Connecting Care

Connecting Care Coordinator: Brandi Cole CNC (LGAs of Sydney City, Leichhardt, Marrickville)
Phone: 8752 4931
Mobile: 0459 826 880

Connecting Care Coordinator: Stefan Nynycz CNC (LGAs of Ashfield, Burwood, Canada Bay, Canterbury and Strathfield)
Phone: 8752 4931
Mobile: 0459 827 615

Connecting Care

The current aims of the program are to improve communication across Primary and Secondary Care and to support patients with chronic diseases to navigate the health system. We support GPs by coordinating care for patients with one or more of the following:

  • Congestive Heart Failure
  • Coronary Artery Disease
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Diabetes
  • Hypertension

Patients can be referred from 16 years old (15 years old if Aboriginal).

Care Coordination can include a wide range of activities

  • Locating and engaging non government organisations (NGO’s) to provide services to patients in their homes
  • Referring to existing chronic care programs (such as heart failure or respiratory programs)
  • Refer patients for ACAT assessments and or case management services
  • Assist patients in understanding their chronic health condition and self management.
  • Assist in arranging transport services for specialist and clinic appointments.
  • Short term review and monitoring of management plans.

The Care Coordinator will work collaboratively with the GP and patient in accordance with the shared care plan. The patient’s GPMP and/or TCA become a central part of the coordination. Patients are assessed by Connecting Care Coordinators to determine if they would benefit from the program. Patient consent will also need to be obtained.

Patients can be referred by:

  • GPs, if the GP is of the opinion that the patient who has one of the listed chronic diseases is at risk of a hospital admission or already has multiple hospital admissions.
  • By Hospital clinics / departments

GPs can refer patients to connecting care by either:

  • Faxing referral form (available on CSGPN website) directly to secure fax: 9009 0790
  • Phoning Stefan Nynycz on Ph: 8752 4923

Templates for Referral

Connecting Care Referral form for Medical Director
Connecting Care Referral form for Best Practice
Connecting Care Referral form (manual)

Useful Links

Connecting Care Ministry of Health NSW:
http://www.health.nsw.gov.au/cdm/severe_chronic_disease_management_program.asp
Chronic Disease Management (CSGPN):
http://csgpn.org.au/services/info/chronic_disease_management/
Aboriginal Health (CSGPN):
http://csgpn.org.au/services/info/aboriginal_health/

Disability

Project Officer: Lisa Maude
Phone: 8752 4902

This page offers useful websites for GPs and the community.

Annual Health Assessment for People with an Intellectual Disability

Special Care Dentistry Services

For GPs

Specialist Clinics and Services

Respite and Day Centres in the Inner West

Associations

Useful links for families and carers

Service Directories for Local Councils

Mental Health Nursing

Project Officer: Karen Frost
Phone: 8752 4910

The Mental Health Nurse Incentive Program

The Mental Health Nurse Incentive Program (MHNIP) provides a non-MBS incentive payments to community based general practices, private psychiatry services and other appropriate organisations (including divisions of general practice) who engage mental health nurses to assist in the provision of coordinated clinical care for people with severe mental disorders in the community.

Mental health nurses work in collaboration with psychiatrists and general practitioners to provide services such as monitoring a patient’s mental state, medication management and improving links to other health professionals and clinical service providers.

For more information including brochures and fact sheets and advice on recruiting mental health nurses please call Karen Frost on 8752 4910 or visit www.acmhn.org.

Resources

  • Medicare Australia has a variety of resources available for the MHNIP, including:
    • Program overview
    • Eligibility
    • Payments
    • Application details
    • MHNIP documents

  • The Australian College of Mental Health Nurses website has information regarding:

Aboriginal Health

Project Officer: Kim Toole
Phone: 8752 4924

Aboriginal Outreach Project Officer: Rose Nean
Phone: 8752 4948
Mobile: 0420 365 454

Care Coordination and Supplementary Services Officer: Helen Golightly
Phone: 8752 4935
Mobile: 0420 518 515

Closing the Gap - Improving Indigenous Access to Mainstream Primary Care Program

Central Sydney GP Network acknowledges the traditional custodians of the land that we work on - the Gadigal and Wangal people of the Eora Nation and we pay our respects to the Elders, both past and present.

The Central Sydney GP Network (CSGPN) Aboriginal Health webpage refers only to Aboriginal people, in recognition that Aboriginal people are the original inhabitants of NSW. The use of “Torres Strait Islander” and “Indigenous” is only made when quoting the Commonwealth Government, which has a charter of providing services to both Aboriginal and Torres Strait Islander peoples.

Background

In 2008 the Council of Australian Governments (COAG) agreed to a $1.6 billion National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes to fund a broad package of initiatives addressing the target of closing the life expectancy gap within a generation.

One element of the package has involved engaging GP Networks to deliver the Closing the Gap – Improving Indigenous Access to Mainstream Primary Care Program. The aim of this program is to contribute to closing the gap in life expectancy by improving access to culturally sensitive primary care services for Aboriginal Australians.

Primary care services have been identified as generally being a first point of contact for health services in Australia. However, cultural barriers have historically limited access by Aboriginal people. According to 2006 Census figures the area serviced by CSGPN is home to approximately 4,800 Aboriginal Australians, which represents 3.3% of the NSW Aboriginal population. Within the network there are several Aboriginal specific health services, however as part of improving the options for Aboriginal Australians and ultimately their health it is important that all Central Sydney mainstream primary care services commit to playing their part.

The Closing the Gap – Improving Indigenous Access to Mainstream Primary Care Program is funded by the Department of Health and Ageing (DoHA).

Program Objectives

(source: DoHA Version 1.1 March 2010)

  • increase access to mainstream primary care services by Aboriginal and Torres Strait Islander peoples;
  • improve the capacity of general practice to deliver culturally sensitive primary care services;
  • increase the uptake of Indigenous specific Medical Benefits Schedule (MBS) items including Indigenous health checks and follow up items;
  • support mainstream primary care services to encourage Indigenous Australians to self-identify
  • increase the awareness and understanding of Closing the Gap measures relevant to mainstream primary care; and
  • foster collaboration and support between the mainstream primary care and the Indigenous health sectors.

Activities

CSGPN has several activities planned to meet the above objectives, which will be tailored to meet local needs. These involve:

  • promotion of the Program to community organisations through a range of methods.
  • collaborating with Aboriginal health organisations to identify and address barriers to Aboriginal Australians accessing primary care services.
  • promoting general practice as a valid, trustworthy and accessible first point of contact for Aboriginal health needs.
  • assisting general practice to manage specific Aboriginal health needs and issues at the local level.
  • providing support to general practices on methods to encourage Aboriginal Australians to self-identify when accessing primary care services.
  • coordinating education events for general practitioners and Division staff, including cultural awareness training and quality improvement activities.
  • developing and disseminating information resources for Aboriginal Australians.

Aboriginal Outreach Workers

Our aim is to contribute to closing the gap in life expectancy by improving access to culturally sensitive primary care services by the local Aboriginal community.

As part of the Closing the Gap program the Aboriginal Outreach Worker is available to support Aboriginal and Torres Strait Islander people to access local health services including GPs, specialists and allied health providers.

    The Aboriginal Outreach Worker can provide the following:
  • Information & resources about locally available health services
  • Referrals to culturally appropriate health care providers & services
  • Information & assistance with travel options to & from health appointments
  • Support when attending health appointments, including GPs, specialists, allied health providers & diagnostic tests
  • Assistance with effective communication between yourself & the health care provider
  • Information about local community services & activities

All services by the Aboriginal Outreach Worker are STRICTLY CONFIDENTIAL and FREE

If you are a GP with an Aboriginal patient who requires any of the above assistance please complete the Closing the Gap Referral Form and send via secure fax to: 9009 0690.

Care Coordination and Supplementary Services

The Care Coordination and Supplementary Services (CCSS) program is one of the measures under the Closing the Gap scheme aimed at improving chronic disease management in Aboriginal patients. This program has recently commenced at CSGPN. The program has two main components:

  1. Care Coordination provided by qualified healthcare workers to Aboriginal patients with a chronic disease. Patients will be referred by GP’s in general practices participating in the Practice Incentives Program (PIP) Indigenous Health Incentive; and
  2. Supplementary Services: A flexible pool of funds that can be used to assist patients receiving care coordination under the CCSS program. The funds can be used to access medical specialist and allied health services that are in accordance with the patient’s care plan. Care coordination can:
    • assist people in understanding their chronic health condition and managing it on a daily basis;
    • advise on the importance of following their care plan; and
    • provide support in identifying signs that their condition may require further assistance from a health professional.

The care coordinator may assist the patient in a number of ways, e.g. assisting them to access specialist services, ensuring patients can get to appointments, assisting them to participate in regular reviews with their GP, develop chronic condition self management skills and connect with community based services as needed. The care coordinator will work collaboratively with the GP and in accordance with the care plan.

All services provided by the Care Coordinator are free.

If you are a GP with an Aboriginal patient who requires the above service, please complete the CCSS referral form and send it via secure fax to 9009 0690.

The role of mainstream general practice

“While Aboriginal community controlled health services (ACCHSs) play a vital role in Aboriginal health, it is estimated that 60% of Aboriginal people and Torres Strait Islanders access health care elsewhere. Mainstream general practice therefore has an important role in ensuring better service provision, including improved HA (health assessment) uptake” (Kehoe, H., Lovett, R. W. (2008). Aboriginal and Torres Strait Islander health assessments - barriers to improving uptake. Australian Family Physician, 37(12), p. 1033).

Identifying Patients of Aboriginal Descent

This is important to know because the health of Aboriginal Australians is still significantly poorer than that of non-Aboriginal Australians. Identifying patients as Aboriginal ensures health services are matched to their needs. Practice staff and GPs can actively encourage Aboriginal patients to self-identify, which is the essential first step in providing specific health services.

A patient is considered to be of Aboriginal descent if they identify as being so. Appearance is not a reliable way of determining cultural identity. Routine identification can be assisted through:

  • staff cultural awareness training
  • improved understanding of the need for and the benefits of the health assessments
  • culturally appropriate resources in the waiting room
  • being confident when asking patients the question. An appropriate way to ask is:

    “Are you of Aboriginal and/or Torres Strait Islander descent?”

A RACGP fact sheet on identification of Aboriginal and Torres Strait Islander patients can be viewed at:
RACGP rd Edition Standards Fact Sheet for Identification of Patients.

DoHA Practice support: How to Identify Aboriginal and/or Torres Strait Islander Patients.

Health Assessments

Early indications are that the Medicare Aboriginal and Torres Strait Islander health assessments have the potential to considerably reduce morbidity and mortality. Early detection, diagnosis and intervention of common, treatable conditions needs to start happening to reduce the disproportionately high rate of late presentation, diagnosis and hospitalisation amongst Aboriginal Australians.

NACCHO National guide to a Preventative Health Assessment in Aboriginal and Torres Strait Islander peoples

Proformas:

PIP Indigenous Health Incentive

The Practice Incentive Program (PIP) Indigenous Health Incentive is aimed at supporting general practice, as well as Aboriginal health services to provide a comprehensive range of health services to Aboriginal people with chronic health problems. Financial incentives are arranged into 3 components that are based upon the level of care provided. Practices participating in the incentive will also have increased access to supporting health services for their patients.

More information on the PIP Indigenous Health Incentive can be accessed at:

Practices registered for the Indigenous Health Practice Incentive Program

current as of 27 March 2012

Practice Address Phone
Aboriginal Medical Service Cooperative (AMS) 36 Turner Street, Redfern 9319 5823
Albert Road Medical Centre 60 Albert Rd, Strathfield 9746 9440
Alice St General Practice 6 Alice St, Newtown 9550 6201
Broadway General Practice Lvl 1, Broadway Shopping Centre 9281 5085
Burleigh Street Surgery 4 Burleigh Street, Burwood 9745 6560
Burwood Medical Practice 179 Burwood Rd, Burwood 9747 6327
Campsie Family Medical Centre 248 Beamish Street, Campsie 9718 0633
Campsie Healthcare Medical Practice Lvl 1, 157-159 Beamish St, Campsie 9787 9766
Church Street Medical Practice 280 Church Street, Newtown 9516 2944
The Clocktower Medical Centre Shop 2, 266-274 Burwood Road, Burwood 9747 4005
DMC Medical Centre 159 Victoria Rd, Drummoyne 9819 6666
Dr Doong’s Surgery 8 Burwood Road, Burwood 9745 2755
Dr Hamdy Boulis Surgery 14 Evaline Street, Campsie 9787 4986
Dr A. Jones Surgery 79 Pitt St, Redfern 9699 8327
Dr Ramrakha Surgery 77 Elliott Street, Balmain 9810 1523
Dr Tan Surgery 672 Elizabeth Street, Waterloo 9699 8593
General Medical Practice 102 Marion Street, Leichhardt 9569 6051
Glebe Family Medical Practice 114 Glebe Point Road, Glebe 9660 8399
Homebush Medical and Dental Centre 17 The Crescent, Homebush 9746 7789
Krishnan Services Redfern 429 Cleveland Street, Redfern 9319 7600
Leichhardt General Practice 112 Balmain Road, Leichhardt 9560 2511
Marrickville Medical Practice 221a Marrickville Road, Marrickville 9550 9292
Newtown Medical Practice 327 King StNewtown 9557 5254
Dr Papadakis & Dr Ralec Surgery 18 Clarke St, Earlwood 9558 0171
Dr Patricia Mohr-Bell Surgery 342 Stanmore Rd, Petersham 9560 5610
Poet’s Corner Medical Centre Shop 5, 45 Morehead Street, Redfern 9698 3060
Rozelle Medical Centre 687 Darling Street, Rozelle 9818 1355
Rozelle Total Health 579 Darling Street, Rozelle 9087 4600
Sanctuary Health Wellbeing Village 7 Harris St, Pyrmont 9506 0400
Surry Hills Village Medical Centre Shop 13, Surry Hills Village Centre, Redfern 9319 0656
Sydney Inner West Medical Centre 188-190 Burwood Road, Burwood 9745 3381
The Village Medical Practice 130 Smith St, Summer Hill 9798 3100
Waterloo Medical Centre 134 Raglan Street, Waterloo 9319 5823
Your Doctors Leichhardt 93-95 Balmain Rd, Leichhardt 9550 0288
Your Doctors Summer Hill 3 Lackey St, Summer Hill 9797 3900

PBS Co-payment Measure

The Government has introduced assistance to eliminate or lower the cost of Pharmaceutical Benefits Scheme (PBS) medicines for Aboriginal patients living with, or at risk of, chronic disease. The PBS Co-payment Measure is a response to identifying that cost is a significant barrier to accessing medicines for Aboriginal people.

Additional information on the Measure is available at:
Medicare - closing the gap

Forms for the PIP Indigenous Health Incentive and PBS Co-Payment Measure:

Resources and Useful Links

Aboriginal organisations

National Indigenous newspapers

Additional Information

Health Checks and Assessment

Project Officer: Vijay Ramanathan
Phone: 8752 4915

Overview Health Checks and Health Assessments



Health assessments overview

Health assessments are used to assess the over health of a patient taking into consideration their social, physical, physiological health, family history and environmental risk factors. They are useful tools to establish a baseline for the patient to consider, monitor or focus on self management to maintain or address their potential future health predicament.

They can provide the impetus needed to address a potential health problem such as CVD or diabetes. They can be valuable to patients and carers to help direct interventions before problems arise such as hearing problems in small children or dental issues in intellectually delayed patients.

They are also there to show parents the positives about their health. That their children are doing really well, they have reached the appropriate milestones and everything is on track.

We encourage all practices to take a whole of practice approach and utilise health assessments as a best practice frontline approach to health promotion, encouraging patient wellness and self management of care.

Guidelines to Health Assessments

  • The patient must give consent and the consent must be recorded. If the patient can’t give it or is too young. It will need to be given by a responsible person who has the authority to do so i.e. a parent, carers or guardian.
  • The patient’s usual doctor is best placed to carry out the assessment. Usual means having seen the patient on previous occasions over the past 12 months.
  • Both Practice Nurse and registered Aboriginal Health Workers are able to assist with history taking and provide health promotion interventions. All clinical diagnosis of the health assessment must be conducted under the care of the GP.
  • The patient should receive a copy of their health assessment.
  • Follow up and review where appropriate particularly with lifestyle interventions and goal setting.

Claiming rules

  • Always check with Medicare on 131231 to ensure the patient is eligible for the health assessment.
  • Health Assessments should not be claimed with other consolation unless it is clinical significant. The exception to this is with a Healthy kids check or a Comprehensive Medical Assessment. When they are often provided in conjunction with another consultation.
  • Bulk billing incentives can be claimed with health assessments.
  • Practice nurse item numbers and health assessments can also be claimed together.
  • The GP and the practice nurses total time combined equates to the item number claimed.

New rules for claiming and assessing (Question and Answers)
From 1 May 2010 new rules apply to health assessments this cheat sheet should help explain the process.

1.  Healthy Kids Check

Claiming rules

Only claim once

  • Claimed with practice nurse immunisation item number
  • Claimed with bulk billing incentive

Can be completed by

  • GP
  • GP and practice nurse
  • Practice nurse or Aboriginal Health Worker (item 10986)

Eligible children must:

  1. Be aged between 3 and 5 years of age
  2. Have received or be going to received their 4 year old vaccinations (NSW health Schedule)
  3. Have consent from parent or carers
  4. Be provided with a copy of “Get set 4 Life”

2.  45-49 year old Health Check for patients

Claiming rules

Patients is eligible for ONE health check between the age of 45-49 years Claimed with bulk billing incentive can be completed by

  • GP
  • GP with the assistance of a practice nurse

The patient

  • Aged between 45-49 years of age
  • At risk of developing a chronic disease

Risk factors include

  • Smoking
  • Poor nutrition and Physical inactivity
  • Alcohol intake

Biomedical Risk Factors

  • Blood pressure
  • High cholesterol
  • Weight issues
  • Impaired glucose metabolism
  • Family history

Tools to assist

3.  Type Two Diabetes Risk Evaluation – people 40-49

Target

people aged 40-49 at risk of developing Type 2 diabetes

Claiming rules

  • Once every three years
  • Claimed with bulk billing incentive

Can be completed by the

  • GP
  • GP and practice nurse

The patient

  • aged between 40 - 49 years of age Complete AUSDrisk assessment tool (link)
  • Have consent from parent or carers
  • Be provided with a copy of Get set for Life
  • Clinical risk factors
  • Lifestyle factors
  • Smoking
  • Poor nutrition
  • inactivity

Biomedical risk factors

  • blood pressure
  • weight
  • impaired glucose metabolism
  • recent diagnostic test results
  • family history of chronic illness

The health assessment will include

  • evaluation of patients risk using AusDRISK completed at least 3months before the health assesment
  • physcial examination and update of patients history and clincial investigation
  • make the assessment of patients risk
  • initiate patients readiness to change interventions
  • recommend Lifestyle Modification Program (LMP)
  • Contact CSGPN for referral number and provider
  • Implement motivalion interviewing and lifestyle coaching

Other services to support newly diagnosed diabetics

4.  75+ Health Assessment

5.  CMA

6.  People with an Intellectual Disability

7.  Refugee and Humanitarian Check

8.  Health Checks for Aboriginal and Torres Strait Islander patients

Children aged 0-5 information and form
Adults aged 16-54 information and form
Older patients aged above 55 information and form

Links

Further Resources

Modified Otago Falls Prevention Program

Overview

Falls are a common and potentially devastating cause of morbidity in older people living in the community. Falls result not only in physical injury, but can potentially reduce independence and impair quality of life. However, falls can be prevented.

CSGPN in collaboration with SSWAHS is now conducting a Modified Otago Falls Prevention Pilot Program. This project will assess the effect of an exercise program, developed specifically for each individual, to reduce their risk of falling and to improve their balance and strength.

The Modified Otago Program will work with participants to implement a home-based, individual exercise plan with the addition of three group based Otago exercise sessions at weeks 2, 4 and 8. These group sessions are intended to increase motivation, improve compliance, and monitor individual progress.

The original Otago Exercise Program has been shown to be highly effective in reducing the risk of falling in older people through individual exercise plans. This program was shown to be most effective in 80+ year olds and reduced falls risk by 35%.

Exercise programs for falls prevention have been shown to be most effective if targeted at older people who have had a recent fall or are at high risk of falling. However, current strategies for recruiting people into community-based exercise programs cannot screen participants for risk. The modified Otago program has been able to identify an effective screening tool to help identify those at risk of suffering a fall by examining the risk factors associated with this.

The aims of this program are to:

  • Test whether a modified Otago program can achieve greater participant compliance
  • Evaluate a modified Otago program for decreasing falls in a high risk population
  • Develop and evaluate referral pathways from primary care providers onto a modified Otago program
  • Increase the capacity within SSWAHS and the local community for providing Otago style programs
  • Recruit 100 community dwelling people aged 75 years and older with falls risk factors into the project
  • To engage selected local fitness providers and train exercise physiologists to deliver a modified Otago program in a group-based setting.

Screening

Screening will involve completing the 75+ Health Assessment for eligible patients. As part of this assessment GPs will be required to also complete the QuickScreen© Falls Risk Assessment (developed by the Prince of Wales Medical Research Institute.)

GPs role

  • Screen patients over the age of 75, using the MBS 75+ Health Assessment
  • During the assessment screen your patients for falls risk using the QuickScreen Falls Risk Assessment
  • Generate management plan (or GPMP if chronic conditions exist)
  • Refer eligible patients (with their consent) to the program coordinator.

GP benefits

  • 40 RACGP points for referring a minimum of 5 patients and performing a simple audit
  • Feedback on your patient’s progress in the program and health outcomes
  • Financial reimbursement for your time via the Medicare rebate for the 75+ Health Assessment (MBS item no. 700, 702)
  • A free QuickScreen© Falls Risk Assessment package (valued at $300) to assist in the screening process.

Patient benefits

  • A comprehensive assessment of their falls risk that provides a risk factor score that correlates with their probability of falling in the next 12 months
  • A visit from an exercise physiologist who will assess their abilities and tailor an exercise program to suit their needs
  • Three, free group exercise classes in their local community instructed by an exercise physiologist
  • Additionally, it is hoped that at the end of the six-month program they will have improved strength, balance and confidence in avoiding falls, as well as a decreased risk of falls.

Target areas

    At present, this study is targeting practices in the following areas:
  • Belmore
  • Campsie
  • Lakemba
  • Hurlstone Park
  • Kingsgrove
  • Ashfield
  • Croydon
  • Summer Hill
  • Lewisham
  • Petersham

Advance Care Planning

Project Officer: Vijay Ramanathan
Phone: 8752 4915

What is Advance Care Planning?

Advance Care Planning involves a patient thinking about and communicating to others how they would like to be treated in the future if they have a condition where they can no longer speak for themself. This may happen, for example, because of a stroke, progressive dementia, or becoming unconscious from some form of accident or illness. For more information, please visit SSWAHS or download the ACP Information Sheet for GPs.

Advance Care Planning used to be called Advance Care Directives and many web sites still utilise this terminology. Another term is Respecting Patient Choices.

Why Advance Care Planning is important?

Undertaking ACP means that future decisions about a person’s care are more likely to reflect their wishes. It helps them raise sensitive issues about the future with those close to them that they might otherwise avoid. It will mean that other people will not have to make decisions on the person’s behalf without knowing what that person’s real feelings and wishes would be. It reduces the chance of confusion and conflict when others are making decisions about a person’s care. It means that the patient and the people close to them can feel comfortable and reassured that there will be a common and calm approach to their care toward the end-of-life.

What does ACP involve for GPs?

The role of GPs in advance care planning may include:

  1. discussing the idea of advance care planning with patients/residents
  2. providing patients/residents with information regarding their current health status, prognosis and future treatment options
  3. witnessing or completing instructional directives where appropriate
  4. applying patients’/residents’ wishes to medical management.

What are the steps involved?

Step 1: Incorporate advance care planning as part of routine care of patients/residents
Step 2: Assess capacity of patient/resident to appoint a representative and complete an advance care plan
Step 3: Support discussion and documentation of advance care plan
Step 4: Apply the patient’s/resident’s wishes to medical care
Step 5: Review plan regularly or when health status changes significantly

SUGGESTION: Discuss ACP with the patients or residents during an ordinary consultation (opportunistic) or as part of health assessments.

Templates to complete ACP

  1. Statement of Values and Wishes (completed by the patient) Statement of Values and Wishes (Patient)
  2. Statement of Values and Wishes (completed for the patient) Statement of Values and Wishes (completed for the patient)
  3. Record of ACP discussion (for RACFs to complete) Record of ACP discussions

Links

  • Sydney South West Area Health Service: My Wishes SSWAHS My Wishes
  • The Royal Australian College of General Practitioners has guidelines on Advance Care Planning
  • New South Wales Government- Attorney General’s Department Capacity Toolkit - Information for government and community workers, professionals, families and carers in NSW. This has a section on Health including using their terminology Advanced Care Directives. Phone 02 8688 7507 or email diversity_services@agd.nsw.gov.au
  • The Advance Care Directives Association also has its own website and a book ‘My Health, My Future, My Choice’ can be purchased
  • The Benevolent Society developed a booklet that is no longer in print but can be downloaded titled ‘Your Future Starts Now - Guide for the over 50s’ -  (search for Advance Care Planning on their website)
  • Aged care assessment care planning framework 2009

Directory of Medical Specialists

This page provides a directory of services developed by CSGPN and other affiliated services. If you have any updates or would like to contribute a link to this directory, please contact Lee Sheppard on 8752 4927.

Medical Specialists

Surgical Specialists

Specialists Colleges

Others

Diabetes Prevention

Diabetes Prevention

Project Officer: Vijay Ramanathan
Phone: 8752 4915

Diabetes mellitus was endorsed as a National Health Priority Area at the Australian Health Ministers’ Conference in 1996 in recognition of the high prevalence of the disease in Australia, its impact on morbidity and mortality, and its potential for health improvements through prevention and treatment programs.

Type Two Diabetes Risk Evaluation

The Australian Type 2 Diabetes Risk Assessment Tool was developed by the Baker IDI Heart and Diabetes Institute on behalf of the Australian, state and territory governments as part of the COAG initiative to reduce the risk of type 2 diabetes.

Target people aged 40-49 at risk of developing Type 2 diabetes

To know more about and/or complete AUSDRISK, visit AUSDRISK Tool.

LIFESCRIPTS

The Lifescripts initiative provides general practice with evidence-based tools and skills to help patients address the main lifestyle risk factors for chronic disease: smoking; poor nutrition; alcohol misuse; physical inactivity; and unhealthy weight. The initiative assists with the provision of tailored advice to patients on modifying their lifestyle.

Lifescripts resources have been developed specifically for use with Aboriginal and Torres Strait Islander patients. The resources can be used by Aboriginal health workers, general practitioners and practice nurses within general practice or in Aboriginal and Torres Strait Islander health care settings.

Lifescripts resources are available in hard copy and as electronic template (Medical Director, Best Practice) from the Department of Health and Ageing website. The Lifescripts resoruces are available in English, Arabic, Chinese, Greek, Italian and Vietnamese.

Mental Health - Medicare

Project Officer: Mano Arumanayagam
Phone: 8752 4907

Overview

The ‘Better Access to Psychiatrists, Psychologists and GPs through the MBS’ initiative (Better Access) introduced new Medicare items in 2006 to provide better and more affordable mental health care.  The Medicare Item Numbers are designed to promote a team approach to mental health care, with GPs better supported to continue working with psychiatrists, clinical psychologists, and other allied mental health professionals to increase the availability of care.

If you need any help with medicare item numbers and billings procedures please call Mano Arumanayagam on 8752 4907. Alternatively you can search the Medicare Benefits Schedule online Medicare Benefits Schedule - Search

For futher information on the Better Access project please visit the AGPN Primary Mental Health Care Network website.

Resources

  • CSGPNs Mental Health Treatment Plan and Review template
  • The Australian General Practice Network has a range of resources for GPs to assist with the implementation of the GP component of the Better Access to Mental Health Care Initiative, including:
    • The Better Access to Mental Health Care: Orientation Manual
    • The Better Access - General Practice Briefing - Powerpoint Presentation
    • Patient Pathways Flowchart
    • Outcome measurement tools
      • To access these resources please visit the AGPN Primary Mental Health Care Network Resources page on the AGPN website.
  • The Department of Health and Ageing website contains information on initiatives to build the capacity of the mental health care system

Urgent advice from pychiatrists

Mental Health Skills Training for GPs

  • CSGPN regularly runs Mental Health CPD events (including MHST), please refer to the CPD Events page on our website for further details.
  • A number of external education providers (including the Black Dog Institute and The NSW Institute of Psychiatry) offer mental health activities. For details on external education providers refer to the External Education page of our website.

Sexual Health

Project Officers:

Vijay Ramanathan Phone: 8752 4915
Julie McLean Phone: 8752 4905

Sexual health is a major aspect of health worldwide and an integral component of reproductive health. The World Health Organisation (WHO) defines it as:

‘a state of physical, emotional, mental and social wellbeing related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled’.

Sexually transmissible infections (STIs) is an important SH problem in Australia where 20.2% of males and 16.9% of females had reported that they had been diagnosed with an STI at some stage of their life.

General Practitioners are the most common source of treatment for sexually transmissible infections. Also, GPs are normally considered as the first medical contact for men with sexual dysfunction.

Key organisations

CSGPN distributes information on STIs and other sexual health issues and provides education on a range of sexual health topics through continuing professional development. Some useful information and vital resources:

Men’s Sexual Health

Women’s Sexual and Reproductive Health

Sexual health - Education and Training

ThinkGP Education

  • Interactive case studies on men’s health, women’s health and sexual health
  • Activities for practicing sexual history taking and managing specific sexual health issues
  • Activities can be found at www.thinkgp.com.au/education

Vital contacts

RPA Sexual Health Clinic
Ground Floor, Page Building (Building 14) RPA Hospital
119-143 Missenden Road, Camperdown
Phone: 02 9515 3131

Sexual Health Infoline: 1800 451 624

NPS - better choices, better health

NPS Facilitators:
Beba Ostrugnaj Phone: 8752 4909
Cameron Stewart Phone: 8752 4939

NPS Administration:
Julie McLean Phone: 8752 4905
Mary Eurlings Phone: 8752 4948

About NPS

NPS is an independent, not-for-profit and evidence based organisation that enables better decisions about medicines and medical tests. We are funded by the Australian Government Department of Health and Ageing. To find more about NPS, go to About NPS.

Therapeutic Topics 2010-2011

Topic Availability Topic flyer
Balancing benefits & risks of antipsychotics Feb 2012 - June 2012 Antipsychotics_flyer.pdf
Antibiotic resistance & respiratorty tract infections July 2012 – Dec 2012

For further information on this program or to book a practice visit please contact the NPS Facilitators on 9799 0933

CSGPN educational visiting program includes

  • One-to-one practice visits to discuss objective up-to-date information on drug therapies and guidelines are offered on two therapeutic topics per year.
  • Small group case study discussions on select therapeutic area involving up to 12 GPs.
  • Interactive workshops on select therapeutic area, involving GPs, practice nurses and pharmacists.
  • Workshops that encourage further development of critical appraisal skills
  • Education and resources for consumers about QUM.

What is Quality Use of Medicines?

Quality Use of Medicines (QUM) is one of the central objectives of Australia’s National Medicines Policy. QUM means:

  • Selecting management options wisely
  • Choosing suitable medicines if a medicine is considered necessary
  • Using medicines safely and effectively to get best possible results

CSGPN and NPS

CSGPN works in partnership with the NPS to provide independent evidence based information and support to health professionals and consumers on the quality use of medicines through education and quality assurance activities, local programs, training and skills development.

Quality Prescribing Initiative (QPI)

GP participation in practice visits and nationally co-ordinated NPS clinical audits & case studies will qualify accredited practices for the Quality Prescribing Initiative (QPI) of Practice Incentives Program (PIP). NPS activities attract QA & CPD RACGP points.

NPS Resources

  • NPS Nurse Update is a digest of evidence-based information to help you improve your knowledge of medicines use and prescribing practices. NPS actively engages with nurses to encourage a greater understanding of medicines by providing information and activities on various therapeutic programs
  • NPS News is distributed bimonthly with Australian Prescriber and contains summaries of specific therapeutic areas and updates on complementary medicines.
  • Case studies are provided as inserts to NPS News and may be completed and returned to the NPS. GPs who participate receive a report on the aggregated responses
  • Clinical audits developed or approved by the NPS are free to GPs and recognised by the RACGP Quality Assurance and Continuing Professional Development Program
  • Prescribing Practice Reviews mailed to all GPs provide evidence-based information and prescribing data to enable doctors to review their own prescribing practices
  • RADAR (Rational Assessment of Drugs and Research) provides information on new drugs, PBS listings and commentaries of new research relevant to primary practice. Access quarterly RADAR releases at RADAR or look in your prescribing software.
  • Therapeutic Advice and Information Service (TAIS) phone 1300138 677 provides information to health professionals on newly available drugs, drug interactions, adverse drug reactions, use of drugs in unapproved indications.
  • Patient leaflets and action plans are designed to help health professionals communicate essential treatment messages to their patients and are best used in conjunction with verbal communication during patient consultation
  • NPS tools for health professionals practical help for health professionals in prescribing and achieving Quality Use of Medicines in practice.
  • Medicines Line phone 1300 888 763 provides consumers with independent information on prescription, over-the-counter and complementary medicines.

Useful links

Practice Support and Accreditation

Project Officer: Catherine Scardilli
Phone: 8752 4937

Quick Reference Link
Practice Accreditation
4th Edition RACGP Standard
Accreditation Links and Resources
Practice Incentive Program
Practice Management Information

 

Program Overview

The Central Sydney GP Network (CSGPN) Practice Management Project provides support and information to GPs and practice staff through the following:

  • Practice Visits
  • On-site presentations to GPs and Practice Staff
  • Helpdesk (telephone and email)
  • Workshops
  • Communication tools such as newsletters, fax-outs and emails.

Assistance is available to practices in the following areas:

  • Accreditation: accreditation advice and assistance, collation of patient survey results, mock accreditation
  • Practice Incentives Program (PIP) & Service Incentives Payments (SIP)
  • Starting a new practice - assistance with all aspects of starting a practice
  • Business Process Review: review current processes and provide recommendations and advice on the flow of procedures including procedure manuals
  • Change Management and Human Resources
  • Workshops for GPs and Practice Staff
  • Risk Management and Occupational Health & Safety
  • Privacy and Confidentiality including record retention guidelines
  • Infection Control
  • Other practice management enquiries as required

What is Accreditation?

Accreditation is the assessment of a general practice against the requirements outlined in the Standards of General Practice written and published by the Royal Australian College of General Practitioners (RACGP). The Standards of General Practice are considered the benchmark for Australian practices. The accreditation process is completed by either AGPAL or GPA Plus and covers the following areas:

  • Practice Administration: appointment systems, triage processes, communication tools, interpreter services, after hours services, home visits, security, signage and health promotion
  • Practice Management: human resources, training, occupational health and safety, quality improvement
  • Consultation Room: facilities including design layout of the rooms and what to include in the doctor’s bag
  • Management of Health Information: confidentiality, privacy, transfer of health information, retention and destruction of records, electronic information security and access, content of patient records
  • Patient Management: practice costs, health promotion, continuity and co-ordination of care, recall systems, engaging other services, collaborating with patients
  • Treatment Room: practice equipment, Schedule 8 medicines, vaccine potency, perishable materials, perishable materials, infection control
  • Interviews: doctor interview, clinical staff (if applicable), staff interview
  • Document Review: practice information sheet, policies and procedures; patient feedback surveys

What benefits do I get from being an Accredited practice?

  • Guidance for best practice using benchmarks with other accredited practices
  • Access to the Commonwealth’s financial incentives programs - Practice Incentives Program (PIP) and Service Incentives Program (SIP)
  • RACGP QI & CPD points (Category 2)
  • Increased recognition from insurance providers
  • Reduced risks in service delivery
  • Improved practice efficiency
  • Improved patient outcomes

What does it involve?

Most practices prepare up to 8 months ahead of their accreditation date to gradually address the tasks needed. Practices must complete a Policy and Procedures manual, Patient Feedback survey and a formal Survey visit. Most requirements are already in place within practices however this process is a formal documentation and recognition of practices. For new registrations, the accreditation cycle lasts 12 months. The normal accreditation cycle lasts for 3 years. CSGPN is available to assist practices register and prepare for their accreditation.

New Changes in the 4th Edition Standards

From 1st of July until 31st of October 2011, any practice which registers for accreditation will be able to choose between the 3rd or 4th Edition RACGP Standards for General Practice for their practice assessment. Practices who are currently accredited and whose expiry dates fall between 1st of April 2012 and 31st of July 2012 will also have a choice of which edition they would like to be re-accredited against.The 4th Edition Standards will be used for all practices who register for accreditation from the 1st of November 2011 and whose current accreditation expires after the 1st of August 2012.

To help familiarise practices with the changes in the new edition of the Standards, the RACGP have produced a presentation and summary fact sheet which outlines the key changes between the 3rd and 4th editions.  The RACGP will also be running education sessions scheduled to resume in early September. Visit the RACGP Standards website for more information and timetables.

New Criterion- 1.5.2 Clinical Handover- Our practice has an effective clinical handover system that ensures safe and continuing healthcare delivery for patients
Clinical handover has been defined by the AMA as ‘the transfer of professional responsbility and accountability for some or all aspects of a patient’s or group of patient’s care to another person or professional group on a temporary or permanent basis’. Practices must be able to demonstrate that an effective clinical handover system is in place to deal with situations of clinician illness, annual leave or patient referral to other health services. This procedure should be supported by a documented policy to ensure that it is standardised across all clinicians within the practice and so all practice support staff are aware of it. Attention should be paid to patient health summaries and referral letters as these will assist in the safe handover of patients to other clinicians both internally and externally. Useful resources to assist practices include the ACSQHC OSSIE Guide to Clinical Handover or the AMA’s Safe handover: Safe patients guide.

New Criterion- 3.1.3 Clinical Governance- Our practice has clear lines of accountability and responsibility for encouraging improvement in safety and quality of clinical care.
The RACGP define clinical governance as ‘the framework through which clinicians and health service managers are jointly accountable for patient safety and quality care. This criterion is made up of two flagged indicators:

  • Our practice has leaders who have designated responsbility for safety and quality improvement systems
  • Our practice shares information about quality improvement and patient safety within the practice team

The Australian Commission on Safety and Quality in Health Care proposes that an effective clinical governance model should include recognisably high standards of care, transparent responsbility and accountability for maintaining those standards, and a constant dynamic of quality improvement. Practices must nominate clinical leaders in areas of quality improvement and patient safety who are responsbile for the implementation and monitoring of safety and quality systems. It may be beneficial for practices to consider other activities currently undertaken by the practice or other criterion within the Standards, as many activities may intersect. For example, regular practice meetings and the use of clinical audits, can satisfy more than one criterion and lend itself to elements of a clinical governance system.

New Criterion- 3.1.4- Patient Identification- Our patients are correctly identified at each encounter with our practice team.
Incorrect patient identification can result in medication errors, diagnostic test errors or failure to receive appropriate medical treatment. Studies have shown that using three identifiers decreases the risk of incorrect identification from 1 in 3 to 1 in 3500. The RACGP has introduced one new flagged indicator to meet this criterion: Our practice has a patient identification process using three approved patient identifiers and the practice team can describe how it is applied. The approved identifiers include:

  • Patient name, including given and surname/family name
  • Date of birth
  • Gender (self identified by the patient)
  • Address
  • Patient record number (where one exists)

When asking patient’s for identifying information, it is important that practice staff not volunteer the information for confirmation as errors may occur and that patient’s state their own information. All staff in the practice must be aware of the process for identifying patients and patients should be identified on occasions when attending the practice, over the telephone or when documents are requested/collected. Three approved identifiers must also be used when preparing referral letters.

New Criterion 5.3.1- Safe and Quality Use of Medicines- Our clinical team prescribes, dispenses and administers appropriate medicines safely to informed patients.
The 4th Edition Standards expands on medicine safety outside the previous focus on Schedule 8 medications. The medicines safety framework consists of 4 flagged indicators:

  • Our clinical team can demonstrate how patients are informed about the purpose, importance, benefits and risks of their medicines and how patients are made aware of their own responsbility to comply with the recommended treatment plan
  • Our clinical team can demonstrate how we access current information on medicines and review our prescribing patterns in accordance with best available evidence
  • Our clinical team can demonstrate how we ensure patients and other health providers to whom we refer receive an accurate and current medicines list
  • Our clinical team can demonstrate how we ensure that medicines are acquired, stored, administered, supplied and disposed of in accordance with manufacturers’ directions and jurisdictional requirements

Clinical team members must be able to demonstrate how patients are informed about their medications, how staff access current prescribing information and the medicines management within the practice. Patient medical records and consultation notes are of crucial importance in satisfying this criterion as well as the availability and use of promotional patient information. Clinical desktop systems and prescribing software allow for consumer information to be produced and, in some cases, self-recorded within the patient file. The Therapeutic Goods Administration Safety website has medicine safety information for both consumers and health professionals which may be used.

New Flagged Indicator- 1.7.1B Where our practice has an active hybrid medica record system, for each consultation/interaction, our practice can demonstrate that there is a record made in each system indicating where the clinical notes are recorded
Hybrid record systems pose a significant risk to patient management particularly in situations where patients are unable to see their regular GP. Where hyrbid record systems exist, practices need to ensure that all information is accessible when needed and it is recommended that practices work toward creating wholly electronic systems.

New Flagged Indicator- 5.1.1G The practice must have one or more height-adjustable beds
The RACGP has released a fact sheet on Height-Adjustable Beds outlining the rationale for the change and factors for consideration by practices. To assist practices with the cost of purchasing a new height-adjustable bed, your practice may be eligible for a rebate from Workcover NSW. Visit the Workcover NSW Safety Solutions Rebate page for more information.

New Flagged Indicator- 2.1.2C At least once every 3 years, the practice actively seeks feedback about patient experiences by using a validated patient experience questionnaire approved by the RACGP or their own uniquely developed method
The RACGP has acted on research evidence which suggests that the most meaningful changes to a practice can occur from collecting and using patient experience feedback. Tha RACGP have recently published a detailed guide Learning from our Patients which describes the methods practice can use to gather patient feedback along with their advantages and disadvantages. The RACGP has approved the following survey tools:

  • Patient Accreditation Improvement Survey- developed by Client-Focused Evaluation Programs. Two versions have been approved for use, a whole-of-practice survey and practitioner-specific feedback. Download the CFEP information sheet for more information about fees and processes.
  • PSI v4 of a Patient Satisfaction Instrument- developed by Ultrafeedback. For more information, download the PSI Flyer.

Human Resource System- Designated Responsibility amongst the ‘Practice Team’
The 4th Edition Standards has introduced the term ‘Practice Team’ to reflect the changing dynamics of medical practices and recognises the multi-disciplinary roles amongst practice staff, acknowledging to both clinical and non-clinical staff. Practice must now designate a team member responsbility in the following areas:

  • Cleaning
  • Complaints Management
  • Infection Control
  • Information technology
  • Quality Improvement
  • Risk Management Systems
  • Sterilisation
  • Vaccine Management

Under the 4th Edition Standards, position descriptions are now mandatory for all staff and if a team member has a deligated responsbility in the above areas, it must be documented as part of this document. It is expected that all other members of the practice team can identify the designated leaders in each area and that a process is implemented to monitor team member performance against their position descriptions. The CSGPN Practice Recruitment Guide may be able to assist you with the require documentation and implementing an effective performance management system.

Accreditation Links and Resources

How can CSGPN Practice Support help practices with Accreditation?

Full assistance is provided by CSGPN to plan for the accreditation visit including the provision of resources, checklists, collating patient survey results, mock interviews and training with staff, and conducting a mock accreditation visit.

Practice Incentive Program

The Practice Incentive Program (PIP) provides financial incentives to general practices aimed to encourage improvements in quality of care, access and outcomes of all patients. Practices must either be accredited or become accredited within 12 months to be eligible for the PIP. The PIP is administered by Medicare Australia on behalf of the Department of Health and Ageing. There are 13 individual incentives which make up the PIP each with their own payment structures. Payments are made to both the practice and the individual practitioner, and are generally calculated based on practice size.

For more information about the PIP and the individual incentives, visit Medicare Australia: Practice Incentive Program website.

The New Practice Nurse Incentive Program

Medicare Australia and the Commonwealth Government released in early June the guidelines for the new Practice Nurse Incentive Program (PNIP). The PNIP is designed to streamline current financial payments made to practices through the PIP Nurse Incentive and MBS nurse items into one single payment. Under these new arrangements, eligible practices will be supported with payments of up to $12,500 per annum for an Enrolled nurse or Aboriginal Health Worker and up to $25,000 for a Registered nurse. Payments are calculate based on practice SWPE and contracted hours of the employed nurse or Aboriginal health worker.

The program also offers a one-off $5,000 incentive payment to eligible non-accredited practices to become accredited. Applications for the program open 1st of October 2011. For more information on the PNIP, click on the program guidelines below. To calculate how much your practice may be eligible for, use the Ready Reckoner link below.

PIP Links and Resources

 

Practice Management

Practice management is a growing area of need for Australian general practices and is now being recognised by professional bodies as a key element in the delivery of high quality healthcare services. The RACGP in it’s review and development of the new 4th Edition Standards for General Practice, has acknowledged the evolution in the general practice environment and the growth of the general practice team by acknowledging the contribution they can make in areas of risk management and service coordination. In the RACGP’s Draft Definition of General Practice published in March 2011, there is further acknowledgement of the need for coordination and teamwork in delivering high quality patient care including compliance with national standards and guidelines, in the general practice setting. Practice management encompasses a number of issues which affect the day-to-day running of a practice including human resources, information technology and information management, facility and equipment maintenance, accreditation and compliance, administration and finance.

Practice Management Training Providers

  • The Australian Association of Practice Managers (AAPM) is a non-profit, national organisation which exists to provide professional support, advocacy and education to Practice Managers to assist them with the performance of their practice.
  • UNE Partnerships is the education and training company of the University of New England and in association with the AAPM, have developed a number of professional qualifications for Practice Managers.
  • Indigo Medical and Dental Consulting are a nationally Registered Training Organisation (RTO) who have several courses available in Healthcare Business Administration, Medical Reception, Dental Assisting and Practice Management. I
  • Medical Administration Training is a natioanlly Registered Training Organisation (RTO) who has been delivering medical administration courses since 2004.
  • Some courses are available for completion as Traineeships in conjunction with some RTO’s so employees can learn whilst ‘on-the-job’. The NSW State Government supports the employment of Trainees and there may be financial incentives available for employers to establish Traineeships. Download the NSW State Government Guide to Apprenticeships and Traineeships in NSW for more information or contact CSGPN for a list of Australian Apprenticeship Centres in your area.

How CSGPN supports Practice Managers

CSGPN helps support the education and professional development of Practice Managers with monthly practice staff events with a range of topics to address practice management issues. Visit our CPD Page to access presentations from previous events. 

We strongly encourage Practice Managers to provide feedback and comments on what topics or information should be featured both at events and on our website. Use the feedback tool on the website to send us your comments.

CSGPN also offers Practice Managers, Practice Nurses and Aboriginal Health Workers, working in practices within the CSGPN area to apply for full Ordinary membership. If you are interested in a Member, please visit the Membership page for more information or to download an application form.

Diabetes Prevention: Live Life Well for 50-65 year olds

Project Officer: Vijay Ramanathan
Phone: 8752 4915

The Prevent Diabetes Live Life Well program is being run in collaboration with Sydney University, SLHD, Diabetes Australia NSW and funded by NSW Health. This program is available to patients of participating GPs, aged 50 - 65 years at risk of developing type 2 diabetes. Participants receive an initial 90-minute consultation followed by 3 two-hour group sessions where they learn about eating better, moving more and behavioural change skills. Follow-up support is provided for 1 year after referral to the program. The consultation and sessions are run by trained Lifestyle Officers and will be held across three locations in the Central Sydney GP Network area. For more information including a copy of our fact sheets, please visit www.livelifewell.nsw.gov.au.

We are no longer accepting new referrals into this Program. Please contact Vijay Ramanathan on 8752 4915 if you have any questions.

Domestic Violence

Project Officer: Lisa Maude
Phone: 8752 4902

DOMESTIC VIOLENCE HOTLINE 1800 656 463
Domestic Violence is a very challenging issue for general practice. It is a problem that does not discriminate between social status, race or religion. One in four women will experience Domestic Violence in their lifetime. Often their GP is the person the patient will turn to seeking support and guidance.

This page offers useful tools, links and contacts that can help better resource GPs to support their patients living in Domestic Violence situations.

White Ribbon Campaign

Disclosure is the first step to helping patients who are victims of Domestic Violence deal with their situation. Providing a safe environment for the patient to do so is vital.

One way to create a safe environment for the patient is to demonstrate your stance against Domestic Violence. Signage, posters and brochures can express your position and help the patient feel validated and safe.

The White Ribbon is internationally recognised as a symbol that represents The National Day of Remembrance and Action on Violence against Women. Displaying the symbol and supporting the cause is just one way to share your concern with patients. If not already, have you and your practice considered joining the campaign and signing the national pledge to stop violence against women? To do so go to: www.whiteribbonday.org.au

Useful tools for general practice

  • Power and control wheel (a useful tool in helping to understanding the patterns of abusive and violent behaviours that can be used to establish and control and power over others)
  • SOFFT method of recording file notes. In order to discharge your professional responsibilities to patients, meet all legal requirements and provide a record of your treatment and the decisions you have made in relation to treatment. The SOFFT method of recording file notes is recommended. SOFFT stands for SAID OBSERVED FELT FORMULATION THEN

Child safety

Services that support patients

Directory of Allied Health Services

This page provides a directory of services developed by CSGPN and other affiliated services. If you have any updates or would like to contribute a link to this directory, please contact Lee Sheppard on 8752 4927.

Allied Health

 

Newsletters - Central Viewpoint

Co-ordination and Production: Lee Sheppard
Phone: 8752 4927

CSGPN produces a number of publications and resources that provide information regarding services and activities of the Division:
One core activity of the Network is the production of the monthly newsletter which is circulated 11 times per year (excluding January) to approximately 750 GPs within the Central Sydney network boundaries, as well as key affiliated services and stakeholders. Details on network reach can be found on our Ad Rates and booking form for 2012 document.

Central Viewpoint is unique in informing local GPs of relevant information regarding divisional management news, specific project reports, internal and external educational activities, available local resources and services, conducting surveys and relevant National and State initiatives.

For the latest newsletter in PDF format and recent issues, please click here.

2012 Newsletter deadlines

Deadlines for 2012 will be the first Monday of each month for the following month’s issue. Each issue will be mailed to members in the last week of the month prior to issue date. It is preferable that material be sent via email.

February Edition - Tue 3 January 2012
March Edition - Mon 6 February 2012
April Edition - Mon 5 March 2012
May Edition - Thu 5 April 2012
June Edition - Mon 7 May 2012
July Edition - Mon 4 June 2012
August Edition - Mon 2 July 2012
September Edition - Mon 6 August 2012
October Edition - Mon 3 September 2012
November Edition - Tue 2 October 2012
Dec/Jan Edition - Mon 5 November 2012

Fax outs

Fax Co-ordination and Production: Ian Hunter
Phone: 8752 4922
Download fax releases

Fax - CENTRAL EXPRESS

Central Express is a supplement to Central Viewpoint. A fortnightly fax stream sent to GP practices to serve as a reminder for upcoming events and an opportunity to disperse relevant or urgent information.
Download fax releases

Fax - PRACTICE STAFF BULLETIN

Practice Staff Bulletin is a fortnightly fax aimed at practice managers and staff informing them of educational events and other relevant practice information.
Download fax releases

External education

Project Officer: Julie McLean
Phone: 8752 4905

Below is a list of external education facilities to assist in providing you with CPD point opportunities.

Online Video

Preventive Health

Project Officer: Vijay Ramanathan
Phone: 8752 4915

Preventive Health includes a wide range of programs and projects that have a common goal of reducing the risk of ill-health and disability in an identified population.

Preventive interventions include primary prevention (seeking to prevent or delay disease in healthy persons), secondary prevention (seeking early detection of disease), and tertiary prevention (seeking to reduce disability caused by existing disease, including chronic disease management strategies).

These may include both clinical services (such as immunisations and cancer screenings) and behavioral/lifestyle interventions (such as those aimed at smoking cessation, falls prevention, and increased physical activity).

Health assessments are used to assess the over health of a patient taking into consideration their social, physical, physiological health, family history and environmental risk factors. They are useful tools to establish a baseline for the patient to consider, monitor or focus on self management to maintain or address their potential future health predicament.To know more about different health assessments please visit CSGPN: Health checks and assessments

The A-Z index of Preventive Health

A

Alcohol


DoHA: Alcohol

Arthritis

Arthritis Australia
Arthritis NSW

Asthma


National Asthma Council (NAC).
Please find information about appropriate use of inhalers Managing Asthma - video on how to use an inhaler

B

Breast Screening

Breast Screen Australia program
Breast Screen NSW

C

Cancer:

Sydney Cancer Centre
Cancer Institute of NSW; Cancer treatments
Online directory of specialist services
Cancer Council; Myth Busting website
Directory of cancer care resources

Cardiovascular Disease

Heart Foundation Australia
Stroke Foundation

Cervical Screening

CSGPN: Cervical Screening Program

D

Diabetes

Diabetes Australia
Diabetes Risk Assessment (AUSDRISK) tool

E

Eating disorder

Health Insite: eating Disorder

Exercise

Exercise is Medicine
Exercise and Sport Science Aus
Local Exercise initiatives
Local exercise and nutrition providers

F

Falls Prevention

Sydney local health network falls prevention initiatives
CSGPN: Modified Otago Program

G

Gay Men’s sexual health

Gay Men

Gestational Diabetes

Diabetes Australia
Mr Dr

H

Home Medicines Review

HMR

I

Immunisation

CSGPN: Immunisation

K

Kidney Health

Kidney Health

L

Lifestyle

CSGPN: LMP
Lifescripts Resources
RACGP: Smoking Nutrition Alcohol Physical Activity (SNAP) guidelines
Guidelines for Preventive Activities in General Practice (RACGP Red Book)
Putting Prevention into Practice (RACGP green book)

Lung Disease

Lung Foundation Australia

M

Men’s health

Andrology Australia

N

Nutrition

Nutrition Australia
Dietitians Association of Australia
Local exercise and nutrition providers

O

Obesity

A Healthy and Active Australia

Osteoporosis

Osteoporosis Australia

P

Pain

Australian Pain Management Association

Physical Activity

See

Exercise

Polycystic Ovary Syndrome (PCOS)

Managing PCOS

R

Respiratory - COPD

Chronic Obstructive Pulmonary Disease

S

Skin

Skin

Smoking

The National Tobacco Campaign

Sexual health

CSGPN: Sexual health

T

Therapeutics

NPS Better Choices- Better Health

Travel Health

Australian Smart Traveller

W

Women’s health

Family Planning NSW
Australasian Menopause Society
Jean Hailes for Women’s health

Diabetes Management

Collaboratives

Wave 6 - Diabetes Prevention and Management

Project Officer: Vijay Ramanathan
Phone: 8752 4915

CSGPN offers various services to support GPs and practice nurses in chronic disease management (CDM), especially that of diabetes. Some of them are:

  • One-to-one practice visit by project officers to discuss about non-clinical issues around CDM such as MBS item claims, PIP/SIP
  • Continuing Professional Development - to offer up-to-date information on clinical guidelines by experts in the respective fields
  • Make credible resources like the Diabetes Management in General Practice, 2010-2011 readily available

Australian Primary Care Collaboratives

The Australian Primary Care Collaboratives (APCC) Program helps general practitioners (GPs) and primary health care providers work together to:
  * Improve patient clinical outcomes
  * Reduce lifestyle risk factors
  * Help maintain good health for those with chronic and complex conditions and;
  * Promote a culture of quality improvement in primary health care.

Ultimately, the APCC Program aims to find better ways to provide primary health care services to patients through shared learning, peer support, training, education and support systems.
To read more about APCC, please click here

CSGPN is currently involved in Collaborative program, Wave 6 - Diabetes Prevention & Management. Each wave of APCC is about 18 months and currently there are thirteen practices involved in wave 6.

CSGPN promotes credible services to the general practice. Information about such services could be found below -

ComDiab

What is ComDiab?
ComDiab is a group introductory diabetes education offered in the community for ANYONE who wants to know about diabetes. The education offers practical information to better understand diabetes and enable individuals to self-manage diabetes. This in turn, reduce the burden on health professionals and health system. ComDiab does not replace any other diabetic education services but only reinforces and enhances individual’s knowledge about diabetes.

Why this program is different to others?

  • Quality service for the public offered by well trained persons
  • Free of cost to the public
  • Readily accessible, especially when there is delay in accessing other services
  • No referrals required

Who runs ComDiab?
It is offered by professionals (mainly community health nurses) who are well trained and assessed in diabetes by the Australian Diabetes Council

How many sessions can each individual get?
Two sessions of 2 hrs each.

Where will these sessions take place?
The group education sessions take place in various locations within the CSGPN catchment area [Croydon, Marrickville, Canterbury, Concord and Redfern].

Who can benefit from this program?
Anyone who wants to know about diabetes but in specific those who are at low to medium risk of diabetes or newly diagnosed with diabetes.

Further information

For any questions related to CSGPN’s diabetes activities, resources and services please contact Vijay Ramanathan on 8752 4915.

Chronic Disease Management

Project Officer: Vijay Ramanathan
Phone: 8752 4915

Chronic Disease Management (MBS Primary Care Items)

The Chronic Disease Management (CDM) Medicare items on the Medicare Benefits Schedule (MBS) enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers. The items are designed for patients who require a structured approach to their care.

CDM items were previously known as the Enhanced Primary Care (EPC) items. The term ‘EPC plan’ is now obsolete. There are no changes to the eligibility requirements for the CDM items, including the allied health services for people with chronic disease. This is simply a change to terminology to bring it up to date. Medicare Australia and provider organisations have been advised of the change. EPC language has also been removed from the MBS Group A14 (Health Assessments) items.

CDM items (items 721 - 732) include:

  • Item 721: Preparation of a GP Management Plan (GPMP)
  • Item 723: Coordination of Team Care Arrangements (TCAs)
  • Item 732: Review of a GP Management Plan or Coordination of a Review of Team Care Arrangements
  • Item 729: Contribution to a Multidisciplinary Care Plan, or to a review of a multidisciplinary care plan, for a patient who is not a care recipient in a residential aged care facility
  • Item 731: Contribution to a multidisciplinary care plan, or to a review of a multidisciplinary care plan, for a resident in an aged care facility

For details of the above mentioned CDM items (such as mandatory requirements, patient eligibility) please visit MBS note A37.

CDM referrals

CSGPN: support and services:

  • Hard copy resource folder
  • Phone support if you have any questions in regard to the item numbers
  • Practice visits to provide one-to-one support also to your practice staff
  • Resources and advice on Recall and Reminder Systems

Useful Links

Mental Health - overview and referral pathways

Project Officer (ATAPS): Mano Arumanayagam
Phone: 8752 4907

Mental Health GP Advisors: Dr Margo Hoekstra
Drug & Alcohol GP Advisors: Dr Hester Wilson & Dr Paul Sztolcman

Clinical Trials
Consumers and Carers
Education
Local services and referral pathways
Online mental health programs for consumers

Overview

CSGPN’s Mental Health and Drug and Alcohol Projects aim to improve and enhance the generalist psychiatry and drug and alcohol assessment, diagnostic and management skills of family physicians and local doctors. The aim is to improve timely access to evidence based quality treatments for their patients presenting with mental health and drug and alcohol problems.

CSGPN does this through a range of activities including:

  • developing shared care partnerships between doctors and specialist psychiatry and psychology services
  • coordinating professional development programs
  • auspicing a strategic advisory committee which brings doctors and specialists together to discuss and sort out issues
  • providing advice to doctors about how they can access various Australian Government funded treatment and support services for their patients

Local services and referral pathways

Please contact Mano Arumanayagam for referral pathway enquiries

Psychiatry Support

SLHN Services

Sydney Local Health Network (SLHN) has a specific Area Mental Health website which offers support and information for consumers, carers and other service providers. The website has a ‘Find a service’ option which allows users to search for local services, including information on community mental health teams, boarding house teams, clinics for specific mental health disorders and specialist mental health services for older people. Emergency numbers are listed under the ‘Other Service Providers’ tab.

Child, Adolescent and Family

MBS Rebated Service Providers

Multicultural Services

Targeted counselling services

Local Private Hospitals

Non Government Organisations

GP Education & Training - specific training

  • CSGPN regularly runs Mental Health CPD events (including MHST), please refer to our CPD Events page of the website for further details.
  • A number of external education providers offer mental health activities. For details on external education providers refer to the External Education page of our website.
  • GP Psychiatrist Supervision Program: We coordinate two small groups where GPs meet up with a psychiatrist to discuss care issues and mental health management. For more information on these groups, Karen Frost
  • Clinical Attachments: We link interested GPs with specialist mental health services, and provide an information kit to help with the RACGP requirements. If you would like to be involved, contact Karen Frost Also see RACGP clinical attachment GP forms and guides.
  • The Royal Australian College of General Practitioners has a mental health website with many resources for GPs. Visit their website, click on the following link RACGP

Consumers and Carers

  • Lifeline free helpline 24-hour telephone counselling services 13 11 14
  • Kids Helpline free helpline 1800 55 1800
  • Reach Out website for youth to find information on mental health and wellbeing, and connect with other youth
  • The Butterfly Foundation - provides support for Australians who suffer from eating disorders and negative body image issues and their carers
  • SANE Australia free helpline 1800 18 7263
  • Families NSW - provides parents and carers with information on a wide variety of services for families in NSW
  • Carer Assist - provides individual advocacy, support, education and training programs to families and carers of someone who has a mental illness
  • Mental Health First Aid

Online mental health programs for consumers

  • Mood Assessment Program (MAP) - The Black Dog Institute’s computerised assessment and diagnostic tool for mood disorders.
  • Anxiety Online - developed by Swinbourne Unversity of Technology offering information, assessment, online diagnosis and treatment programs (“eTherapy”) for the anxiety disorders
  • CRUfad Clinic - inititative of St Vincent’s Hospital; an online courses for people with anxiety or depressive disorders

Clinical Trials

Nursing in General Practice

Project Officer: Julie McLean
Phone: 8752 4905

For the Practice:

Nurses are highly skilled and knowledgeable health professionals who work collaboratively with GPs and other members of the practice team, to provide safe and quality care.

Recognised benefits nurses can bring to general practice include:

  • Improved outcomes in chronic disease
  • An increase in the range of service available at the practice
  • Reduction in waiting times
  • Improved public access
  • Improved integration with the acute sector
  • Enhanced consumer satisfaction

Need some assistance with recruitment and orientation of a practice nurse? Go to the AGPN Nurse Recruit website to access a fantastic resource including templates for job descriptions, and contracts, orientation guides and support materials for both practices and practice nurses.

For the Practice Nurse:

Nursing in General practice is a dynamic and vibrant area of the nursing profession. In general practice you will be a core member of general practice teams, providing significant benefits to the provision of primary health services.

Benefits for the nurse:

  • Flexible working arrangements with little or no shift work
  • Working as a valued member of a small team
  • Ability to be self directed and utilise many skills
  • Opportunity to specialise in areas of interest
  • Access to a range of postgraduate programs designed specifically for general practice nurses

Publications and Resources available:

Links:

If you require further information or assistance please do not hesitate to contact Julie McLean

Drugs and Alcohol

Drug and Alcohol Program

Over the last several years the CSGPN has identified Drug and Alcohol as an important area for the focus of support and resources delivery to GPs.

Building Partnerships

In 2004, the CSGPN achieved a Memorandum of Understanding with the Central Sydney Area Health Drug Health Services, signaling a formal commitment on both sides to the process. Following this MoU, we continue to build strong links between GPs, Drug Health Services and local non government drug and alcohol non service providers.

Sydney Local Health District Drug & Alcohol Services

Drug Health Services intake number : 9515 6311, hours of operation 0830 to 1700 Monday to Friday.
After hours number is for ADIS - State-wide 24 hour 7 days a week information service (Alcohol and Drug Info Service) 9361 8000 for after hours information and advice.

Resources for GPs

    Education for GPs

    • AGPN Clinical Can Do - comorbidity training modules
    • CSGPN offers a range of education activities throughout the year including drug and alcohol and comorbid mental health and drug and alcohol activites. For details on these activities refer to the CPD Events page of our website.
    • A number of external education providers offer drug and alcohol and comorbid mental health and drug and alcohol activities, including ‘X-Concord Series for 2012’. For details on external education providers refer to the External Education page of our website.
    • Royal Australasian College of Physicians - Chapter of Addiction Medicine

    Clinical Practice Guidelines

    Other resources

    Outcome Tools

    NGO

    Resources for Carers and Consumers

      Antenatal Shared Care

      Project Officer: Karen Wheeler

      Main: 9799 0933

      For RPA Women and Babies and The Canterbury Hospital ANSC program enquiries, contact Karen Wheeler

      GP Liaison Midwife: Clare Jordan
      Phone: 0425 230 662  
      Hours:  Mon-Thurs : 7.30-5.30pm For urgent clinical enquiries, page O&G Registrar at RPA or TCH.

        The GP Liaison Midwife assists with the co-ordination of the ANSC program by:
      • Conducting ANSC orientation sessions for new GPs joining the program
      • Supports GPs in accessing maternity hospital services and answering telephone enquires
      • Provides the interface for feedback and improved communication between the hospital and GPs
      • Liaises with CSGPN to ensure policies, procedures and clinical practice guidelines ratified by the Maternity Services Advisory Committee are distributed to ANSC GPs
      • Assists CSGPN in the co-ordination of the CPD education program and by maintaining the ANSC data entry of GPs.

      Quick link reference list
      Orientation to ANSC Program
      Hospital Referral Postcodes
      Hospital Booking Process
      Hospital Clinics and Services
      Preconception Planning
      ANSC Protocol
      Group B Streptococcus
      Genetic Counselling
      Pregnancy Assessment
      Risk Management
      Postpartum Assessment and Management
      Referral Forms
      Patient Information
      Online education
      Translated Information
      Useful Website Links

      For copies of the ANSC GP Resource Manual v6 (2011), please contact Karen Wheeler on 9799 0933

      Program overview

      Antenatal Shared Care (ANSC) is an option of care provided collaboratively by the GP and the hospital-based maternity services. It is offered to all pregnant women assessed as suitable throughout the Sydney Local Health District (SLHD).
      The program aims to:

      • provide pregnant women with flexibility, choice and continuity of care
      • caters for the preferences and needs of women from culturally and diverse backgrounds
      • enhances the skills of GPs caring for women during pregnancy
      • promote communication between GPs and the participating hospitals

      The ANSC program is a joint initiative of:

      The program is offered at other maternity facilites across Sydney. For further information regarding the program, contact the local hospital or GP Network in your particular area.

      Orientation to the Antenatal Shared Care Program

      Hospital Referral Postcodes

      There is a restricted access by residential postcode for women with low risk pregnancy to book for delivery at RPA Women and Babies and The Canterbury Hospitals. The postcode access areas for each facility are listed below:

      Women requiring complex or specialised care who live outside the suburbs covered by RPA Antenatal Clinic may be referred to RPA by their doctor. A letter of request is to be sent to the Director of O&G at RPA Women and Babies.

      RPA Women and Babies Booking Process

      RPA First Antenatal Clinic Visit
      A woman is required to book either on-line or by fax ( 9515 3454) after completing the First Antenatal Visit Booking Form.The form can also be accessed via the RPA Women and Babies website under the tab “Information for Pregnant Women”.

      Access to Medical Director and Best Practice templates of the RPA Women and Babies First Antenatal Visit Booking Form

      Antenatal Clinic Booking Follow up
      Hospital staff will contact the woman via mail ( ~2 weeks) with further information and an appointment date.

      Delivery Booking Process
      All women need to book their bed for delivery after 20 weeks gestation (usually soon after the obstetric review visit). The woman will need to take her yellow card and registration form to the RPA Medical Centre Suite 210, Level 2, cnr Carillon Ave and Missenden Rd.

      The Booking Office is open from 7.30am till 5.00pm Monday - Friday

      Canterbury Hospital Maternity Booking Process

      For appointment bookings contact the Antenatal Clinic ph 9787 0250 ( Mon-Fri 9.00am - 4.30pm)

      Hospital Clinics and Services

      Fetal Medicine Department RPA Women and Babies
      The Fetal Medicine Department has introduced a paging system to assist GPs in contacting the Fetal Medicine Department for urgent matters.

      Contact RPA Hospital on ph 9515 6111 Pager # 81668

      The paging system is to be used to access urgent ultrasound bookings, urgent ultrasound reports, second opinions or if advice is required from a Fetal Medicine Specialist. The service will operate between Monday and Friday from 7.00am-3.30pm. If the pager is not answered please contact the Department on 9515 6042.

      Gynaecology Referral RPA Women and Babies
      The RPA Women and Babies Gynaecology Referral Form is required for referral to all Specialist Women’s Clinics. Appointment requests are by fax only ( 9515 3454). It is mandatory that a telephone contact is available so the woman can be contacted for an appointment time and date. The staff will make two(2) attempts only to contact the woman and she can be expected to be contacted within three (3) business days of the hospital receiving the completed information.

      The Canterbury Hospital

      Preconception Planning

      Antenatal Shared Care Protocol

      ( for other languages see ” Translated Information” )


      Group B Streptococcus (GBS) Information


      Genetics Counselling
      The Fetal Medicine Unit at RPA Women and Babies offers Nuchal Translucency Screening with biochemistry to all pregnant women booking at RPA and Canterbury Hospitals. Shared care GPs who have attended the introductory information session through the Central Sydney GP Network on “options of prenatal screening/testing” can refer women directly to the Fetal Medicine Unit at RPA Women and Babies on 9515 6042 or 9515 8258.

      GPs who have not attended this session have the option of referring women to the genetic counselling clinics at RPA Hospital on 9515 7101 and Canterbury Hospital on 9787 0183.

      This resource booklet is used by Sydney Local Health District (SLHD) Genetic Services when discussing options for prenatal screening and testing. Copies of the ” Prenatal Testing” booklet are available from CSGPN. Additional information on a range of genetic matters can be accessed from The Centre for Genetics Education and the National Health and Medical Research Council - NHMRC.

      Translated material regarding genetics, prenatal testing and pregnancy can be located at the NSW Health: Multicultural Health Communication Service

      Pregnancy Assessment

      Early Pregnancy Assessment Service

      Perinatal Mental Health

      Risk Management

      Gestational Diabetes Management

      Postpartum Assessment and Management

      Perinatal Mental Health

      Immunisation

      Referral Forms

      Best Practice and Medical Director Forms

      Patient Information

      Parent Education Classes

      RPA Women and Babies/The Canterbury Hospital

      Early Pregnancy Assessment Service

      Gestational Diabetes

      Postnatal Contacts

      • Early Childhood Centres Contacts
      • Inner West Breastfeeding Groups (Nov 2011)

      • Online Education Options

        Translated Information

        Translated material regarding pregnancy related issues can be located at NSW Health: Multicultural Health Communication Sevice. Information available include Maternity Care Options, Planning a Pregnancy, Caring for a Baby at Home and Depression during Pregnancy and Early Parenthood.

          Sydney Local Health District (SLHD) ANSC Protocol

          Preparation for GTT (various languages)

          Vitamin D information for pregnant women and new mothers

          Useful Website Links

          • RANZCOG:Royal Australian and New Zealand College of Obsetricians and Gynaecologists
          • ADIPS:Australian Diabetes in Pregnancy Society
          • GDM Recipes:Gestational Diabetes Mellitus Recipes:Dietitian reviewed
          • beyondblue: :Information on antenatal and postnatal depression
          • Gidget Foundation: Raising awareness of perinatal anxiety and depression
          • PANDA: Post and Antenatal Depression Association Inc
          • St John of God Hospital: Mental Health Services: Mother and baby unit
          • Centre for Genetic Education: NSW Health : Centre for Genetics Education
          • Mothersafe: Counselling service regarding medications and/or exposures during pregnancy and breastfeeding
          • Sids and Kids: Breavement support, education and advocacy for families who have experienced the unexpected loss of a baby or child
          • NSW Multicultural Health: Multicultural Health Communication Service: resources available by topic and language
          • ASHM:Comprehensive directory of health services relating to HIV, viral hepatitis and related areas
          • Mental Health - ATAPS

            Project Officer: Mano Arumanayagam
            Phone: 8752 4907

            Overview

            In July 2001, the Australian Government introduced Better Outcomes in Mental Health Care (BOiMHC) which included the Access to Allied Psychological Services (ATAPS) project and GP Psych Support. This was followed in November 2006 by Better Access to Psychiatrists, Psychologists and GPs through the Medicare Benefits Schedule program.  Both programs include a mechanism by which GPs can refer patients with mental health disorders such as anxiety, depression, stress, perinatal depression and self harm to an allied health professional (AHP) for evidence - based focussed psychological strategies.

            Funded by the Department of Health and Ageing (DoHA) and managed by Divisions or Networks of General Practice throughout Australia, the ATAPS project is primarily aimed at patients who are socio-economically disadvantaged.

            Allied Health Providers eligible to take part in the ATAPS project include psychologists, social workers, mental health nurses, occupational therapists and Aboriginal and Torres Strait Islander health workers with specific mental health qualifications.

            Through ATAPS, patients are eligible for a maximum of 12 sessions per calendar year and the sessions may be individual and/or group therapy sessions.

            To be eligible for focussed psychological strategies, patients must have received an assessment and a Mental Health Treatment Plan.

            ATAPS currently has three clinical streams:

            • ATAPS Anxiety, Depression, Stress and other mental health disorders
            • ATAPS Perinatal Depression Initiative
            • ATAPS Self harm prevention and early intervention

            For the General Practitioner

            For Free Advice from Psychiatrists

            Referral Processes

            ATAPS Allied Health Professionals Directory

            Resources

            For the Allied Health Professional

            Resources

            Outcome Tools

            Provider Reporting Templates

            GP Mental Health Resources

            Courses - Refer to the External Education page

            Useful Links

            Immunisation

            Project Officer: Lisa Maude
            Phone: 8752 4902

            The CSGPN Immunisation Project supports general practices in the CSGPN area to:

            1. maintain high standards of cold-chain management to ensure vaccine efficacy.
            2. deliver immunisation services in accordance with the Australian Standard Immunisation Schedule and current national and state best-practice guidelines.
            3. adopt a sustainable approach to reporting to the Australian Childhood Immunistion Register (ACIR).
            4. optimise child immunisation coverage rates.
            5. optimise access to the general practice immunisation incentives (GPII) scheme.

            The immunisation project officer is available to provide phone support and practice visits as required. You can contact Lisa Maude on 8752 4902. For specific clinical enquires please contact the Immunisation Coordinator, Fiona Steele at the SLHN Public Health Unit: 9515 9425.

            The Australian Standard Vaccination Schedule

            The General Practice Immunisation Incentive Scheme (GPII)

            Outline of GPII
            If your practice is not accredited you are still eligible to receive GPII. The same application form is used for both the GPII scheme and the Practice Incentive Program (PIP). However applicants can use the form to apply for the GPII scheme only.

            To obtain an application form contact the PIP enquiry line: 1800 222 032.
            For further information on GPII contact Lisa Maude at CSGPN: 8752 4902 or visit the Medicare Australia website.

            Improving immunisation coverage

            CSGPN monitors the percentage of children in the division and in individual practices who have received all required immunisations according to the Australian Standard Immunisation Schedule. Rates are calculated quarterly according to data supplied to the Australian Childhood Immunisation Register. We aim to improve the immunisation coverage rate across CSGPN to more than 90%.

            CSGPN Go for 90! Pilot Project evaluation report

            CSGPN supports practices to improve their immunisation coverage rates by providing onsite visits to:

            1. discuss ways that reporting to the ACIR can be streamlined in an individual practice.
            2. train GPs and practice staff to use the ACIR secure internet site to report immunisations.
            3. discuss systems for identification and recall of children who are overdue for immunisation.

            To request any of these services contact Lisa Maude on 8752 4902.

            Reporting immunisations to ACIR

            The Australian Childhood Immunisation Register (the ACIR) is a national register administered by Medicare Australia that records details of vaccinations given to children under seven years of age who live in Australia. It was established in 1996 in response to a decline in childhood immunisation in Australia and an increase in preventable childhood diseases.

            Immunisations can be reported to ACIR manually using paper immunisation encounter forms or electronically through a number of different methods. CSGPN can provide advice on what method reporting would best suit your practice.

            Further information on ACIR, including all relevant forms, are available on the Medicare Australia website.

            Cold chain and vaccine storage

            Vaccines should be stored in the range +2 to +8 degrees celsius. In general practice this usually involves:

            1. purchase and maintenance of an appropriate refrigerator for storage of vaccine.
            2. installation of a temperature probe within the fridge and daily monitoring and recording of the fridge temperature.
            3. staff taking appropriate and timely action in the event that the fridge temperature is shown to be outside the recommended temperature range.

            CSGPN supports general practices to maintain the cold chain through:

            1. onsite visits on request to conduct an audit of practice cold chain procedures.
            2. data logging of vaccine fridges.
            3. provision of reliable thermometers and vaccine fridge logbooks.
            4. advice and support in the event of a cold-chain failure.

            Websites for health professionals

            Websites for Parents

            Websites for Travellers

            Information Management and Technology

            Project Officer: Alex Dolezal
            Phone: 8752 4912

            Mission

            To improve the health and quality of life of the community in the Central Sydney boundaries through a process of ensuring the smooth flow, introduction, implementation and management of information management and information technologies in general practice.

            Vision

            To ensure that the GPs in our division are at ease with the use of information technology for clinical and administrative purposes.

            Training

            We conduct regular Medical Director and Best Practice courses for GPs and practice staff in our offices. Medical Director and Best Practice training for GPs is offered in the form of active learning modules for beginners and advanced users. Practice staff can assist with information management of your practice. The introductory training for practice staff provides general understanding of Medical Director and Best Practice, with focus on maintaining the patient database, updating the address book and identifying at risk patients. The advanced module concentrates on recalls and the use of letter writer.

            Practice Support

            Computerisation Support

            Once a practice decides to computerise, the GPs are not sure where to start. This can be a daunting task and the project provides support with advice on what hardware, software and other system requirements are required for efficient computer system.

            Information Security

            The requirements of the 4th edition RACGP Standards for GP for information security place increased responsibility on practices to protect their electronic data. These include appointing practice IT security coordinator, ensuring regular backups of your data, sufficient password protection, protecting your data from viruses and other malicious attacks if connected to the Internet, having a disaster recovery plan in place etc. The project provides explanation of the requirements and helps you complete the security template.

            On-Site Training

            Individualised Medical Director and Best Practice training and troubleshooting in your practice.

            Recall & Reminder Visits

            Practice support for setting up an efficient electronic recall system. During the practice visit which demonstrates how the recall process should be conducted on your system.

            Resources

            Medical Director and Best Practice letter writing templates are gradually being developed. You can download these and import into Medical Director/Best Practice using the guide provided. You can also place a request for having a particular letter writing template/customised letter head developed by contacting the IM Project Officer.

            PEN Clinical Audit Tool

            The PEN Clinical Audit Tool (CAT) provides an overview of practice population from the perspective of chronic disease prevention and management. This software integrates with clinical systems such as Medical Director, Best Practice, Genie and Zedmed.

            PEN CAT allows practices to examine their data to achieve better clinical outcomes and improve data quality. Gaps in data sets vital for accreditation can also be identified. The aggregated patient information is presented in easy to interpret graphical format and lists of patients who fall into selected target groups can be generated. Business opportunities can be identified.

            For a description of functionalities for PEN CAT and the benefits it can offer to your practice, please visit PEN Computer Systems website at PEN Clinical Audit Tool Overview. PEN CAT installation and user training is offered to CSGPN members.

            Useful Links

            Downloads

            Continuing Professional Development

            Project Officer: Julie McLean
            Phone: 8752 4905

            The CSGPN provides a range of educational activities for GPs and practice staff that focus on relevant clinical and practice support areas in general practice, Network related projects as well as considering the health profile of the local community. Further information on the new triennium is available at RACGP or by contacting CSGPN.

            CSGPN CPD EVENTS

            Click here For UPCOMING EVENTS.

            To download the 6-monthly calendar, click on Our Programs, Continuing Professional Development, CPD Events 2012 PDF Calendar

            RACGP CPD Requirements for GPs 2011-2013

            CPD Requirements for GPs

            CPD Resources

            Below is a directory of CPD presentations undertaken by CSGPN. These presentations are copyright and remain the property of the authors. Permission to use these slides in any presentation or publication must be sought from the author.

            Large Group Workshops 2012

            Musculoskeletal

            Cardiovascular

            Small Group Workshops 2012

            Screening, Imaging and Treatment of Hepatoceullar cancer

            How to Build a Good Team

            ALM 2012

            ANSC ALM

             

            Home Medicines Review (HMR)

            HMR is also known as Domiciliary Medication Management Review (DMMR).
            HMR is an initiative of The Pharmacy Guild of Australia funded by the Australian Government Department of Health and Ageing as part of the Fourth Community Pharmacy Agreement.

            “The person who takes medicine must recover twice, once from the disease and once from the medicine.” William Osler, M.D.

            “If all the medicine in the world were thrown into the sea, it would be bad for the fish and good for humanity” O.W. Holmes, (Prof. of Med. Harvard University)

            About HMR

            The HMR is a consumer-focused, structured and collaborative health care service provided in the community setting, to optimise quality use of medicines and consumer understanding.  It involves the consumer, their general practitioner, their pharmacy, and other relevant members of the health care team.

            Some of the benefits of HMR

            For GPs:

            • Comprehensive, up-to-date information about all the medicines, complementary products, devices and other prescriptions being used by the patients.
            • HMR reinforces the medication related advice(s) given by the GP to their patients.

            For Patients:

            • SUPPORT: Assistance with medications/aids/devices to improve compliance and early detection and management of medicine-related problems.
            • EDUCATION: HMR helps patients to understand their medicines better and enhances their ability to manage their medicines appropriately.

            How to do HMR

            What are the eligibility criteria for HMR?

            • Patient MUST be living at home (community setting)
            • At risk of medication misadventure
            • Done annually by a regular GP

            What are the risk factors for medication misadventure?

            The issues listed below are some of the risk factors for medication misadventure and are NOT eligibility criteria.

            Examples of known risk factors that may lead to medication misadventure in patients:

            • Currently taking 5 or more regular medications;
            • Taking more than 12 doses of medication/day;
            • Significant changes made to the medication regimen in the last 3 months;
            • Medication with a narrow therapeutic index or medications requiring therapeutic monitoring;
            • Symptoms suggestive of an adverse drug reaction;
            • Sub-therapeutic response to treatment with medicines;
            • Suspected non-compliance or inability to manage medication related therapeutic devices;
            • Patients having difficulty managing their own medicines because of literacy or language difficulties, dexterity problems or impaired sight, confusion/dementia or other cognitive difficulties;
            • Patients attending a number of different doctors, both general practitioners and specialists;
            • Recent discharge from a facility/hospital (in the last 4 weeks) and/or
            • OTHERS (e.g. loss of spouse, different health care professional involved in treatment)

            Steps involved in a HMR (MBS Item 900)

            Identify patient for HMR

            • Can be done by any member of the health care team, patient or carer

            GP initiates and refers to community pharmacy

            • GP decides if patient may benefit, using the risk factors and
obtains patient consent for the process and  the exchange of information
            • Refers to community pharmacy of the patient’s choice

            Pharmacist conducts patient interview

            • Preferred place is the patient’s home, but venue is the patient’s choice
            • Can be conducted by community pharmacists or accredited pharmacist

            Pharmacist conducts Medication Management Review

            • Must be conducted by an accredited pharmacist
            • Using all the available information such as the patient interview, the information from the GP and  the dispensed medication history

            Pharmacist reports to GP

            • Verbal and written report 

            GP consultative management plan for patient – claim item 900

            • Done in consultation with the patient, can lead to a new GP Management Plan or Team Care Arrangement

            GP sends management plan to pharmacy

            • And offers a copy to the patient

            Consumers

            ‘How to get HMR’ - Cartoon
            HMR information – English
            HMR information – Chinese
            HMR information – Vietnamese
            HMR information –  Arabic
            HMR information –  Italian
            HMR information – Greek

            Important links:

            Medicare Australia – Home Medicines Review
            Medicare Benefits Schedule - Note A39
            The Pharmacy Guild of Australia – Medication Management Review Program
            The Australian Association of Consultant Pharmacy
            The Pharmaceutical Society of Australia

            Frequently Asked Questions

            • What is the MBS Item number for HMR?
              Item 900
            • When should the Item 900 be claimed?
              The claim MUST be done after completing the management plan on the second visit with the patient.
            • Can a normal consultation item (Item 23) be claimed in addition to Item 900?
              No.
            • Can a patient on less than 5 medicines have a HMR?
              YES. Please refer to the GP resources – 4: Eligibility criteria.
            • Can HMR be done more than once in a 12month period?
              YES, but there should be a significant change in their condition or medication regimen, like recent discharge from hospital or diagnosed with a new medical condition. Also, the reason must be annotated on the Medicare slip.
            • Which pharmacy do I need to send the HMR referral to?
              Usually the patient’s preferred community pharmacy.
            • What to do if the patient is not willing to have the HMR interview at home?
              It is preferred but not mandatory to have the interview at home. The place of interview can be negotiated between the patient and the pharmacy.
            • How long will it take to receive the HMR report from the pharmacy?
              It is a requirement for the pharmacy to send the report within 4 weeks of receipt of the HMR referral. The pharmacy need to notify the GP in case of any unexpected delays. Please contact the Facilitators at CSGPN for any follow-up.
            • How to know whether the patient had a HMR by another GP within 12 months?
              Currently there is no provision for the GP to find this information from Medicare. In doubt, you may ask the patient to contact Medicare and check this information for you.
            • What to do when the HMR report is not up to your expectation?
              Usually the MR accredited pharmacists address all the issues raised by the GP and patient. Should you have any concerns about the report, please discuss it with the pharmacist. Still not convinced, please contact the HMR Facilitators at CSGPN.

            Directory of Local Services

            This directory is provided as is, if you have any updates or changes you would like to inform us of please contact Lee Sheppard on 8752 4927.

            Breast Screening
            Community Health Centres
            Disability Services
            Local Police
            Early Childhood Centres
            Health Interpreter Service
            Home Nursing
            Hospitals
            Mental Health
            Sight, Speech & Hearing
            Specialised Health Services
            Women’s Health
            Support
            Sexual Assault Centre
            Welfare Groups
            Child & Family Health
            Aged Care Services
            Home Care & Support

            BREAST SCREEN NSW fixed screening centres
            BANKSTOWN
            Ground Floor, Civic Tower Building
            Cnr Rickard Road and Jacobs Street, BANKSTOWN 2200            		 Bookings: 13 20 50
            CAMPERDOWN - screening and assessment
            Royal Prince Alfred Hospital
            Level 4, Gloucester House
            58 Missenden Rd, CAMPERDOWN 2050            		 Bookings : 13 20 50
            CROYDON
            Croydon Health Centre
            24 Liverpool Road, CROYDON 2132            		 Bookings:  13 20 50


            Community Health Centres
            Camperdown Community Mental Health Service
            Level 5, King George V Bldg, Missenden Rd, Camperdown 2050            		 9515 9000
            a/h 9767 5000
            Canterbury Community Health Centre
            Canterbury Hospital
            Thorncroft Parade, Campsie            		 9787 0600
            Croydon Community Health Centre
            24 Liverpool Road, Croydon            		 9378 1100
            Leichhardt Community Women’s Health Centre
            55 Thornley St, Leichhardt            		 9560 3011
            Marrickville Community Health Centre
            155-157 Livingstone Rd, Marrickville            		 9562 0500
            Redfern Community Health Centre
            155 Pitt Street, Redfern            		 9395 0444


            Disability Services
            Centre for Disability Studies
            59 Charles Street, Ryde            		 8878 0500
            Disability Specialist Unit Burwood (run by The Children’s Hospital Westmead)
            Level 2, 56 Railway Parade, Burwood            		 9701 6300

            Disability related organisations in NSW


            Police
            Annandale (Glebe LAC) 9560 9866
            Ashfield 9797 4099
            Balmain (Glebe LAC) 9556 0699
            Burwood 9745 8499
            Campsie 9784 9399
            City Central LAC 9265 6499
            Five Dock 8753 3599
            Flemington LAC 9646 8699
            Glebe 9552 8099
            Kingsgrove (Hurstville LAC) 9150 0441
            Leichhardt (Glebe LAC) 9569 1616
            Marrickville LAC 9568 9299
            Newtown LAC 9550 8199
            Redfern LAC 8303 5199
            Strathfield 9746 7084


             
            Early Childhood Centres
            Ashfield Early Childhood Centre
            260 Liverpool Rd, Ashfield            		 9716 1853
            Burwood Early Childhood Centre
            24 Liverpool Rd, Croydon            		 9378 1156
            Chiswick Early Childhood Centre
            5a Blackwall Pt Rd, Chiswick            		 9712 1983
            Concord Early Childhood Centre
            57 Wellbank St, Concord            		 9743 1654
            Five Dock Early Childhood Centre
            Cnr. Park Rd and First Ave, Five Dock            		 9713 6140
            Redfern Early Childhood Centre
            4/95 Wellington St, Waterloo            		 9698 1613
            Homebusch Early Childhood Centre
            2A Fraser St, Homebush            		 9746 7763


            Health Interpreter Service
            NESB Carers Support Project fax 9515 3222


            Home Nursing
            Lewisham Community Nursing Service 9562 0500
            Concord Centre 9743 6199
            Croydon Centre 9745 4999
            Lewisham Centre 9560 9226
            Redfern Centre 9690 1222


            Hospitals
            Balmain Booth St, Balmain
            Physiotherapy
            GP Casualty
            Ambulatory Care            		 9395 2111
            9395 2093
            9395 2155
            9395 2317
            Canterbury Canterbury Road, Campsie 9787 0000
            Concord Hospital Rd, Concord
            Admissions
            Emergency
            Medical Centre
            Physiotherapy
            Occupational Therapy
            Nutrition/Dietetics
            Rehabilitation Pain Management
            Speech Pathology
            		 9767 5000
            9767 6855
            9767 6090
            9767 7900
            9767 6101
            9767 6270
            9767 6328
            9767 7233
            9767 6441
            Royal Prince Alfred : Mother’s & Babies Missenden Rd, Camperdown
            Outpatients
            Bookings
            Fetal Medicine Unit
            9515 6111
            9515 7101
            9515 7095
            9515 6042
            Royal Prince Alfred Missenden Rd, Camperdown
            Emergency
            Bookings (inpatient)
            Outpatients (general)
            Queen Elizabeth II Rehabilitation Centre
            Speech Pathology
            Occupational Therapy
            Physiotherapy
            Pain Management Clinic
            Nutrition/Dietetics
            		 9515 6111
            9515 8141
            9515 8112
            9515 7344
            9515 6111
            9515 9845
            9515 9926
            9515 9853
            9515 9870
            9515 8053
            St Vincent’s Victoria St, Darlinghurst 8382 1111
            Sydney Children’s Hospital High St, Randwick 9382 1111
            Sydney & Sydney Eye Hospital Macquarie St, Sydney 9382 7111
            The New Children’s Hospital Hawsksbury Rd, Westmead 9845 0000


            Mental Health
            Mental Health Information & Referral Service 1300 794 991
            Croydon Child, Adolescent and Family health Services
            24 Liverpool Rd, Croydon            		 9378 1100
            Croydon Living Skills Centre
            34 Malvern Ave, Croydon            		 9378 1199
            Camperdown Community Mental Health Service
            Level 5, Kind Georges V Bldg., Missenden Rd, Camperdown            		 9515 9000, 9556 9100
            SANE Mental Illness Helpline (9.00am-5.30pm) Mon -Fri 1800 688 382 (freecall)


            Sight, Speech & Hearing
            Better Hearing Australia
            29 Burwood Rd, Concord            		 9744 0167
            Speech Pathology Australia
            Concord Hospital Medical Centre            		 9743 0013
            The Eye Clinic
            Level 4 POW, Randwick            		 9382 2261


            Specialised Health Services
            Aboriginal Medical Services
            36 Turner St, Redfern            		 9319 5823
            Arthritis NSW
            13 Harold St, Nth Parramatta            		 9683 1622
            Assoc. of Genetic Support
            66 Albion St, Surry Hills            		 9211 1462
            Asthma Foundation NSW
            1/82-86 Pacific Hwy, St Leonards            		 9906 3233
            Australian Red Cross Blood Service 131 495
            Cancer Council NSW
            15 Dowling St, Woolloomooloo            		 9334 1900
            Diabetes Australia, NSW
            26 Arundel St, Glebe            		 9552 9900
            Epilepsy Action
            Suite 8, 44-46 Oxford St, Epping            		 9856 7090
            Multiple Scleroisis Soc. Ltd.
            Joseph St, Lidcombe            		 9646 0600
            Heart Foundation of NSW
            Level 3, 80 William St, East Sydney            		 9219 2444
            Arthritis/ Osteoporosis NSW
            13 Harold St, Nth Parramatta            		 9683 1622


            Women’s Health
            Family Planning Australia (FPA) Health
            328-336 Liverpool Rd, Ashfield            		 8752 4300
            Leichhardt Women’s Community Health Centre
            55 Thornley St, Leichhardt            		 9560 3011
            Newborn Family Support Team 9515 6435
            Tresillian Canterbury 9787 0800
            Australian Breastfeeding Association (Breastfeeding Helpline) 1800 686 2686 (Freecall)


            Support
            Compassionate Friends
            (for bereaved parents & siblings)            		 9290 2355
            SIDS and Kids NSW (24 Hour Support)
            Support for families bereaved during pregnancy, birth, infancy & children up to 6 years old.            		 1800 651 186
            Social Work Department Royal Hospital for Women
            Rendwick            		 9382 6670
            Benevolent Society of NSW
            Help at Home            		 9556 1022
            Department of Ageing, Disability and Home Care (DADAC)
            Inner West/ Metro Branch, Level 2/ 4 Railway Pde, Burwood            		 9744 3955


            Sexual Assault Centre
            RPAH 9515 9040
            Sexual Assault website


            Welfare Groups
            St Vincent De Paul
            125 Pitt St, Redfern            		 9698 1529
            Mission Australia
            Level 7, 580 George St, Sydney            		 9219 2000
            The Salvation Army
            140 Elizabeth St, Sydney            		 9264 1711
            The Smith Family
            Level 9/ 117 Clarence St, Sydney            		 9085 7222


            Child & Family Health
            DoCS Helpline 132111
            Domestic Violence
            Line for NSW            		 1800 656 463


            Aged Care Services
            Ella Community Centre
            58A Dalhousie St, Haberfield
            Kalparrin Day Centre
            Concord Hospital
            Lilyfield Rd Day Centre
            158 Lilyfield Rd, Leichhardt
            Strathfield Respite Day Care
            1B Bates St, Homebush
            Lucan Seniors
            Leichhardt
            Sita Carter Day Centre
            Marrickville
            The Tom Forster Community Centre
            Newtown            		 9335 2153
            The Carter Day Centre
            Newtown (also groups for people with dementia)            		 9557 0032
            Department of Ageing, Disability and Home Care
            Burwood            		 9744 3955
            The Home Care Service of NSW 1800 350 792
            Meals On Wheels
            Burwood
            Concord
            Homebush-Strathfield
            South/ East Sydney
            Marrickville
            9744 1866
            9747 1135
            9746 7801
            8512 4230
            9335 2153
            Dementia Helpline 1800 639 331


            Home Care & Support
            Lewisham Community Nursing Service
            Concord
            Croydon
            Lewisham
            Redfern            		 9562 0500
            9743 6199
            9745 4999
            9560 9226
            9690 1222
            Aged Care and Rehabilitation
            Outpatients Clinic
            Concord ACAT
            9767 6931
            9767 7888
            Home Visiting Service for Aged, Disable and Dementia
            Referrals to ACAT            		 9550 4637
            1800 556 533
            Newtown Police Care Register 9550 8159
            Marrickville Police Station 9568 9299
            Mental Health Service Camperdown 9515 9000
            Tom Foster Community Care 9335 2153
            Respite Care
            Inner West Carer Respite Centre
            emergency contact            		 9767 7888
            e - 1800 059059
            Carers NSW 9280 4744
            1800 242 636 (business hours)
            Lifeline 131 114 (after hours)

            Cervical Screening

            Overview

            Since the introduction of the National Cervical Screening Program in 1991, deaths from cervical cancer have been declining by 5.7% each year, and between 1997 and 2006 the incidence and mortality rates due to cervical cancer in NSW decreased by about 40%.

            Pap test is a screening test, not a diagnostic test. This means that women are tested regularly to check for changes in the cells of the cervix. If changes are found, they can be monitored, and if needed further investigated and treated well before cancer develops.

            The National Cervical Screening Program provides guidelines on which women need screening and how often Pap tests should be performed. It states:

            • Routine screening with Pap smears should be carried out every two years for women who have no symptoms or history suggestive of cervical pathology.
            • All women who have ever been sexually active should start having Pap smears between the ages of 18 and 20 years, or one or two years after first having sexual intercourse, whichever is later.
            • Pap smears may cease at the age of 70 years for women who have had two normal Pap smears within the last five years. Women over 70 years who have never had a Pap smear, or who request a Pap smear, should be screened.

            These guidelines apply to women with no symptoms and a normal Pap smear result. Women with abnormal smear results should be managed in accordance with the National Health and Medical Research Council: Screening to Prevent Cervical Cancer: Guidelines for the Management of Asymptomatic Women with Screen-detected Abnormalities.

            CSGPN is committed to supporting general practices in increasing the rate of cervical screening in our area. Our Cervical Screening Project, funded by Cancer Institute NSW, aims to promote awareness among women in our community of the importance of having regular Pap tests improve the availability of Pap test services available through general practice (particularly though practice nurses) improve patient access to women’s health clinics and referral services.

            The NSW Cervical Screening Program is a jointly funded Commonwealth/State and Territory initiative managed by the Cancer Institute NSW. The goal of the NSW Cervical Screening Program is to achieve optimal reductions in the incidence of and mortality attributed to cervical cancer at an acceptable cost to the community. For more information, visit their website by clicking here - NSW Cervical Screening Program.

            The aim of CSGPN is to increase the participation rate for cervical screening by working with GPs, Community Groups and carrying out mass media campaigns in addition to GPs and Practice Nurses being trained in undertaking satisfactory Pap Smears.

            Recall and Reminder Systems

            CSGPN can assist GPs and their practice staff by implementing an effective recall and reminder system using the software in their practice.

            Alternately, the GPs could request the NSW Pap Test register to obtain the list of patients who are overdue for a Pap test. To download the application form, click on Pap Test Register Data Request form or call 1800671693 to obtain a copy. Complete and fax it to the number shown on the form. The list will be provided on a CD with a password.

            Upskilling for GPs and Practice Nurses

            Family planning NSW (FPNSW) has been funded for the last 10 years by the NSW Cervical Screening Programme to provide courses for GPs and practice nurses throughout metropolitan and rural NSW.

            The Cervical Screening Upskilling for GPs

            This is a 2.5 hour workshop is ideal for GP registrars and GPs who wish to refresh their skills and improve participation rates in their practice by identifying barriers to screening especially in women from culturally and linguistically diverse groups (non-English speaking background), improving awareness of client comfort and the quality of the Pap smears taken, and to apply current NHMRC guidelines on follow-up of abnormal Pap test results. In addition, the GPs will learn about new technologies and information about new HPV vaccines.

            This course attracts 5 category 2 points for the RACGP QA&CPD program for 2008-2010 triennium.

            The Well Women’s Screening course

            This 1 day course provides nurses with the skills to undertake cervical screening in a competent manner. The following topics are covered: Revision of Anatomy and Physiology, Cervical Screening, Breast Health, Policy and Procedure, Legal Issues, Infection Control, Pathology Follow Up and History Taking. In addition nurses are required to undertake a minimum 14 hours of supervised clinical placement with a final assessment Take-Home Examination.

            This course has been endorsed by APEC No. 060310255 as authorised by Royal College of Nursing Australia, according to approved criteria. CNE points: 25

            You may visit www.fpnsw.org.au to see the full list of courses on offer under Education and Calendar.

            Pap Test Providers

            To find a Pap test provider in your area (postcode), gender and language spoken, click here.

            Payments and Incentives

            MBS Item Numbers for claiming Cervical Screening services:
            For GPs
            For Practice nurses
            Or visit www.health.gov.au, click on MBS online, type in the number.
            Practice Incentive Payments - Visit Medicare’s website, under healthy professionals, Incentives and Allowances.

            Resources

            A range of resources for health service providers and consumers is available from the NSW Cervical Screening Program in English and other languages. Click here.
            RACGP Clinical Audit information and application forms, click here.

            Downloads

            MD template: Pap test recall

            Useful Web sites

            NSW Cervical Screening Program
            Cancer Institute NSW
            Cancer Council NSW
            Family Planning NSW
            Breast Screen NSW
            National Cervical Screening Program

            Aged Care

            Project Officer: Lara Leibbrandt
            Phone: 8752 4911

            News Items

            NHMRC Study at Aged Care Department and CERA, Concord Hospital
            A randomised clinical trial of testosterone supplementation and nutritional supplementation in under nourished older people.
            Chief Investigator: Associate Professor Vasi Naganathan
            Recruiting:

            • men and women aged 65years or older
            • weight loss or BMI <22kg/m2
            • MMSE >23
            • living at home or independent living unit

            Exclusion Criteria:

            • past or present history of prostate and/or breast cancer
            • significant heart disease
            • severe liver or kidney disease
              • There are other exclusion criteria but we go through this when screening potential participants. Contact: Melissa Casey (Research Nurse) by ringing 9767 5965 or Melissa.CASEY@sswahs.nsw.gov.au If you would like to recruit patients from your practice, please contact Lara Leibbrandt (contact details above) Participant Information Leaflet: Pariticipation Leaflet

            Sydney Local Health District (SLHD) Aged Care and Rehabilitation Service (ACCR)
            The SLHD now has increased capacity, with a new appointment to the Concord Geriatric Medicine Department. Dr Jennifer McMeniman, who is working with other Concord Geriatricians, predominantly Dr Eric Diu to assist with the management of RACF residents in the facilities. Service models offered include:

            • Traditional Clinical Reviews
            • Care Planning meetings (please contact Lara Leibbrandt, ph:8752 4911 or email: lleibbrandt@csgpn.com.au if you would like to be involved in these)
            • Case Conferences with a Geriatrician

            Geriatrician in Canterbury Hospital, Dr Bill Thoo will be available to hold regular clinics at each RACF in Canterbury. Dr Rosemary Sheehy will continue to provide Geriatric Medicine consultations to residents of RACFs in the vicinity of RPAH and Balmain Hospitals.

            Please bear in mind that a Geriatrician (ie. Not only a Psycho-Geriatrician) can be an appropriate Specialist to refer to when a person is presenting with Behavioural and Psychological Symptoms of Dementia (BPSD).

            The Sydney LHD Geriatricians and Psychogeriatricians work closely together.

            ACCT


            The Aged Care Triage (ACT) now the Aged and Chronic Care Triage (ACCT) is a single point of contact/access for staff of Residential Aged Care Facilities (RACFs) and GPs for clinical issues of RACF residents within SLHD. ACCT is available 7 days a week from 8.00am to 10.00pm.

            Referrals for Geriatric Medicine Review of RACF residents should be directed to the ACCT by fax, phone, letter, email

            FAX: 9767 7058 (preferred) Phone: 1800 556 211 (when a more urgent response is required) Email: act@sswahs.nsw.gov.au (scanned and attached)

            Medicare help
            NEW: A Summary of new Medicare Benefits Schedule (MBS) item numbers: general practice and allied health is available. This new flip chart resource has been developed by Victoria Health with information on MBS items. Flip Chart MBS Resource.

            You can now directly email Medicare Australia with any question you have relating to Medical Benefits Schedule (MBS) items at askMBS@humanservices.gov.au. Questions will be answered by a centralised specialist team, who are trained to respond to these often complex MBS interpretation questions. General provider enquiries like provider registration status, claims enquiries and stationery requests should still be directed to the email address: medicare.prov@humanservices.gov.au

            Aged Care Overview

            The Aged Care Team’s aim is to provide support to general practice/General Practitioners (GPs) and Allied Health Professionals (AHPs) with a goal of enhancing access to services to improve the quality of care for residents of Residential Aged Care Facilities (RACFs).

            CSGPN works closely with RACFs, GPs, AHPs and Sydney Local Health District (SLHD) to facilitate access to aged care services.

            Information for GPs

            CSGPN Aged Care Program - the Aged Care Access Initiative (ACAI)
            The aim of the Aged Care Access Initiative (ACAI) is to improve access to primary care -including GP and allied health services - for residents of aged care facilities.

            The GP component of the ACAI recognises some of the difficulties faced by GPs in providing care in these settings and aims to encourage GPs to continue to provide increased and continuing services in RACFs. GPs who care for residents will be paid an Incentive Payment directly through Medicare Australia. This payment will be based on a the number of Medicare services provided by a GP in RACFs over a financial year.

            Over 75 Health Assessment
            A medical practitioner may select MBS item 701 (brief), 703 (standard), 705 (long) or 707 (prolonged) to undertake a health assessment for a person aged 75 years and older, depending on the length of the consultation which will be determined by the complexity of the patient’s presentation.

            A health assessment of an older person is an in-depth assessment of a patient aged 75 years and over. It provides a structured way of identifying health issues and conditions that are potentially preventable or amenable to interventions in order to improve health and/or quality of life.

            Components of a health assessment for a person aged 75 years and older
            The health assessment must include:

            • information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;
            • making an overall assessment of the patient;
            • recommending appropriate interventions;
            • providing advice and information to the patient;
            • keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
            • offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

            Specific components of the health assessment for older people include:

            • measurement of the patient’s blood pressure, pulse rate and rhythm;
            • an assessment of the patient’s medication;
            • an assessment of the patient’s continence;
            • an assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus;
            • an assessment of the patient’s physical function, including the patient’s activities of daily living, and whether or not the patient has had a fall in the last 3 months;
            • an assessment of the patient’s psychological function, including the patient’s cognition and mood; and
            • an assessment of the patient’s social function, including the availability and adequacy of paid and unpaid help, and whether the patient is responsible for caring for another person.

            For further information on these MBS items please follow the below link to the DoHA website and Fact Sheet released by DoHA.
            Health Assessment for People over 75 years
            Older persons health assessment FACT SHEET

            Comprehensive Medical Assessments (CMA)
            A comprehensive medical assessment is a review of the resident, including assessment of the resident’s health and physical and psychological functioning.

            Components of a comprehensive medical assessment
            A comprehensive medical assessment must include a personal attendance by a medical practitioner. The components of the assessment include:

              * information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;
              * making an overall assessment of the patient;
              * recommending appropriate interventions;
              * providing advice and information to the patient;
              * keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
              * providing a written summary of the outcomes of the assessment for the resident’s records and to inform the provision of care for the resident by the residential aged care facility and assist in the provision of medication management review services for the resident.

            Medical practitioners may review and incorporate into the comprehensive medical assessment relevant assessments or information about the resident that is available from the residential aged care facility.

            In undertaking the assessment the medical practitioner should consider the following, as appropriate to the resident:

              * cardiovascular and respiratory systems, and other systems as indicated;
              * physical causes of acute and chronic pain;
              * an assessment of the resident’s:
                  - physical function, including activities of daily living;
                  - psychological function, including cognition and mood;
                  - oral health, nutrition status and dietary needs; and
                  - skin integrity.

            The comprehensive medical assessment may also cover matters of particular relevance to the resident.
            For example, an assessment of the following factors may be undertaken as relevant to the resident:

              * hearing and vision;
              * smoking and alcohol use;
              * foot care;
              * sleep; and
              * incidents of falls.

            For further information on these MBS items please follow the below link to the Department of Health and Ageing.
            Comprehensive Medical Assessment for residents of residential aged care facilities
            A Comprehensive Medical Assessment (CMA, item 712) is not a requirement of ACFI - however, the contents of a CMA will assist RACF staff in completing an ACFI assessment. It is also recognised as best practice.

            Previously CSGPN advised RACFs that concern had been expressed by many local GPs that some RACFs have either contracted with private medical companies or are in negotiation with private medical companies to complete CMAs on their residents. This trend has been met with alarm from CSGPN members. While CSGPN understands that most RACFs have not been taking this approach the following clarification was made:

            1. Doing CMAs on all residents is not required by the ACFI.
            2. Doing CMAs on all residents would be regarded by the MBS as overservicing.
            3. Outsourcing CMAs compromises the care of residents as their usual GP is disengaged from the care and treatment decisions by having a private company contracted to do CMAs. This is not best practice. We have had feedback from many GPs that they would withdraw their services from RACFs who compromised the care of their patients in this way.

            Enhanced Primary Care (EPC) Services
            Residents of Residential Aged Care Facilities (RACFs) are eligible for comprehensive assessment and multidisciplinary care through Enhanced Primary Care (EPC) Services.

            For further information: EPC/Chronic Disease
            Or contact Lisa Maude on 8752 4902

            Commonwealth Respite and Carelink Centres (CRCC)
            The Inner West office of CRCC presents general practitioners and health professionals with time saving services. A single phone call by freecall 1800 052 222 will link you to your local centre, and up to date information about community services for patients, including costs and eligibility and assessment requirements.

            Offering both

            • Quick access to information about community services
            • 24 hours support for carers who require urgent or planned respite.

            Call 1800 052 222 to find out more or go to www.wesleymission.org.au/crcc to read more about our services, such as Mental Health Respite and Young Carer Program, and find links to useful information for your patients to take home.

            Information for Residential Aged Care Facilities and Allied Health Professionals

            Aged Care Access Initiative (ACAI) information for Residential Aged Care Facilities (RACFs) and Allied Health Professionals (AHPs)

            CSGPN is managing the ACAI program. ACAI facilitates the provision of quality and related programs from AHPs in RACFs. Funding has been allocated following the initial round of submissions and will continue as per agreements.

            In the 2009/10 financial year, ACAI applies to residents of low care Commonwealth funded RACFs, Services provided on an individual and group basis are eligible. AHPs cannot claim from Medicare for the same function performed under this initiative. These facilities (low care RACFs) will be informed by letter and allocated funding in the above allied health areas.

            Individual services may include one-on-one services such as podiatry or physiotherapy. Group services might include group psychology sessions or exercise and falls prevention programs and staff education.

            The CSGPN allied health priority program areas were based on a needs analysis conducted in 2008 and are:

            • Speech Pathology
            • Dietitian/Nutritionist
            • Physiotherapist/Occupational Therapist/
            • Exercise Physiologist/Diversional Therapist
            • Podiatrist
            • Specialist Nurse in Mental Health /Counsellor/Psychologist

            Other Allied Health Service areas will be considered on a case by case basis.

            Submissions were sought from RACFs for ACAI funding and contractual arrangements entered into with interested AHPs.

            If you are a RACF or an AHP working in Central Sydney and are interested in the ACAI program please contact Lara Leibbrandt on 8752 4911. To apply for funding please download the submission form by clicking on the link below.

            RACFSubmissionProforma.doc

            Funding of Residential Aged Care Facilities (RACFs)

            Aged Care Funding Instrument (ACFI) and Comprehensive Medical Assessments (CMA)
            In March 2008, the ACFI replaced the Resident Classification Scale (RCS) as the method of determining residential care subsidies. The ACFI is a funding tool; it measures only those care elements that best distinguish the costs of care.

              The ACFI was designed to:
            • better match funding to the complex care needs of residents;
            • reduce the documentation created by aged care providers to justify funding; and
            • achieve higher levels of agreement between aged care staff and departmental review officers in review audits (known as validation).

            Sydney Local Health District (SLHD) information about services

            SLHD Contacts and Services

            The following services have been established to assist GPs and RACFs in the clinical care of residents.

            Aged & Chronic Care Triage Service (ACCT)
            Contact ACCT on 1800 556 211 available 7 days, from 0800 hrs - 2200 hrs
            The ACCT aims to provide the best care for residents of RACFs in the most appropriate setting. Offering clinical advice and arranging of services for residents to support their care within the RACF and to minimize the unnecessary transfer of residents to hospital. The ACCT is a single point of telephone contact service that provides clinical advice and support to residential aged care facility staff, GP and Carers and includes clients enrolled “Connecting Care” Program. It offers a partnership between RACFs, GPs and hospitals within the SLHD by linking medical specialists and Clinical Nurse Consultants (CNCs), of our hospitals with GPs, Community teams, RACF staff and the Referral Information Center (RIC). ACCT has the capacity to facilitate and coordinate transfers to the most appropriate health services, such as appropriate emergency department if required.

            Referrals for Geriatric Medicine Review of RACF residents should be directed to the ACCT by fax, phone, letter, email

            The ACCT can arrange outreach or outpatient services for clinical issues such as:

            • Wound management
            • Continence management
            • Behavioural issues
            • IV antibiotic therapy
            • Diabetes management

            The ACCT staff have access to other specialist nurses and on-call geriatrician should they need advice on how to best meet the needs of the resident.

            Community Nursing (CHAIN) and Community & Post Acute Care Service (CAPAC)
            SLHD has also introduced the Community & Post Acute Care Service (CAPACS) program. One of the aims of this initiative is to support GPs in caring for patients at home or in Residential Aged Care Facilities, who either have been discharged from hospital with ongoing support or to initiate care which enables patients to be cared for at home or in the aged care facility.

            Community Nursing and CAPAC Guidelines
            CHAIN GP Referral form

            Mental Health Services for older people: Specialist Mental Health Services for Older Persons (SMHSOP)
            SMHSOP has now separated and no longer comes under the Aged Care Assessment Team (ACAT) Structure. This service works across the Health Districts, including Central Sydney (inner west), South West Sydney (Bankstown, Liverpool and Campbeltown). The service provides:
            • Case management,
            • Outpatient clinics,
            • Home visits, and
            • RACF visits
            It includes the in the team a Psycho geriatrician.

            The SMHSOP look after people who have developed or are at risk of developing a mental health disorder such as Depression or Psychosis or may have severe behavioural problems. The SMHSOP comprises:

            • Community Teams located across the area (Concord, Camperdown, Catnerbury and through South West) and provide specialist clinical assessment and case management in conjunction with GPs and other service providers.

            • Inpatient Facilities are provided at Concord, Braeside and Bankstown Hospitals providing specialist clinical assessment, treatment and case management.

            • BASISI/DBMAS Teams (Behaviour Assessment and Intervention Service and Dementia Behaviour Management Advisory Service) provide clinical assessments and support for challenging behaviours associated with dementia or mental illness

            To refer to any of these SMHSOP services, fax or phone the Referral and Information Centre (RIC) of Sydney Local Health District (SLHD). Office hours are 10am to 4pm Monday to Friday.

            Contact SMHSOP via RIC
            Phone: 1800 556 533
            Fax:  9767 6929 (preferred)
            Email: RICNorth@sswahs.nsw.gov.au (scanned and attached)

            Please also find the most recent referral form to download at the following location on our website:
            http://csgpn.org.au/services/info/aged_care/  then scroll down to DOWNLOADS.

            Advance Care Planning

            Advance Care Planning involves a patient thinking about and communicating to others how they would like to be treated in the future if they have a condition where they can no longer speak for themself. This may happen, for example, because of a stroke, progressive dementia, or becoming unconscious from some form of accident or illness. For information on Advance Care Planning please follow the below link.
            Advance Care Planning information

            NPS Drug Use Evaluation (DUE) for RACFs

            Drug use evaluation (DUE) is a quality improvement activity which uses an ongoing cyclical process to improve the Quality Use of Medicines and health outcomes. It involves monitoring and reviewing drug use, evaluating and comparing it with best practice guidelines, and using multifaceted interventions to improve drug use and overall patient care - this cycle is repeated as often as necessary to achieve set goals. DUE activities put focus on specific disease states or therapeutic areas for residents of aged care facilities as well as hospitals. These priority areas are chosen based on evidence of a therapeutic problem, variation in prescribing or adverse outcomes, and existence of best practice guidelines.

              Why do a DUE?
            • To assist your aged care facility to meet components of the Residential Care Standards issued by the Aged Care Standards and Accreditation Agency
            • To comply with the Australian Pharmaceutical Advisory Council Guidelines for medication management in aged care homes
            • To assist you to provide facility - focused activities to promote the quality use of medicines (QUM) in line with Pharmaceutical Society of Australia Guidelines and Standards
            • To contribute to your professional development and education; this activity is recognised by a number of professional bodies for continuing professional development points.

            DUE kit for care homes

            Useful contact numbers and websites

            For information on accessing services

            Translation and Interpreting Services (TIS)
            TIS Doctors Priority Line: 1300 131 450
            To Register: 1300 655 820

            The Doctors Priority Line is a free telephone interpreting service which helps medical practitioners to communicate with their non-English Speaking patients.

            Medical Practitioners can use the Doctors Priority Line when providing services that are: Claimable under Medicare, and in private practices, as well as providing to non-English speakers who are Australian citizens and permanent residents.

            Commonwealth Carer Resource Centre
            Commonwealth Carer Resource Centres can give you up-to-date, relevant information about all the government programs designed to support carers.

            • Carers Australia For carer information, counselling and support freecall (except mobiles) 1800 242 636
            • Carers NSW For carer information, counselling and support freecall (except mobiles) 1800 242 636
            • Council of the Ageing
            • Guardianship Board
            • Guardianship Tribunal
            • Local Government Information
            • The Aged Care Rights Service (TARS)
              The Aged-care Rights Service (TARS) is a community legal centre that provides advocacy for the residents of Commonwealth funded hostels and nursing homes, self-care retirement villages and recipients of in-home aged care in NSW. We also give information on the costs associated with entering an aged care facility and give advice on retirement village contracts. All calls to TARS are confidential.
            • NSW Transcultural Aged Care Service (TACS) The NSW Transcultural Aged Care Service (TACS) is for aged care service providers, community organisations, carers and other members of the community, providing information about cross-cultural resources such as training, translated materials, recipes, demographic data, contacts and links.

            For clinical or program information

            DOWNLOADS

            Do you have patients in Residential Aged Care Facilities? – Infectious Disease Information for RACF patients

            Dementia Awareness and Resources

            There are currently around 245,000 people with dementia in Australia. By mid-century, we will have over 1.13 million Australians with dementia. Dementia is the leading single cause of disability in older Australians (aged 65 years or older) and is responsible for one year in every six years of disability burden for this group.

            It is one of the fastest growing sources of major disease burden. Dementia will become the third greatest source of health and residential aged care spending within about two decades. By the 2060’s, spending on dementia is set to outstrip that any other health condition. It is projected to be $83 billion (in 2006-2007 dollars), and will represent around 11.0% of the entire health and residential aged care sector spending. (Access Economics 2009)

            By 2011 it is estimated that 22.5% of the total older Australian population will come from culturally and linguistically diverse backgrounds. The strategic plan of Ashfield Council in the heart of CSGPN’s region indicates that dementia is set to increase six fold by 2050 in Middle Eastern communities.

            Purpose of the Project:

            • Engage with the Arabic GP’s in the Canterbury LGA in relation to the gaps which currently exists in the understanding of dementia on the part of the Arabic community and health service providers in Canterbury LGA
            • Facilitate GP’s participation in an education and information program which uses existing partnerships and resources to improve their understanding of the needs of the Arabic patients, their families and carers in Canterbury LGA
            • Involve in this program where appropriate relevant community organizations and conduct community education
            • Assess the outcomes
            • Thereby derive recommendations for future sustainable action to achieve:
              1. Improved GP care and referral pathways for Arabic patients suffering from dementia in Canterbury LGA, their families and carers.
              2. Positive attitudes around dementia in the Arabic community within the Canterbury LGA.
              3. Reduce isolation of patients, families and carers living with dementia in the target group.

            Dementia Support Services

            GP_Dementia_services_and_resources_CSGPN.pdf

            • The Cognitive Disorders Service Concord Repatriation General Hospital (diagnosis, education, and management services) 1800 556 533 or 9767 5200
            • Inner West Dementia Advisory Service 9378 1258
            • Carers’ NSW (counseling, support, groups & information) 1800 242 636
            • Carer Respite & Carelink Centre 1800 052 222
            • Aged Care Assessment Teams 1800 556 553
            • Dementia Support Service (Home respite) 9767 7888
            • National Dementia Helpline 1800 100 500
            • NSW Dementia Behaviour Management Advisory Services 1800 699 799
            • “On Track” Café  Rhodes Park. Support group for people with Dementia, families, friends. Concord. 9378 1258
            • DeSteel Cafe’ - multicultural support group. For people with dementia, families, friends - Marrickville - 9378 1258
            • Canterbury Dementia Carer support group. Canterbury hospital 9378 1258
            • Inner west community transport 9745 5800
            • Canterbury & Marrickville multicultural home respite & Dementia support service (language specific) 9550 4637
            • Guardianship tribunal 9556 7600

            Resources

            Websites

    Wednesday, May 23rd 2012

    Office hours are weekdays 9am - 5pm
    Contact reception on 9799 0933
    The time of your visit here is 2:25am

    Upcoming events

    1. CPD event : May 31, Thursday
      Cultural Awareness

    2. CPD event : June 4, Monday
      Drug and Alcohol ALM III

    3. CPD event : June 5, Tuesday
      Keys to a Healthy Practice

    4. CPD event : June 13, Wednesday
      Women’s Health

    5. CPD event : June 16, Saturday
      Antenatal Shared Care Update

      6. Click here for more...
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