March 2019

With the Federal Election on the horizon, the RACGP will be campaigning strongly for significantly increased support of and investment in general practice. Politicians often talk about the importance of general practice; however, there seems to be a lack of the ability to convert rhetoric into meaningful policy. Healthcare costs continue to soar with a failure to realise that general practice is the answer, not the problem. Politicians need to be reminded of the need for long-term reform in the primary care sector, rather than short-term funding cuts to general practice, which can only be described as a fiscal ‘sugar hit’ for the Federal Treasury.

General practice is the heart of Australia’s healthcare system. GPs and their practice teams are responsible for the heavy lifting and positive outcomes seen in our health system. Unfortunately, this great work is overshadowed by news headlines featuring hospital waiting times and ambulance queues.

The challenge is ensuring our political leaders value what we do and part of the solution is, of course, valuing our vital work and ourselves. It is essential that we value our work and never relinquish the important work we do. General practice is under a dual threat. At the top end of practice, GPs have other specialists often seeking to do more and more of the traditional work of GPs. At the lower end of our scope of practice, pharmacists and nurse practitioners feel that they are just as qualified to complete the same work as GPs. In spite of overwhelming evidence both from Australia and overseas, having a regular GP improves patient outcomes.

It is important we continue to work at the full scope of our practice. Dwindling Medicare rebates risk some GPs referring patients earlier and more often in order to see more patients and keep their heads above water. Unfortunately, this approach risks making it easier for some groups to point to the activities of GPs as being able to be taken over by other less qualified health professionals.

General practitioners are constantly being asked to do more in less time for lower rebates. To maintain practice standards, patients who can afford to pay will be increasingly called on to pay for their services. We should not be frightened to do this – it is hard to ask others to value our services if we don’t value ourselves.

Federal Parliament has risen and the election is not yet called, so this next month is a window for us to all contact our Federal Members of Parliament (MP) and explain the issues facing general practice and the importance of advocating for strong primary care in this country. Please make an appointment to see your local MP if you can or, better yet, invite your MP to your practice so they can see what you do and to meet the team.

RACGP Queensland has useful resources that can be used for these visits. For more information, please contact this office by email qld@racgp.org.au or call 07 3456 8944.

Cheers, 

Dr Bruce Willett
RACGP Queensland Chair

Registration is currently open for the above linked events. Bookmark the Queensland events page to keep up to date with education and networking events across Queensland.

Friday and Saturday 3–4 May 2019 – Sofitel Brisbane Central

Why you shouldn’t miss this year’s Clinical Update Weekend:

• Clinical Update’s flexible program allows you to attend a full range of chronic disease and business of general practice topics.
• Collegial networking drinks and canapés are complimentary for all delegates, giving you the opportunity to catch up with friends and colleagues, old and new.
• Enjoy the sites of Brisbane over Queensland’s Labour Day long weekend (now with two conference-free weekend days to enjoy).

Places are now limited in a number of workshops and active learning module sessions. 

​Register now to secure your preferred sessions.

This article pick was submitted by Assoc Prof Jane Smith from Bond University.

Our recent journal club on ankle sprains was initiated by a question from a registrar asking about the benefit of using double tubigrip to treat ankle sprains.

So, we looked for the evidence regarding the benefits from tubigrip compression to find that quite the opposite was likely. Although most (75%) ankles sprains are treated with tubigrip, the evidence suggests this is associated with more need for analgesia compared to no treatment, and slower recovery compared to below knee elastic compression stockings.¹

A small, randomised controlled trial compared tubigrip with below knee elastic compression stockings (20–30 mmHg). The trial showed the tubigrip to be more effective, thus resulting in less swelling, less need for analgesia, faster recovery and return to work. A larger trial comparing compression stocking to placebo non-compressive tubing, did not find so many differences, but did show a faster return to sport.^2,3

So, what else can we do to help our patients with these painful types of injuries? Afterall, not everyone likes to swallow tablets. An overview of Cochrane Reviews came up with some encouraging results. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for acute musculoskeletal strains and sprains, with diclofenac emulgel being the most effective formula with the number needed to treat (NNT) or 1.8.

However, other forms of diclofenac, ibuprofen, ketoprofen, and piroxicam also work topically, with NNT of 1.8 to 4.7. For chronic musculoskeletal pain, topical NSAID worked, but with higher NNT, between 5- 10.⁴

For any of you with an interest in alternative and integrative medicine, there has been a trial comparing topical comfrey to topical diclofenac for ankle sprain showing non-inferiority, meaning both were found to be as effective as each other⁵.

References

1. Hansrani V, Khanbhai M, Bhandari S, Pillai A, McCollum CN. The role of compression in the management of soft tissue ankle injuries: A systematic review. Eur J Orthop Surg Traumatol. 2015;25(6):987–95.
2. Sultan MJ, McKeown A, McLaughlin I, Kurdy N, McCollum CN. Elastic stockings or Tubigrip for ankle sprain: a randomised clinical trial. Injury. 2012;43(7):1079–83.
3. Bendahou M, Khiami F, Saidi K, Blanchard C, Scepi M, Riou B, et al. Compression stockings in ankle sprain: A multicenter randomized study. Am J Emerg Med. 2014;32(9):1005–10.
4. Derry S, Wiffen PJ, Kalso EA, Bell RF, Aldington D, Phillips T, et al. Topical analgesics for acute and chronic pain in adults – An overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;5:CD008609.
5. Predel HG, Giannetti B, Koll R, Bulitta M, Staiger C. Efficacy of a comfrey root extract ointment in comparison to a diclofenac gel in the treatment of ankle distortions: Results of an observer–blind, randomized, multicenter study. Phytomedicine. 2005;12(10):707–14.

If you are interested in becoming an examiner and practice on the Gold Coast or in Beaudesert, the RACGP Queensland Examinations team would like to hear from you. Training will be available for successful applicants in September 2019 (exact dates to be advised).

Contributing to the RACGP examinations is a valuable accomplishment and allows examiners to earn QI&CPD points.

For more information, email qld.exam@racgp.org.au or call 07 3456 8944. Alternatively, download and submit the application form.

Developed and delivered by members of the RACGP Expert Committee – Practice Technology and Management (REC—PTM) and eHealth experts, the RACGP eHealth webinar series will present monthly webinars throughout 2019 on eHealth topics pertinent to general practice.

All webinars are accredited for two Category 2 QI&CPD points for the 2017–19 triennium and are free of charge for all participants.

Webinar recordings are made available via the RACGP website at the conclusion of each month’s sessions.

Are you thinking about a career in general practice or know someone who is?

Expressions of interest are now open for the 2020 intake of the Australian General Practice Training (AGPT) Program with the RACGP.

AGPT with the RACGP is a three to four-year, full-time training program offered in metropolitan, rural, remote or very remote locations around Australia. It comprises hospital training, general practice placements and extended skills training.

During the 2020 intake, RACGP applicants will be given the opportunity to express interest in Rural Generalist Training; this program combines the Fellowship in Advanced Rural General Practice (FARGP) with the Fellowship of the RACGP (FRACGP).

Applications open at 10.00 am AEDT, Monday 25 March and will close at 10.00 am AEST, Monday 28 April.

Express your interest to stay up to date with the latest information and resources on AGPT.

This year, RACGP Foundation is proud to offer 16 research grants and awards to GPs and registrars. Up to half a million dollars is available in general practice research funding. You could play a vital role in shaping the health of Australia.

RACGP Foundation is where general practice research begins.

Online applications are now open and will close on Monday 6 May 2019.

Every day, you and your practice team seek methods to improve the quality of healthcare you provide to your patients.

If you can capture that improvement by describing, documenting and evaluating your practises, then you can use your experience to complete the quality improvement (QI) requirement for the QI&CPD 2017–19 triennium.

The following activity options capture QI:

• Small group learning (SGL)
• Clinical audit
• General practice research
• Evidence-based medicine journal club (EBMJC)
• Supervised clinical attachment (SCA)
• Plan, do, study, act (PDSA)
• Planning learning and need (PLAN)
• QI reflection form

The RACGP can support you with meeting your QI&CPD requirements. If you require assistance, please contact us.

Join in the exciting new program changes for GP19 supporting 'Your patients. Your community. Your solutions'.  Session submissions are now open and this is your chance to be a part of something innovative.

With the introduction of new and dynamic delivery styles, such as wisdom in small episode or 'WISE', PechaKucha and speed-dating style presentations, there will be an exciting range of hands-on, interactive and highly engaging program sessions.

Session submissions close at 12.00‌ am AEST, Tuesday 30 April 2019. To learn how you can be a part of GP19, visit the GP19 website.

Insight is a Queensland Health initiative that provides free alcohol and drug training and workforce development services.

Insight has recently published a series of five A3 colour Ultra brief intervention tools that can be used by GPs and other health professionals to structure a 15-minute health intervention with someone who identifies as using alcohol, cannabis, opioids, benzodiazepines, and/or methamphetamines, which the patient can then take home as a brochure.

All tools are free to download and use, and include the national 24/7 alcohol and drug hotline number 1800 250 015, which patients can use anywhere in Australia.

Download the Ultra brief intervention tools.

Ten years ago, three corporate executives in Sydney established The Pinnacle Foundation, a donor-funded charity that supports young LGBTIQ+ students who have experienced discrimination and disadvantage.

The volunteers in The Pinnacle Foundation have been able to move from a start-up with two scholars in 2010 to recently supporting 38 scholars in 2018.

In 2019, we will be providing scholarships for 31 full-time students from across the country. 

Queensland has been very successful in delivering high-achieving scholars. Each Pinnacle scholar receives ongoing funding of about $5000 per year for education purposes for the duration of their degree and a mentor to help them become the person they want to be.

The mentors come from the professions that scholars seek to join. Mentors are located close to the scholar and share the same sexual identification as the scholar with the caveat that transgender professionals are often the most difficult to match with young transgender scholars, and we sometimes don’t achieve an exact match.

In recent years, the Foundation has had increasing numbers of lesbian, gay and transgender scholars studying medicine and other health sciences who are requesting to work in rural areas. Their ambition to transform cultural attitudes across the country is commendable, but it has taxed the mentor database assembled over the past 10 years and the Foundation has turned to organisations, such as the RACGP in Queensland for help, with outstanding success. 

Thank you to all RACGP members for the kindness you have shown our scholars, especially to the people who put their hands up to be mentors.

Women are choosing to delay childbearing until more advanced maternal ages. As fertility rates decline with age, the prevention of infertility is becoming more important. GPs are often the first healthcare professional that patients approach in relation to their fertility.

Melbourne University Medical School is looking for GPs to participate in a 10-minute online survey (Ethics ID #1853398). This research aims to illuminate this gap by elucidating perceptions, practices and the current level of understanding that GPs have of oocyte cryopreservation (egg freezing) and to determine if and what further resources are required for GPs. We appreciate your feedback.

Participate in the survey.