he adds, if a trial concludes OTC ICS is safe, it will be a patient’s right to make informed choices.

“Intranasal corticosteroids are already available OTC, even in supermarkets, and they have a wide use, working incredibly well for things like allergic rhinitis,” he says.

“Patient self-care and self-management is going to be increasingly important in providing adequate healthcare and ensuring adequate access to medicines in Australia, whether we GPs like it or not.”

The draft strategy is open for public comment until 24 August 2015.

Medical Observer: ICS stunt growth, slightly

 

A LARGE meta-analysis shows that inhaled corticosteroids (ICS) stunt growth in children but specialists want parents to be reassured the outcome is “almost imperceptible”.

The study, funded by Asthma UK, found that in the worst case scenario children on ICS were 1.2cm shorter by adulthood than those taking placebo.

There were also “consistent findings” suggesting a dose-response relationship, where lower doses had less of an impact on height than higher doses.

“The results… are a great example of data that may be described as statistically significant, but are in fact clinically completely irrelevant,” says Professor Bastian Seidel, the RACGP representative on the National Asthma Council.

“All parents want to do the right thing by their children but there has been this long-held community perception that long-term use of inhaled corticosteroids may do harm and affect the child’s growth as a side effect,” he says.

“This meta-analysis conclusively demonstrates that if inhaled corticosteroids are used long term in childhood, it may hardly affect adult height.”

The review of 23 studies found children younger than 10 appeared to be affected by ICS more than older children, and that the effects of ICS on height were most pronounced in the first year of treatment.

In the “worst case scenario”, children on 400mcg of budesonide a day continuously for three years ended up being 1.2cm shorter.

But in the real world, this dose would be titrated up and down as needed, notes paediatrician and respiratory physician Professor Craig Mellis, at the University of Sydney.

He agrees that parents can be reassured by the findings. Nevertheless he recommends starting with small doses and being cautious about prescribing the medication in younger patients.

“For a lot of people, wheeze equals inhaled corticosteroids — which is madness,” Professor Mellis says.

The main message is “don’t use it if they don’t need it”, he says.Medications in the analysis included beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone and mometasone, with no one compound being safer than another.

Australian Doctor: LABA overuse may explain childhood asthma deaths

 

An increase in child asthma deaths may be due to inappropriate use of combination inhalers, a leading respiratory specialist says.

Intermittent use of combined inhaled corticosteroids (ICS) and LABAs may reduce short-acting beta agonist efficacy and minimise bronchoprotection from exercise-induced asthma in children, according to aMedical Journal of Australia Perspective by Professor Peter van Asperen.

A review of 20 child asthma deaths in NSW over the past decade highlighted the role of intermittent preventer use and widespread use of LABAs, said Professor van Asperen, of the Children’s Hospital at Westmead, Sydney.

Asthma management guidelines advised against first-line use of ICS-LABAs as preventers for children with asthma, he said.

“[Inappropriate LABA use] might also be responsible for increases in exacerbations and episodes of exercise-induced asthma in children … particularly those who may be genetically predisposed to adverse effects,” he wrote.

Dr Bastian Seidel, a Tasmanian GP and RACGP representative on the National Asthma Council, said the key message from the review was that children with asthma needed education rather than just an inhaler prescription.

“There may be a perception among GPs that they’re doing the right thing by using a combination as step-up therapy. Unfortunately, they are being used intermittently and that’s going to do more harm than good,” he said.

“We as GPs need to be aware of the other step-up options like increasing the dose of steroid inhaler or using montelukast chewable tablets.”

The Examiner: Antidepressants not a ‘quick fix’ for GPs: Mental Health Council of Tasmania

 

Royal Australian College of General Practitioners Tasmanian chairman Bastian Seidel said medications may be prescribed in the absence of affordable services.

“Using medication may be the only alternative and that’s certainly something we’re concerned about,” he said.

Examiner: Experts divided on antidepressant data

 

New data from the ABS shows patterns of antidepressant use in 2011. Dr. Bastian Seidel, chairman of Tasmania’s Royal Australian College of General Practitioners responds.

The Examiner: Paracetamol study to inform general practice on arthritis

 

Doctors have praised a new study which found paracetamol is ineffective on its own in treating osteoarthritis.

Bastian Seidel, chairman of Tasmania’s Royal Australian College of General Practitioners, said the study was useful and would influence clinical decision making by GPs and pain specialists.

936 ABC Hobart: Is Tasmania actually closing the gap?

 

Dr Bastian Seidel, Chair of the Tasmania Faculty of the Royal Australian College of General Practitioners, and Heather Sculthorpe, CEO of the Tasmanian Aboriginal Centre, spoke with Leon Compton on ABC Radio Tasmania Mornings about how well the initiative has worked in Tasmania and some of the continuing problems faced by Indigenous Tasmanians.