Both Libs and Labor Promise a New Canberra Hospital

CANBERRA

Informing the Canberra Doctor medical community since 1988 AUGUST 2016 | Canberra Doctor is proudly brought to you by the AMA (ACT) Limited. Circulation: 1,900 in ACT & region Both Libs and Labor promise a new Canberra Hospital

Both major parties have made significant commitments to redevelop Canberra Hospital should they be elected to govern the ACT on 15 October. While the Canberra Liberals have taken a further step in pledging two new “local hospitals” at Gungahlin and Tuggeranong, the Barr Labor team proposes a bigger spend at the Canberra Hospital and an all-new plan.

The Liberals’ Plan “The $395 million new hospital First out of the blocks was the building at the Canberra Hospital Canberra Liberals with an an- site will be supported by $8 million nouncement that they will fund the for new nurses, doctors and other first stage of a redevelopment at staff.” Mr Hanson said. TCH. The promise, worth $395m, “The new hospital will also cater picks up the planning work done for a new 25 bed medical assess- by the previous Labor Government ment planning unit, 105 ambula- under former Chief Minister, now tory treatment spaces and a new Senator, Katy Gallagher. state of the art medical imaging The Canberra Liberals proposed redevelopment at Canberra Hospital unit. There will be a new admission Opposition Leader Jeremy Hanson foyer, sterilisation unit and new pa- plan as has Jenny Miragaya, Secre- said the new building would house AMA (ACT) tient and volunteer facilities. a 92-bed emergency department, welcomes the Liberals’ Plan tary of the Australian Nursing and 48 intensive care beds and capac- Jeremy Hanson, The new facility is planned to be AMA (ACT) President, Prof Steve Midwifery Federation, ACT Branch. ity for 20 new operating theatres. Leader of the Canberra Liberals operational by 2019. Robson, welcomed the Liberals’ Continued page 9...

Volume 28, No. 6 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 Medical Musings WITH PRESIDENT, Professor Steve Robson

If the Federal election revealed one thing, it is probably elect of the Public Health Asso- that health is close to the top of the list of concerns for ciation of Australia, Mr David Tem- voters. This will not be news to the readers of Canberra pleman, has personally briefed the ACT AMA Board about alcohol-re- Doctor. When each of us sits down to help our patients lated harms and solutions. every working day, we see just how important health is to individuals, families, and the whole Canberra Unfortunately, the response from the Chief Minister Mr Barr has community. been extremely disappointing. A multidisciplinary group met with Canberra is regularly named as for specialised services could be the Chief Minister recently, and one of the world’s most ‘liveable improved over current arrange- were appalled by his response to cities’ – much to the chagrin of the ments. Easy, intuitive on-line re- sensible suggestions and initia- leaders of other major Australian ferral systems where interaction tives that have broad support from cities. Canberrans, as a group, is with specialist staff, rather than Canberra’s families. We will keep have high levels of education hospital outpatient administration the pressure on Mr Barr, and look and tend to be very interested in staff, could be piloted. to him for the leadership Canber- health. There is ample opportunity I can imagine a system where rans expect on what is a critical is- for healthy exercise, and no short- GPs can have on-line ‘chats’ with sue for the community. age of healthy food options that specialist staff about patients most can afford. The Leader of the Opposition in they are considering referring to the ACT, Mr Hanson, has been just Yet waiting lists for elective sur- public hospital outpatient clinics. as recalcitrant. The AMA leader- gery tend to be long and tedious, The chats would be captured so ship has met with Mr Hanson and and access to specialist services there is no problem with recall of raised the issue. The Canberra through public hospitals is often conversations, yet allow GPs to Liberals’ ideas about a police solu- difficult. Many families will have to be guided and save patients long tion to alcohol-related violence and wait a long time to see their fam- waits. Or, appropriate investiga- harms are silly, and not supported ily doctor. Individuals in need face tions could be flagged and ar- by ACT Policing and other emer- barriers in accessing bulk-billing ranged in advance to minimise gency services groups. It is high services. delays in care at hospital level. time that ACT political leaders on GPs are key All of these ideas should be ex- both sides of the Assembly had a good hard think about how best to Last month saw the AMA’s annual plored by an innovative, expert serve their fellow Canberrans. Family Doctor Week, with activities group convened and funded by and advocacy promoting Canber- the ACT Government. The group “Medical marijuana” ra’s wonderful General Practition- would include family doctors, hospital specialists, in a broad mul- Secondly, the ACT Government ers. As we all know, Canberra’s has announced plans to develop family doctors face many chal- tidisciplinary group dedicated to improving the patient journey. In a framework for use of ‘medical lenges in providing care. Unfor- marijuana’ in the ACT. Cannabi- tunately, with most funding for a university town like Canberra, it seems staggering that such ini- noids may have a role in manage- General Practice coming through ment of some difficult-to-manage the Federal Government MBS, is- tiatives have not been made by the ACT Government to date. conditions, such as chronic pain sues that would promote and as- and complications of cancer treat- sist Canberra’s family doctors are Alcohol fuelled violence ment. The evidence is, however, seen as ‘Federal issues’ by politi- Two major public health issues are medium-level at best. With the cians positioning themselves for of particular interest to Canberra’s potential for adverse effects, and the ACT election next month. medical community. The first – the the political sensationalism asso- This is not so. General practice introduction of responsible alcohol ciated with cannabis use, the Gov- in Canberra could benefit greatly laws – has been badly handled by ernment must tread with care. The from investment by an ACT Gov- both the ACT Government and Op- AMA are hoping to be involved in ernment. Practice infrastructure, a position. There is clear evidence assisting the expert group, as we major cost for GP practices, could of alcohol-related harm for Can- are well-placed to keep the broad be assisted by Government grants berra’s citizens, and equally clear community interest foremost. and investment. Nurses provid- evidence that Canberrans support The ACT election is looming, and ing emergency services could be sensible legislative change pro- there are promising signs that placed in General Practice settings moting responsible alcohol use. health will again play a prominent – something guaranteed to improve The ACT AMA has been working role in electors’ minds. Here at the continuity of care – with ACT fund- closely with the learned Colleges – AMA we will provide a voice for the ing. Transitions of care between the Colleges of Emergency Medi- doctors who strive to improve the community-based doctors and cine, Surgeons, and Obstetricians health, relationships, and quality Canberra’s public hospitals could and Gynaecologists – along with of life for the people of the ACT. be vastly improved with targeted FARE (the Foundation for Alcohol Now is the time for us to do this by ACT Government investment. Research and Education) to en- working with those who lead, and Importantly, systems allowing fam gage with the ACT Government seek to lead, the Government of ily doctors to refer their patients about these laws. The President- our community. [2] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 AUGUST 2016 Minister Corbell signs new VMO contract One of the last acts of outgoing Health Minister, Simon Corbell, prior to the start of the ACT Government’s caretaker period was to sign-off on the new Core Conditions for ACT VMOs. In brief the new contracts have given some new rights to ACT Health but largely maintained the current remuneration arrangements and indexed the rates by 2.5% p.a.

Given the strained relationship between AMA (ACT), the Visit- ing Medical Officers Association (VMOA) and ACT Health at various stages including threats of litiga- tion, walk outs, media stories, Dr Peter Hughes, VMOA President accusations of bias and personal In brief, the new core condi- attacks, it was no surprise that tions will result in some greater precious little progress was made rights handed to ACT Health during the “negotiating” period. but overall not too much has changed. Notable matters in- Further, given that ACT Health’s relationship between the annual review. position as put to the arbitrator clude: VMO and ACT Health. Payment in lieu of notice on entailed unfettered termination VMOs are required to keep Rates for Fee for Service termination. rights, reversion to NSW rates Dr Elizabeth Gallagher, AMA (ACT) abreast of relevant policies and sessional contracts with little or no increase for the Immediate Past President and VMO Dispute resolution process including when contracted indexed by 2.5% p.a. FFS at life of the instrument, workload Negotiator may be used where at Calvary. ACT Health 125.06% of 1 July 2016 MBS changes on one month’s notice termination occurs. must establish proper / sessional at $309 per hour and a host of other detriments, Timeframes for dispute communications with from 1 July 2016. the scope for negotiation even VMOs so that, when change resolution process have during the course of arbitration occurs, it can be brought to No minimum duration for been tightened. hearing was extremely limited. the notice of VMOs. contracts. VMO and ACT As a matter of principle, Health can negotiate the VMOs should be included in In the end, it fell to Arbitrator, Additional time for term of contract. Greg Smith, to comb through managing a unit, the “life” of the department, Updated rolling billing the various claims and coun- department or service unit or service and given procedure. ter-claims and come up with a and teaching can be opportunities to participate compromise. It’s a credit to the incorporated into contracts VMOs may salary sacrifice in activities. perseverance of the VMOs and and remunerated in although the precise Reduction in workload on their representative organisa- accordance with the nature of non-cash benefits three month’s notice. tions and the arbitrator that the sessional rate. that might be included is The new contract will be issued outcome has been core condi- Some enhanced rights to inclear. shortly and AMA will forward to tions that contain only incre- Dr Andrew Miller, AMA (ACT) termination, for example, Two week’s notice to be VMO members further, detailed mental change. Treasurer and VMO Negotiator a breakdown in the given to VMO prior to information on the changes.

AUGUST 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [3] Family Doctors: invaluable to your health

This year, to mark Family Doctor Week and recognise the vital role that General Practitioners play in keeping Canberrans healthy, AMA (ACT) hosted a dinner for Canberra GPs. Ms Meegan Fitzharris, ACT Assistant Minister for Health, Dr Michael Gannon, AMA Federal President and Dr Tony Bartone, AMA Federal Vice President, were guests for the evening. Their presence was much appreciated.

Following dinner, Minister Fitzhar- ris and Dr Gannon addressed the gathering emphasising the key role Family Doctors play in our health system. We were also fortunate to have a number of other organisations represented including Ms Julie Tongs, CEO Winunga Nimmityjah AHS, Dr Karen Flegg from the Royal Australian College of Gener- al Practitioners, Dr John Norgrove from the Capital Health Network and Lynne Kelly from BOQS, our sponsors for the evening, The dinner was hosted by Dr An- tonio Di Dio, AMA (ACT) Presi- Dr Antonio Di Dio introduces Minister dent-Elect. Fitzharris. The theme for Family Doctor Just as the AMA recognises the Week in 2016 was Family Doc- pivotal role that GPs play, so From left, Dr Suzanne Davey, Dr Elizabeth Gallagher tors: Invaluable to your health Australians value their family and Dr Tony Bartone. – with AMA highlighting the vi- doctors. More than 90% of Aus- tal role played by family doc- tralians visit the same practices, tors in preventative health, aged and two-thirds actually see the care and end of life care. Family same GP for ongoing care. Our Doctor Week also gives us an- GPs are the most utilised and, other opportunity to raise health indeed, the most trusted source policy issues that are now hot of child health information. issues such as the Medicare re- Kathryn Conroy, ACT Health with bate freeze and general practice All in all, very good reasons to Adrian Watts from the National training and funding. celebrate Family Doctors. Health Co-op.

The Medical Benevolent Association of NSW (MBANSW) Provides a free and confidential support service to Canberra doctors in need and their family. Financial assistance and counselling support are available to colleagues who have fallen on hard times through illness or untimely death. Support is also available to medical practitioners who may be experiencing difficulties at work or in their personal relationships. The MBANSW is funded by your donations; please allow us to continue to provide support and assistance to your colleagues in need by making a donation to the Medical Benevolent Association Annual Appeal. Donations can be made visiting our website www. mbansw.org.au

If you are concerned about your own situation or that of a colleague, please contact the MBANSW Social Worker, Meredith McVey on (02) 9987 0504.

[4] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 AUGUST 2016 Prof Kirsty Douglas from the Academic GP Unit at ANU Medical School with Dr Elizabeth Gallagher.

Assistant Minister for Health, Meegan Fitzharris with Dr Antonio Di Dio, AMA (ACT) President Elect. Dr Michael Gannon, AMA President addresses the dinner.

Dr Tuck Meng Soo with Dr Rashmi Sharma. From left, Dr Alan Shroot, Dr Suzanne Davey and Dr Caroline Luke.

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AUGUST 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [5] AIHW releases Australia’s Health 2016 AIHW has released its latest report card on how healthy Australians are. AIHW Director and CEO Barry Sandison said the report provided new insights and new ways of understanding the health of Australians.

‘The report shows that Australia has much to be proud of in terms of health,’ he said. ‘We are living longer than ever before, death rates continue to fall, and most of us consider ourselves to be in good health.’ If Australia had a population of just 100 people, 56 would rate their health as ‘excellent’, or ‘very good’ and 29 as ‘good’. ‘However, 19 of us would have a disability, 20 a mental health dis- order in the last 12 months, and 50 at least one chronic disease.’ ‘13 out of 100 of us smoke daily, 18 activity, 63 of us are overweight or drink alcohol at risky levels, and 95 obese.’ Mr Sandison said the influence do not eat the recommended serv- of lifestyle factors on a person’s The full report can be accessed at ings of fruit and vegetables. health was a recurring theme of http://www.aihw.gov.au/australi- the report. ‘And while 55 do enough physical as-health/2016/

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[6] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 AUGUST 2016 Why I called out a 62-year-old’s decision to have a child BY Dr Michael Gannon, AMA President

A 62-year-old Tasmanian woman gave birth to her first This baby was born at 34 weeks. Let’s have greater investment child in Melbourne early in August. The story made Babies born six weeks prema- in health education, get wait- headlines – and rightly so, given the circumstances. ture are inevitably admitted to ing times for public urogynae- a Special Care Nursery. They cological appointments down, The child was conceived overseas, they developed IVF in the late face higher risks of respiratory enhance obstetric services for problems, infection, and jaun- via IVF, using a donor embryo. The 1970s. This amazing technology mothers who speak english as has brought much joy to many dice. The child may be more baby girl was delivered by caesar- a second language, and close ean section at 34 weeks gestation. across the world. vulnerable to chest infections the gap in the perinatal and in- The mother was supported by her and asthma as it grows up. But just because medical sci- 78-year-old partner. fant mortality rates suffered by ence can do something does not Why was baby delivered early? Aboriginal children. When asked to comment, as mean we have to do it, or should Growth restricted babies have an experienced obstetrician/ do it. We are learning more The IVF ‘‘treatment’’ in this higher rates of chronic disease gynaecologist and president of about the risks of being con- case took place overseas. Most like diabetes and hyperten- the Australian Medical Asso- ceived from older sperm, but states in Australia have lax leg- the fact is that the involvement this is avoidable, and no amount sion in adulthood. If it was de- ciation (AMA), I described the islation with any limits of treat- whole episode as ‘‘selfish’’ and of the male of the species in hu- of anti-oxidant supplements or livered early on purely mater- ment provided coming down to ‘wrong’’. I stand by those words. man reproduction is measured kale smoothies can arrest the nal grounds, it had no chance in minutes, if not seconds. inevitability of ageing. to prepare for it – potentially the ethics of individual doctors This case should open a broader missing out on crucial brain and clinics. To our credit, Aus- Then let us consider the age of Our blood vessels, as we reach debate about assisted reproduc- development, and being at in- tralia leads the world in rates of the mother. Using a woman’s our 50s and 60s, become hard- tion in Australia, and the issue creased risk of learning prob- own eggs after 42-43 years is er and less elastic. Women the safer process of single em- surrounding the obstetric care of lems and developmental delay. women returning home pregnant rarely successful. The aver- this age are more susceptible bryo transfer. Sadly, there is lit- after ‘‘treatment’’ overseas. age age of natural menopause to blood clots, heart attacks, This baby is receiving care the tle legislative protection to stop is 51-53 years. Most IVF clinics and strokes – a potentially high equal of any in the world. But it the unscrupulous use of multi- This must not be narrowly price to pay to have a baby. in Australia will have a policy to comes at a price. A bed in a spe- ple IVF cycles to desperate old- viewed as a women’s rights is- not offer treatment to women Ageing is natural and inevitable. cial care nursery costs around er women who have single digit sue. Nor is it about ageism. over this age. Older women are more likely to $2500 per day. Who pays for percentage chances of success. As a community, we need to There are good reasons for this. have degenerative conditions this? Even with private patients, consider the rights of the child, and/or chronic disease. As we the community pays most of the We need to have a debate about There is a gradual increase in the rights of society, the re- get older, we slow down. bill – through our taxes which the funding and regulation of sponsibilities of proper parent- the incidence of adverse ob- What about the demands of par- fund the Commonwealth’s con- assisted reproduction. It is the ing, the health of the parents, stetric outcomes from age 30. enting the child? Most 32-year- tribution to inpatient care, and mother of all debates – one we the health risks to the child at This includes infertility, miscar- riage, chromosomal abnormali- old mothers (and fathers) will through our pooled health in- need to have openly, honestly birth and beyond, and the costs ties, diabetes, pre-eclampsia, tell you how hard it is bringing surance premiums. When this and responsibly. to the health system and the caesarean section and still- up a child. I genuinely hope that nation can properly fund Gen- taxpayers that fund it. birth. These risks relate to the this child has her 80-year-old eral Practice and mental health This opinion piece was first This is not what Steptoe and increasing age of the eggs, the mother at her 18th birthday services, we can talk about published in Fairfax Media on 4 Edwards had in mind when womb and other organs. None of party. Her father will be 96. more money for private IVF. August 2016.

Personal and supportive service Doctors’ Health Advisory Service (ACT) Here for you and your needs The DHAS (ACT) provides peer support for you and your family The DHAS (ACT) provides a protective environment of anonymity, cultural sensitivity, confidentiality and discretion. There is no charge for using the DHAS (ACT). l a stressful incident l burnout l violence or trauma in your workplace l your professional life l workplace issues such as bullying or harassment l your career plans l workload concerns l personal issues l feelings of stress or inability to cope l your well-being The DHAS (ACT) is a group of experienced Canberra-based general practitioners who are committed to providing support to colleagues and their families experiencing difficult times – which may include: The DHAS (ACT) can link you with expert services and resources according to your needs. Privacy and confidentiality are assured. The DHAS (ACT) is fully supported by, but operates independently of, the AMA (ACT) Ltd as a community service. 02 9437 6552 24 hours

AUGUST 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [7] AMA (ACT) President’s Award for Dr Peggy Brown

Although the annual President’s Award is usually made at the Annual General Meeting, this year’s recipient Dr Peggy Brown was overseas at the time. Dr Brown, immediate past Director-General of ACT Health was recognised for her outstanding contribution to the provision of mental health services in the ACT and her work as Director-General of ACT Health.

The full citation for Dr Brown’s through a period of growth and award reads: change including the opening “For outstanding service to of the Centenary Hospital for the health of the ACT commu- Women and the Canberra Re- nity and the medical profession gion Cancer Centre. in the areas of psychiatry and Dr Brown’s longstanding com- health administration. Dr Brown has shown outstanding leader- mitment to mental health policy ship and professionalism from development and implementa- her first appointment as ACT tion has given her a national Chief Psychiatrist in 2004 then and international reputation ac- ACT Director of Mental Health knowledged by her peers. She Services in 2005 and for her has held numerous positions on term as Director General of ACT professional bodies and, while Health from 2010 until 2015. Director General of ACT Health, Dr Brown is much admired for chaired the Australian Health her work in leading ACT Health Ministers Advisory Committee.”

Dr Peggy Brown, centre, with Prof Steve Robson, current AMA (ACT) President, left, and Dr Elizabeth Gallagher, immediate past AMA (ACT) President, right.

[8] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 AUGUST 2016 …a new Canberra Hospital…continued

...from page 1 The initial response from the ACT The SPIRE Centre, which will begin Labor was to reject the Liberals’ operating in around 2022, expands plan with Health Minster Simon the Canberra Hospital’s theatre Corbell saying that advice provided capacity from 13 to 20 theatres and to the government in 2015 was that offers two inpatient wards with 64 better use of existing beds would beds for patients requiring over- provide Canberra Hospital with the night care, dedicated theatres for capacity it needed for another five emergency surgery and elective to 10 years. surgery and a new coronary care unit with 24 beds. The ALP plan There will also be new intensive Despite this criticism, ACT Labor care unit with 48 bed bays, offering has now announced a matching both high dependency and inten- plan, worth more than $650 mil- sive care beds. ACT Labor’s plans for Canberra Hospital lion, centred around the creation of a new Surgical Procedures, In- Centenary hospital AMA (ACT)’s response bed-block. Our hard working staff Prof Steve Robson, strive to do their best in circum- terventional Radiology and Emer- Labor will grow the capacity of the Prof Steve Robson, AMA (ACT) AMA (ACT) President stances that make it difficult.” gency (“SPIRE”) Centre and exten- Centenary Hospital for Women and President emphasised the im- “Canberra’s doctors welcome the sion to the Centenary Hospital for Children and fund new staff and portance of health to the current “As good as ACT Labor’s One commitment by Leader of the Op- Women and Children. services including a new elective ACT election and welcomed ACT plans look, one area of concern position, Jeremy Hanson, to rede- child and adolescent orthopaedic Labor’s commitment to significant for us is that they appear to be on veloping Canberra Hospital.” Pro- service and a new specialised ado- new health spending. a much longer timeline than those fessor Robson said. lescent gynaecology service. “While I’ve been impressed with the of the Canberra Liberals with the SPIRE Centre not due to be oper- “With increasing demand for sur- In addition, the ALP plan calls for plans of the Canberra Liberals and gical and other health services in a new 12-bed child and adolescent been urging Labor to take a more ating until ‘around 2022’. Whoever Canberra, there is rapidly-closing mental health unit and 12 new pae- bipartisan approach, I’m delighted wins the election, we need to get window of opportunity to move for- diatric high-dependency units and that Andrew Barr has stepped up things moving as soon as possi- ward with the Canberra Hospital four paediatric intensive care beds. and put the health of Canberrans ble.” added Prof Robson. expansion, before the existing fa- first.” Prof Robson said. Comparing the plans cilities are overwhelmed.” Profes- A new expanded general Emer- AMA (ACT) has compiled a rough sor Robson added. gency Department, adjacent to “Labor’s plans for the Centenary the SPIRE Centre, will allow for Hospital for Women and Chil- guide to the plans proposed by the “All Canberrans with an interest in the current ED to be dedicated to dren are particularly welcome. Canberra Liberals and ACT Labor. advancing health care should sup- women and children with the two As someone who works there, I While both plans are yet to be fully port policy like this.” said Profes- EDs operating as one but with have know first-hand the ongoing prob- fleshed out, we’ve attempted to sor Robson. Andrew Barr, ACT Chief Minister separate entrances. lems with staffing, capacity and compare what we do know. Ama Health Policy proposal comparison Health infrastructure in the ACT is lagging badly behind other states, so potential solutions are badly overdue. Here, we rate the two proposals on the basis of need for the community, innovation, proposed timelines for delivery, and detail about how they will be paid for. Our overall rating of the policies is as follows: 4 Great idea! 8 Not so great idea! ? Some more detail needed at this stage Canberra Labor Canberra Liberals “SPIRE Centre” New main building at Canberra Hospital campus, already designed in collaboration with • 7 new operating theatres 4 clinicians (including surgeons): • A new intensive care unit with 48 bed bays 4 • Capacity for 20 new operating theatres. 4 4 • Two inpatient wards with 64 beds 4 • A new 48 bed intensive care unit. 4 • A new high care coronary care unit with 24 beds. 4 • A new 92 bed emergency department. 4 • Enhanced surgical, procedural, critical care and imaging facilities. 4 • A new 25 bed emergency medical unit. 4 • A new day surgery centre with seven procedure rooms 4 • A new 25 bed medical assessment planning unit. 4 Timeline • 105 ambulatory treatment spaces and a new state of the art medical imaging unit. 4 In operation from ‘about 2022’ 8 Investment Comment: No detail available about how ‘Spire centre’ was planned. ? $395m for new building Centenary Hospital for Women and Children $8m for extra staff • A new 12-bed child and adolescent mental health unit attached to Centenary Hospital. 4 Timeline • 12 new paediatric high-dependency units and four paediatric intensive care beds. 4 In operation from 2020 4 4 • More than 107 additional medical professionals 4 • A new elective child and adolescent orthopaedic service. 4 • A new specialised adolescent gynaecology service. 4 Comment: The physical infrastructure of the Centenary Hospital is already at capacity, so it is unclear where all the additional facilities will be housed and located. ? Timeframe None given 8 Investment $650m total spend ??

AUGUST 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [9] Beware – small business unfair contract terms Medical Practices need to be aware that from 12 Novem ber 2016, the unfair contract terms under the Australian Consumer Law will also cover standard form small bus iness contracts entered into, or renewed, on or after 12 November 2016.

What does this mean? When is a term unfair? If your practice has: The Australian Consumer Law does not provide a specific defini- entered into a contract for tion of what is to be considered the supply of financial goods an unfair term. In general, a term or services; and will be considered unfair if it would at least one of the parties is cause a significant imbalance be- a ‘small business’; and tween the rights of the parties or the upfront price payable if it is not reasonably necessary under the contract does to protect the legitimate interests not exceed $300,000, or $1 of a party. The following kinds of million if the contract is for terms may be considered unfair: more than 12 months automatic roll over for then you may have a legal remedy excessive periods; if you believe the contract is unfair. restrictions on the right of What is a Small Business? one party to terminate the contract; A ‘small business’ employs fewer than 20 people, including casual unilateral variation; and staff who may be employed on a excessive cancellation fees. regular and systematic basis. Ac- The Court will also consider contract will continue to bind the provisions of the Australian Con- cordingly, it is possible that both whether the terms and the con- parties if it is capable of operating sumer Law. parties to a transaction will be able tract as a whole is transparent. without the unfair term. It is important to note that your to rely on the unfair contract terms. This involves looking at whether The Court may also vary the con- medical practice itself may also be the terms are expressed in plain What is a standard form subject to the Australian Consum- language, presented clearly and tract, direct a party to refund mon- er Law if you enter into standard contract? readily available. Terms are un- ey to the affected party or direct form contracts with other small A standard form contact is usually likely to be transparent when they a party to provide services at that businesses. characterised as an agreement are phrased in legal, complex or party’s expense. pre-prepared by one party with technical language. Conclusion Should an issue arise then advice standardised terms which is pre- should be sought at the earliest sented on the basis that the other What happens if a term is We recommend that you review possible time to ensure your rights party can “take it or leave it” with found to be unfair? all agreements (whether these are protected. If you have any no effective opportunity to negoti- In the event the Court finds a term are agreements with custom- questions about the impact of the ate the terms. For instance, a mo- to be unfair it has the power to de- ers, suppliers or independent Australian Consumer Law please bile phone contract or a contract clare the term void and not bind- contractors) to work out which contact TressCox Lawyers’ Health for medical supplies. ing on either party. The rest of the contracts are affected by the new & Aged Care Team. Karen Keogh, Partner

Directory of Medical Specialists, AMA (ACT) Allied Health Professionals & General Practitioners is now on Facebook! with Special Interests AMA (ACT) has jumped into the wide world of Facebook so please For inclusion in the… – 12th edition get online and like us. It’s a great way to find out what’s going on 2017 Specialist Directory quickly and keep up to date with events. Recent posts have featured 2017 the decision by Fair Work Australia to retain one agreement for ACT hospital doctors and the meeting with ACT Health Minister, Simon Corbell. It’s easy – just search for AMA ACT.

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[10] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 AUGUST 2016 CLINICAL CASE STUDY BE AN AMA 20 good reasons MEMBER Sometimes fat helps to be a member of the IN 2016 BY Dr David Morewood, MBChB(Hons), MRCP, DMRD, FRCR, FFRRCSI Australian Medical Association

Fat Pads around the elbow and around the wrist can be extremely helpful in diagnosing fractures that may not 1) Political lobbying on behalf of the entire profession

be visible on initial radiography. 2) An independent voice 3) Unprecedented engagement with ministers and the media In the elbow it is normal to see the joint fracture. Various studies have 4) The AMA is there for you if things go wrong anterior fat pad immediately anteri- described the sensitivity of this or to the humerus. The posterior fat sign as being up to 98%. In an adult 5) Public education on public health and other medical issues pad should not normally be seen. If if the fracture is not clearly visible 6) The scrapping of the tax cap for self-education expenses after trauma the anterior and pos- it is likely that there is an undis- 7) AMA advocacy helps to reduce bureaucracy terior fat pads can both be seen placed fracture of the radius or A normal anterior fat pad. elevated from the anterior and pos- scaphoid. In a child there may be 8) The AMA supports medical leadership and terior aspects of the humerus then a green stick fracture of the radius clinician engagement significant trauma has occurred to or a scaphoid fracture. the elbow. In an adult if a fracture 9) A proven record of supporting medical research If these fat pads are displaced ei- is not clearly visible it is likely that 10) We ﬁ ght for timely emergency and elective surgery, and beds ther a follow up radiograph in 10 – there is an occult fracture of the 14 days time should be performed 11) Lobbying for intern and training positions radial head or neck. In a child it is or if the diagnosis is needed soon- likely that there is an occult supra- 12) Our opinion is valued: our submissions to Government er than this in adults a CT or MR condylar fracture of the humerus. scan can be performed. In children are heeded In the wrist on lateral radiographs under 16 years of age Medicare 13) Resources: practice support tools, news, the pronator fat pad is normally a have a rebate for elbow and wrist guidelines and position statements thin radiolucent line with its base MR scans for suspected signifi- 14) Workplace advice, support and training attached to the palmar surface of cant trauma of the elbow or for a the radius. It is seen 90% of the suspected scaphoid fracture. So 15) Support for the Medical Benevolent Association time. Displacement and anterior an MR scan should be performed An elevated anterior fat pad. 16) Support for Doctors’ Health bowing of this fat plane in the set- in children so that they are not ex- ting of trauma may indicate a wrist posed to unnecessary radiation. 17) Commercial beneﬁ ts and member discounts 18) The Medical Journal of Australia subscription is included 19) Fellowship and peer support, you are never alone

20) AMA MEMBERSHIP MAKES A DIFFERENCE Go to join.ama.com.au or call (02) 6270 5410 Don’t forget, membership fees are tax deductible or may be claimable against PD allowances as they include the Medical Journal of Australia

Ph: 02 6270 5410 | Fax: 02 6273 0455 A periosteal reaction and greenstick PO Box 560, Curtin ACT 2605 | www.ama-act.com.au fracture of the radial neck.

A normal pronator fat pad. The pronator fat pad is bowed anteriorly. Need a JP? Certification of documents, witnessing of statutory declarations and affadavits, witnessing of signatures. Call Christin e Brill 0407 123 670

A subtle fracture of the distal pole of the scaphoid associated. AUGUST 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [11] Changes to CHO approvals for controlled medicines BY Renae Beardmore, Acting Chief Pharmacist, ACT Health

Prescribers in the ACT have previously advocated for a change to the approval system that exists for controlled medicines, the “CHO approvals”. Following consultations in 2013 and 2015, the ACT Government has now changed the legislative framework for controlled medicines. This change is in line with a key priorities of the ACT Government – improve public health outcomes and reduce red tape for doctors, pharmacists and patients with regards to the supply of controlled medicines.

More flexibility for controlled medicines by drug prescribers approval, consistent with the From 1 August 2016, amendments previous approval approach have been made to the Medicines where the prescriber applied Poisons and Therapeutic Goods for a specific drug’s dose, Regulation to introduce a more form and strength. flexible approach when apply- A copy of the Prescribing Stand- ing for Chief Health Officer (CHO) ards, including a description of approval. One new element of the categories, information sheet this framework is that Controlled and FAQs are accessible from Medicines Prescribing Stand- http://www.health.act.gov.au/ ards (Prescribing Standards) has public-information/businesses/ been developed. The Prescribing pharmaceutical-services/con- Standards, approved by the CHO, Health Protection Service trolled-medicines. provide for prescribers to apply to Prescribers are encouraged to prescribe a controlled medicine In addition, from 1 August 2016, contact the HPS by emailing either via a: prescribers are no longer required [email protected] or calling 6205 controlled medicines by to annotate the CHO approval de 0998 during normal business category approval, provided tails on a prescription and as such hours so that HPS can support This change allows the ACT to us to be a leader in reducing the pharmacists may dispense pre- you with any queries you may that set conditions and retain the regulatory framework, harms associated with controlled criteria outlined in the scriptions for controlled medicines have relating to the Prescrib- which when combined with the Prescribing Standards are without the approval number on ing Standards or any other con- small size of our jurisdiction medicine abuse, misuse and di- met, or the prescription. trolled medicines issues. provides a real opportunity for version in our community.

Don’t Leave Your AMA Career To Fortune

The AMA’s Career Advice Service CAREER will assist you with: G Career Coaching G Applications, CV’s ADVICE and interview skills G Real life advice; and HUB G Much, much more.

For more information contact: Christine Brill (Career Adviser) [email protected] 02 6270 5483 ama.com.au/careers/

[12] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 AUGUST 2016 AMA Council of General Practice

Dr Suzanne Davey, ACT GP and AMA (ACT) Secretary gives The Council discussed the results ensure that those providing us the run-down on the most recent meeting of the AMA’s of the WA Medical Deputising Sur- genuine urgent after hours peak representative body for general practitioners – the vey which highlighted concerns care are not exposed to Council of General Practice. that some deputising services undue liability. were: AMA CPD Tracking Service Promoting themselves as a Dr Richard Kidd has succeeded Dr concerns were raised including: The AMA CPD Tracking service Brian Morton as chair of the CGP convenient alternative to a Timely and affordable access is available to all medical profes- after a long period of outstanding patient’s GP; sionals to help manage Continu- to specialists, especially in service from Brian; GPs owe Brian Promoting their services as ing Professional Development rural and remote areas, or a significant vote of thanks. being free, thus encouraging (CPD) recording requirements. for patients facing significant convenience with home This service is available free to Matters of interest from the meet- financial hardship; visits; AMA members and at a small ing included: Time-consuming access to Not working with a general cost to non-members. https:// Centrelink over the phone for Dr Suzanne Davey. Red Tape: Disability Support practice; and learning.doctorportal.com.au/ advice and support; bundle existing chronic disease Pension claims Unnecessarily complex Not advising patients that they GP Desktop Practice Representatives from the Depart- management items. bureaucratic processes could be seen by a non-GP. Support Toolkit ments of Social Services and Hu- often beyond the grasp of While there was majority support The AMA has written to the Chair This toolkit contains links to man Services briefed the Council those patients with limited for payment going to the practice, of the Medicare Benefits Schedule about 300 commonly used prac- on the revised assessment pro- capacity, especially those there was also a strong view that Review Taskforce suggesting that: tice tools for general practition- cess for Disability Support Pen- who have literacy and the AMA should play a key role in ers. It is available free for AMA When considering GP sion (DSP) Claims. They noted how numeracy issues. Greater ensuring the Health Care Home is members and can be download- attendance items under the the focus had shifted to identifying access to social workers or adequately funded. ed to your computer - https:// review, priority be given to those who have job capacity and liaison officers is needed, ama.com.au/article/introduc- Medical Deputising Services assisting them to work or testing particularly in rural areas, to the after-hours MBS items. tion-ama-gp-practice-support- their capacity before approving a assist these people through and the use of Urgent After- Exercising caution in toolkit (you’ll need your AMA DSP claim and that this has had a the process; Hours Attendance items approaching this issue to login and password for this). significant impact on the number Concern about the impact of people eligible for a DSP. of the review process on Council was advised that a GP’s current DSP patients; professional medical opinion will No feedback to GPs from continue to be part of the assess- Centrelink on an assessment ment process, although Assess- and no access point for GPs; ment Officers are highly trained in No easily accessible determining from the raw medi- communication mechanism cal evidence whether an applicant for informing GPs of the is fully diagnosed, treated and process and requirements. stabilised. So under the new arrangements, eligibility is not just Health Care Home – about the medical condition, it is Chronic Care Trial also about the person’s capacity The AMA is approaching this mat- to work. ter with some care, particularly in regard to the funding mechanism Where the applicant is manifestly for the Health Care Home given eligible, fast-tracking is available that funding will be directed to As might be imagined, from a gen- the practice rather than the treat- eral practice perspective several ing practitioner. This payment will

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AUGUST 2016 CANBERRA DOCTOR: Informing the Canberra medical community since 1988 [13] Book reviews: REVIEW BY Associate Professor Jeffrey Looi, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School

The toll of mortality adumbrates through four recent books: When Breath Becomes Air – Paul Kalinithi, Vintage Publishing, ISBN: 9781847923677 Gratitude – Oliver Sacks, Picador, ISBN: 9781509822805 Quicksand – Henning Mankell, Vintage Publishing, ISBN: 9781846559952 Sentenced to Life – Clive James, Picador ISBN: 9781447284055

his daughter brings in the face of with bittersweet melancholy akin his fate. to that found in much Japanese poetry on the ephemerality of life. Sack’s collection of four feuil- This slim volume traverses his letons over the last year of his current death-sharpened sense life resound with the tones of a of life, his memories of Australia life well-lived, if not immediately and his melancholy regrets. cherished in his more difficult years of youth. He is a master These gifts from those passed, of the short newspaper essay, and passing, are generous re- as was Joseph Roth and, more flections on what it is like to live, recently, Tony Judt. His writ- and to die. ing traverses playful thoughts, wistful reflections and generous gratitude on reminiscences of his remarkable life. INVITATION ...... YOUR HEALTH, YOUR VOTES ACT election forum Two physician authors, one at Mankell’s quixotic memoir wan- the end of an august career, Oli- ders through his memories and On Saturday 15 October 2016, the Australian Capital Territory ver Sacks, and the other cut-off his concerns for the future of (ACT) will head to the polls for the 2016 Legislative Assembly in stride, Paul Kalinithi, describe humanity. He contrasts his epi- election. their dying through cancer. sodes of seeming wellness with Join us to hear what our political parties and independents the certitude of his demise from Kalinthi, a talented liberal arts plan to do to reduce the growing burden of disease and injury cancer. He is best known for his scholar, enters medical school crime novels featuring Kurt Wal- in the nation’s capital. mindful of mortality. He wends lander, but was also a philanthro- If you have a question in mind for the candidates don’t forget his way into neurosurgery. Near pist committed to development in to submit your suggestions when you register. the end of his specialist resi- Africa. It is further poignant that dency training, he discovers he This event is free and open to members of the public. Please this is also the last translation by has a metastatic cancer. Deter- RSVP online by 3 October 2016. one of Mankell’s regular trans- minedly grasping the time left lators, Reg Keeland – as author he finishes his training, qualify- and translator both died in 2015. Wednesday 5 October 2016 ing as a specialist. He and his Two respected, but very differ- partner decide they will have a ent writers, Henning Mankell and James, is currently, in his own 6:00 to 8:00PM child, and he fathers a daughter. Clive James, have also penned words “highly embarrassed” to The Drawing Room, University House Kalinithi admits he writes in part reflections on mortality, also in be still alive with a terminal can- to convey the joy that the birth of the context of cancer. cer. His book of poems is infused The Australian National University Register online at www.actelectionforum.eventbrite.com.au or Qantas Club membership rates call Helen Cannon at FARE on (02) 6122 8600 for AMA members

Joining Fee: $240 (save $140) 1 Year Membership: $390.60 (save $119.30) 2 Year Membership: $697.50 (save $227.50) (all rates are inclusive of GST)

To renew your Qantas Club Corporate Membership For further information or an contact the secretariat to obtain the AMA application form please contact the corporate scheme number. AMA ACT secretariat on 6270 5410 For new memberships download the application or download the application from the from the Members’ Only section of the AMA ACT Members’ Only section of the AMA website: www.ama-act.com.au ACT website: www.ama-act.com.au

[14] CANBERRA DOCTOR: Informing the Canberra medical community since 1988 AUGUST 2016 Call for presentations

The MJA has established a series of CPD seminars that has quickly gained a reputation as one of the best education programmes for GPs in Australia, because of its credibility, relevance to clinical practice and willingness to address challenging issues.

Past presenters have found the Mental Health tivity to use interactive modes of MJA audience highly engaged and Respiratory Medicine education. provided useful insights into the Infectious Diseases general practice environment. MJA and doctorportal are pro- Cardiology duced by the Australasian Medi- Physicians also have a need for Oncology cal Publishing Company P/L education in related areas outside Paediatrics their core discipline. MJA CPD Level 19, seminars are unique in serving Aged care 456 Kent Street, this need as well as the learning If you believe you can contribute Sydney 2000 needs of GPs. Typically MJA CPD to an area of challenge in pri- Phone 02 9562 6666 is accredited for RACGP Category mary care please contact MJA www.doctorportal.com.au 1, ACRRM PRDP and RACP three Professional Development at www.mja.com.au points per hour. [email protected]. www.ampco.com.au Regular programmes are con- Opportunities are available to ducted within the main disease contribute to the development of areas of: a programme or present a one- hour interactive seminar ses- Endocrinology sion. The RACGP requires the Gastroenterology majority of a Category 1 CPD ac-

A News Magazine for all Doctors in the Canberra Region ISSN 13118X25 Published by the Australian Medical Association (ACT) Limited 42 Macquarie St Barton (PO Box 560, Curtin ACT 2605) FAST-TRACK UROLOGY Editorial: If you wish your patients to be Fast Tracked and avoid long Peter Somerville waiting times, Dr Maurice Mulcahy at Canberra Urology will Ph 6270 5410 Fax 6273 0455 arrange for this to happen through the Private Sector for all [email protected] urological conditions including the following: Typesetting: Design Graphix • Acute Presentation of Ureteric Colic with Ph 0410 080 619 Non-contrast CT Urogram and FBC, UEC & MSU Editorial Committee: • Stone Disease Peter Somerville – Production Mngr • Haematuria Dr Ray Cook • Elevated PSA Dr John Donovan AMA ACT membership AMA ACT membership • Bladder Outlet obstruction A/Prof Jeffrey Looi entitles you to access this entitles you to access this • Testicular Cancer Advertising: Member Reward Partner Member Reward Partner Ph 6270 5410, Fax 6273 0455 • Renal Masses [email protected] BELLUCI’S • Other Urological Cancers and Conditions Articles: RESTAURANTS CRABTREE & EVELYN PLEASE PHONE: Copy is preferred by email to Ph: (02) 6282 1700 (Phillip) Ph: (02) 6257 7722 Ph: (02) 6239 7424 (Manuka) [email protected] – Bath and body products, gourmet 02 6281 0222 – Award winning, foods, candles, home decor, and gifts in “Microsoft Word” or RTF casual Italian dining. for any occasion format, (not PDF) with graphics Conditions may apply and you must produce your Conditions may apply and you must produce your membership card to access these bene ts. membership card to access these bene ts. in TIFF, EPS or JPEG format. Next edition of Canberra Doctor – September 2016. AMA ACT membership AMA ACT membership AMA ACT membership entitles you to access this entitles you to access this entitles you to access this Membership Member Reward Partner Member Reward Partner Member Reward Partner Rewards Disclaimer Program Partners The Australian Medical Association (ACT) Lim- JirraJirra WinesWines ited shall not be responsible in any manner ~ 10% discount* whatsoever to any person who relies, in whole Jirra Wines or in part, on the contents of this publication HOTEL REALM Fax: 6227 5171 Joanne Flowers See Page 13 for unless authorised in writing by it. You don’t need to go to Tuscany for Ph: (02) 6295 0315 The comments or conclusion set out in this Ph: (02) 6163 1888 good Italian wines. Canberra has a details… publication are not necessarily approved or – Accommodation only climate very close to Tuscany’s. – Beautiful Flowers and Gifts endorsed by the Australian Medical Association Conditions may apply and you must produce your Conditions may apply and you must produce your Conditions may apply and you must produce your * conditions may apply. (ACT) Limited. membership card to access these bene ts. membership card to access these benefits. membership card to access these benefits.

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