SSWAHS = SWSLHD + SLHD and the Medicare Locals - 60

Mediation failure forces divisions to quit ML merger

24th Oct 2011 Byron Kaye   all articles by this author

Medical Observer

DOUBTS about the federal government’s Medicare Local (ML) boundaries have re-emerged after mediation between two Sydney division-led bodies, aimed at forcing them into a single ML, collapsed.

Souring relations between a Bankstown division-led consortium and a group led by Macarthur and Southern Highlands divisions prior to the first ML deadline had previously prompted the AGPN to appoint a mediator so the parties could form an ML by next year.

But mediation has since failed, with Macarthur-Southern Highlands having now lodged its own bid, which could see it handed responsibility for the 35 practices it is locked in a feud with.

A Macarthur spokesperson told MO the group would not agree to further mediation until the fate of the ML had been decided.

Bankstown chair Dr Susan Harnett said if the department of health would not force Macarthur-Southern Highlands into more mediation, it should simply split the ML in two.

“It’s such an enormous area with so many complex needs and organisations,” she said.

Dr Brian Morton, chair of the AMA Council of General Practice, warned divisions to settle their differences or risk having general practice “locked out” of MLs. A department spokesperson said the awarding of tenders took into account the applicants’ “ability to engage with key stakeholders”.


Well, it seems the fickle finger of fate has written on the wall of the Southern Highlands Division of General Practice! Christmas is beginning to look gloomy for the CEO and Board of the local Division. 

The final paragraph of the statement above is pretty clear about what causes a Division like the Macarthur - Southern Highlands consortium being "locked out" of Medicare Locals because they can't settle their differences. Certainly the Department of Health and Aging representative suggesting the criteria of the applicant's "ability to engage with key stakeholders" does not apply to the SHDGP's involvement with local people, public and private health practitioners and NGOs. Telling key stakeholders after the event what the SHDGP has done to apply for Medicare Local funding is hardly consulting or engaging, with them.

The other bit of mis-information the Chair of the SHDGP published in his lengthy column in the Division's last newsletter was that the mediation between the Macarthur-Southern Highlands consortium ended because the Bankstown GP Division put in their own application. However, the report published above suggests that it was the Macarthur-Southern Highlands consortium who withdrew from the mediation to lodge their own submission first. Further, the Macarthur spokesperson stated that they would not engage in any further mediation until after the outcome of the second series of Medicare Local allocations had been resolved. It seems they are hoping to get in and only then use their improved position to hammer away at the Bankstown GP Division.

"Bankstown chair Dr Susan Harnett said if the department of health would not force Macarthur-Southern Highlands into more mediation, it should simply split the ML in two.
“It’s such an enormous area with so many complex needs and organisations,” she said."  

This suggestion by Dr Harnett is Solomon-like in its simplicity. The Medicare Local could be split in two. However, in order for the Bankstown GP Division to achieve the numerical population quota set by DoHA, required for MLs it is likely that they may have to extract from Macarthur-Southern Highlands some of the territory that they acquired prior to the implementation of the Medicare Locals. 

Can I see these empire-building expansionists willing to hand over territory? Not likely!

SWSLHD and Bowral's Health - 43

Reflections on GP mental health care over 45 years: a father and son perspective

24th Oct 2011 Dr Tim Blashki and Dr Grant Blashki   all articles by this author

Medical Observer

THEN

I AM delighted to read about changes in GP mental health in the past 20 years. Forty-five years ago the concept did not even exist, not to mention the range of treatment options currently available.

Imagine for a moment a GP waiting room in 1965: a hot stuffy place occupied by the old and the young. Weekday appointments are seven minutes long and five minutes on Saturday.

Doctors work an exhausting 70 hours a week, usually running late because they have been delivering babies, making home visits, or assisting at the hospital. There is no Medicare and the fee is meager.

Both doctor and patient are under pressure when they meet in the consulting room. As the patient tells of their symptoms, the doctor localises the malady, examines the patient and prescribes the treatment.

Bearing in mind the pressure the patient sees the doctor is under, into this mix he or she may or may not mention in passing that they are depressed or anxious, have domestic strife, sexual problems or indeed that they are deluded, hallucinating or even suicidal.

Stressed and short on knowledge, having attended only half a dozen lectures and visited a psychiatric facility once or twice in the course of his six years of medical training, what is the doctor to do beyond scream for help?

He or she may choose to see the patient after hours when there is a little more time or prescribe anything from dill water, rose water, vitamins, or his or her own (or the pharmacy’s) special concoction.

Barbiturates, chloral hydrate, bromides, or one of the emerging class of antidepressants; MAOIs, tricyclics or the diazepines for anxiety are other options. The choice is usually based on what the drug rep says, for there is virtually no educational material.

If the patient is very disturbed, the doctor may choose to send him to a (rarely available) psychiatrist, an outpatient department or a psychiatric institution.

In general, there is no therapy as such, no cognitive behavioural therapy (CBT), perhaps just some good advice to ‘have a rest’, ‘get off the alcohol’, ‘look to one’s responsibilities’, ‘think about the better things in life’.

This is all well-meaning, and when given in a supportive environment where the doctor knows the patient well, it probably helps. This is not surprising, as a number of studies have shown that 50–60% of patients with mild to moderate depression get better with appropriate support and placebo alone.

Having said this, a significant group of doctors simply focus on the physical and avoid the psychological altogether. I would emphasise that these doctors are not bad doctors or bad people, they are simply trying to survive in their own particular way in an environment that is not conducive to helping people in a psychological sense.
Dr Tim Blashki

Dr Tim Blashki is a retired psychiatrist, former GP, and author of one of the world’s first trials of GP depression management (BMJ, 1971).

NOW

I’VE been a GP for almost 20 years, and over that time I’ve seen many changes in mental health, most of them positive. Perhaps the biggest change has been in the language of GP psychiatry. Terms like “psychiatric illness” have been traded in for phrases like “mental health problems”, reflecting a shift in values and the philosophical approach to people’s experiences of mental illnesses.

General practice now shares much of the responsibility and burden for mental health care with other primary health professionals. Psychiatry has also had to make room for a plethora of mental health specialists, in particular psychologists, who are now integral to team care. The expansion of responsibility for community care to allied health professional has greatly improved the access and affordability of care.

When I started general practice, referrals for mental health problems were often the most difficult. Telling an unemployed depressed patient that what they needed was a series of specialist consultations at $100–$200 a pop generally didn’t go down well.

Federal governments since early 2000 deserve credit for substantially funding programs, such as the current Better Access to Mental Health Care, which have put in-depth psychological care within financial reach for most Australians. Needless to say, I think recent cuts to these initiatives are shortsighted.

However, not all the reforms have been rosy. The bureaucracy of government funded mental health services can be intrusive to the normal flow and rhythm of quite intimate and sensitive GP consultations. Sometimes handing a patient a tissue will tell you more than handing them a K10. And the structured paperwork and various “plans” draw GPs’ attention away from listening and eye contact, to typing and printing forms from a computer.

Templates with boxes and headings such as “Problem 1” and “Action 1” compartmentalise the consultation and subtly infiltrate GPs’ notions of the nature of mental illness, and what ought to be done. Round pegs and square holes come to mind.

Community narratives about mental illness have also evolved and biological metaphors have flourished. Patients are often told: “Depression is just like diabetes; instead of a problem with insulin, there’s a deficiency in your serotonin level.” This oversimplified story has gained currency, and millions of scripts are written every year for antidepressants, particularly SSRIs, to “fix the serotonin levels”.

Concurrently, non-pharmacological and complementary approaches have also gained traction with patients, such as CBT, meditation and mindfulness.

Fortunately, the idea of mental illness as a weakness to be ashamed of has waned, thanks in large part to the sustained efforts of not-for-profits like beyondblue, the Black Dog Institute and Sane Australia.

A procession of high-profile personalities going public with their experience of mental illness has also helped shift community understanding. After all, if one can have a mental illness and still be a famous football player or inspiring parliamentarian, maybe it’s not such an intractable problem after all.

So after 20 years in practice, I do believe people get a much better GP mental health care than they used to. Opportunities for GPs to learn new mental health skills have also grown, and there’s a much broader range of specialist services available for GPs to refer to when needed.
Dr Grant Blashki

Associate Professor Grant Blashki is a GP and lead editor of General Practice Psychiatry.

SWSLHD and Bowral's Health - 42

Pride and prejudice: the mentally ill GP

24th Oct 2011 Pamela Wilson   all articles by this author

Medical Observer

Should doctors with mental health issues continue to practise? Pamela Wilson investigates.

Sydney magistrate Brian Vincent Maloney has fought a very public battle with bipolar II disorder – and because of it he very nearly lost his job.

Earlier this month he survived a motion in the NSW Legislative Council to remove him following a string of complaints about inappropriate behaviour in the years before his illness was diagnosed, including that he repeatedly asked a pregnant woman to stand up to show how pregnant she was and showing a screensaver of half-naked women to a female colleague.

In May, a NSW Judicial Commission had deemed him incapable of performing his role as a magistrate, despite his condition now being treated and well controlled. MPs’ debate centred on whether Mr Maloney remained incapacitated for the job – though for him their decision had more important implications.

“Upon your decision, in this case, depends whether a person suffering from a mental illness will dare to seek medical assistance,” Mr Maloney said in an address to the Upper House in June.

He could have been speaking for the one in five GPs with mental illness, many of whom are continuing in their professional role: should a well controlled mental illness be a barrier to employment for those in positions of responsibility?

“We know that even with severe mental illness, doctors can practise safely once it is controlled,” says Brisbane GP Dr Margaret Kay, who works with the Doctors’ Health Advisory Service Queensland.

The only time a doctor’s health status should be called into question – legally and ethically − is when it severely impacts on their ability to perform their job within the accepted standards and puts the public at risk, she says.

“We are not allowed to have untreated depression that is affecting our practice because we can hurt people. But we also know that it’s very rare for that to happen,” Dr Kay says.

The law governing medical practice states that anyone who places the public at risk should not be working, but as Medical Board of Australia (MBA) chair Dr Joanna Flynn points out, conversely this means that anyone not placing the public at risk is well within their rights to practise medicine.

If a doctor’s behaviour is brought to the attention of the board, the conditions or penalties they face are not draconian.

“It’s an extremely rare thing for someone to have their registration taken away because of a health problem. It’s only in circumstances where someone is severely ill and not taking the medical advice they are given that their registration would be taken away,” Dr Flynn says.

“There is a process of assessment and negotiation with the practitioner about the conditions under which they can work safely and what monitoring needs to be put in place.”

Despite the laws mirroring the medical profession’s long-standing philosophy of what constitutes best practice in these situations, national mandatory reporting legislation introduced last year seems to have blurred the lines of perception and reality for many in the medical fraternity.

Because doctors are now bound by law to report ‘notifiable’ behaviour of their colleagues, many doctors with mental illness are not seeking help for fear of putting their livelihoods at risk.

Legal sanctions can be imposed on doctors who fail to report colleagues who place the public at risk of substantial harm because they have an impairment or severely breach professional standards. Practising while intoxicated and sexual misconduct in connection with work are also considered notifiable conduct.

Western Australia is the only state in which treating doctors are exempt from mandatory reporting laws.

Since the introduction of mandatory reporting, there has been a drop in the number of doctors seeking help. While hard data is not available, anecdotal evidence suggests a direct correlation between the two.

Dr Kay says the advisory service reported a marked drop in doctors calling for advice at the same time that mandatory reporting was introduced in Queensland.

“It was very hard for us to not think this sudden precipitous drop in calls was related in some way, and then we started getting a number of calls from people asking about mandatory reporting,” she says.

“It’s not that much different to what we have always been professionally and ethically required to do... It’s the perception that is different.”

Dr Kay says the service’s consultants also report that callers are now admitting they delayed seeking treatment because of mandatory reporting, and that they are seeing an increase in doctors reporting to be suicidal.

AMA president Dr Steve Hambleton says it’s regrettable that doctors don’t feel they can seek the advice of a treating doctor without fear of being reported.

“As it stands, doctors are actually not self-reporting, not going to see their doctor as much as they were because they are concerned their livelihood is going to be put at risk,” he says.

Dr Flynn concedes this perception now exists, but stresses it is an unjustified fear.

“The biggest concern we have is that people misunderstand the situation and don’t seek care when they need it because they’re afraid of being reported,” she says.

Melbourne GP Dr Caroline Johnson, a spokesperson on mental health for the RACGP, believes the issue is a complex one that needs more debate to get it right.

“The goal is that health professionals can seek treatment, advice [and] support without fear of being reported. By the same token, we obviously need to make sure there are standards in place and there are safety measures, and I think the legislation hasn’t really addressed that balance.”

The first annual report into mandatory reporting will be released in coming weeks, but Dr Flynn says there has been no major increase in mandatory reports since the change in legislation.

All doctors who come before the medical board are treated individually and sensitively.

“The people who do that role understand they need to look at their public protection role but also need to weigh against that the legitimate interests of the doctor in continuing to work… and their health needs,” she says.

Starting the conversation
TWO years ago federal politician Andrew Robb announced he was stepping down from his duties for three months to seek treatment for a depressive illness.

Openly admitting to having a mental disorder took some strength. Mr Robb says in his memoir, Black Dog Daze, that he knew it could be seen as a weakness and could count against him politically, but  he “couldn’t be cowered by that”.

However speaking up and seeking support for a mental illness can actually preserve professional integrity, explains Dr Caroline Johnson.

“If you put your head in the sand... [it could] increase your risk of being unable to work,” she says.

Usually when it comes to mental illness, most doctors who come before the MBA achieve a good outcome, says Dr Kay.

“Even with severe mental health problems, when people are involved with the medical board most of them get back to work very safely,” she says.

Speaking up also helps reduce the stigma of mental illness in the community, says SANE Australia executive director Barbara Hocking.

“[Doctors] have an important role to demonstrate to the community that in fact there is no shame in having mental health problems, and the earlier you get the support and treatment you need, the better it’s going to be for everyone.”

Under the Australian Medical Council’s code of conduct, any doctor concerned that their health status may adversely affect their judgement, performance or their patient’s health must seek medical advice and not rely on their own assessment of the risk posed to patients.

In its document, Guidelines for Mandatory Notification, the MBA offers advice and questions to help reporting doctors choose the best course of action.

It stresses that the threshold that must be met to trigger a mandatory notification is high.

“The notifiable conduct of the practitioner must have placed the public at risk of harm as well as being a significant departure from accepted professional standards before a notification is required,” it says.

AVANT’s special counsel in professional conduct, Helen Turnbull, says the first step for reporting doctors is to approach their colleague with their concerns and encourage them to seek advice.

It is also vital they take time to consider the facts and seek advice from colleagues, medical defence organisations and/or support services so the burden of reporting is a shared decision.

“As they talk through it, they realise in many cases that it’s more an element of a colleague simply being unwell, i.e. suffering from depression, but there is no actual impact on patient safety,” Ms Turnbull says of many of the doctors who call them for advice.

Dr Johnson says all doctors should try to become involved with a GP support network so they have a forum where they can seek advice in these situations.

SWSLHD and Bowral's Health - 41

Mental health nurses improve access

• By Gemma Collins on  24 October 2011 - 6Minutes

Incorporating mental health nurses into general practice can lead to better outcomes for patients and GPs, but a shortage of these specialist nurses could make it difficult to expand the program, a pilot scheme has found.

A four-year program, which involved mental health nurses working with GPs and private psychiatrists in five states, was found to have “significantly improved” access to appropriate mental health services, a report has revealed (link).

More than 40,500 people received a service through the $191.6m Mental Health Nurse Incentive Program (MHNIP) from 2007-2011, in a range of areas which ranged from one nurse supporting one practice to seven nurses supporting 29 practices, according to the recently released report.

The authors say the program led to earlier intervention, shorter admissions and better follow-up with patients receiving mental health services in “convenient and non-stigmatising settings”.

GPs said they felt better supported in their work with mentally ill patients and said their knowledge and confidence had improved. 

Out of the 57 patients who were surveyed, 80% reported improvements in their mental health and almost half reported improvements in their social relationships. 

The government has since announced it will allocate a further $13m over two years to employ an additional 136 mental health nurses.     

But the limited availability of ‘credentialed’ nurses, particularly in rural areas, could make it difficult for the program to expand, the authors say.  

The funding which was based around a fixed payment per half day session was also found to be a deterrent, as it did not allow for any additional costs including computers or professional development and for the extra time needed to get around rural areas.

Now here is an interesting tale! I'm told that the Southern Highlands still has only one Credentialed Mental Health Nurse who provides this service. Other's have tried to enter the SH area to also provide the service but have not been supported by .... you guessed it !... the CEO of the Southern Highlands Division of General Practice..... who suggests it may be due instead to the others not being able to market themselves to the GPs. I guess it does not help if the CEO informs the GPs who are interested that they would be more open to being audited and other bits of misinformation guaranteed to turn off even the most ardent advocate for the program. The fact remains that since the failure of their own staff member in achieving credentialed mental health nurse status, the Southern Highlands Division of General Practice has taken their bat and ball and left the MHNIP field of play.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 59

Southern Highlands Division of GPs - Is this its last Hurrah?

A strange thing happened on the way to the Forum a few weeks ago! Sighted coming out of Springett's Arcade into the Oxley Mall carpark was a very distracted CEO of the Southern Highlands Division of General Practice, Dr Warwick Ruscoe. No doubt he was trying to work out if he will have a job (or a Division) after July 1st, 2012.


It has been interesting to follow the fall and fall of the SHDGP and its diehard Chair and CEO. I notice that even the Sydney South West GP Link (formerly the Macarthur Division of General Practice) is being very peripheral in its reference to any possible association with the Southern Highlands Division. Like an afterthought, the reference is tacked on the end of their latest news on their website. Possibly much like their expectation of what they think they can bring to the Southern Highlands.

In his September 2011 SHDGP Newsletter column the CEO says: "Successful applicants to establish Medicare Locals in rounds 2 and 3 are expected to be notified in October or November, for implementation in either January or July 2012." Hope springs eternal in his breast, it seems. Fortunately, the CEO has kept it a very brief comment this time round. Perhaps Dr Ruscoe has seen the fickle finger of fate writing on the wall of his office.


However, the Chair (Dr Vince Roche) of the SHDGP Board was a bit more forthright in the same September Newsletter - well perhaps a lot more forthright in his comments! He says: "In my last piece in May, I wrote that “the pace of threatened Primary Care reform quickens!” I would qualify this now with the further words “for some”!" This was possibly a reference to their failed attempt at convincing that the combined Macarthur-Southern Highlands Medicare Local submission should have been one of the Round One successes. Is this sour grapes? 

Dr Roche states in the Newsletter: "A great deal of time and energy has been invested by Warwick, Sally and myself in getting our Medicare Local (ML) proposal – in conjunction with the Macarthur Division of General Practice (now known as SSW GP Link) – ready for the second application deadline in July. Huge efforts were made to have Bankstown GP Division join Southern Highlands Division and GP Link in this proposal, as Bankstown lies in the ML footprint determined by the Federal Government. However, at the last moment, negotiations fell through and Bankstown again lodged an independent proposal."

What is not stated is that the Bankstown GP Division rejected the advances of the Macarthur-Southern Highlands consortium because they felt that itwas not in the best interests of their consumers. They knew this because they had frequent and extensive community forums with consumers, NGOs and public and private health providers. They also felt that the Macarthur-Southern Highlands proposal did not understand the social demography of their population, nor did it respect the GP and other healthcare providers in the Bankstown area.


Says Dr Roche: "The first 19 MLs were announced in June – and four in NSW. Why four? A cynical observer might postulate that one went to an urban ML (Western Sydney ML), one regional (Hunter Urban ML), one rural (Murrumbidgee ML) and one to an Independent MP's seat (New England ML)." Perhaps the only cynical observer is Dr Roche. Perhaps those four NSW Medicare Locals simply put in the best submissions by complying with all the criteria that the Commonwealth had required. Something which the SHDGP did not.

"The federal Government will announce the successful bidders in October or November, and these MLs will become operational from January or July 2012", says Dr Roche. Alarmingly, Dr Roche is suggesting a: real need to bring GPs from the Divisions into cooperation and participation as leaders in the new MLs, and that experience serving in Divisions over the previous 18 years had created skills in governance, service delivery and population health that few other potential ML Board members drawn from other branches of healthcare would have in the short term." This is the sort of self-promotion which seems to have been the cause of the failure of the Macarthur-Southern Highlands sortie into the Bankstown GP Division's jurisdiction.

Perhaps, the people of the Southern Highlands can do without the entrepreurship and empire building of the Macarthur (SSW GP Link)-Southern Highlands consortium. Let's just depend upon the GP Practices to continue to deliver all the services we need.

SWSLHD and Bowral's Health - 40

GPs to prepare for mental health cuts

• By Gemma Collins on  21 October 2011 - 6Minutes

Many bulk-billing GP practices will have to start charging patients for Better Access services, the RACGP says.

With the final report into the Senate inquiry on mental health cuts being delayed, the College has said that the changes to the Better Access general practice mental health item numbers announced in the May budget, are likely to come into effect from November 1. 

Ina  series of likely scenarios (link) the College says it will continue to lobby the government but “practices may require revised practice systems and billings in order to continue delivering high quality patient care”.

College members have come up with a list of different practice scenarios to provide GPs with alternatives models of care for mental health services.

It has given the scenarios of a large practice in the northern suburbs of Melbourne and a small busy private practice in the western suburbs of Sydney that will both no longer be able to afford to continue bulk-billing mental health services through the Better Access program.

They will instead charge a patient co-payment for all the mental health services or refer their patient to public state-based services.

Meanwhile a medium sized private rural general practice in Queensland that employs a practice nurse with mental health skills is planning to use General Practice Management Plans (GPMP) and Team Care Arrangements (TCAs) which will involve the GP and the practice nurse who will coordinate mental health screening and assessment. 

Meanwhile a fourth scenario for a bulk-billing practice that is unable to charge a patient co-payment due to its service charter, is to use the new MBS item 2715 in combination with other appropriate MBS items.

GPs are being told to contact the RACGP Policy & Practice Support Unit for advice (advocacy@racgp.org.au)

Comments

We drew up our new fees at the beginning of October and published them at the practice for patient’s information. Mostly our Gap is $30, but the gap for <40minutes plan is higher. I only realised this week when I received a mailing from Psychologist Association the if a patient has already used 10 sessions this year, they are ineligible for any more session after November 1st.

Milton Doctor | 22 October 2011 at 20:56

SWSLHD and Bowral's Health - 39

‘Vexatious’ big tobacco swamping plain-packaging push

20th Oct 2011 AAP   all articles by this author - Medical Observer

THE federal health department is considering taking action against big tobacco for lodging "vexatious" Freedom of Information (FOI) claims as part of the industry's fight against Labor's plain-packaging push.

Health department secretary Jane Halton says the department is being "swamped" with FOI requests as part of a deliberate campaign by cigarette manufacturers.

"This is a very specific and deliberate attempt to divert resources," Ms Halton told a Senate estimates hearing on Wednesday.

"There will come a point where we will have to consider what to do about that."

Ms Halton said there was a provision in the FOI legislation relating to vexatious applicants.

"We are intending to take advice on that," she said. "It is being discussed."

The health department has received 63 FOI requests, of which 52 were from big tobacco. Some 35 are still being dealt with.

The Gillard government wants to force all cigarettes to be sold in drab olive-brown packs from mid-2012.

Cigarette manufacturers have threatened to challenge the world-first laws in court after they pass the Senate later this year.

Ms Halton said on Wednesday big tobacco's FOI requests had cost the department "an awful lot". Industry is disputing some of the charges.

The department secretary said she supported the principle of openness but "the way the current FOI laws are written there are huge opportunities for people who wish to abuse process to do so".

The amount the department can charge for processing requests "goes nowhere near meeting our costs", Ms Halton said.

It can only charge $15 per hour for search and retrieval and $20 an hour for decision-making time. The staff doing the work can earn up to $50 an hour.

"So we are hardly talking reasonable recompense for the amount of time and energy it's taking," Ms Halton said.

British American Tobacco Australia (BATA) argues it's been forced to rely on FOI applications because Health Minister Nicola Roxon refuses to consult industry.

BATA has lodged 15 FOI requests with the health department in the past 18 months and is currently waiting on six to be finalised.

"Documents [already obtained] from the government show they have concerns about the need to pay compensation to the tobacco industry for removing our intellectual property, the growth in illegal tobacco once all packs look the same and an increase in smoking rates due to cheaper cigarettes," BATA spokesman Scott McIntyre told AAP in a statement.

An April 2010 briefing note from the government body, which administers Australia's intellectual property rights system, states plain packaging would impinge on trademark rights.

But, IP Australia points out, that might not be a problem if it serves the public interest.

Greens health spokesman Richard Di Natale says big tobacco is using every tactic possible to derail plain packaging.

"They have resorted to trying to clog up the health department with vexatious FOI requests," he said in a statement on Wednesday.

"The tobacco industry should halt their campaign of mischief and let the health department do its job protecting the public's health."

Under Australia's FOI laws an applicant can be declared "vexatious" by the information commissioner.

Tags: Plain packaging, cigarettes, big tobacco, Roxon, Jane Halton, FOI, freedom of information

SWSLHD and Bowral's Health - 38

TGA knew of Fluvax side effects in 2009

20th Oct 2011 AAP   all articles by this author  - Medical Observer

THE TGA has admitted that it knew in 2009 that Fluvax caused higher rates of fever than other trivalent influenza brands but took no action as the side effects were mostly mild or moderate.

An article in the MJA online on Monday raised questions about the fact that data from trials that found a high rate of fever were not included in Fluvax product information in 2010  (MO, 17 October).

TGA national manager Dr Rohan Hammett was questioned at a Senate estimates committee hearing yesterday about adverse events in children receiving Fluvax in 2010, which led to the withdrawal of the vaccine.

Dr Hammett said the TGA was made aware in 2009 of findings from a published trial that 22.5% of toddlers younger than three experienced fever after being given Fluvax in 2005.

That figure jumped to 39.5% in 2006, but only the 2005 data was included in the 2010 Fluvax PI.

Dr Hammett said people were now using a "retrospective scope" to suggest the TGA should have picked up on the problem before the 2010 flu season.

"Indeed in those earlier clinical trials there were rates of fever for the Fluvax vaccine that were higher than some other comparable vaccines," he told the hearing.

"However... most of those fevers were mild and moderate and there was no sign of a febrile convulsion signal."

Dr Hammett said the TGA had written to CSL seeking “to gain a greater understanding of what they knew when".

"We haven't yet received a response," he said.

Liberal senator Concetta Fierravanti-Wells also quizzed the TGA about the US Food and Drug Administration’s concerns about CSL's manufacturing process, including its accusation of an "inadequate" examination of dark particles found in vaccines sold in the US.

"Why are we leaving it to the US FDA to identify deficiencies with CSL?" Senator Fierravanti-Wells said.

"Why isn't the TGA doing that?"

Dr Hammett said the TGA was currently auditing CSL on a monthly basis.

Tags: CSL, Fluvax, fevers, TGA, Senate Estimates

 

SWSLHD and Bowral's Health - 37

Smokers not quitting after cancer diagnosis

• By Gemma Collins on  19 October 2011 - 6Minutes

 
A cancer diagnosis is not motivating smokers to quit, suggesting the need for a smoking cessation intervention, an Australian study has found.

A survey of 100 patients who were newly diagnosed with cancer and receiving radiotherapy, found that half of the smokers made no reduction in their smoking habits and only two out of the 14 quit altogether, according to the study (link) in the Journal of Medical Imaging and Radiation Oncology (online Oct 18).

The researchers in Victoria and Queensland found one current smoker even increased their smoking after being diagnosed with melanoma while another breast cancer patient took-up the habit.

Any changes in smoking habits occurred within the first 30 days of diagnosis.

Around 79% of the smokers believed that the radiation oncologist should discuss smoking cessation with them and they thought that the first consultation would be the ideal time.

“…the diagnosis of cancer alone is not sufficient to obtain the benefits from smoking cessation by radiotherapy patients and some form of intervention may be appropriate,” the researchers say.  

“The results relating to the receptiveness of the patients to intervention seem to support the concept of radiotherapy providing a ‘teachable moment’ for accepting smoking cessation and perhaps other lifestyle changes.”

They do suggest that the patients are screened for symptoms of depression and anxiety as well as smoking cessation as part of standard cancer care. 

SWSLHD and Bowral's Health - 36

Midwife restriction push women to freebirth

• By Gemma Collins on  20 October 2011 - 6Minutes

New restrictions for midwives are forcing more women to have a ‘free birth’ in their home rather than be treated in hospital, according to midwives.

Speaking at the Australian College of Midwives conference in Sydney, midwife Melanie Jackson said the new legislation, which requires privately registered midwives to secure professional indemnity insurance, means that fewer midwives are doing homebirths.

As a result more women are choosing to go through the birth unassisted, just so they can stay at home, she said.

And she said that although there is no specific data on free births, she estimates there are around 800 free births are going on across the country every year.

“A lot of women who are doing free births don’t want to have a free birth but that is their only choice,” she said.

“I think by restricting home birth midwives, the result has been that women do not want to go into hospital so there are more free births.”

Meanwhile, criminal charges are being considered against a former midwife who is now practising as an unregistered homebirth practitioner.

The South Australian Health Minister John Hill has asked  the Director of Public Prosecutions to investigate whether charges can be laid against Lisa Barrett relating to deaths of two babies during home births.

SWSLHD and Bowral's Health - 35

Four fixes needed for PCEHR

• By Michael Woodhead on  20 October 2011 - 6Minutes

The success of the PCEHR is threatened by the lack of GP input into the program and lack of a Medicare rebate to recognise the extra workload it will create for GPs, the RACGP says.

In a statement released this week,  the College says  the lack of clinical input into the design and implementation of an electronic record system was one of the key reasons for the demise of the UK’s e-health program.

It says the Department of Health and Ageing, NEHTA and the RACGP need to reach agreement on critical issues “such as data quality and ownership within the PCEHR, the PCEHR’s links with clinical software, and possible impact on clinical and practice workflows which will be a disincentive to widespread adoption. “

RACGP president Professor Claire Jackson says the College is also concerned about the lack of any incentives  for general practice for additional tasks such as creating PCEHR documents and obtaining informed consent.

The College has also highlighted two other critical areas of the PCEHR that need attention, citing the need to get patient s from high risk groups to “opt in” and the clinical and medicolegal risks of allowing  patients to alter their clinical record.

A program is needed to encourage PCEHR uptake by the groups that will most likely to benefit, namely patients with chronic and complex conditions, older Australians, Aboriginal people and mothers with new-born children, it says.

GP Super Clinics - Is there ever anything for nothing - 8 ?!

Super clinic collapse warning went unheeded

17th Oct 2011 Byron Kaye   all articles by this author

HEALTH Minister Nicola Roxon’s office was warned 14 months ago that the Sorell GP super clinic would collapse without extra funding but promised to “make a priority of sorting this immediately post election”, MO can reveal.

But rather than give a $1.5 million lifeline as requested by its operators, the Department of Health and Ageing asked the clinic owner after the 2010 election to cut costs by substituting curtains for walls between doctors’ rooms, lowering the entire building, and relying on “natural ventilation” instead of toilet exhaust systems.

Edward Gauden, CEO of Sorell Integrated Healthcare (SIH), which was to operate the Sorrel super clinic, refused these requests but, encouraged by Ms Roxon’s office, was holding out for other commonwealth funding when he learned on the evening news this month that the minister had scrapped the project.

Emails between the offices of Ms Roxon and local Labor MP Dick Adams, the department and Mr Gauden, obtained by MO, confirm Mr Gauden’s claims that he had long warned the government that the super clinic – which had support among local doctors – could not be built for the allotted $2.5 million, and that he was repeatedly assured the government would step in to save it.

On 12 August 2010, with the federal election less than two weeks away, Mr Adams’s electorate officer Dee Alty wrote to the minister warning that if a funding solution could not be found that same day, SIH would be “announcing publicly tomorrow that they will not be going ahead as they do not have the funding… It is just insufficient”.

The email also questioned “why the Sorell super clinic is not being seen as a proper super clinic which should like the others attract the $5 million”.

Ms Roxon’s chief of staff Angela Pratt responded that the government was in caretaker mode and could not commit new money, but advised that Mr Adams “should say [to Mr Gauden] that he has spoken to the minister’s office and been given an assurance that we will look at the issue post election if Labor is returned, to get the clinic back on track”.

Ms Alty pressed further, writing the next day that Mr Gauden needed assurance the building would be finished by the end of 2010. Ms Pratt replied: “We will make a priority of sorting this immediately post election… Obviously we don’t want it to fall over either!”

Ms Roxon announced on 7 October 2011 the clinic would not go ahead. Three days later the government committed another $3.2 million to the troubled Redcliffe super clinic in Queensland, on top of an existing $10 million outlay. A spokesperson for Ms Roxon said the department met with SIH “on numerous occasions to assist them in reworking their proposal but unfortunately we have recently been made aware that they will not proceed on this original basis”.

Mr Adams said his office had pressed for more funds, but Mr Gauden should have been able to build the clinic for $2.5 million.

Tags: Sorell; Super Clinics; Roxon; DOHA

Comments

DrPhil
18th Oct 2011
3:27pm

curtains not walls between consulting rooms???? is this 1948 or what????

Limmie
18th Oct 2011
4:08pm

I wonder if Roxon will be happy to see her doctor if the doctor were consulting in a space that is partitioned off with a curtain rather than sound dampened or sound proof walls? How ridiculous is this Minister? I bet, if MO asked her directly, she will vow that she was not aware of the machinations going on with the SIH. Once again, we see evidence that decisions about superclinics have been political rather than business-based. The waste of tax payers money by this Labor government is the same as the days of Whitlam's largess. This spend-a-thon has to stop. As taxpayers, we are not getting value for money.
I don't know the medical manpower supply for Sorell nor whether there is indeed a need for same. It seems the support of local GPs made no difference to the decisions made by the Minister. I wonder, if the local GPs were vociferous in condemning the superclinic, the Minister might consider the request for further funds for the SIH as worthy of supporting. Hasn't that been the pattern of her behaviour. Anything she can do to get stuck into medical practitioners, she will do. Add this to the insult to the Medicare rebate for non-VR doctors now becoming lower than that of "Noctors", can we call this style of governance fair and equitable?

SWSLHD and Bowral's Health - 34

E-health record failure blamed on top-down approach

• By Gemma Collins on  18 October 2011

The failure of the UK’s e-health program has been blamed on rushed implementation, failure to engage clinicians and a top-down government-driven partnership with private contractors. 

A review of the UK’s program, similar to the $500 million PCEHR planned in Australia, concluded that it was “time consuming and challenging, with as yet limited discernible benefits for clinicians and no clear advantages for patients.”

Researchers who reviewed five areas where the IT system was implemented through partners such as Cerner and iSoft, blamed the program’s ‘top down’ approach which led to an “unrealistic, politically driven timeline from the outset”, with “multiple tensions” between the creators and NHS staff.

In their review (link) the authors suggest there needs to be a clear vision and realistic timescale from the start with more “user involvement” of local clinicians and health staff in decision making.

They say a key lesson is the need to “move away from technology driven models of implementation,” and to “consider the merits of participating in the development of open source systems as opposed to the purchase of commercially developed systems.”

Large scale procurement projects were used in an effort to save money, but these often resulted in the ‘tail wagging the dog’ and programs being influenced by the particular type of software implemented.

 

  Comments

Yet another monumental waste of taxpayer funds. With all the privacy restrictions placed on the EHR by well-meaning but misguided people, it will only serve those who don't cause problems within the health system but would potentially generate a lot of wasted time and effort - if doctors had the time to actually do what is being asked. The drug dependent patients and doctor-shoppers where this initiative could be useful will just restrict their EHR access. What's the point of such a system? As in the UK, no benefits, just cost and effort. Why can't we learn from the experiences of others but be doomed to repeat them? Count me out. I'll give my patients a one-page summary where necessary.

Dr. Igor Jakubowicz | 18 October 2011 at 15:43

SWSLHD and Bowral's Health - 33

McGorry’s mental health minefield

17th Oct 2011 Jodie Thomson   all articles by this author

Professor Patrick McGorry is fending off a barrage of bitter and very personal dissent over his approach to mental health.

AT THE eye of the stormy debate around mental health funding sits one man: the 2010 Australian of the Year, Professor Patrick McGorry.

While he’s lifted the profile of mental health among the general public – and been referred to as ‘the most powerful psychiatrist in the world’ – many of his peers have showered him with criticism since the 2011–12 federal budget.

That’s when funding was diverted from  the GP-led Better Access program to early intervention youth services, leaving GPs concerned that there would be a gaping hole in primary care services for mental health patients.

Professor McGorry, an adviser to the government on mental health funding and founder of the Early Psychosis Prevention and Intervention Centres (EPPIC) and headspace programs, has been accused of bias towards his early intervention models and conflict of interest over his advisory position to the government.

There is also doubt about the stated benefits of EPPIC and headspace, which have scored almost a quarter of the $2.2 billion mental health package.

And there’s concern around early intervention treatment that involves giving antipsychotic medication to young people merely at risk of psychosis.

“We need to get broader advice to government, we need the right advisers, who truly understand developmental principles and a lifespan approach,” says Professor Louise Newman, director of the Centre for Developmental Psychiatry and Psychology at Monash University.

The criticisms have grown increasingly personal in recent weeks. Professor McGorry was attacked by a prominent American psychiatrist, Professor Allen Frances, chair of the DSM-IV Task Force, who accused him in the Psychiatric Times of having a “messianic blind spot” and being an “unreliable evaluator of scientific evidence”.

Professor McGorry says these kinds of criticisms are “false and baseless” and “those making them have not been able to substantiate them in the face of facts”.

He vehemently refutes suggestions of a conflict of interest over his advisory role with the government.

“It is unclear exactly what improper behaviour I’m being accused of here,” he says.

“It is also unclear what criteria would disqualify my participation in the expert group due to my involvement in non-profit youth mental health organisations that would not also disbar all other members of the expert group on the grounds of their professional or organisational affiliations.”

The government says Professor McGorry was just one member of the Mental Health Expert Working Group, which was made up of experts from a range of health and non-health sectors, plus consumer and carer representatives.

“While these consultations helped to inform the development of the government’s record mental health package, decisions on the specific content... were solely a matter for the government,” said a spokesperson for Mark Butler, Minister for Mental Health.

With regard to claims of bias over the high proportion of funding that youth mental health received in the budget, Professor McGorry said three-quarters of the mental health budget went to areas other than youth.

“I would also note that when the Independent National Health and Hospitals Reform Commission considered this issue, they made early intervention models the first two of their 12 mental health recommendations.”

Most psychiatrists’ criticisms concern whether the benefits of the early intervention programs have been overstated. Nearly two-thirds of pyschiatrists in a recent poll thought the government’s focus on EPPIC was inappropriate.1

Professor Frances has described it as a “massive new experiment in early intervention”. Others question Professor McGorry’s claims that the programs are backed by solid evidence.

“They’ve made a lot of promises and raised a lot of expectations and these have not been borne out in the studies,” says Professor David Castle, head of psychiatry at Melbourne’s St Vincent’s Hospital.

In response, Professor McGorry argues early intervention programs like these have been used in hundreds of centres internationally for many years with great success.

“Consequently, there is very good evidence that early intervention for first-episode psychosis is more humane, effective and cost-effective.”

Adelaide University Associate Professor Jon Jureidini says he is concerned the early intervention programs have been misrepresented.

“I don’t think there’s anything wrong with either EPPIC or headspace as models, but there are other approaches to youth mental health, and these two approaches have not been proven to the extent where they dominate the funding,” Professor Jureidini says.

Concerns about the efficacy of the early intervention approach are not shared by the Royal Australian and New Zealand College of Psychiatrists (RANZCP), which has called them “essential” in a recent Senate submission on mental health funding.

“The government must commit to the full implementation of a national youth primary care service (headspace or similar) and a national network of Early Psychosis Prevention and Intervention Centres,” the RANZCP submission stated.

One controversial issue is whether the EPPIC treatment model involves giving antipsychotic medication to young people at risk of psychosis.

A trial by Professor McGorry of antipsychotic drugs on people aged 15–40 who were “at risk” of psychosis was recently cancelled.

“A lot of people are very, very concerned about the potential for over-labelling, over-medicalising and over-treating youngsters,” says Professor Castle.

“In America there’s been a 400% increase in bipolar diagnosis in children, and these kids do not all go on to get bipolar disorder. There’s a danger this sort of stuff will happen here.”

Professor McGorry, however, has repeatedly stated that antipsychotic medication will not be used as a first-line treatment option.

“A key goal of youth mental health models... is to address the over-medication of people with mental ill health in our overstretched and under-resourced mental health system,” he wrote recently on his website.

AMA president and GP Dr Steve Hambleton supports the need for early youth intervention.

“In general we want to intervene early and it doesn’t necessarily mean early use of medication,” he says. “We don’t want to label people too early, but services like headspace are appropriate for young people. We don’t want to put people on medication up front and Professor McGorry doesn’t want to do that either.”

For many GPs, a crucial issue is whether Professor McGorry’s influence has seen funding diverted to early intervention services at the expense of the Better Access program.

“Everyone would applaud his bringing youth mental health issues to the fore, but we have a right to be very angry about the diversion of funding,” says Dr Brian Morton, chair of the AMA Council of General Practice.

While the RANZCP and AMA acknowledge there may have been problems with evaluating Better Access properly, GPs believe the cuts will be devastating.

“The mental health cuts are going to disadvantage patients, in particular those who have more chronic and difficult issues,” says Perth GP Dr Stephen Wilson.

Professor McGorry describes Better Access as an “excellent program” that has been a “building block for mental health reform”.

“While I personally did not advocate the changes made in the recent budget – nor did I have prior knowledge of the changes – now that this has occurred, we need to review what is really required to provide appropriately skilled care for those with more complex mental disorders for which Better Access was designed,” he says.

“In the very next federal budget, the federal government [should] fund a more specialised tier of service which would draw in clinical psychologists – who are clearly required if the problem is more serious and persistent –  psychiatrists in many cases, and other disciplines as well, notably social workers and occupational therapists.”

Some argue the real need is for more independent analysis of all areas of mental health and a more involved discussion on which ones have the greatest need.

“I would implore people like Patrick McGorry to understand they are a part of a much bigger system,” says Dr Wilson.

“They need to take a step-back view of policy and realise it’s not just their area of work that needs a lot more funding.”

Professor McGorry says his core recommendation is that mental health policy should ensure all Australians of all ages have the same access to quality care for mental ill health, as for physical ill health.

“Those criticising the decisions of the government on mental health reform are perfectly entitled to do so, though it would be good to learn what their alternative plans are, if any, especially for the million young people with mental ill health,” he says.  

Reference

1. Psychiatry Update, 6 October 2011, http://enews.psychiatryupdate.com.au/cgi-bin19/DM/t/nMCS0FVx0FM0j7tF0E7

 

SWSLHD and Bowral's Health - 32

Fels to chair Mental Health Commission

17th Oct 2011 Mark O’Brien   all articles by this author

PROFESSOR Allan Fels, AO, has been welcomed as the replacement chair of the first National Mental Health Commission, which is set to report on the state of Australian mental health care and suicide prevention next year.

The commission is to be established by the federal government as an independent body and will report to the Prime Minister.

Professor Fels is best known as the former head of the Australian Competition and Consumer Commission and is dean of the Australia and New Zealand School of Government, chair of the Haven Foundation and patron of numerous mental health organisations.

The appointment follows the decision of senior South Australian Catholic priest Monsignor David Cappo, the government’s original choice for the role, to decline the job last month.

Monsignor Cappo was forced to turn down the position following accusations he had not acted “in a timely manner” when Adelaide-based Anglican Archbishop John Hepworth revealed he was the victim of violent rapes at the hands of three priests beginning in 1960.

Mental Health Council of Australia CEO Frank Quinlan said Professor Fels had championed mental health reform for many years and his work in the sector made him the ideal choice to chair the new commission.

“Professor Fels will bring his years of experience on administration, leadership, and advocacy to this position, and his appointment is warmly welcomed by the mental health sector,” he said.

“The establishment of a Mental Health Commission is a key part of the Government’s mental health reform agenda, which includes delivering a 10-year roadmap to reform.

“The MHCA looks forward to working with Professor Fels in achieving this milestone in mental health.”

Mental Health Minister Mark Butler said commissioners would be drawn from a range of areas and would improve transparency and accountability in the system.

Professor Fels said the commission would advocate for consumers and carers and ensure their needs were “given the priority they warrant by all levels of government”.

The commission’s responsibilities include managing the Annual National Report Card on Mental Health and Suicide Prevention, monitoring the performance of the mental health system and providing policy advice to the government.

SWSLHD and Bowral's Health - 31

Doubt over effectiveness of domestic violence training

14th Oct 2011 Catherine Hanrahan   all articles by this author

TRAINING GPs to identify women experiencing domestic violence dramatically increases referral to specialist services, a new study shows, but experts question whether it actually benefits the victims.

In the UK study, 24 general practice teams were given prompts in their medical record software to ask women about abuse, and training sessions were delivered by domestic violence experts who also acted as the advocate for referral.

The research showed that practices trained to identify cases of domestic abuse referred 223 women to advocacy over a 12-month period, compared with only 12 referrals from practices not given the intervention.

Similarly, practices in the intervention group recorded three times more cases of domestic violence than the control group.

“We showed… clinician behaviour with regards to domestic violence – a major public health and healthcare issue that has largely been ignored in clinical practice – can be changed,” the authors said.

Associate Professor Kelsey Hegarty, who leads the University of Melbourne’s abuse and violence research program in the Department of General Practice, said in an editorial published with the study that it showed the intensiveness required to change clinicians’ behaviour.

“However, the clinical significance is unknown and therefore it is difficult to be sure whether this intervention, if replicated, will improve abused women’s health and wellbeing,” the editorial said.

The Lancet 2011; online 13 Oct

Tags: domestic violence, general practice teams, advocacy

   

Comments:

Mia
14th Oct 2011
4:59pm

When a system of management fails to work optimally at times there is a confounding variable.
It has been traditional to categorise domestic violence management under the notion of assailant and assailee.
After decades of working as a GP I tend to see the phenomenon as a dyadic or co-dependent one: That both parties have difficutlies in negotiating differences in a win-win style. Commonly one utilises their physical powers, the other chronic low grade passive aggression which causes the other to snap using the only skill that they know.
Could it be that we need to redefine the concept of domestic violence.

SWSLHD and Bowral's Health - 30

Inquiry into rural classification scheme

• By Gemma Collins on  14 October 2011

The strongly disputed new rural classification system is to be investigated as part of a Senate inquiry into the factors affecting health services in the bush.

The review which was given the go-ahead yesterday will help determine whether the Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system is ensuring “appropriate distribution of funds” and “delivering intended outcomes”.

It follows ongoing criticism from rural GPs who insist the incentive scheme, introduced in July last year, is resulting in rural and remote areas losing doctors and struggling to attract them to the area, as it places many smaller rural towns in the same classification category as larger regional centres.

For example, doctors receive the same payments under the Rural Relocation Incentive Grant scheme whether they practice in the rural town of Werris Creek in NSW or in Hobart.

Dr Paul Mara, President of the Rural Doctors Association of Australia, who has been campaigning for a review of the scheme, said: “It is hard enough for small rural towns, often with not much more than a main street with a Chinese restaurant, a war memorial and a café, to attract doctors.

“They should never have been classed as equally or less regional than major coastal cities with their tourist attractions, schools, restaurants and large hospitals.”

Australian Greens Senator Rachel Siewert called for the inquiry in the Senate yesterday which will be referred to the Community Affairs References Committee (link).
The inquiry will also look at the effect of the introduction of Medicare Locals on the provision of medical services in rural areas.

A report is due back on April 30 next year.

SWSLHD and Bowral's Health - 29

Quitters need support to try and try again

• By Gemma Collins on  14 October 2011

Smokers make many failed attempts to quit, suggesting more needs to be done to reduce long-term relapse, Australian researchers have found. 

Using data involving more than 21,000 smokers, researchers from Cancer Council Victoria found that the majority of quitters succeeded in staying smoke-free for more than a month, with one third having stopped for more than six months.

And the average 40-year-old smoker who started in their teens will have made over 20 failed quit attempts, according to the study (link) published in Addiction (online 12 Oct).

The review of the data from the International Tobacco Control 4-Country survey that involved smokers from Australia, Canada, UK and the US, also revealed that it was very common for smokers to think about quitting but never attempting to do it.

The researchers suggest “smoking cessation is clearly on the minds of most smokers” but the “key challenge” is helping smokers stay quit long term.

And they recommend there needs to be different interventions for those who think about quitting, those who attempt to quit and fail and those who are able to stay smoke-free for a longer amount of time.

“There is a huge amount of unsuccessful quitting activity going on among smokers.,” they say.

“We need to review what we consider to be success when around one third of current smokers have achieved that milestone (six months abstinence) in the past.”
 

SWSLHD and Bowral's Health - 28

Drug abuse fears

Anthea Cannon   |  October 14th, 2011

ABUSE of prescription drugs and a growing black market in Geelong has health authorities and police scrambling for a solution.

They say drug users are turning to anti-anxiety drug Xanax and painkiller oxycondone because they're easier to access than illicit drugs.
They're calling for a database to stop "doctor shopping", which fuels the black market.
Barwon Health drug expert Mark Davies said Xanax, called "angry" on the street, was a "complete disaster of a drug" because it made users extremely violent.
"I think it should be banned," he said. "Users can't remember stealing and having car accidents, it's a very difficult drug to use properly."

Geelong police say Xanax use has increased and is regularly found in raids.

A spokesman for Health Minister Nicola Roxon said she was working with the states to establish a national system to address forgery and doctor shopping.
Dr Davies, who founded the Barwon Health methadone program, said the highly-addictive oxycondones, mainly OxyContin, now represented 40 per cent of opiate users, instead of heroin.
"Oxycondones are like heroin, you're relaxed and calm when you're on them and then bad on the withdrawal," he said.

Dr Davies spoke about the dangers of the drugs at a seminar in Geelong on Tuesday. He said users either took a handful of the prescription tablets or dissolved and injected them, which was extremely dangerous.
Unlike oxycondones, there is no treatment program for Xanax.
"It's a very similar drug to rohypnol which was banned, it's four times as strong as Valium and you just need to stop it or change to lower doses of Valium," he said.

Geelong Divisional Response Unit Sergant Nick Ryan said Xanax abuse was "absolutely" on the increase.
"When illicit drugs aren't available, these drugs are easy to get," he said. "People 'lose' their prescription and report it so they can get another one but they're selling them.
"We're regularly finding them when we execute warrants  cannabis and amphetamines are the worst, then Xanax.
"It's not coming from Melbourne, it's all local."

Sgt Ryan said, while amphetamines sold for about $100, Xanax tablets were $20-$50 each and many people took more than one or two at a time.
He said people on Xanax became irrational and violent and broke the law, not to sustain their habit but as a symptom of it.
"They are very difficult to deal with," he said.

Barwon Medicare Local medical advisor Jane Opie said, because of the severity of the problem, several clinics refused to prescribe Xanax, while others only prescribed it to long-established patients.
She said a system for doctors and pharmacists to monitor prescriptions would make a big difference to the prevalence of abuse.
"It's (doctor shopping) very commonplace. Every single doctor would have experienced it, especially within the central bulk-billing clinics with more transient patients," she said.
Australian Medical Association Victoria president Harry Hemley agreed that abuse of prescription drugs was increasing.
The association is calling for an online, real-time prescription monitoring system to stop doctor shopping, greater access to detox and pain management services and more prescription education for doctors.

A spokeswoman for Pfizer, which makes Xanax, said the product information cautions doctors about prescribing the drug to people known to be addiction prone or increase their dosage.
Purdue Pharma, makers of Oxycontin, did not respond to a request for comment before deadline.

XANAX
Xanax is in a group of drugs called benzodiazepines.
It affects chemicals in the brain that may become unbalanced and cause anxiety.
Xanax is used to treat anxiety disorders, panic disorders and anxiety caused by depression.
Side effects include drowsiness, dizziness, light-headedness, fatigue, unsteadiness and impaired coordination, and vertigo.

OXYCONTIN
OxyContin (oxycodone) is a narcotic pain reliever similar to morphine.
It is used to treat moderate to severe pain that is expected to last for an extended period of time.
OxyContin is used for around-the-clock treatment of pain.
The most commonly reported effects include memory loss, constipation, fatigue, dizziness, nausea, lightheadedness, headache, dry mouth and anxiety.
Source: www.drugs.com


anthea.cannon@geelongadvertiser.com.au

GP Super Clinics - Is there ever anything for nothing - 7 ?!

AMA calls for super clinics inquiry

13th Oct 2011 AAP   all articles by this author

HEALTH Minister Nicola Roxon has taken a swipe at the AMA following the association’s call for the auditor-general to investigate the federal government's GP super clinics program.

The move by the AMA comes after Ms Roxon announced the scrapping of a planned clinic in Darwin on Wednesday and the axing of a Tasmanian super clinic last week.

AMA president Dr Steve Hambleton has written to Auditor-General Ian McPhee "urging a thorough audit of the program by the Australian National Audit Office".

Dr Hambleton accused the government of putting political needs ahead of patients.

"There is emerging evidence that the GP super clinics program is a failed initiative in concept, design and implementation," he said in a statement.

"In terms of planning, the location of clinics appears to be largely a political process that is not necessarily linked to community need."

Ms Roxon hit back, accusing the AMA of being unhelpful.

"The AMA is not interested in ways to improve the GP super clinic program," she told AAP in a statement.

"They have never supported it and never accepted the need to find ways to attract doctors to undersupplied areas.

"Those who don't change with the times are often reduced to an ineffective chorus muttering on the edge of the stage about keeping things the way they always were."

It was revealed last week that a $2.5 million clinic in Tasmania was to be abandoned, while on Monday Ms Roxon pledged $3.2 million to bail out a stalled Brisbane clinic.

Dr Hambleton said that if the program was found to be flawed, allocated funds should be redirected to improve existing general practices.

The Coalition's Parliamentary Secretary for Primary Healthcare, Dr Andrew Southcott, said the GP super clinics program was a shambles from the beginning.

The Country Liberals MP for Solomon, Natasha Griggs, said Ms Roxon needed to explain how the $5 million originally allocated for primary healthcare in Darwin was going to be spent.

Ms Roxon said 17 GP super clinics are operational Australia-wide. Another 16 are providing early services or are under construction.

Tags: Nicola Roxon, GP Super Clinic, AMA, Steve Hambleton, National Audit Office