In Practice newsletter
8 April 2016
Top clinical resources for GPs
The good GP knows how to access a multitude of clinical and organisational tools.
Arming ourselves with the right information and guidance is fundamental to the role we play in providing our patients with the best possible evidence-based medical advice, diagnosis and care.
The Royal Australian College of General Practitioners (RACGP) has always been committed to developing and endorsing high-calibre clinical resources for GPs and supporting quality improvement in general practice.
The RACGP has an enormous wealth of resources to assist members at all stages of their general practice career. Some of these will be very familiar, such as the Standards for general practices and the Guidelines for preventive activities in general practice (Red Book). Others may not be utilised as often or as well known, but are equally valuable and worth scrutinising.
The RACGP has recently reviewed its resource webpage views and downloads. Here are some highlights, researched and written by front line general practitioners just like you and me.
The top ten downloaded RACGP resources from March 2015 – March 2016 are:
1. Guidelines for preventive activities in general practice (Red Book)
2. General practice management of type 2 diabetes (diabetes handbook)
3. Medical care of older persons in residential aged care facilities (Silver Book)
4. Preventive activities over the lifecycle – adults
5. Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men
6. Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting (Green Book)
7. Smoking, nutrition, alcohol, physical activity (SNAP)
8. Detection, prevention and treatment of osteoporosis
9. Should I have prostate cancer screening?
10. Guideline for the non-surgical management of hip and knee osteoarthritis
Annually, the RACGP also produces the MBS Fee summary targeted at general practice item numbers, which is extraordinarily useful in day-to-day practice and as a focused educational tool. A hard copy will be delivered to members with this month’s copy of Australian Family Physician (AFP).
Of particular note, the most viewed RACGP webpages for the past year are the diabetes handbook – case finding and diagnosis, followed by the smoking cessation guidelines, and the Red Book chapters on early detection of cervical cancer, breast cancer, vascular disease and bowel cancer.
In total, RACGP guidelines and resources received 1.2 million page views and more than 115,000 downloads in the year to 31 March 2016.
I encourage all members to familiarise themselves with the RACGP’s breadth of clinical guidelines and policies as we all need this type of information on a daily basis to ensure our patients receive the best quality healthcare and health outcomes.
Dr Frank R Jones
RACGP President
New Advanced Rural Skills Training – Curriculum for Palliative Care
The RACGP has released a new rural palliative care curriculum to provide GPs and registrars with the skills, knowledge and confidence to provide quality palliative care in their rural and remote communities.
The Advanced Rural Skills Training (ARST) – Curriculum for Palliative Care will be offered as part of the RACGP Fellowship in Advanced Rural General Practice (FARGP).
This curriculum release is part of a broader priority rural skills project, informed by RACGP Rural research undertaken in 2014. This research revealed the top five priority areas for RACGP Rural members are emergency medicine, palliative care, paediatrics, mental health and aged care. RACGP Rural has taken action to begin addressing these priority areas through training, rural curriculum renewal and accessible training modules for GPs.
The RACGP has also released a position statement on GP-led palliative care in rural Australia, advocating for stronger policy action to increase access to rural palliative care services for patients and support to facilitate more GP-led care by addressing the training barriers which persist for rural GPs.
Application call for registrar representative on Board of Assessment
The position of registrar representative on the Board of Assessment (BoA) offers the opportunity for a newly admitted Fellow of the RACGP to take part in a different aspect of RACGP life. The ideal applicant will hold a keen interest in the education, training and assessment of GPs and feel strongly about speaking on behalf of registrars. Applications close Friday 29 April.
The position advertisement, BoA terms of reference, dates for the remaining meetings in 2016 and details of how to apply are available on the RACGP website.
RACGP 2016.1 Key Feature Problem exam results released
The RACGP is pleased to announce the 2016.1 Key Feature Problem (KFP) results have been released. Candidates can access their results by logging into the RACGP website.
Please contact the RACGP on 1800 626 901 or email racgpeducation@racgp.org.au if you have any enquiries.
RACGP Clinical Pearl – Choosing Wisely part 1
The RACGP is proud to be a partner of Choosing Wisely Australia. Over the next few weeks, In Practice will highlight recommendations of tests, treatments and procedures that should be questioned by GPs and their patients.
Don’t order colonoscopy as a screening test for bowel cancer in people at average or slightly above average risk. Use faecal occult blood testing instead.
RACGP guidelines recommend two-yearly faecal occult blood testing (FOBT) for the asymptomatic ‘average’ or ‘slightly above average’ risk population from 50-75 years of age (98% of Australians). However, data to 2011 suggests 13% of this group were instead over-screened using colonoscopy.
National Bowel Cancer Screening Program (NBCSP) data shows that, per 10,000 people in this group followed up for an average 18 months, 6 will die from bowel cancer if unscreened. If screened with colonoscopy, 2.3 will die, compared to 1.9 deaths for FOBT. A colonoscopy risks bowel perforation, involves bowel preparation and costs around $3000. NBCSP monitoring shows the negative predictive value of FOBT is 99.9%.
Visit Choosing Wisely Australia for more information, including exceptions and supporting evidence.
In Practice poll – Practice Incentive Payment: Diabetes incentive
The Practice Incentive Payment (PIP) - Diabetes Incentive aims to encourage GPs to provide earlier diagnosis and effective management of people with established diabetes mellitus.
To receive the Diabetes PIP outcome payment (one component of the PIP –Diabetes Incentive), at least 2% of practice patients must be diagnosed with diabetes mellitus and a diabetes cycle of care must be completed for at least 50% of these patients.
The number of patients in a practice with a diabetes mellitus diagnosis is based on the number of patients who have had an HbA1c test for the management of diabetes in the previous two years.
To correctly bill HbA1c tests for the purposes of the Diabetes PIP, pathology providers are supposed to use the MBS item 66841 for the diagnosis of diabetes, while the MBS item numbers 66551 or 66554 (if the patient is pregnant) should be used for diabetes management. The referring GP should indicate on the pathology request form whether the HbA1c test is for diabetes diagnosis or management.
RACGP members have raised concern that some pathology providers are not using the correct item numbers when billing HbA1c tests. For example, a pathology provider might use one MBS item number for all HbA1c tests while another provider might use various item numbers seemingly without regard to the intention of the test.
We invite you to participate in the current poll to help the RACGP better understand the extent to which our members are being affected by inconsistent pathology billing for diabetes HbA1c tests.