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RACGP Specific Interests newsletter

17 December 2018

From where we sit

Dr Cameron Loy introduces Dr Lara Roeske, Chair RACGP Specific Interests

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In focus – Aged care

Terms of reference for the aged care Royal Commission

The Federal Government has announced the Terms of Reference of the Royal Commission into Aged Care Quality and Safety.
Former Federal Court Judge, Justice Richard Tracey, and a former Chief Executive of Medicare Australia, Ms Lynelle Briggs, have been appointed to lead the commission, which will be based in Adelaide.
The Royal Commission comes in the wake of serious issues that have plagued the aged care sector, including poor standards of care, physical assaults and extremely challenging working conditions. In particular, last year’s revelations of abuse, neglect and mistreatment at a mental health care service in Oakden, South Australia, sent shockwaves that served to greatly undermine trust in the care being provided.
The Royal Commission will submit an interim report by 31 October 2019 with a final report due on 30 April 2020.
The Government inquiry will primarily examine residential aged care facilities and home care services, but will also look at the care provided to young people with disabilities who live in aged care homes.
The Royal Commission’s Terms of Reference include:

  • quality and safety, including the extent of sub-standard care
  • how to best deliver care services to people with disabilities residing in aged care facilities, including younger people
  • how to best deliver care to the increasing number of Australians living with dementia
  • the future challenges and opportunities for delivering accessible, affordable and high-quality aged care services, including people’s desire to remain living at home as they age and aged care in rural, regional and remote Australia
  • what the Government, the aged care sector, Australian families and the wider community can do to strengthen care services to ensure quality and safety
  • how to allow people greater choice, control and independence and how to improve engagement with families and carers
  • how to best deliver sustainable aged care services through innovative care and investment in the aged care workforce and infrastructure.

The RACGP has made a submission to the Terms of Reference focusing on three main categories:

  1. Government oversight and management.
  2. Role of aged care facilities in a modern health system.
  3. Clinical governance in aged care facilities.

RACGP President Dr Harry Nespolon welcomed the commitment to restore trust in aged care. He said GPs have long been concerned over conditions in the sector and has called for ‘real action’ to ensure the delivery of quality care.
‘For a long time, GPs have been concerned with the lack of investment and the inadequate staffing levels within residential aged care facilities,’ Dr Nespolon told newsGP.
‘Due to inconsistent staffing and investment, some medical practitioners have been … placed in a position where they cannot provide the best possible care to their patients.
‘This review provides an opportunity to genuinely improve healthcare services for some of Australia’s most vulnerable patients.’

First hearing of Royal Commission to be held in January

The initial hearing of the Royal Commission into Aged Care Quality and Safety will take place in Adelaide on Friday 18 January 2019.

Commissioners Justice Richard Tracey and Ms Lynelle Briggs recently invited approved aged care providers to make an early submission to the commission detailing any instances of poor care or complaints since 2013.

The largest 100 providers have been asked to respond to an eight-question survey by Monday 7 January 2019 and the remaining providers by Friday 8 February 2019 with a comprehensive emailed report that ‘should not exceed 50 pages for each service or outlet’.

The Royal Commission has updated its website with information about the scope of the survey and definitions of terms, such as sub-standard care and mistreatment, in response to questions from providers.

The website advice states that providers have been asked for their cooperation, but are not compelled to provide any or all of the information requested at this time.

‘However, the Royal Commission has extensive compulsory powers and may, if necessary, exercise those to secure the information in question’, the advice also states.

Providers have been asked to provide a comprehensive response for the full five-year period from 1 July 2013 to 30 June 2018, including any period in which the service or outlet were under previous ownership.

The survey only relates to services under the Aged Care Act meaning the Commonwealth Home Support Program and veterans home care program are both out of scope.

How aged care work can be the best part of the week – A personal perspective

Dr Troye Wallett FRACGP* (pictured) reflects on his work in residential aged care facilities (RACFs) and encourages other GPs to give it a try.

There is a trend towards GPs not working in aged care1. There are many valid and understandable reasons for it. Traditionally, attending RACFs is frustrating and the remuneration is poor2

However, that is no longer the case. With mobile technology, it has become simpler, satisfying and efficient to deliver care to older Australians. All it takes is some thought and structure to the visits. 

The joy of aged care work is the flexibility that comes with the work. No fixed appointments, no waiting rooms full of frustrated patients and the GP can take as long as required with patients. 

The following is a brief introduction on how to set up aged care work to minimise the frustration and maximise the joy. 

Structure your visit
Allocating a session or a day to aged care patients is optimal. The RACF knows when the GP attends and can prepare for their visit. By visiting regularly, the registered nurse gets to know the GP and their working style. They become comfortable leaving non-urgent issues for the visits which leads to fewer phone calls. The satisfaction of working in a team becomes apparent with regularity and the patients appreciate the attention.

Managing notes and sharing information is specific to the facility and the GP's systems. Having remote access to the medical software makes a big difference to efficiency. Being able to write directly into the electronic medical records prevents duplication of work. Printing the clinical notes for paper-based RACFs or copying and pasting for those with electronic systems is important for communication.

Preventative care instead of putting out ‘spot fires’.
Systematising preventative care can only lead to better outcomes. In the aged care setting, the focus of prevention changes. It shifts from preventing mortality to preventing morbidity. Frailty, nutrition and preventing unneeded hospital transfers are examples of preventative activities relevant to aged care.

Care plans and the comprehensive medical assessments are tools to be used for preventative activities and are invaluable. They are done over three months and it is useful to use a ‘to do’ list or schedule the reminders on the medical software. They can be used as a prompt to do blood tests, assessments or review medications. 

Comprehensive medical assessments (CMA) are invaluable. In medical clinics, it is traditional for the practice nurse to do the health assessments, but it is rare to have a nurse in an RACF; however, this is not a disadvantage. On the contrary, the rapport that one builds with the patient from doing the assessment is priceless. The information gathered is vital and the skills gained are a bonus. The billing for a CMA is higher than consultations, so there is no loss there. Using the CMA to focus on preventive measures is good practice as is doing an advanced care directives an essential, but not mandated, part of the CMA. 

The learning curve
Anecdotal evidence suggests that some GPs, while interested, are intimidated by aged care – they question their ability and knowledge of aged care medicine. Doing anything new is always daunting but take heart, the conditions seen are similar to seen in regular clinics. Upskilling is rapid, and the RACGP Silver book provides guidance on topics to review. It is currently being updated, but is still a good start. 

Try something new
Aged care is a growing and a purpose-filled part of a GP's practice. If it is something that is not part of your week, give it a go, try something new. With the right support and systems, it will become the best part of your week.

Chat to your practice about their systems and how they can support aged care work. A few brave GPs set out on their own and focus solely on RACFs. A third option is to join an aged care-specific group or practice. They have done the hard work of setting up the systems, have the network of GPs for support and are ready to help you get down to the critical work of delivering the best care to your older patients.

However you decide to do it, your work will be appreciated, the sessions will be rewarding and just one session out of the clinic will be refreshing.

*  Dr Troye Wallett FRACGP, is a GP with a specific interest in aged care. He greatly considers how to deliver best medical care to older Australians. Currently, he is on the Silver Book Expert Advisory Committee in charge of updating the book. His declared conflict of interest is that he is the co-founder of GenWise. GenWise is an aged care specific general practice with the mission to support GPs in RACFs.

  1. Australian Medical Association. 2017 AMA Aged Care Survey Report. Barton ACT: AMA 2018. Available at [Accessed 10 December 2018]
  2. Long B. ‘Hide and seek’: A barrier to GPs visiting residential aged care facilities. University of Wollongong Newsroom. 28 March 2018.

'Silver book' update

The Expert Advisory Group, chaired by Assoc Prof Morton Rawlin, commenced work on the update of the Medical care of older persons in residential aged care facilities (Silver Book) in April 2018.

Significant progress has been made to date. Several meetings have been convened and advisory group members are currently working on content updates.

Assoc Prof Rawlin also presented an overview of the current update at the GP18 conference on the Gold Coast.

RACGP Specific Interests Aged Care on shareGP

RACGP Specific Interests Aged Care has established a closed shareGP group for members with an interest in the role of general practice in aged care. The group will be a platform for members to discuss issues in aged, dementia and end-of-life care. It is also an ideal place to share your news and opinions, and to provide research, clinical or conference updates with like-minded GPs.

To join, simply log in to shareGP (you will need your RACGP log in and password) and ‘ask to join this group’. A moderator will then approve your membership and you can start participating.

International Research Network on Dementia Prevention – Primary healthcare survey

The International Research Network on Dementia Prevention (IRNDP) is a free-to-join global network aiming to deliver, facilitate and support research and knowledge translation relating to the prevention or delay of cognitive decline and dementia. 

IRNDP is currently inviting people who work in primary healthcare in Australia to complete a brief online survey. It will be using the results to help support dementia prevention and knowledge translation in primary care.

The survey aims to establish:

  • what primary healthcare providers already know about dementia risk reduction
  • whether primary healthcare staff feel that further knowledge is required
  • where there might be barriers for dementia risk reduction in primary healthcare.

Complete the survey.

Aged care in the news

Family doctor a vital part of cradle-to-grave care reboot 

Assoc Prof Joel Rhee (Chair RACGP Specific Interests Cancer and Palliative Care and researcher with University of Wollongong’s School of Medicine) has published a qualitative study on GP involvement with end-of-life care. The study interviewed GPs and specialist palliative care clinicians in New South Wales and Queensland to understand why GPs are not more involved, particularly when evidence shows that proactive GP involvement contributes to patients being cared for and dying in their preferred place. (University of Wollongong Media Release 29 November 2018.)

Interactive dementia app encourages ‘a better visit’

Dementia Australia have launched free iPad app, A better visit that features a range of two-player games designed to enhance communication and facilitate positive social interactions between people with dementia and their visitors. It is available on the iTunes app store. (Aged care guide, 5 December 2018.)

Dementia carers unprepared and distressed by end-of-life decisions

New international research from Advance Care Planning Australia (ACPA) reveals that dementia carers need more support and guidance to navigate end-of-life care for their loved one. The study, published in Palliative care, shows that less than 40% of people with dementia undertake advance care planning internationally. Advance care planning aims to ensure that care received during serious and chronic illness is consistent with the person’s values, preferences and goals, but the study shows that people with dementia and their carers felt uncertain in making treatment decisions. (Mirage news, 21 November 2018.)

Exercise and protein 'can beat frailty'

In a new study published in the British Journal of General Practiceresearchers conducted a systematic review on studies on frailty interventions. They found interventions with both muscle strength training and protein supplements were consistently considered the best for effectiveness and ease of implementation. ( 4 December 2018.)


Specific Interests news

Integrative approaches to women’s health ALM

On Saturday 17 November, almost fifty GPs attended the active learning module (ALM), ‘Integrative approaches to women’s health’ at the National Institute of Complementary Medicine (NICM) Health Research Institute, Western Sydney University.

Dr Carolyn Ee, Assoc Prof Vicki Kotsirilos and Dr Paulette Maroun presented sessions on managing menstrual disorders, polycystic ovary syndrome (PCOS) and menopause according to the latest best practice recommendations. 

The presenters stressed the importance of providing patients with the best available evidence on the efficacy and/or effectiveness of integrative therapies. GPs must be able to facilitate informed decisions and be able to counsel patients on the potential risks of commonly used integrative therapies.   

RACGP Specific Interests received excellent feedback from attendees with many requesting future ALMs in this area.

Many thanks to the support of Paradigm.


Save the date: Business of General Practice networking event

7.00 pm AEDT, Tuesday 12 February 2019

RACGP Specific Interests Business of General Practice is currently planning a networking event to be held in Melbourne at the RACGP national office.

Further details will be released in early 2019.

RACGP Specific Interests and Emerging Minds webinar series

RACGP Specific Interests has combined with Emerging Minds – National Workforce Centre for Child Mental Health to deliver a series of four webinars on mental health issues for infants and children. 

Emerging Minds was established to assist professionals and organisations who work with children and/or parents, guardians and families in identifying, assessing and supporting children at risk of mental health conditions.

Preventing mental health issues for infants and children
Thursday 14 February 2019

This webinar focuses on parent engagement as a preventative strategy. Using case studies from Emerging Minds’ eLearning content, GPs will describe the use of engagement in their practice that enables parents/guardians to describe their concerns for their children’s physical and mental health.

Responding to the mental health needs of infants and toddlers
Thursday 7 March 2019

This webinar examines presentations of mental health difficulties in infants and toddlers, from newborn to three years of age. It explores GP interactions with infants, toddlers and their parents/guardians in ways that effectively support coordinated service responses.

Responding to the mental health of school-aged children
Thursday 4 April 2019

The 2015 Young Minds Matter survey showed that 13.6% of Australian children between four and eleven years old met the criteria for at least one mental health disorder. The ability of GPs to assess issues for school-aged children is critical. This webinar examines the type of issues with which school-aged children present, how these issues can be affected by adverse family or schooling circumstances, and how GPs can open up helpful and supportive conversations with children and parents/guardians.

The effects of trauma on children’s mental health
Thursday 23 May 2019

A child’s psychological recovery from experiences of trauma, loss and other adverse experiences is often dependent on their network of supportive and nurturing relationships. This webinar examines frameworks that GPs can use to remain curious about the circumstances of children affected by trauma, while establishing support networks that assist in recovery.

The webinars are free of charge to RACGP members and are accredited for three Category 2 Quality Improvement and Continuing Professional Development (QI&CPD) for the 2017–19 triennium.

All four webinars will be held at 7.00–8.30 pm AEDT/AEST.

Further information and registration is available on the RACGP Specific Interests events page.

International Medicine in Addiction Conference 2019

Friday to Sunday 1–3 March 2019

The International Medicine in Addiction Conference 2019 (IMiA19) program is currently in development and includes a mix of presentations from Australian and international clinical and research experts.

Already confirmed program highlights include:

  • Prof Jon E Grant – Gambling and behavioural addictions
  • Prof Rajita Sinha – Stress and resilience
  • Dr Iván Montoya – New horizons/approaches in the USA
  • Dr Marc Auriacombe – Opiate and addiction update from Europe
  • Dr Edward Ogden – Driving impairment
  • Dr David Cunnington  – Sleep, and alcohol and prescription drugs
  • Prof Peter Miller – Alcohol and violence

Stay informed of program updates at the IMiA website.

IMiA19 will be held at the Melbourne Convention and Exhibition Centre. Registrations are now open.

External news and opportunities*

GP assistance to recruit parents/guardians or carers of children with eosinophilic oesophagitis

Researchers from Griffith University are seeking GP assistance in identifying parents/guardians or carers of children with eosinophilic oesophagitis (EoE) to participate in the research project, ‘Exploring healthcare use, burden of disease and satisfaction with care in paediatric eosinophilic oesophagitis.

Currently, there is no cure for EoE and treatment involves strict food elimination diets, steroid medication and special nutritional formulas. EoE patients often feel socially isolated due to their food restrictions and may seek complementary medicines and therapies, such as acupuncture, herbal medicine and nutritional supplements, to help manage their symptoms. There have been limited studies to assess use with, and satisfaction of, these medicines by EoE patients, particularly children.

This study aims to explore the experiences of parents/guardians or carers of children with EoE in managing this condition. This includes the physical and emotional impact of paediatric EoE on the family, as well as the use, perceived efficacy of, and satisfaction with conventional and complementary treatment.

GPs are asked to assist in this research project by alerting patients who meet the study criteria to the online information and survey.

The project has been ethically approved by Griffith University Human Research Ethics (GU Ref No: 2018/120).

Do you provide menopause care for patients who have migrated from low and middle-income countries?

Researchers from the School of Public Health and Preventative Medicine, Monash University are inviting healthcare practitioners to participate in a survey that will inform the research project, ‘Healthcare providers’ learning needs for providing culturally competent menopause-related health care.’

As part of the project, the researchers are would like to hear about your experiences, the barriers you have encountered and your information needs when providing care to patients in midlife who have migrated from low and middle-income countries to Australia.

The brief survey, ‘Menopause care for women who have migrated from low and middle income countries: What works?’, includes questions about your views on how these patients understand and manage menopause, and what might help you provide menopause-related care. 

2019 Australian Pain Society Annual Scientific Meeting

The International Association for the Study of Pain (IASP) has declared 2019 the ‘IASP Year against pain in the most vulnerable’. The 2019 Australian Pain Society (APS) Annual Scientific Meeting will reflect on this theme.

The 2019 meeting will be held on the Gold Coast on Sunday to Wednesday 7–10 April. Registrations are now open. An early registration discount applies until Friday 22 February 2019.

Landmark study highlights long-term success of weight loss surgery*

A 20-year study1 by Monash University researchers has demonstrated that lap-band surgery provides substantial weight loss to people affected by obesity for at least 20 years. The findings are now available online.

The study, by Monash University’s Centre for Obesity Research and Education (CORE), and the Centre for Bariatric Surgery (CBS) demonstrated that patients who had lap-band surgery 20 years ago now weigh on average 30.1 kg less than their initial weight. Lap-band surgery places an adjustable band around the top of the stomach to reduce appetite.

This study examined data from an initial group of more than 8000 people and is believed to be the largest and longest-running of its kind in the world.  

‘These data show that lap-band procedure has the potential to provide an acceptable and cost-effective long-term solution to obesity,’ lead author Prof Paul O’Brien said.

People with obesity are more likely to be affected by health problems, including heart and lung disease, type 2 diabetes, high blood pressure, many cancers, osteoarthritis, psychosocial problems, depression, and reduced life expectancy.

‘As people with obesity are at risk of many potentially lethal diseases, the surgery can be life-saving. A long-term partnership between doctor and patient with attention to eating rules, good nutritional care, exercise and activity was very important,’ Prof O’Brien said.

  1. O'Brien PE, Hindle A, Brennan L, Skinner S, Burton P, Smith A, Croswaithe G, Brown W. Long-term outcomes after bariatric surgery: A systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg 2018. doi:10.1007/s11695-018-3525-0.

*Sponsored content from Apollo Endosurgery Australia 

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