Resourcing general practice research
A core function of the Royal Australian College of General Practitioners (RACGP) as an academic body is research, with the goal of improving health outcomes for our patients and communities.
The critical importance of general practice-related funding for research was thrown into the spotlight again this week after the University of Sydney announced its Bettering the Evaluation and Care of Health (BEACH) program would close due a lack of ongoing funding.
The loss of funding to the Primary Health Care Research Information Service (PHCRIS) and closure of the Australian Primary Healthcare Research Institute (APHCRI) further endorses the totally incorrect assumption that all healthcare is provided within the specialist or hospital paradigm.
Fortuitously, BEACH has had a reprieve, as the University of Sydney has since said it is exploring options to ensure the continuity of the program over the next 12 months. However, details of any future funding sources are yet to be confirmed.
I have written to the Health Minister Sussan Ley expressing the RACGP’s serious concerns over the ongoing decline in support and funding for research in primary healthcare and requested an urgent re-appraisal of priorities in healthcare analysis.
General practice and primary healthcare research funded through the National Health and Medical Research Council (NHMRC) is consistently low, at only 2-3% of the total NHMRC research pool. A structural and cultural shift and strong leadership is required to urgently address this issue.
It is incongruous that GPs see 85% of the Australian population annually but only receive 2–3% of health related research funding.
This incongruity is also out of step with general practice funding in comparable OECD countries, such as the UK and the Netherlands, where capacity and funding per capita for general practice research is much higher.
Tertiary level research does not necessarily translate to contextual patient presentations in general practice. Without the mechanisms to collate, report and evaluate general practice activity, crucial health data that could inform innovation and progression in general practice will be lost.
If new methods of data collection and research are planned, as reported in the media this week, the RACGP will endeavour to work with Minister Ley and the Department of Health to design a system that will contribute to cost-effective, high quality data collection and research programs.
Dr Frank R Jones
RACGP President
New General Practice Experience pathway
The RACGP will pilot a new General Practice Experience (GPE) pathway from Monday 30 May, 2016.
The 12-month education program will replace the former Practice Eligible (PE) pathway and has been developed in response to a comprehensive review by the RACGP. The old PE pathway will continue to be available until 29 May 2018.
The new GPE pathway is designed to allow candidates to demonstrate their skills and knowledge based on an individual learning needs assessment. It will ensure international medical graduates receive the best possible support as they work towards RACGP Fellowship.
The key components of the new GPE pathway include:
- learning needs assessment to determine individual participants’ learning gaps
- access to RACGP gplearning activities
- three hours of targeted medical educator support for each candidate
- structured exam preparation.
Applications for the GPE pathway open on Monday 18 April and close on Friday 13 May.
Successful candidates will start the program on Monday 30 May. More detailed information, including the application form and FAQ document, is available on the RACGP website.
RACGP resources for the Practice Incentives Program (PIP) Digital Health Incentive
The Practice Incentives Program (PIP) Digital Health Incentive (formerly the PIP eHealth Incentive Payment or ePIP) eligibility criteria has been revised and will come into effect from May 2016.
In addition to the existing criteria, general practices are now required to upload a specified number of shared health summaries to the My Health Record (formerly the Personally Controlled Electronic Health Record [PCEHR]).
The RACGP has identified significant new risks and responsibilities for practices and practice staff due to the required practitioner participation in My Health Record to receive the PIP Digital Health Incentive.
General and individual practitioners need to carefully consider these risks and responsibilities before participating in the PIP Digital Health Incentive.
The RACGP has developed information and useful templates around the requirements to support and guide general practices who wish to apply for the PIP Digital Health Incentive and therefore participate in the My Health Record. These new resources can be accessed on the RACGP website.
Iron on the Pharmaceutical Benefits Schedule for Aboriginal and Torres Strait Islander patients
Changes to the Pharmaceutical Benefits Schedule (PBS) and a manufacturer decision have resulted in fewer iron preparations being available on the PBS, including for Aboriginal and Torres Strait Islander patients.
The only option for oral iron on the PBS now is:
- ferrous sulfate 30 mg/mL (equivalent to 6 mg/mL elemental iron) oral liquid, 250 mL (Ferro-Liquid)
There are also injectable forms available on the PBS as follows:
- iron (as ferric carboxymaltose) 500 mg/10 mL injection, 1 x 10 mL vial (Ferrinject)
- iron (as polymaltose) 100 mg/2 mL injection, 5 x 2 mL ampoules (Ferrosig; Ferrum H)
- iron (as sucrose) 100 mg/5 mL injection, 5 x 5 mL ampoules (Venofer)
This change has arisen as a consequence of the delisting of over-the-counter medications from the PBS and a subsequent decision by one manufacturer to remove its iron formulation from the PBS entirely making it no longer available for Aboriginal and Torres Strait Islander people.
The RACGP has made representation to the Health Minister that the effect of these decisions is to make iron tablets of any kind unavailable on the PBS for Aboriginal and Torres Strait Islander people, and the potential health consequences of this.
Prescribing and PBS information is available on the PBS website.
RACGP Clinical Pearl
Choosing Wisely part 2
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 chest x-rays in patients with uncomplicated acute bronchitis
Acute bronchitis is the most common cause of cough presenting to GPs. It is usually viral (>90%) and self-limiting, and antibiotics should not routinely be used.
Chest x-rays (CXRs) are the imaging tests most frequently ordered by Australian GPs and the most common indication is acute bronchitis.
‘Uncomplicated’ bronchitis refers to cough and sputum lasting less than three weeks in immunocompetent patients without underlying respiratory disease and no clinical features suggesting pneumonia (heart rate >100, resp rate >24, temp >38.0C, haemoptysis, signs of consolidation). Note that purulent (green) sputum is not predictive of bacterial infection and is not in itself an indication for CXR.
CXRs may also lead to false positives, further investigation and unnecessary radiation. The threshold for CXR should be lower in patients over 60.
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.