WA News Have You Heard?
Have You Heard
March 2017
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Time AHPRA changed its ways

Doctors are concerned that reports to AHPRA against health professionals are too easily vexatious (whether colleagues or patients) and investigated for too long, which along with other behaviours, constitutes bullying. These issues were raised in testimony to a Senate Committee, set up following the high profile case of the Queensland neurosurgeon who returned to France. AHPRA received 3147 notifications about medical practitioners in 2015-16 (12% from other medical practitioners); 33% were fully investigated (the rest were closed on assessment); 3.2% of complaints led to a panel hearing and 3.5% to a tribunal hearing. In 2014-15, 17 doctors (23% of complaints) felt compelled to contact the Ombudsman about AHPRA’s handling of notifications against them. AHPRA says its target is to complete each investigation within six months. One would have thought for an organisation that has been operating for five years and has sat through one inquiry where longevity of complaint handling was singled out as an issue, that a rundown of the age of outstanding complaints would be a simple, important response. Instead it came up with the median age of open notifications at 137 days (and mentioned a five-day reduction from the previous year). According to AHPRA it is working diligently to “bring those time frames within reasonable expectations.” The College of Anaesthetists argued that justice delayed is justice denied. The College of Psychiatrists argued that timeliness of investigation is both vital and frequently absent. The Australian Dental Association (ADA) argued that practitioners not only invested time in defending complaints, they experienced shame, humiliation and psychological stress, particularly where the complaint was later deemed unfounded (two thirds of complaints). The Committee was not convinced that AHPRA's processes were adequate for the purpose of identifying complaints made vexatiously. “Alongside timeliness, the committee notes that the level and style of communication with both notifiers and practitioners has been one of the key concerns raised about AHPRA's management of complaints. […] Many people have suggested there is a need for more change.” With no appreciable action taken to resolve these matters, the Senate Committee’s findings were taken as an ineffectual white-wash.

Doctors on the hustings

As far as our head count could determine there are three medical doctors standing for election at the March 11 state poll. Dr Alida Lancee and Dr Michael Watson are standing as independents in Premier Colin Barnett’s Legislative Assembly seat of Cottesloe. Alida is running a high-profile campaign on end-of-life choices, while Michael is tackling bureaucratic culture in health and education. Long-time Liberal MP Dr Graham Jacobs has been in the WA Parliament since 2005 and this year contests the new seat of Roe. Well-known Kimberley health worker Dr Julie Owen is standing for the Legislative Council region of Mining & Pastoral.

New thinking for pain management

The Australian Pain Society’s annual scientific meeting is being held in Adelaide on April 9-12 and there will be a lot of rethinking problems, the new world order in drug use for chronic pain and the word neuromodulation crops up more than a few times in the program. The title of the meeting is Expanding Horizons. WA is represented on the podium by A/Prof Juli Coffin (Notre Dame University) and UWA’s Dr Ivan Lin who are giving a joint plenary session on musculoskeletal pain in Aboriginal Australians. Juli is a Master of public health and tropical medicine and Ivan is a physiotherapist in Geraldton and researcher at the WA Centre for Rural Health.

No relief for post-surgery pain

Putting opioids in the pain management spotlight, the team at SCGH is mounting a campaign encouraging GPs to reduce high opiate doses for patients needing elective hip or knee joint replacement surgery. Hospital pain specialist Dr Lindy Roberts told Medical Forum post-operative pain was becoming too difficult to manage as some patients had developed a high tolerance to the drugs and opioid-induced pain sensitivity. Surgeons may not undertake elective surgery unless the dosage drops given that the results for patients are not as good, with poorer function and an increased risk of complications such as infection and need for revision surgery. “We are not going to leave GPs without assistance if they need it, and we have arranged for the SCGH pain clinic to provide advice over the phone if the GP is having trouble.”

Stubborn back pain

Australian researchers are building a reputation for telling it how it is. This study, published in the BMJ, looked for consensus on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for back pain. A systematic review with meta-analysis of 35 kosher randomised placebo-controlled trials found that NSAIDs reduced pain and disability but not significantly more than placebo. In fact, six patients needed to be treated for one to achieve clinically important pain reduction, with the risk of gastrointestinal reactions 2.5 times higher during the median NSAID trial of 7 days. According to a report of an interview with researchers at the George Institute in Sydney, “Previous research has already demonstrated that paracetamol is ineffective and opioids are not much better […]. The findings are likely to impact on current clinical guidelines that continue to recommend paracetamol as a first-line analgesic, after NSAIDs, followed by opioids.” Ref: ‘Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis’

Parent support waivers

Public health physician Dr Bret Hart has written in this edition on the correlation between a child’s education and their long-term health outcomes (see p28). There is concern among some doctors that health care in the ante-natal and early childhood phases appears to be a victim of cost-cutting. Given the news in December that the State Government has a new tender process, which saw the peak body Ngala lose some central contracts for parenting and children’s services, there is pause for thought. The Community Services Minister Paul Miles announced $5.6m in tenders to community groups in metro and regional WA, including Shire of Mundaring, Ngala, Communicare, Meerilinga and Anglicare. Ngala received extra funding for its 24-hour phone service. It is to be seen whether Ngala’s loss costs the kids of WA.

Excellence comes at a price

The Community Services Minister has been busy. Before the writs were issued for the March 11 poll, Paul Miles opened a $455,000 Centre for Parenting Excellence to encourage, no less, best practice in parenting services and to monitor parent support needs and service outcomes. A steering committee of 12 including CEOs of Ngala and Centrecare and Prof Stephen Zubrick from Telethon Kids has been appointed. Could be good … could be half a million dollars of unaccountable funding. Who’s watching?

Commissioner to head bush

The new Assistant Minister for Health, Dr David Gillespie, who is by the way a gastroenterologist by profession before becoming a Nationals MP in 2013 and a former director of training at Port Macquarie Hospital, is introducing legislation to create an independent National Rural Health Commissioner to advocate (and hopefully adjudicate) for regional, rural and remote health. Dr Gillespie is enthusiastic to receive frank advice on regional and rural health reform so it is hoped that the first Commissioner will be someone who’s prepared to call a spade a shovel. The Minister said the Commissioner’s first priority was the development of the medical generalist pathway – “giving consideration to the nursing, dental health, Indigenous health, mental health, midwifery and allied health needs in regional, rural and remote Australia”.

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