From the UK - Chris Middleton - AMA President
I am writing from Northumberland just south of Hadrian’s Wall whilst on a brief sojourn to the green and pleasant land of my birth. Michael Aizen and Don Rose are filling in as Southern and Northern Vice Presidents respectively during this time and my thanks to them both.
As you may be aware, the National Registration and Accreditation process is well advanced and there has been a draft of Bill C on the DHHS website. AMA Tasmania has written to the Premier and the Minister for Health quite recently and we have also lodged a submission to the draft legislation.
Our main concerns relate to the reserve powers available to Ministers in the current legislation, mandatory reporting of colleagues and other health workers, lack of protection for the titles “physician” and “surgeon” and the proposal that any future amendments to the legislation only need to be passed in Queensland to be automatically applied everywhere else in the country.
The AMA has recently supported our nursing colleagues’ concerns regarding amendments to the Poisons Act which may have the presumably unintended consequence of permitting high level residential aged care facilities to operate without nurses on site. Don Rose has written a comprehensive account which features later in this issue of TasTalk.
In another joint initiative, AMA Tasmania together with medical student bodies AMSA and TUMSS recently wrote to the Health Minister to reiterate our concern that Tasmanian medical graduates may miss out on internships in the near future unless some fairly urgent attention is given to increasing the number of training positions in our public hospitals. I had the opportunity to speak to the PM about this recently at a forum at the LGH and the obvious lack of cohesion in medical workforce planning was clearly of significant concern to him also.
As usual, there is much to report but Tony has asked me to be succinct so I’ll sign off here and revert to holiday mode.
Cheers and best regards to all,
Chris
Poisonous Outcomes? - Donald Rose - AMA Branch Councillor
Poisons Amendment Bill 2009 and Nursing Homes – the saga continues
The recent changes to the Poisons Act in Tasmania has been a particularly long and drawn out process and has involved a lot of work on the part of the AMA with some good outcomes. The original draft legislation raised all sorts of issues around privacy as it proposed that any patient demonstrating drug seeking behaviour had to be mandatorily reported. There was no protection in the legislation for this breaching of confidentiality and eventually the draft legislation was revised to incorporate the AMA’s concerns.
Additionally the original legislation included a deregulation of the administration of medications so that carers could administer medications without supervision. This was already being done in some settings and one of the purposes of the legislation was to clarify who could do what. The original legislation, however, was very light on detail so this part of the legislation was delayed for 12 months of further consultation at the request of nursing representatives.
This is where life became interesting. The owners of nursing homes were facing a number of difficulties with the administration of medications. The Poisons Act before it was changed required a nurse to administer medications in nursing homes and this could not be delegated to a non-nurse. Nursing home owners argued they were having difficulty attracting nurses as distributing drugs was “boring” and did not use the skills of nurses. As a result they were having difficulty complying with the law.
Nurses were split on the issue as some argued the drug rounds gave them a chance to assess each resident at least daily and check they were ok. They also argued the reason nursing homes had trouble attracting nurses is because they pay significantly less. In the other camp were the nurses who believed the drug round was too time consuming and was restricting their ability to carry out other nursing duties that included wound management, more thorough clinical assessments and better communication with other providers.
The AMA decided this was an issue the Australian Nursing Federation and the Nursing Board of Tasmania should thrash out with the Government and left much of the negotiation to these bodies. Somewhat to our surprise the Government largely ignored the concerns of the nurses’ representative bodies and decided to push through with the Bill and its Regulations with very few guidelines for nursing homes. Had the Bill passed in the form favoured by the Government it would have been possible for nursing homes to operate with medication endorsed aged care workers administering medications under the supervision of a nurse who could be off site which could have been from another nursing home or even at home. The Government tried to argue accreditation standards would make it impossible for nursing homes to operate without a nurse on site but in the States that have already deregulated drug administration nursing homes are already operating legally without nurses on site.
The Governments determination to push the legislation through without the appropriate guidelines was difficult to follow. The owners of nursing homes in Tasmania have a very effective lobby group, Aged and Community Services Tasmania, which boast as members most of the aged care providers in the State. They were arguing strong and hard that they needed to have carers administering medications to free up nurses to do other duties. When quizzed about what these other duties would be there was clearly differing views. The bigger nursing homes had visions of improving the nursing care in nursing homes as well as pushing the nurses into some neglected administration work. The smaller nursing homes seemed more intent on reducing nursing hours to make their operation more cost effective. The days of the enrolled nurse in the smaller homes seemed very numbered.
When it became clear the Bill and its regulations could allow nursing homes to operate without nurses the AMA, along with the ANF, made representations to the Legislative Council to ask they not allow the Bill through until guidelines were developed that would ensure no high care facility could operate without a nurse on site. The AMA took this position for a number of reasons not least is which we totally rely on nurses to monitor patients under our care in these facilities and were they not there it would be impossible to safely manage these patients without much more supervision and direct input. Currently fewer and fewer GPs are looking after more and more nursing home patients and they can only continue this trend with the support of efficient, reliable and on site nurses. We did not object to medication endorsed aged care workers delivering routine medications as this is a totally reasonable step to take with the availability of dose administration aids.
To get the Bill through the Parliament the Government agreed at the last hurdle to develop guidelines for nursing homes over the next six months and these will have to be approved by the Legislative Council. Exactly what the guidelines will be will now have to be negotiated and in some way the battle continues. The AMA will be firm on its position that high care facilities require nurses on site at all times. During the representations to the Legislative Council no stakeholder argued they were going to try and operate without nurses and indeed some aged care lobbyists actually argued they believed the changes will make nursing homes more attractive to nurses and attract more to their facilities. The AMA will be asking all stakeholders to put their words into actions by supporting that the guidelines include the requirement that all high care facilities must have a nurse on site at all times.
Donald Rose, Branch Councillor.
Changing face of the healthcare industry - Aequis
At a special event held recently in Hobart, leading cultural anthropologist Dr Barbara West, presented her views, alongside an industry panel, of the changing face of the healthcare industry. The research was undertaken by Access Economics to examine future trends in the healthcare sector and the event was sponsored by NAB Health and Aequis.
The research looked at five main areas of the healthcare sector, Pharmacy, Dentistry, General Practitioners, Medical Specialists, and Vets and I have outlined some of the highlights of the report below:
There is a general “Feminisation” of the sector with growth in number of females in the industry exploding. The number of female GPs is expected to outstrip the number of male GPs by 2038. However, many female GPs will choose to work part time to balance their work with their family life. Women are increasingly becoming medical specialists, which is reshaping many medical specialist professions.
There are succession planning challenges particularly in the Pharmacy sector as pharmacies have grown in value, it has become more challenging for junior partners to buy into a pharmacy.
This report shows that new trends facing medical specialist professions are having a significant effect on the shape of these fields:
• Training opportunities for specialists are reducing, while at the same time, demand for specialists is increasing.
• New technologies are increasing specialists’ ability to provide outstanding medical care, but
at the same time the cost of providing specialist medical services is increasing.
The financial planning sector is also undergoing significant change and this has been driven primarily by consumers. Our clients are demanding more comprehensive advice than ever before for more complex financial issues and expect to pay transparent fees.
Aequis is a true fee-for-advice business that specialises in providing advice to health professionals. To make an appointment to speak to one of our advisers contact our Rosny office on 6282 2822 or visit our website www.aequis.com.au
*Doug Davey and Aequis Pty Ltd are Authorised Representatives of GWM Adviser Services Limited ABN 96 002 071 749 Australian Financial Services Licensee Registered Office at 105 – 153 Miller Street North Sydney NSW 2060. GWM Adviser Services Limited is a Principal member of the Financial Planning Association.
This advice may not be suitable to you because it contains general advice that has not been tailored to your personal circumstances. Please seek personal financial and taxation advice prior to acting on this information.
DEANS DESK - Professor Allan Carmichael
The new Medical Science Building which will accommodate the Medical School and the Menzies Research Institute is fast approaching completion. The practical completion is on target for November 23, with a staged move planned over the following 8 weeks.
I am sure that you have been watching the changing skyline and wondering what the interior is like. The unique lecture theatre which can be flooded with natural light, seating up to 170 students and the open and inviting reception area. The new lecture theatre Reception located on the corner of Campbell and Liverpool St.
An interesting aspect of the building is its flexibility. The laboratory spaces are located next to each other. If a lab session needs to facilitate a large group the session can be taught into multiple lab spaces at one time. The use of open plan office space also provides additional flexibility.
The School of Medicine is actively engaged with the DHHS and related stakeholders in the planning phase for the establishment of Integrated Care Centres (ICCs) in both Launceston, adjacent to the LGH, and at Clarence. The ICC at Clarence will be co-located with the proposed GP “Super Clinic”.
The development plans for the Clarence GP Super Clinic are progressing well, with Professor Mark Nelson and Dr Emma Warnecke from the School of Medicine being involved as members of the Advisory Committee that is investigating potential models of operation and governance.
GP Super Clinics are a Commonwealth Government initiative targeted at providing well-integrated multidisciplinary and patient-centred care in the community, primary care setting. The Commonwealth program objectives identify such clinics as sites for high quality education and training, as well as for the provision of positive learning experiences for medical students so that they may be potentially drawn to careers as General Practitioners. Undergraduate medical students will have tremendous opportunities for effective placements in the Clarence Superclinic, and the School looks forward to supporting academic engagement of the General Practitioners who will be engaged in this exciting venture.
The School of Medicine is proud of their teaching and research staff achievements. We would like to congratulate Professor Mark Nelson on his recent notable achievement as the recipient of the Bridges-Webb medal. Professor Nelson was nominated for the award for his work in Cluster Randomized Controlled Trial of Oscillometric Versus Manual Sphygmomanometer for Blood Pressure Management in Primary Care (CRAB).
Recently Clinical Associate Professor appointments were approved. I congratulate Clinical Associate Professors Tim Greenaway, Paul Dunne, Michael Sladden and Shanmugarah Rajendra and welcome their continued contribution and support to the School of Medicine.
AMA on the rise - Tony Steven - CEO
CEO Update to members:
Activity within the AMA is definitely on the rise with the successful reintroducing of the Southern Division Meetings at Calvary Hospital, Marion House. Generally held on the first Tuesday of each month (the November meeting attracted a good attendance and a great conversation) we have seen an array of quality speakers including Michael Pervan from the RHH, Prof. Alan Carmichael from the Clinical School, Uni of Tas and Dr. Paul Dunne on Euthanasia. These meetings are the primary way for members to inject their input into the direction of the AMA and the issues we address. Non members are also welcome if they are considering membership, please contact me at AMA House.
There are quite a number of students graduating this year from the three campuses and I was pleased to get the chance to speak to them all late in October about the benefits of joining the AMA. Notably I was pleased to get a very positive response when I pushed the altruistic reasons for joining, they are keen to contribute.
The Tasmanian Government, AMA and the TSMPS (Tasmanian Salaried Medical Practitioners Society) have now signed a “Heads of Agreement” document that outlines the main points to be included in the new Industrial Agreement for Salaried Doctors for the next three years. Member support for the C2009 campaign has been fantastic and we have negotiated a good result for all.
The President of the AMA in Tasmania Dr. Chris Middleton has appointed a number of sub committees in several areas, see http://www.amatas.com.au/committees/. These committees provide yet another way for members to have input to the AMA by contacting the chairs of each region. Please feel free to call AMA House for contact details. 03 6223 2047.
We have also been working hard on the list of benefits for members, brochures are now being produced with updated information, plus the website will also reflect these changes over the next month or so. This is all happening in time for the renewal campaign scheduled to commence early December for the 2010 membership year. Easy to pay monthly, quarterly and salary deductions processes will be available.
Tony Steven
CEO
The Public Trustee - Peter Maloney
Understanding an Enduring Power of Attorney
Peter Maloney CEO, The Public Trustee
What is an Enduring Power of Attorney?
An enduring Power of Attorney (EPA) is a legal document, which allows you to appoint a statutory trustee (like the Public Trustee) or an individual to manage your financial affairs if you direct them or lose the capacity to make independent, informed financial decisions.
An Enduring Power of Attorney:
• operates during your lifetime only
• ceases on your death
• does not deal with your lifestyle or medical decisions
• deals with your financial affairs
Why have an Enduring Power of Attorney?
If you can no longer manage your financial affairs for medical reasons (eg dementia) or otherwise, you won’t be able to operate a bank account, pay bills, sell property, complete your tax return or manage your investments.
Preparing an EPA is like taking out insurance – to be there, just in case you need it if you lose capacity. Until your EPA is activated, you retain complete control of your affairs, but you will have the peace of mind of knowing you have immediate access to essential assistance.
When is an Enduring Power of Attorney activated?
An EPA is activated by choice or in the event an individual loses capacity.
The Public Trustee requires confirmation from a doctor to say that the individual concerned has lost capacity. Once this confirmation is received we will register the person’s EPA and begin to manage their financial affairs.
An EPA only operates after being registered at the Land Titles Office. It can be held at the Public Trustee, without having effect, until you request the document be activated or lose the capacity to manage your financial affairs.
Sometimes people choose to activate their EPA when they no longer want to be burdened with managing their own financial affairs.
For example, some people when going on an extended holiday, choose to have the Public Trustee manage their bills, tax returns and other financial issues, so they can travel Australia or the world without worrying about whether the bills are being paid back at home.
When does the Enduring Power of Attorney cease?
It ceases if:
• you revoke it by giving notice of the revocation to your Attorney
• you die
• you become bankrupt or insolvent
• it is revoked by the Guardianship and Administration Board
Internet based practice management for Independent Medical Assessors
The enormous value of the web to Tasmania has been clearly shown by the fact that Tasmania will be the first state to enjoy the benefits of the National Broadband Rollout. The benefits offered by the internet are also being clearly recognised and adopted by many of the members of the Australian Medical Association throughout Tasmania and Australia.
Many of these benefits have been harnessed by eReports who have recently started operating in Tasmania. eReports was founded in 2000 and has continued to be the leader in the use of the internet in the area of Independent Medical Assessments throughout Australia.
Their extensive client base of insurers, self-insurers, superannuation funds, lawyers and government agencies throughout Australia enjoy a totally online, and real time, free booking service for the eReports team of highly regarded specialists.
eReports also utilises the web to communicate to a client the progress on their patient, or workers consultation, as well the status of their report and its subsequent delivery. “Ease of use and very rapid report turnaround have been key to our success, and we couldn’t achieve either without the internet,” says co-founder John Catlin.
For their specialists they offer a totally online practice management environment that embraces every aspect of a specialist’s day to day activities. These range from scheduling appointments, access to and storage of all documents relating to an assessment, dictation and online approval of reports and even invoicing and banking reconciliation. This enables specialists to focus entirely on the quality of the consultation and the report by providing a complete service delivered via the web. By using the web all of these the services are available 24 hours a day, 7 days a week to a specialist regardless of their location.
Currently all eReports specialists are based outside of Tasmania but, moving forward, hopefully this will change as eReports becomes more established in Tasmania. eReports are already recruiting Tasmanian based specialists.
“We are delighted with the warmth of our welcome in Tasmania and the level of adoption and expertise around the web. Some of our Tasmanian clients have already driven enhancements in our services and technology to meet their requirements in areas such as electronic document distribution and compliance,” John Catlin.
For further information on working with eReports in Tasmania or elsewhere in Australia please contact either Chris Argyle or John Catlin, admin@ereports.com.au, 1300130963.
TASMANIA’S HEALTH PLAN Statewide Clinical Networks UPDATE
Tasmanian Cancer Clinical Network
The Tasmanian Cancer Clinical Network was established following the conclusion of the first phase of the Cancer Services Networks National Demonstration Program (CanNET), in May 2009.
The TCCN Steering Committee has been appointed and the committee will meet for the first time on October 28 to determine priorities for the annual TCCN Work Plan with a focus on implementation of the work plan in 2009 -2010.
Additional work for the TCCN has been the progression of two major Cancer Australia joint jurisdictional projects with Victoria; One of these projects is working on a range of developments for adolescent and young Tasmanians with cancer and the other is the Gynaecological Cancer Workforce Initiative which seeks to improve outcomes and support for women with a gynaecological cancer.
For further information, contact Denise Walshe, Clinical Advisory Coordinator on denise.walshe@dhhs.tas.gov.au or (03) 6233 3358.
Aged Care and Rehabilitation Network
This network will be formally launched on December 11 in Launceston, but work is already underway.
The first four key projects for this Network are now well underway. They are:
• the State Wide Directory project;
• the Long stay Older Patient Terminology project;
• the Standardised Assessment Tools project; and
• the Capacity Toolkit project.
This last working group has gained approval from the NSW government to produce a Tasmanian version of the Capacity Toolkit and the content application is underway with advice from a subcommittee of legal experts.
Good progress is being made across all projects. In keeping with the aim of the network, these projects all link together people and projects across sectors, regions and disciplines.
For further information, contact Nadia Mahjouri, Clinical Network Aged Care and Rehabilitation on nadia.mahjouri@dhhs.tas.gov.au or (03) 6236 5614.
Palliative Care Network
To date there has been a high level of community interest and broad based support for developing the Palliative Care Network. Projects underway include:
• Advance Care Planning project: improving provision of information about advance care planning to the public and professionals and making information about existing advance care plans more broadly available to medical professionals.
• Communications Resources project: designed for the public and health professionals regarding provision of patient fact sheets, clinical guidelines on major symptoms and a drug formulary.
• Grief and Bereavement project: to build community support capacity by making group focused grief and bereavement resources more widely available.
For further information, contact Carole McQueeney (03) 6233 0848 (Mon - Wed.) carole.mcqueeney@dhhs.tas.gov.au Bruce Wilson (03) 6236 5616 (Wed - Thur) bruce.wilson@dhhs.tas.gov.au .
Chronic Disease Network
The establishment of the Chronic Disease Network has been identified as a priority for late 2009 and has commenced. This network will be a major vehicle for driving the implementation of Connecting Care, a chronic disease framework for Tasmania. Connecting Care aims to improve the prevention, detection and management of chronic disease in Tasmania and will be identifying key areas for action.
For further information, contact Amanda Daly, Project Consultant (03) 6236 5622 amanda.daly@dhhs.tas.gov.au
THE HON NICOLA ROXON MP Minister for Health and Ageing - MEDIA RELEASE
5 November 2009
MIDWIVES/ NURSE PRACTITIONER AMENDMENT
The Minister for Health and Ageing, Nicola Roxon has today circulated an amendment the Government intends to introduce into the Health Legislation (Midwives and Nurse Practitioners) Bill and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill.
This amendment makes clear in the legislation something that was articulated both on introduction of the Bill to Parliament and in the explanatory material tabled at that time.
Following requests for clarification, this amendment will simply clarify in legislation that collaborative arrangements with medical practitioners will be required to access the new arrangements.
The details of these requirements will be specified in subordinate legislation following the ongoing consultation with the professional groups.
These bills are a key plank of the Government’s 2009/10 Budget commitments which recognise for the first time the role of appropriately qualified and experienced midwives and nurse practitioners in our health system.
The Minister for Health and Ageing said today “I thank the doctors, nurses and midwives for their constructive engagement to date to ensure these new opportunities for nurses and midwives are implemented in an integrated fashion for the benefit of patients.”
For more information contact the Minister’s office on 02 6277 7220
