Close the Gap 10th anniversary
Most Australians enjoy access to a world class healthcare system that translates to one of the highest life expectancies of any country in the world.
This is not true for every Australian.
Aboriginal and Torres Strait Islander people continue to experience higher rates of preventable illness such as heart disease, kidney disease and diabetes and can expect to live 10-17 years less than non-Indigenous Australians.
On 17 March, Australia marks the 10th anniversary of Close the Gap which aims to raise the health and life expectancy of Aboriginal and Torres Strait Islander peoples to that of the non-Indigenous population within a generation: to close the gap by 2030.
The Royal Australian College of General Practitioners (RACGP) is a proud member of the Close the Gap Steering Committee and is strongly committed to supporting the campaign’s goal to achieve health equality for all Australians within a generation.
GPs play a vital role in efforts to close the gap by addressing the barriers that Aboriginal and Torres Strait Islander patients face in accessing quality healthcare. Individual Indigenous communities have different needs and direct local consultation is needed.
On Wednesday 10 February an RACGP delegation including RACGP Aboriginal and Torres Strait Islander Health Chair Associate Professor Brad Murphy, attended a parliamentary breakfast, where the Close the Gap – Progress & Priorities Report 2016 was tabled.
The report, tabled by Prime Minister Malcolm Turnbull, indicated there are still significant challenges to meeting the target of closing the life expectancy gap by 2030.
A/Prof Murphy said the event had ‘a real air of not focusing on the negatives, but instead celebrating the achievements so far, whilst acknowledging there is a long way to go’. This will only be achieved if the great words and promises of Australia’s leaders and bipartisan support is met by the appropriate funding from the Federal Government.
The RACGP acknowledges the daily work of its members to improve health outcomes for their Aboriginal and Torres Strait Islander patients.
With approximately 15 years remaining to close the gap, I encourage all GPs to sign the Close the Gap pledge and join the 200,000-plus Australians who have already committed to ending the health equality gap by 2030.
There has been positive progress in some Close the Gap objectives since its launch in 2006, including a reduction in child mortality, however there is still considerable progress to be made.
Coordinated support from the general practice profession will help to ensure the Australian government continues to work with Indigenous communities and invest in partnerships that will see all Australians experience access to quality healthcare.
On 17 March, RACGP offices nation-wide will acknowledge the 10th anniversary of Close the Gap with various events and activities, RACGP members are also encouraged to mark the occasion in their practices.
Dr Frank R Jones
RACGP President
RACGP calls for release of children and their families from immigration detention
In light of the recent High Court decision paving the way for the return to Nauru of 267 people, including 54 children and 37 babies, the RACGP has repeated its call to remove all children and their families from immigration detention.
RACGP President Dr Frank R Jones said there was overwhelming information on the public record that immigration detention was detrimental to the cognitive development and mental health of young children.
‘The RACGP reaffirms its view that asylum seekers should be accommodated in the Australian community, where families are kept together and given access to independent medical services,’ Dr Jones said.
Zika virus update
During January 2016 outbreaks of the mosquito-borne Zika virus have been reported in several countries including Brazil, where the virus is currently active. Zika is a mosquito-borne virus, closely related to Dengue. It is of particular concern for pregnant women as there is a possible association with microcephaly (small/underdeveloped brain) in unborn babies.
Only one person in five who becomes infected is likely to have any symptoms, and if they do, the disease is generally not severe and lasts only a few days. Symptoms are flu-like and typically include fever, pain in joints, muscle pain, headache behind the eyes, conjunctivitis, a skin rash and weakness of lack of energy.
Brazilian scientists have reported the detection of Zika virus in saliva and urine. At the height of an infection, virus can often be detected in other bodily fluids but this does not mean it will reach the bloodstream of another person and cause infection. The risk of infection from different modes of transmission is still unclear. Bites from infected mosquitoes are the most important route by far.
As of Thursday 11 February, there have been six confirmed cases of Zika virus in Australia this year – three in Queensland, one in Western Australia and two in New South Wales. All cases have been from Australians recently returned from travel in South and Central America. More information, including travel advice for patients can be found on the Department of Health website.
No Jab, No Pay - medical exemption form
The No Jab, No Pay policy commenced on 1 January 2016. For parents to continue to receive family assistance payments (Child Care benefit, Child Care Rebate and Family Tax Benefit Part A Supplement), children and young people up to the age of 20 years must be fully immunised, on a catch-up schedule, or have an approved medical exemption.
Conscientious objection (vaccination objection on non-medical grounds) is no longer a valid exemption from the immunisation requirements.
From 1 January 2016, new notifications of medical contraindication and natural immunity must be provided on the approved ACIR Immunisation Medical Exemption form. The new medical exemption form for general practitioners to complete is available on the Department of Human Services website.
The new medical exemption form includes guidance for general practitioners on what is, and is not, considered a valid reason for a medical exemption. More detailed information on contraindications to vaccination, including false contraindications, is provided in The Australian Immunisation Handbook (10th edition).
Further information for general practitioners on the policy, vaccination catch-up arrangements, how to plan catch-up vaccinations, changes to the Australian Childhood Immunisation Register and reporting obligations is available on the Immunise Australia Program website.
Dermatological surgery – national workshop
Enrolments are now open for the dermatological surgery workshop, to be held 28-29 May 2016 in Melbourne.
The workshop is hosted by the Australasian College of Dermatologists (ACD) in collaboration with the RACGP and ACRRM.
This workshop forms part of the Certificate of Primary Care Dermatology comprehensive training course and is available to GPs, GP registrars and ACD training program registrars seeking to improve and expand their dermatological surgery techniques.
Topics covered include cryotherapy, excisions, intralesional steroid injections and flap repairs.
For more information and to register visit the RACGP website.
National Bowel Cancer Screening Program
To reduce deaths from bowel cancer, faecal occult blood testing (FOBT) is recommended at least every two years for people over the age of 50.
In line with this, the National Bowel Cancer Screening Program (NBCSP) is expanding in stages so that by 2020, all eligible Australians aged 50-74 years will be invited by the NBCSP to screen every two years.
Despite a strong evidence base for regular bowel cancer screening, current participation in the NBCSP is relatively low at only 36%. Modelling predicts that the NBCSP could prevent more than 70,000 deaths over the next 40 years at the current participation rate and if participation rose to 60%, it is predicted that an additional 20,000 deaths could be prevented over that period.
Evidence shows a recommendation from a GP to screen for bowel cancer is an important motivator for participation.
The RACGP is working with the NBCSP to help promote screening and advocating for ways to ensure GPs are more central to the screening program.
GPs should be aware that outside of the NBCSP, patients can still obtain an FOBT on Medicare through their GP.
Visit the National Bowel Cancer Screening Program website for more information and the RACGP’s Guidelines for preventive activities in general practice (Red book) for guidance on cancer screening.
RACGP Clinical Pearl
Recognising the signs of DKA in type 2 diabetes patients
Diabetic ketoacidosis (DKA), can occur in both previously undiagnosed and existing patients with type 2 diabetes (not just type 1 diabetes), usually as a consequence of metabolic burden such as surgery, trauma or infections.
Common precipitating factors include UTI, myocardial infarction and pneumonia. Delay in diagnosis may lead to unpredictable and sometimes fatal outcomes. Symptoms and signs of DKA include severe lethargy, nausea or vomiting, dehydration, hyperventilation and ketotic breath.
Clinical assessment of patients should occur without delay by use of point of care glucose testing and ketone testing (positive or elevated) using a suitable monitoring device. Further confirmatory blood pathology tests may support, but not delay office testing. Urgent specialist referral and advice is recommended for any detected DKA.
For more information on the signs of DKA and assessment of patients for risk factors and appropriate follow up, visit Section 11. Glycaemic emergencies General Practice management of type 2 diabetes (2014-15). The TGA also have information.
In Practice poll
ePIP eligibility criteria
The ePIP eligibility criteria has been revised. In addition to the existing criteria, from 1 May 2016, a general practice will be required to upload shared health summaries (SHS) to the My Health Record system (formerly the Personally Controlled Electronic Health Record (PCEHR)) for 0.5% of the practice’s standardised whole patient equivalent (SWPE) to be eligible to receive ongoing ePIP payments.
The revised ePIP requirement equates to about five shared health summaries per full-time equivalent GP per quarter (i.e. for a practice with five full-time equivalent GPs, it would equate to 25 uploads per quarter). A practice can receive a maximum payment of $12,500 per quarter.
The RACGP does not support this change. Instead of SHS upload targets, the RACGP advocated for incentives that support data accuracy and quality, and the appropriate and timely sharing of data across the healthcare sector.
To inform the RACGP’s work in the area, you are invited to participate in a poll to let us know if your practice will upload shared health summaries to maintain ePIP eligibility.