SSWAHS and the Director General of NSW Health

Some may not know that the Director General of NSW Health was once the acting CEO of the SSWAHS predecessor South West Sydney AHS. She also spent some time in the same role in the Illawarra AHS before overseeing the big merger of Area Health Services to their current Imperial status.

With the light going on that there may be a change in the NSW parliament this is what Deb Picone has come out with. She wants our input - oh really! Read for yourself:

Below is a statement distributed today by the NSW Health Director-General, Professor Debora Picone. Croakey readers have already been in touch to say it looks like a case of deja vu. Or back to the future, perhaps…

“Today the Premier Kristina Keneally and the Deputy Premier and Minister for Health, Carmel Tebbutt have released a discussion paper proposing the establishment of 17 Local Health Networks in New South Wales.

You will recall that in April this year the Commonwealth, State and Territory Governments (except WA) reached agreement to reform health care in Australia, to make our health system more sustainable, improve patient care through strengthened local decision-making and improve integration between Commonwealth and State Health Services.

The establishment of Local Health Networks (LHNs) are a key component in driving the implementation of the reforms. As you know, senior health officials and I have been holding forums around the State to seek the views of community, clinicians, and health managers on the best way to approach the creation of the LHNs.

We have used your feedback to develop criteria for the establishment of the networks and drafted a proposal that the Minister and I are now seeking your feedback on, along with that of community members and representative organisations.

The Discussion Paper represents the next significant step in the reform process and proposes 15 LHNs comprising a group of hospitals with geographical or functional links which will work closely with new Medicare Locals to ensure better integration of services. In addition there will be 2 specialist networks – the Sydney Children’s Hospitals Network (Randwick and Westmead)and Forensic Services.

The paper gives a practical outline of the responsibilities of LHNs including: local planning and delivery of clinical services, budget management, clinical governance, patient services, infection control and workforce management.

The paper also includes a commitment to ensure that some of the gains made in recent years such as clinical service networks and our focus on the health needs of the population continue. This reflects the very strong feedback of our clinicians.

Each LHN will have a Chief Executive and Governing Council which will comprise members with a variety of health, clinical, business and other skills. Local clinicians will be included in the membership of governing councils.

I would urge you to have a look at the paper (www.health.nsw.gov.au ) and ask that you provide us with your thoughts and comments over the next four weeks.

Once the boundaries are finalised we will be making the necessary changes to establish the Local Health Networks which will replace the current eight Area Health Services. It is anticipated the bulk of the changes will be in the senior levels of management.

Some key principles will underpin these changes including:

· No disruption to direct patient care services

· These changes will not result in reduction of front line staff

· Openness and transparency in providing information to staff

I am keen to minimise any disruption to you or your colleagues as we transition to the new structure. And I am committed to maintaining regular contact with you, as will your direct managers so as to keep you informed.

I recognise that the transition to LHNs presents some challenges but the scale of national health reform also provides us with great opportunities to improve our already world class health system so that we continue to deliver the best possible patient care.

This is an important time in NSW Health and your input is key in making the best decisions for our public health system. I will continue to meet with staff over the coming weeks and I look to forward to receiving your feedback.

Kind regards

Professor Debora Picone AM
Director-General

Well, Socrates hopes that the discussion does include some with the local communities to be affected by these changes. For so far, there hasn't been much except for those conversations with the sycophantic characters already jockeying for the new jobs or promoting their availability of being on the local clinical councils.
Somehow the process looks like any other NSW Health procedure. Keep it in-house as much as possible and keep the natives in the dark. Smoke and mirrors, smoke and mirrors!
As for not reducing front-line staff! Well that's a load of bull dung already. They've just spent a good part of 2009-10 getting rid of many front line staff by whatever means possible in the SSWAHS Empire. Just look at the number of existing staff doing more than one role and ask the SSWAHS Executive about the number of clinical staff they have run out the door.
As for "Openness and transparency in providing information to staff", it would be nice if, just for once, the SSWAHS Executive were open and transparent in providing information to the community they are meant to serve.

SSWAHS and its false commitment to the people of the Southern Highlands

Well it would appear to Socrates that the claws of the SSWAHS Empire are out and unsheathed when it comes to their last outpost - Bowral.

For years, the health services in the Wingecarribee have struggled to improve the hospital and community based services to the local population. Specialist surgeons are not the only ones feeling the sharpness of the SSWAHS pruning knife. How many clinical and administrative positions in the Bowral Hospital are piggy-backed onto the roles of other positions? How many staff have more than the one role within the health system?

The Community Health Centre in Bowral said farewell to its hardworking (and only) Women's Health Nurse earlier this year. To date - not replaced or even advertised. Why? No doubt the position will become a shared position with the SSWAHS Macarthur health services.

The full time Sexual Assault Worker in Bowral was reassigned to the Macarthur Sexual Assault Team. That worker has great difficulty in managing the crises of sexual assault within the Southern Highlands because of the competing demands from the Macarthur service.

The full time Aboriginal Mental Health Worker position in the Wingecarribee was made vacant by the resignation of the staff member earlier this year. The replacement Aboriginal Mental Health Worker is now a position shared with the SSWAHS Macarthur health service.

The full time Bowral Mental Health Welfare worker who had been "loaned" to the Wollondilly Community Health Centre for one day a week to help them out temporarily seems to have gone into a permanent work program there, thereby denying fulltime services to patients in the Wingecarribee.

The Clinical Nurse Consultant at the Bowral Community Health Centre responsible for managing and monitoring wound care of patients discharged from the Bowral Hospital was successful in gaining an after hours Nurse Manager position at the Bowral Hospital. The community nursing staff (and the general practitioners of the Southern Highlands) are still waiting for SSWAHS to advertise that vacant clinical position. The thinking is that SSWAHS will also see this as a shared position with their Macarthur health services.

To add salt to the wounds of the people of the Southern Highlands, so to speak, SSWAHS Executive has also approved the "lending" of the Bowral Community Nurses to fill the vacant positions of their Community Nurses at the Macarthur health service's Rosemeadow facility. Our Bowral Community Nurses are already over-stretched in performing their current home nursing loads within the Southern Highlands without having to try and prop up the Macarthur services.

SSWAHS as we know it is in a terminal state. The unfortunate outcome for the people of the Southern Highlands is that all that has been done in the past to deliver the best possible health service to the local area is now being bled dry to prop up the carcase of an Area Health Service in terminal decline.

If you think SSWAHS will honour any commitments to Bowral Hospital, think again!

Balmain Hospital Casualty Changes

CAMPAIGN TO RESTORE 24HR CASUALTY SERVICES AT BALMAIN HOSPITAL

Community Update - December 2009

The Leichhardt community has united together to oppose the cuts to Balmain Hospital Casualty Services that has seen the 24 hour casualty service wound back to 8am to 10pm .

Council representatives, key local organisations and residents were called into a meeting with the Sydney South West Area Health Service (SSWAHS) on Monday 27 April 2009 to discuss supposed enhancements to the services at Balmain Hospital. SSWAHS proceeded to tell those present that they were 'expanding' the service and that the service would be open 7 days, 8am to 10pm. Going from a 24 hour service to a 8am to 10pm service doesn’t sound like an expansion of services!

Since then, Leichhardt Council has sought a meeting with the NSW Minister for Health; to discuss these changes but have not received a response. Council has also sought support from the Member for Balmain, Verity Firth MP for this important campaign.

Council has held two public meeting including a public meeting that was held in front of Balmain Hospital. Over 150 people heard many passionate and expert speakers explain the need to retain the 24 hour casualty service, some telling their story of how the Hospital had been there to provide casualty services and treatment in the middle of the night.

As per the resolution adopted by the public meetings, a Citizens Committee has been established to guide the community campaign to restore the 24 hour casualty service. This Committee met on Friday 23 October to discuss the campaign and to develop strategies to overturn the decision. Council and the Committee are now in the process of reviewing current and future local health needs and encouraging the Member for Balmain and Minister for Health to overturn this decision as soon as possible.

If you would like to participate in the Citizens Committee or have any queries regarding the campaign, please contact Council's Media & Public Affairs Officer on (02) 9367 9351.

Cr Jamie Parker

Mayor of Leichhardt

And this was the earlier Mayoral Minute which galvanised the Leichhardt community to action!

MAYORAL MINUTE TO MEETING 28 APRIL 2009

HOURS OF BALMAIN HOSPITAL CASUALTY DEPARTMENT

Balmain Hospital is a crucial part of the Leichhardt municipality and provides excellent care and support for residents. The full hospital service was downgraded in the 1990's and the service was 'replaced' with a 24 hour casualty service in order to blunt the concern of local residents.

Residents may have seen the report in the local newspaper about the rumour that the Balmain hospital 24 hour service was closing. Over the years we have heard this rumour and it has been refuted by Ministers and the Dept of Health and was refuted most recently by the former Premier.

Late last week I received an email requesting I attend Balmain Hospital for a meeting at 10am Monday morning. I agreed to attend but was not told of the purpose of the meeting despite asking. When I attended there were several local representatives from the Chamber of Commerce, Cr John Stamolis, Balmain
Association, and Precincts amongst others. There was also a representative from the local GP network as well as staff from the Department of Heath, Balmain hospital and RPA. They proceeded to tell us that they were 'expanding' the service and the service would now be open 7 days 8am to 10pm. In fact they are
cutting the service.

The Area Health Service is proposing to use the money from the cut service to provide more of an existing service. All of the posters and brochures had already been made up none of which actually indicate the service would be cut We were told letters were being sent that day to all local residents. No discussion - no respect for the community or Council.

This was particularly cynical as the local member has said in the local paper that if there was to be any changes there would be consultation before any announcements. Well guess what the announcement was made at 11am one hour after our 'consultation meeting'.

It is clear that even when this statement was being made to the local papers the decision had already been made. It takes several weeks to design and print posters and to process a full mailing to thousands of people. As our meeting went 'overtime' we left around 11am and ran into the local papers who were there for the announcement.

So in a very cynical manner the community was indeed consulted before the announcement
C124/09
RESOLVED PARKER/STAMOLIS

Council writes to the Health Minister and Premier expressing our deep concern with the decision to reduce the opening hours of the Hospital and express our disappointment with the process.

• That a meeting be sought with the Minister for Health with the Mayor and interested Councillors.
• That Council also write to the Local Member seeking her support.
• That Council convene a public meeting to discuss this matter and that the Local Member be invited.
  

CARRIED UNANIMOUSLY

Socrates can't help but notice the involvement of the Leichhardt Division of General Practice in supporting the decision of SSWAHS to downgrade the Emergency Department Services at Balmain Hospital. You can imagine that the local Division of General Practice would plan to take over the responsibility for providing emergency treatment to the patients who would typically attend their Hospital's Emergency Department. But the question must be put: "Does every general practitioner have the requisite clinical skills to deal with the more complex medical emergencies seen at Hospital Emergency Departments?"

Old Socrates can't help but notice the similarities between what has happened at Balmain Hospital with the collusion of their Division of General Practice, and what is, likely to happen at Bowral Hospital with the current state of collusion between SSWAHS and the Southern Highlands Division of General Practice.

SSWAHS - Spin doctors can't take a trick!

Socrates found this little gem which comes from Sydney's Inner West Courier as described by its scribe Hannah Parkes on 6 July 2010.

Concord foreshore trail kept a secret

"The good news is you can walk the Concord foreshore trail - but you’re not allowed to tell anyone about it.

In a bizarre move, the Sydney South West Area Health Service (SSWAHS) has said the trail will remain open to the public - with conditions.

A statement sent to the Courier from SSWAHS states: “Out of respect for the patients of the Thomas Walker Hospital and Concord Hospital, access to the foreshore area is not actively promoted”.

This means signs redirecting amblers away from the foreshore trail, up through the hospital grounds and carpark will stay up. It also means the Walking Volunteers, who have been working for years compiling maps of harbour foreshore walks, will not be allowed to include the Concord route on their maps.

Walking Volunteers member Leigh Shearer-Heriot said the decision was “breathtakingly weird”.

“Never in our wildest dreams did we think this would be a problem,” he said.

“This is the jewel in the crown of the walking trail, and with all the social history of Dame Eadith Walker opening her estate up we thought this would remain open.

“It’s like China’s views on Taiwan, they know it’s there, we all know it’s there but we’re not meant to talk about it.”

Drummoyne State Labor MP Angela D’Amore said she supported the decision because it provided protection for patients while maintaining public access.

But Philip Jenkyn, foreshore activist and member of the Walking Volunteers said the government’s use of patient safety as a reason was inadequate.

“If walkers are redirected through the hospital grounds they are more likely to come into contact with patients,” he said.

“That cannot be the real reason, there are hidden agendas and they are connected to that land.”

In a further twist a plaque unveiled in 1985 by the then premier Bob Carr when the track was opened to the public has been removed.

A spokeswoman for the SSWAHS said the hospital was unaware of the removal."

Craig writes:
Posted on 11 Jul 10 at 03:40pm

"This reads like an episode of Yes Minister... I suspect Sir Humphrey Appleby is lurking somewhere in the background."

Socrates tends to agree with Craig who made this insightful comment soon after the Courier publication was posted. Can any of you tell Socrates of any other hospital where the public are refused entry to any hospital grounds. I wonder how many community members are refused access if they have to attend the SSWAHS hospitals for medical services or to visit family and friends who are patients of the hospitals in the SSWAHS Empire.

About the Southern Highlands Division of General Practice and the Mental Health Nurse Incentive Program.

Imagine if you had the care of someone with a severe diagnosed mental illness to fit in with a busy day's schedule of work, study or simply self care. Wouldn't you feel somewhat relieved if there was someone who could supply a care coordination role to the person with the mental illness. Would that take some of the load off you? Things like medication compliance, re-socialising within the local community, arranging connections with non-government and government services and general practitioners that could usually be out of your reach. Well the answer is to use the Medicare Australia funded initiative: The Mental Health Nurse Incentive Program (MHNIP).

The entry point for this program is through any general practitioner or any general practice who elects to become an "eligible organisation" registered with Medicare Australia. What does it take to become and eligible organisation? Two pages of basic details about the practitioner or their general practice. What do they get in return? If they refer patients for between one to four sessions each week for care coordination the GP or their practice will receive a grant of $5,000. If they refer their patients to five to ten sessions in a week they receive a one off grant of $10,000. The only requirement for the doctor or the practice is that they have to either recruit or engage (contract) a Credentialed Mental Health Nurse to provide the care coordination. There are less than 800 such Credentialed Mental Health Nurses in Australia so when the Southern Highlands have 3 such Credentialed Nurses we could say we are somewhat blessed. However, the Southern Highlands Division of General Practice does not appear to have effectively promoted this MHNIP to its GPs or Practices. Socrates is aware that every other Division of General Practice has wholeheartedly adopted the MHNIP concept except (apparently) for the Southern Highlands Division.

This is what the Royal Australian College of General Practice had to say about the MHNIP:

Fact sheet for general practices

Summary

• General practices can now engage or retain a mental health nurse to assist in managing community based patients with a severe mental disorder.
• The minimum case load for the mental health nurse is at least two individual patients with a severe mental disorder and being treated in the community per 3.5 hr session (minimum 1 session per week).
• A payment of $240 (GST inclusive) per session is available in urban areas, and $300 (GST inclusive) in very remote, remote, and outer regional areas (defined by the Australian Standard Geographic Classification scheme).
• From 31 December 2009, eligible mental health nurses need to be credentialed by the Australian College of Mental Health Nurses. Until this time, interim arrangements will apply to enable mental health nurses that are not yet credentialed to be engaged.
• Practices choosing not to engage or retain a nurse may still have access to services through nurses employed by a division or other eligible organisation.
• Definitions of eligible practices, and patients with ‘severe mental disorder’ are included within program guidelines available from www.medicareaustralia.gov.au or at www.health.gov.au/coagmentalhealth
• Advice on recruiting mental health nurses can be obtained from the Australian College of Mental Health Nurses at www.acmhn.org.

Background

The Mental Health Nurse Incentive Program provides a non-MBS incentive payment to community based general practices, private psychiatrist services and other appropriate organisations (such as divisions of general practice) that engage or retain mental health nurses to assist in the provision of coordinated clinical care for people with severe mental disorders in the community.

What services are provided?

Mental health nurses engaged under this initiative will support general practitioners (GPs) in managing patients with severe mental disorders in the community and provide a package of services that are tailored to the person’s needs, which could include:

• periodic review of the patient’s mental state
• medication monitoring and management
• providing information on physical healthcare to patients
• integrating services from GPs, psychiatrists and allied health workers (such as psychologists) including arranging access to interventions from other health professionals when these are required
• undertaking home visits (including family interventions if needed).

What are the benefits for general practices/practitioners?

General practices that engage or retain a mental heath nurse under this initiative will have increased capacity to directly provide and coordinate services for people with severe disorders in the community. Services provided by the mental health nurse may also reduce workloads for GPs and other practice staff.

General practices choosing not to participate directly may still be able to access mental health nurse services for their eligible patients through other organisations, such as divisions of general practice, who have engaged a mental health nurse under the initiative.

The RACGP strongly recommends that general practices considering involvement carefully review the guidelines for this initiative in light of their local patient, practice and mental health services profile. Practices are also advised to review the obligations incurred through different models of participation in this initiative. For example, insurance obligations on practices may vary depending on whether mental health nurses are employees or independent contactors.

What are the benefits for patients?

• Access to clinical care by a mental health nurse in the community.
• Continuity of care.
• Provision of multidisciplinary, community based care through one practice.
• Additional assistance with medication.
• A single person coordinating both clinical care and co-ordination with other agencies and
service providers.

How are these services funded?

The Australian Government has provided funding of $191.6 million over 5 years from July 2007 through the Mental Health Nurse Incentive Program. Payments to eligible organisations will be administered by Medicare Australia.

Socrates does have to consider that there is something amiss in the Southern Highlands where this MHNIP initiative does not seem to be taken seriously by the Southern Highlands Division of General Practice or its general practitioner members. In the meantime mentally ill patients and their carers and family members are being denied access to the full extent of the Medicare- provided care coordination services available to them.

As this is a democracy, and everyone has the right to expect access to a complete mental health service available to it, Socrates urges the reader of this tablet to be the activist, advocate and agitator and ask their general practitioner for access to this valuable service. If they can't provide a reason why they don't have the MHNIP service for their mentally ill patients, suggest that you will have to move to a practice which does provide such a service.

The Southern Highlands Division of General Practice could follow the example of the Medical Specialists: Patient care before the drachma grab.

Perhaps the Board and Dr Ruscoe of the Southern Highlands Division of General Practice could be a bit more assertive about the care of their patients than they have demonstrated to date. Socrates keeps finding evidence of how medical specialists who use the Bowral Hospital to improve the quality of life for their patients are able to call a spade a spade when there is a clear need to do so. The following article from the Southern Highland News in June is a good example.

When there was a subsequent public rally in Bowral to make it clear to SSWAHS that shipping out services to other parts of their empire would not be acceptable there was no sighting by Socrates (who was there) of any of the local Division's general practitioners, or their Board members, or the sycophantic CEO of the Southern Highlands Division of General Practice. Perhaps they were hiding out in the rooms that SSWAHS continues to provide them on the Bowral Hospital site. Most other Divisions of General Practice don't have it so good and have to find their own rented accommodation. Ah well! Sometimes SSWAHS providing the Southern Highlands Division of General Practice with publicly owned accommodation "prevents it from biting the hand that feeds it."

Dr disillusioned by Bowral Hospital system

Ben McClellan
16 Jun, 2010 09:23 AM


DOCTOR Nick Hartnell isn’t quite sure why he helped raise $10,000 for a hospital that is refusing to admit his elective surgery patients.

The Bowral orthopaedic surgeon said his patients were already being taken off Bowral Hospital’s waiting list and sent letters telling them to find another hospital at the same time as he was raising funds for the Daffodil Day fundraiser on April 18.

“So it is a complete slap in the face that they have taken me up on the daffs and money, and then shafted me,” he said.

The News revealed earlier this month admission forms for straight-forward procedures, such as cataract surgery, had been rejected by the Sydney South West Area Health Service (SSWAHS).

More than 50 patients have or will be receiving letters from Bowral Hospital general manager Denis Thomas informing them their procedure can’t be done at Bowral due to insufficient theatre time.

Ophthalmological surgeon Peter Macken, along with orthopaedic surgeons Dr Hartnell and Andrew Leicester, disagree and said their patients were being asked to find another surgeon and hospital because of bureaucratic decisions made by SSWAHS heads Mike Wallace and Teresa Anderson.

The bone surgeons are only allowed to do 110 joint replacements a year and a SSWAHS spokesperson said, as of June there were 203 patients on the waiting list, 126 of which were for joint replacements. There were 175 on the ophthalmological list, most of them for cataracts.

The waiting list has no limit, but all patients on it must be treated within a year.

Dr Hartnell said Bowral was one of the best hospitals for joint replacements and the waiting list cap had no logical base.

Mr Leicester said he wasn’t aware of any other surgeons in NSW who were restricted by a cap.

“So far for the year we have done 130, which proves the cap is ridiculous. It’s an arbitrary number pulled out of a hat,” Dr Hartnell said.

Bowral was one of the best performers at the last joint replacement audit in areas such as length of stay, completion rate and a low infection rate, Dr Hartnell said.

He and Mr Leicester had gone to Mr Wallace and Ms Anderson to work out cheaper, more efficient ways of doing more joint replacements, but their suggestions had fallen on deaf ears.

The pair were instead told to “re-educate” their GPs on sending patients elsewhere.

Dr Hartnell said SSWAHS wanted to move patients to RPA in Sydney because it had a shorter waiting list. He said it made more sense to transfer funds to Bowral rather than parcelling off patients to RPA.

“The argument that we are over budget is complete crap,” Dr Hartnell said.

Hospitals are obliged to treat patients within 12-months of receiving an admission form. By rejecting the admission outright, SSWAHS was ensuring the list didn’t go beyond 12 months. This was despite surgeons saying they had the time to do more procedures.

“We can provide the service and treat people within 12 months, but they won’t let us,” Dr Hartnell said.

Dr Hartnell and Mr Leicester each operate one day a week for eight hours a day, but both said they could do more operations if the hospital gave them more theatre time.

Mr Leicester said most of his elderly patients were in pain while they waited on the list.

“It’s very frustrating and upsetting for patients. I haven’t met one who is happy to go to another hospital,” he said.

“There are no problems with resources at Bowral, it makes no sense.”

He also said denying people surgery at their local hospital contradicted government policy and the health act.

Dr Hartnell said Mr Thomas’ argument – that an influx in out-of-area patients being part of the reason for booting patients off the waiting list – held no water.

“Only two are from the South Coast – the so-called out of area patients. So that is, roughly 3.5 per cent of my list is out of area,” Dr Hartnell said.

“The only reason I have these two is the surgeon in Nowra does not do hip replacements. So the argument of out-of-area patients is irrelevant.

“If you look at my patients of, say, 63 needing replacements in the area, the figures for the cap are based on completely wrong assumptions and I alone could do the 110 cap in one year.”

Southern Highlands Division of General Practice - working collaboratively or competitively?

Socrates has said this before, that there is a whiff of smoke coming from the offices of the local Division of General Practice (or is it the smell of bull dung?)

From the Athenian network have come some recent gems of the non-wisdom of the Division's illustrious leader! Take this one, for example, where a local private allied health professional suggested greater collaboration between the private practitioners and the public health system and the local Division in order to improve the health outcomes of their patients, and increase their access to allied health services. The letter was written on 15th February 2010 just after a meeting, sponsored by the Southern Highlands Division of General Practice, with some public health service nursing staff and allied health professionals and perhaps 2-3 general practitioners and their practice nurses. Not many when you consider that there are 18 practices with some 72 general practitioners in the Southern Highlands.

"Dear Dr Ruscoe,

RE: Live Life Well presentation

Thank you for the opportunity to attend the presentation by LD last Thursday. I found it informative, and a useful forum to make contact with other health service providers, many of whom I knew from my previous work within the area health service.

What was perhaps very disappointing was that, with the topic being the connection between chronic medical conditions and mental illness, there was little representation from general practitioners and none at all from the SSWAHS mental health services.

When one speaks of communication between the various health service providers one does usually mean between all health service providers, those in the private and the public health sectors.

It puzzles me that the general practitioners and the local mental health services are now not as responsive to these gatherings and presentations to enable improved utilisation of the health service initiatives available to their patients.

I would be interested to know how an improvement in the liaison and collaboration between all health service providers could be achieved in the future. Perhaps you and the Division have some ideas how this could be achieved.

I intend to discuss with other psychologists the concerns that I have expressed above, that there is a need to find an improved way of developing the communication between all service providers. This may involve better use of telephony (phone, email or fax), or discussion with the Division’s general practitioners as to the way in which they would prefer contact by other allied health workers.

Additionally, I suggest that communication is a two-way process otherwise it is just information. If the Division and the general practitioners have any thoughts about how we allied health professions can improve our process of communication I would be pleased to hear from you or any of the general practitioners.

I might add that I have attempted recently to improve the communication between allied health professionals and the local community mental health service. Unfortunately, the health service appears to be taking the view that they will not proactively encourage their patients to seek appropriate and available help with their long-term health and support needs in the community and private sector. They cite, instead, the NSW Health Code of Conduct which, suggests that they provide a list of local health service providers to a patient who requests it. It is disappointing to discover that the Bowral service do not actively seek to inform their patients of the availability of Medicare funded private mental health services through the Better Access and the MHNIP programs.

I would be pleased to have the opportunity to be able to discuss with the Division and the general practitioners how the private allied health professionals could improve the mental health services they are able to provide to the patients attending their practices. I would be open to any suggestions you might be able make about how this could be achieved.

Yours sincerely,

Kevin O’Neill

Psychologist and Credentialed Mental Health Nurse"

Sadly, the author of this letter sent in February is still awaiting a response to this suggestion that better communication be sought between the private health sector, the public health sector, and the Division of General Practice.

Not to be seen as a unassertive person Mr O'Neill has also provided old Socrates with some additional tablets of writing which may shine a (bright) light upon the workings of the Southern Highlands Division of General Practice and their idea of collaboration.

"Dear Dr Ruscoe,

RE: MHNIP referrals to the Division

I note that in meeting with TK at the MHPN meeting last week that she is no longer pursuing her application to become a Credentialed Mental Health Nurse for the purpose of the Care Coordination role of suitable patients of the general practitioner members of the Division.

Given this current situation I am wondering if the Division would consider informing the general practitioners and the various practices of this change. I believe that this would enable some practitioners, and their practice groups, not already linked with AT to have the additional choice of retaining the two remaining Credentialed Mental Health Nurses in the Southern Highlands.

I would be most happy to discuss how this might be achieved, with individual general practitioners or their practice managers, at their convenience.

In any anticipated discussion the mutual benefit of the practices gaining a financial outcome from Medicare Australia and the added advantage of appropriate care coordination for their referred patients will be an issue to be discussed.

I note that there is possibly due to be an issue of the Highlands Doctor going out to the practices soon. Might I ask that this information be included in the pending Highlands Doctor issue, or by some other means to your Division’s members.

I look forward to your response.

Yours sincerely,

Kevin O’Neill

Psychologist and Credentialed Mental Health Nurse"

Now for the response on July 14th - if it can be called that!

"Dear Kevin,

Thank you for your letter of June 29 in regard to services under the Mental Health Nurse Incentive Program.

Please be assured that we have thoroughly researched the procedures with the Department of Health for the implementation of this program in our practices and that the appropriate advice has been provided to practices.

Yours faithfully,

Warwick Ruscoe"

Well, of course that led to some headscratching on the part of the recipient but, not to be overwhelmed by the vagueness of it all, he did persist. Following his own questions to the Australian College of Mental Health Nurses, who credential the nurses working in the Mental Health Nurse Incentive Program, and who, one would expect, would know all there is to know about how general practitioners can use the Credentialed Mental Health Nurse, it would appear that there had not been any change in the contracting or employment of the qualified nurse by general practitioners. So off went a follow-up letter to the local Division of General Practice.

"Dr Warwick Ruscoe

Southern Highlands Division of General Practice

PO Box 724Bowral NSW 2576

11 August 2010

Dear Dr Ruscoe,

Thanks for your response of 14 July in which you responded to my earlier letter in which I asked about whether General Practitioners would be advised of the availability of the MHNIP services in light of your employed staff member not attaining her credentialing from the Australian College of Mental Health Nurses (ACMHN).

I did ask whether the general practitioners would be advised through the Division’s “Highlands Doctor” that there were other options available should they wished to refer their patient to another credentialed mental health nurse.

Unfortunately, your response of 14 July does not inform me of what your research and discussions with the Department of Health referred to, in respect of the implementation of the MHNIP in the Division's practices, nor was there any indication what the advice might have been that was provided to practices.

Today I received a response from the CEO of the ACMHN who has advised me that there has been no change to the MHNIP by Medicare Australia and that eligible organisations may continue to employ, or engage a Credentialed Mental Health Nurse to carry out the roles described in the program documentation. This means that GPs or Practices which are, or may wish to become, eligible organisations (EO) may employ them or engage them, by way of an agreement between the CMHN and the EO, to provide the service. The engaged or contracted CMHN is required to have adequate PII and registration to assure the EO that they can provide the service adequately to the doctor’s referred patients. The engaged CMHNs are not required to work on-site at the EO but can work from a private practice or even from home.

I would appreciate having access to the information about MHNIP provided by the Division recently to its practices.

Yours sincerely,

Kevin O’Neill

Psychologist andCredentialed Mental Health Nurse"

And here, of course, is the local Division's final word!

"August 18, 2010

Dear Kevin,

Thank you for your latest letter of August 11 in regard to the services under the Mental Health Nurse Incentive Program.

As previously stated, we have informed member practices of the Health Department's guidelines and rules for the engagement by practices of credentialed mental health nurses, either as contractors or employees. Should you wish to offer services in this regard, that is a matter between the practices and yourself.

It is not our policy however to inform outside parties of our communications to our members. The above information is available through the Department of Health's website.

Lastly, I commend to you that, unless there is a change to the rules to this program, this concludes our correspondence on the matter.

Yours faithfully,

Warwick Ruscoe."

Well, that certainly shows that the exchange of wax tablets has certainly dried up! Very pesky of the psychologist to ask such pointed questions. Anyway, it's Doctor's Secret Business anyway! Or is it really? You see, until the most recent "Highlands Doctor" issue the Mental Health Nurse Incentive Program (MHNIP) was commented upon in every issue of the "Highlands Doctor" from late 2007, and the local doctors were exhorted to use the Division's own Credentialed Mental Health Nurse while she was attempting to get her credentials through the Australian College of Mental Health Nurses. After this did not happen and the Division was no longer able to use her, the MHNIP became "secret" business. Now, following the exchange of the wax tablets, Socrates has noted that the public information on this program (which could help many local people with severe mental illnesses) has suddenly been moved to the member's only Login page of the Highland's Doctor. I guess one can only speculate why a once public piece of information has now gone to "It is not our policy to inform outside parties of our communications to our members." Well, in Socrates's reading of the older editions of the "Highland's Doctor" on the Division's website he finds each edition full of the Division's "communications to our members." Especially, the current one, which publicly urges all their member general practitioners to refer their patients to the Division's employee for counselling under the Medicare "Better Access" initiative.

Hmmm! I guess the Southern Highlands Division of General Practice has to go where the money is! I wonder, what happens to the notion of the patient's of the general practitioners having a choice in who they want to see. The Division's position and involvement with the local medical practices does seem to suggest that it has a conflict of interest and, monopoly and, the Gods forbid, might be seen as part of a cartel arrangement. I wonder if the Oracles in the Department of Fair Trading, Small Business, or Medicare Australia would (or should) be concerned about this?