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HEALTH 2009-2010 FEDERAL BUDGET SPECIAL
Roxon prescribes for nurses ■ Louise Durack
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idwives, nurse practitioners, hospitals and cancer services are some of the big winners in this year’s Budget (link), whereas pathology and imaging services and high-cost specialist services such as IVF procedures have been targeted for cuts. Health minister Nicola Roxon’s plans to reform maternity services start with a $120 million scheme to allow midwives to practice independently, with access to Medicare and PBS services and with indeminity insurance
support. Nurse practitioners get a similar budget boost, with $60 million to expand their numbers and provide MBS and PBS items. This year’s budget also sees $1.5 billion funding to upgrade hospital infrastructure around Australia and $2 billion for cancer care infrastructure, including digital mammography services. Specialists’ fees will be capped in areas such as IVF and cataract surgery, and major savings are expected from cuts in MBS fees for many pathology tests, though these will be offset by more incentives for pathology and imaging providers to bulk bill.
In primary care, GPs lose the promised access to MRI scans of the knee and brain, and many incentive payments will now be now paid retrospectively. In addition, non-accredited practices will now have to adhere to proper vaccine storage processes to claim immunisation incentives. The government is also tightening up the Better Access Incentive for mental health, saying psychologists and other allied health professionals will no longer be eligible unless they take part in further training. comment@6minutes.com.au
How the Budget hits your wallet ■ Jared Reed So, how will the Budget affect the average GP? Super benefits take a hit, but there are advantages to nurse practitioner prescribing rights, says one analyst. From 1 July, the tax deduction for GPs who place their practice buildings into negatively geared super funds will halve, with the maximum contribution and matching benefit possible dropping from $50-25,000 for under 50s, and $100-50,000 for over 50s. Taking the icing off the popular tax strategy will discourage owner-operator GPs
GP tax strategies will be hit. from using this saving to build bigger buildings, or merging with other practitioners, says Mr David Dahm, CEO of practice management firm Health and Life. He says GPs recently affected stockmarket-wise had looked to the strategy with the hope of
saving money. “There’s still a tax advantage in putting your practice property into a super fund, and it’s still tax advantageous but it’s obviously limited the advantage … it’s not to say stop expanding your building, there’s still a good commercial reason for having your building, regardless of whether it’s in super or not,” he told 6minutes. He adds that nurse practitioner prescribing rights and MBSaccess should be welcomed from a financial perspective by practices, not viewed as a threat. What do you think? comment@6minutes.com.au
Other Budget changes: • The controversial ‘vial recycling’ scheme for highcost chemotherapy drugs put on hold. • Increased PBS price controls on drugs such as statins. • New funding model for Divisions will benefit those in areas of population growth. • New geographic system for rural and remote areas of need, based on 2006 data. • New GP rural incentives programs will extend cover to 2400 more GPs. • Lower Medicare fees for ageing diagnostic and imaging equipment, to encourage upgrades. • Number of GP Regional Training Providers to be consolidated. • GPET to take over the Prevocational General Practice Placements Program. • Data matching between PBS and Medicare to stop fraud. • Duration of rural training placements to be increased from six to 12 months. • Changes to return of service obligations for bonded medical students. • New Medicare items to be reviewed after three years for value for money.
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t ®Registered trademark of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A. Merck Sharp & Dohme (Australia) Pty Limited, 54–68 Ferndell Street, South Granville NSW 2142. 02-10-JAN-09-AUS-4582-J 7812 BEFORE PRESCRIBING PLEASE SEE PRIMARY ADVERTISEMENT IN THIS PUBLICATION FOR PBS AND PRODUCT INFORMATION
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In other news ... Bowel cancer screening kits used in the Rotary Bowelscan program are totally different to those under investigation in the Federal screening program for being faulty, says the Manning River Times. (read more) A team of 11 WA doctors and nurses led by Perth GP Kevin Carthew are going to Vietnam to operate on 50 children with congenital abnormalities such as cleft lips and palates, says The West Australian. (read more) Almost 16 million people, or 77 per cent of the Australian population have a long-term health condition such as asthma, diabetes or obesity, and many are in denial, according to an official report in The Mercury. (read more)
The chairman of corporate medical centre operator Primary Health Care, Gregory Gardiner, has resigned due to ill health after 14 years in the position, says The Sydney Morning Herald. (read more)
Flu vaccination should be mandatory for all doctors. Mandatory influenza vaccination should be the norm for all healthcare staff, with compulsory signed optout clauses, says the Influenza Specialist group at Virtual Medical Centre. (read more) A 47-year old Australian doctor working for the WHO in the Philippines has been arrested on suspicion of child molestation and trafficking, says the Brisbane Times. (read more)
A ten-fold increase in pertussis this year compared to last year shows the need for booster vaccinations, says the NSW health minister on the ABC. (read more) The health implications of military service overseas are to be studied by groups at the universities of Adelaide and Queensland, says the NT News. (read more) Business is booming for healthcare lawyers, despite the economic downturn, as they are kept busy with medico-legal work and advice on regulation
and pharmaceutical issues, says The Australian. (read more) Vaccine manufacturers such as CSL have a profitable future thanks to fears about pandemics such as swine flu, say business analysts in The Australian. (read more) Hair lice treatments are among several domestic products sold in Australia that contain pesticides, such as permethrin, and malathion/ maldison, which are banned in many other developed countries, says The West Australian. (read more) A Super Clinic for Wallan, north of Melbourne, is in doubt because it would likely cost $20 million, not the $1 million being offered by the government, says The Star News. (read more)
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Enhancing incretins. Enhancing physiological control.1
For the treatment of type 2 diabetes. The oral therapy that by inhibiting DPP-4 * enhances the physiological pathway of glucose control.1 *DPP-4 = dipeptidyl peptidase 4
PBS Information: Authority Required (STREAMLINED). Refer to PBS Schedule for full authority information. References: 1. Approved Product Information for JANUVIA. ŽRegistered trademark of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A. Merck Sharp & Dohme (Australia) Pty Limited, 54–68 Ferndell Street, South Granville NSW 2142. 02-10-JAN-09-AUS-4584-J 7813
BEFORE PRESCRIBING PLEASE SEE PRIMARY ADVERTISEMENT IN THIS PUBLICATION FOR PRODUCT INFORMATION
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Get a life...
Pens and mugs sway drug preferences
Row, row, row your boat ■ Louise Durack Rowing alongside his teammates in the Australian Under-23 rowing team is where Ned Kinnear finds stress release outside of the medical world. A fourth year medical student from the University of Adelaide, Kinnear, 22, has been rowing since his high school days. This then led into joining the Adelaide Uni Boat Club at 18 and then when he realised where his passion lay, onto the World Championships. So far, he has completed in the 2006, 2007, and 2008 World Championships as part of the Men’s Fours and he has recently been selected to compete in the 2009 World
Training in both rowing and medicine is Ned Kinnear (at right) Championships for the Men’s Eights which will be held in the Czech Republic in July. Training commitments are intense, he says, and generally mean around 12-14 training sessions of one and a half hours each week. “If we’re lucky, we may get the occasional Sunday off,
but generally we row every morning together and then individually, we will do the rowing machine at the gym, weights or cycling,” says Ned. “One of the greatest things about doing all this exercise is that I get to basically eat whatever I want, whenever I want,” he says. “I also get to meet a lot of like-minded people which is interesting.” Strength as an individual is very important, he says, “but this needs to be used in synchronisation with the team if the team is to succeed”. When they do succeed, the effort and determination pays off and “you get an incredible high feeling you just can’t beat,” says Ned. What do you think? comment@6minutes.com.au
Doctors develop a more positive attitude to certain brands of drug if given modest drug company freebies such as pens and pads, a new study suggests. In the Archives of Internal Medicine (169: 887-93) this week, a group of US researchers (link) describe the reactions of medical students who were exposed to branded promotional items such as notepads for statins without being aware they were part of a study. Those who were exposed to promotional items had more favourable implicit attitudes towards the brand name drug, compared with the control group who were given blank notepads. Subtle branding exposures are important and influential on drug preferences, the study authors conclude.
www.epicc.org.au
General Practitioner Wanted by Family Medical Clinic Northern Beaches of Sydney F/T or P/T Sessions to suit
WANTED:
• • • • • •
MEDICAL PRACTITIONERS TO TAKE PART IN THE PILOT OF THE EDUCATION PROGRAM IN CANCER CARE (EPICC) AT THE 10TH NATIONAL RURAL HEALTH ALLIANCE CONFERENCE
By attending the EPICC Pilot Workshop on Monday 18 May at 4.50pm, you will have the opportunity to review each module of the program to see how this education program will help you provide better cancer care to your patients. Leading cancer specialists and program developers will be on hand to discuss program content and you will be able to directly evaluate EPICC.
epicc Education Program in Cancer Car e
Long established family practice in Avalon Newly refurbished & extended premises in the heart of the village Great opportunity to carve out a career or work part time Computerised, accredited & with F/T nurse support Mix of private fees & bulk billing (pensioners) High quality of service practice
If you are a GP currently vocationally registered with an unrestricted provider number in Australia & would like to learn more about this opportunity please call Claire Cavanaugh (practice manager) on 0416 047 342 & email your CV to claire12@bigpond.net.au EPICC aims to improve the quality of cancer care in rural and regional Australia by providing greater opportunities for noncancer specialist medical practitioners (general practitioners, gynaecologists, surgeons, general physicians, etc) to increase their knowledge of cancer management.
Pregnancy terminations, D&C, IUD, ultrasound, counselling Est. over 25 years. Sydney, NSW.
Available online, EPICC will provide access to cancer education and information through five broad topics: General principles of cancer care Side effects of cancer treatment and symptom management Oncologic emergencies Psychosocial care Follow up
We understand your needs
COME AND TEST DRIVE THIS LATEST PROGRAM
Interested in a break from long hours in general practice?
Register your interest to attend the Pilot Workshop today by contacting EPICC Project Manager, Ms Kevin Comlossy, on kcomlossy@moga.org.au or 02 9256 9656.
We are looking for a doctor to administer IV sedation for pregnancy terminations 1 to 2 days per week. Earn from $800 to $1500 per day. Non-VR welcome. Must have a provider number. Training provided. For details call Paul on 0427 286 911.
www.epicc.org.au EPICC is funded by the Australian Government through Cancer Australia and has been developed by a multidisciplinary group of medical practitioners led by the Medical Oncology Group of Australia.
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You said it... National registration scheme finalised (link)
Breast screening boosts survival (link)
Local boards are very necessary to be able to head off potential problems before they become big ones. If the "super board" is notified before the local, then time and money will be wasted and reputations potentially destroyed unnecessarily. Uniformity of standards through Australia may be good but not if they can be manipulated by administrators. Tom Walker Member Medical Board, ACT, 1990-1999
It never ceases to amaze me how people can continue to support research into how effective mammography is. We hear the continuing mantra of "early detection" being responsible for better results - what a no brainer! So let’s get fair dinkum and tell it as it is. Because you find a grain of rice sized lump, don't kid yourself that it's early detection - it's earlier detection but certainly not early detection. Early detection is finding the metabolic change taking place in the breast many years before a lump can be found. What we should be spending money on is Australian research into what thousands of women are already doing, and that is Digital Infrared Thermal Imaging. Used in comparative
studies, thermal imaging is a powerful modality capable of very early detection of breast pathology many years before mammography can find the eventual anatomical change, which is certainly not early detection; it's been growing for many years. Graham Baillie
Waste not want not
(link)
Thank you Dr Katelaris. You have written well in your summary of the bureaucratic burdens of general practice. I particularly appreciated your comments about Aged Care - so good that they are worth quoting and re-printing: Aged care has to be the prize winner in bureaucratic time wasting, especially prescribing. How long will it be until the proposed system to use the drug chart as the prescription is in
place? Why do we have to do the form filling for the Aged Care Funding Instrument for the sole purpose of aged care funding? Richard Chittleborough GP working full time in RACFs
Bowel screening faults 'a great shame' (link) 10-20% of 100,000 tests is only 10,000 to 20,000 people with potentially false negative tests results, NOT 100,000 people with potentially false negative tests results! Alison Free
Rosanna Capolingua bows out (link) In two years what has been achieved by Dr Capolingua? Hmmm? Ummm? Must be something… Joe Kosterich
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Enhancing incretins. Enhancing physiological control.1 Indications: Type 2 diabetes mellitus, in persons ≥18 years old, who have failed dietary measures and exercise as dual combination therapy with metformin or with a sulfonylurea, or with a thiazolidinedione where the use of a thiazolidinedione is considered appropriate. Contraindications: Hypersensitivity to any component of the product. Precautions: Renal insufficiency; hypoglycaemia in combination with a sulfonylurea; pregnancy (Cat B3); lactation; children; not for type 1 diabetes mellitus or diabetic ketoacidosis. Interactions: No clinically significant interactions observed with metformin, glibenclamide, simvastatin, rosiglitazone, warfarin, oral contraceptives, digoxin or cyclosporin. (see full PI). Adverse reactions: URTI, nasopharyngitis, headache and hypersensitivity reactions. Hypoglycaemia, when used in combination with a sulfonylurea. Dosage: 100 mg once-daily. Adjust for moderate and severe renal insufficiency (see full PI). Consider reduced dose of sulfonylurea when used in combination. Tablet Rx (S4) sitagliptin; lactose free; 25 mg (pink), 50 mg (light beige), 100 mg (beige). Pack size [28] - Starter Pack [7]. PBS dispensed price $90.73. References: 1. Approved Product Information for JANUVIA. ®Registered trademark of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A. Merck Sharp & Dohme (Australia) Pty Limited, 54–68 Ferndell Street, South Granville NSW 2142. 02-10-JAN-09-AUS-4583-J 7814
PBS Information: Authority Required (STREAMLINED). Refer to PBS Schedule for full authority information. PLEASE REVIEW THE PRODUCT INFORMATION BEFORE PRESCRIBING. FULL PRODUCT INFORMATION IS AVAILABLE FROM MERCK SHARP & DOHME.