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RACGP Queensland newsletter

20 September 2018

Chair report

Message from Dr Bruce Willett, RACGP Queensland Chair

Quality Improvement Practice Incentives Program (QIPIP) payments

Many RACGP members are not aware that the Federal Government is seeking to scrap the current Practice Incentives Program (PIP) and Service Incentive Payments (SIP) scheme. The proposed changes will see most PIP payments and the SIP removed or dramatically changed, and a plan to introduce a ‘Quality Improvement’ PIP (QIPIP) payment. This is an important issue as the changes have the ability to threaten the viability of private practice.

 

While, philosophically, the idea of pay for performance is appealing, those of us who work in private practice understand the reality of these sorts of payments – they will disadvantage those who are already receiving payments for improvement, as well as those who are working in areas of social disadvantage and receiving payments for absolute values. Similar changes to primary health care incentives overseas has demonstrated that performance-based payments lead to games and undue focus on the narrow parameters being measured. An additional concern is the mandatory requirement to pass practice data onto the local primary health network (PHN).

 

Despite the RACGP taking a strong stance against QIPIP, the Commonwealth Government seems intent on rolling out this program. The RACGP will continue to advocate for a more useful basis for measuring these payments.

 

PHN contracts

Several members have expressed concern over clauses in PHN contracts that require practice data to be supplied to PHNs. I would like to take this opportunity to remind all members to please read your contracts thoroughly and consider independent legal advice before signing.

 

Queensland parliamentary inquiry into pharmacy practice

On 3 September, I gave evidence to the Queensland parliamentary inquiry into pharmacy ownership and the extended scope of practice. The Pharmacy Guild requested the inquiry to consider the establishment of a pharmacy board that would oversee pharmacy ownership and extend the scope of practice, particularly with the aim to enable pharmacists to prescribe Schedule 4 drugs.

 

On behalf of Queensland GPs, the RACGP strongly opposed the Pharmacy Guild’s plan to permit pharmacists to prescribe in Queensland. The inquiry committee is due to release their report at the end of September. In the meantime, it is imperative that Queensland GPs contact their local state Members of Parliament and make them aware of the safety issues for our patients and their voters. 

 

RACGP Queensland has developed resources with facts that you can use when contacting your local politician. For a copy of these resources, please email the RACGP Queensland team.

 

Cheers, 

Dr Bruce Willett
RACGP Queensland Chair

RACGP Queensland news and events

Calendar of events

Rural hospital clinical simulation

Wednesday 10 October

Gold Coast

National Fellowship and Awards Ceremony

Wednesday 10 October

Gold Coast

Educator workshop: Difficult conversations

Thursday 11 October

Gold Coast

Educator workshop: Critical incidents in the practice

Thursday 11 October Gold Coast

Educator workshop: When things go wrong with your registrar

Thursday 11 October Gold Coast

Educator workshop: Help! I’m in trouble with the Medical Board

Thursday 11 October Gold Coast

GP18

Thursday to Saturday 11–13 October

Gold Coast

CPR workshop

Tuesday 23 October

Brisbane

CPR workshop

Tuesday 4 December

Brisbane

Bookmark the Queensland Events page to keep up to date with education and networking events across Queensland.

A message from Dr Lucy Ingram, RACGP Queensland New Fellows Committee Chair

Hello Queensland New Fellows,

 

Thank you to the participants and supporters of the New Fellows team who completed the Bridge to Brisbane Fun Run on 26 August. We got thoroughly drenched during the 5 km walk, but were able to warm up afterwards with a group lunch. Altogether, the New Fellows Committee raised $600 for the Doctors’ Health Advisory Service, Queensland (DHAS[Q]).

 

If you wish to make a donation to support doctors' health, contact DHAS(Q).

If you or someone you know needs help, call the 24/7 helpline on 07 3833 4352.  For more information, visit the DHAS(Q) website.  

 

Next stop: GP18! The Queensland New Fellows Committee will be hosting a session on GP wellbeing on Thursday 11 October at the national conference on the Gold Coast. I hope to see many of you there!

 

The New Fellows-hosted 'Paediatrics update for GPs' active learning module (ALM) in Cairns on Saturday 17 November is now fully booked. Please email the Queensland events team if you wish to be placed on the waitlist.

 

We have a fantastic day of medical education planned, including sessions on paediatric ophthalmology, dermatology, abnormal pubertal presentations, sleep disorders and developmental disorders.

Thanks to the generous Dr Bruce Roberts Bequest, this ALM will deliver valuable education to GPs in North Queensland.

A thank you message from DHAS(Q)

I am writing to formally thank the RACGP Queensland New Fellows Committee for the kind and thoughtful donation to the DHAS(Q) following their recent participation in the Bridge to Brisbane Fun Run.

 

This was a positive focus on wellness through participation in a fun run for health, while also supporting the wellness of other doctors in your support of the DHAS(Q).

 

We are truly grateful for your generosity.

 

Yours faithfully,

 

Dr Anne Ulcoq
DHAS(Q) President

Examination dates for 2018–19

2018.2 OSCE pre-exam workshop (Cairns) Saturday 6 October 2018
2018.2 OSCE Sunday 11 November 2018
2019.1 AKT/KFP pre-exam workshop (Brisbane) Saturday 1 December 2018
2019.1 AKT/KFP pre-exam workshop (Brisbane) Sunday 2 December 2018
2019.1 KFP Friday 1 February 2019
2019.1 AKT Saturday 2 February 2019
2019.1 OSCE pre-exam workshop (Brisbane) Saturday 6 April 2019
   

If you are interested in becoming an examiner, the RACGP Queensland Examination team is interested in hearing from you now. Contributing to the RACGP examinations is a valuable accomplishment and offers the opportunity to earn Quality Improvement and Continuting Professional Development (QI&CPD) points.

 

New examiner applicants for the 2019.1 OSCE will need to complete training on Saturday 6 April 2019.

 

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

National news and events

Advanced CEMP workshop – Gold Coast

Sunday and Monday 14–15 October 2018

Places are still available for the Advanced CEMP workshop being held in conjunction with GP18. This workshop is designed to teach you the skillset required to stabilise patients in the first 30 minutes of an emergency.

CEMP workshops are eligible for the Rural Procedural Grants Program.

For more information, visit the RACGP QLD Events webpage, email gpeducation@racgp.org.au or call the RACGP National Events team on 03 8699 0557.

Rural hospital clinical simulation ALM

Wednesday 10 October 2018

RACGP Rural is pleased to offer the 'Rural hospital clinical simulation' ALM as part of the RACGP annual conference, GP18. Participants will have the opportunity to take part in seven simulated scenarios with a strong emphasis on emergency medicine skills, doctor self-care, coordinating and communicating with other healthcare professionals, stress management and debriefing skills.

The ALM will take place at the Faculty of Health Sciences and Medicine at Bond University in Robina. A charter bus will be available between the Gold Coast Convention and Exhibition Centre (GCCEC) and Bond University.

This ALM is accredited for 40 Category 1 QI&CPD points. It is also eligible for a one-day Rural Procedural Grant for those eligible in either of the emergency medicine, anaesthesia or obstetrics components.

View more information or register for this event.  

Article pick*

Water cooling treatment for burns

I get the impression that I see less patients presenting with burns than I used to 30 years ago despite at least 200,000 people requiring burn treatment each year in Australia, including the 10% that need hospitalisation.

For this reason, an article regarding the use of water as first aid, by Fiona Woods (renowned in advancing the treatment of burns), is to be taken seriously.

 

The paper is worth reading in full, but I will summarise the most important take-home messages from the article:

 

  • Water cooling for 20 minutes within three hours of any type of burn provides the most benefit and was shown to reduce:
    • the risk of admission to the intensive care unit by 48%
    • the number of days in hospital by 18%
    • the need of a skin graft by 13%
    • cooling for less time was not as beneficial; cooling for longer than 40 minutes appeared to cause harm.
  • Water temperature guidelines:
    • The water temperature should be running tap water between 8–15ºC
    • The ideal water temperature is 15ºC
    • The water temperature range must be within 8–25ºC.

 

Note: We tested the temperature of a cold water tap on a warm day to find it not within the ideal range (26ºC); this is likely to be common in most parts of Queensland during the warmer months.

 

Current practice

While most burn patients receive water cooling first aid, less than half of them receive the ideal water cooling duration as defined above and within the guidelines. Water cooling is used in a more haphazard way than recommended.

 

Implementation of better practice

Changing practice to water cooling for a duration of 20 minutes would lead to better outcomes according to evidence. Ensuring the ideal water temperature may also bring added benefits.

 

References

  1. Wood F, et al Water first aid is beneficial in humans post-burn: Evidence from a bi-national cohort study. Wood F, et. al. PLoS One. 2016 Jan 25;11(1):e0147259 
  2. Fein M, et al Pre-hospital paediatric burn care: New priorities in paramedic reporting. Emerg Med Australas 2014 Dec;26(6):609–15. 
  3. New Zealand Guidelines Group. Management of burns and scalds in primary care: Evidence-based best practice guideline summary. June 2007. 
  4. NSW Agency for Clinical Innovation. Clinical practice guidelines: Burn patient management. August 2011.

 

This article was submitted by Assoc Prof Jane Smith, Head of General Practice and Year 5, Bond University.    

Research corner

The RACGP Queensland Research Support Committee coordinates the ‘Article pick’ segment. We are looking for contributors for 2018. Please submit your article pick or send any queries about contributing to Queensland Research Support

*Please note, the opinions expressed by 'Article pick' authors may not reflect the opinions of the RACGP.

External news and events*

NDIS and psychosocial disability – GP resources available from Aftercare

Aftercare has developed resources to assist GPs and allied health professionals (AHPs) in helping patients who have a mental illness to apply for the National Disability Insurance Scheme (NDIS). We have been a mental health service provider for 110 years and have supported people with NDIS applications since the 2013 Hunter trials.

 

We have developed a video for GPs on ‘Providing evidence of psychosocial disability’ and a matrix tool to assist in completing the access request form. We are also offering PHNs training specifically to support AHPs.

 

Resources are all accessible via the Aftercare health practitioner webpage

 

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Australasian Melanoma Conference 2018 – Melbourne

Friday and Saturday 5–6 October 2018 

The 2018 program has a stream that specifically targets the interests of primary care. International experts will present their findings in the cutting edges of epidemiology, artificial intelligence for diagnosis, dermoscopy and confocal microscopy.

 

Attendance is eligible for 40 Category 1 QI&CPD points.

 

The dermoscopy sessions include basic and advanced lessons. Patient management sessions target surgery in primary care, interpretation of the pathology report, follow-up care, sentinel node biopsy and challenges posed by the new systemic therapies.

 

View the program on the Australasian Melanoma website.

*Advertisement

Notice from Queensland Health Medicines Regulations and Quality Unit regarding Lyrica®

Do you prescribe Lyrica?

Lyrica® (pregabalin) is now ranked sixth in the top 10 subsidised drugs in Australia. Pregabalin is indicated in Australia for the treatment of neuropathic pain in adults (and as adjunctive therapy in adults with partial seizures, with or without secondary generalisation).

Misuse and abuse

Pregabalin is often taken in higher than therapeutic doses with users reporting a variety of effects, including euphoria, relaxation and increased sociability. Both pregabalin and gabapentin can cause central nervous system depression resulting in sedation, respiratory depression and possible death. These effects are enhanced when used with other centrally acting drugs, such as opioids and benzodiazepines.

There is also evidence that pregabalin may reduce tolerance to some opioids, further increasing the risk of fatal respiratory depression.

What can you do?

  1. Complete a risk assessment, including substance misuse history.

  2. Avoid off-label prescribing.

  3. If diversion, misuse or dependence is suspected, seek advice from an addiction specialist. Call the Alcohol and Drug Clinical Advisory Service (ADCAS) on 1800 290 928 or visit the website.

  4. Reduce the amount of medication provided by shortening dispensing intervals (staged supply) to assist in controlling access.

  5. If withdrawal is required, then a tapering of the medication is recommended – pregabalin could be reduced at 50–100 mg weekly or at a rate suitable for the patient.

  6. More regular reviews with the patient assessing risk versus benefit at each review.

  7. Avoid co-prescribing pregabalin or gabapentin with benzodiazepines, and even more importantly with opioids.

Rheumatic heart disease becomes notifiable in Queensland

Dr Jeannette Young, Queensland Chief Health Officer, has advised that rheumatic heart disease (RHD) has been added to the list of notifiable conditions in Queensland. The Public Health Regulation 2018 that came into effect on 1 September 2018 now lists RHD as a clinical diagnosis notifiable condition.

 

The process of notification requires the diagnosing clinician to complete a notification form and send it to the Queensland RHD Register and Control Program via fax 1300 429 536 or via email on ArfRhdRegister@health.qld.gov.au

 

For more information on notifying RHD, including how to gain access to the notification form, Queensland Health guidelines, and resources for health professionals, please visit the communicable disease control guidance website.

Spleen Australia

Literature and registry data indicate that being on a spleen registry substantially decreases the risk of severe illness due to an overwhelming post-splenectomy infection by up to 80%. To reduce the risk for people living without a spleen or with reduced spleen function, Queensland Health is engaging Spleen Australia to help maintain a state-wide registry and provide a range of free support services to eligible Queenslanders and their doctors.

 

Due to feedback from clinicians, a simplified referral process has been developed and is now live. You may provide Spleen Australia with the name and contact details of eligible patients via the Spleen Australia website. Following receipt of these details, Spleen Australia will make contact with your patient via phone or post and manage the consent process.

 

Please encourage eligible patients to register themselves on the Spleen Australia website. Alternatively, they can call 1800 SPLEEN (1800 775 336). You may also start the online process yourself.

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