Newsletter for the Central Sydney GP Network Ltd.

PBS changes for Nicotine Replacement Therapy

• From 1 February 2011 subsidised nicotine patches are available to smokers Patients need to see a doctor and obtain a prescription for Nicotine Replacement Therapy (NRT) patches to be eligible for the subsidy
• At the moment, the cost of a 4-week course of nicotine patches is between $100 and $140.  When subsidised, smokers who obtain a doctor’s prescription for patches will receive a 4-week course for approximately $33.30 or $5.40 if they hold a concession card
• Each smoker will be eligible to receive 12 weeks supply of NRT patches per year (one original script plus two repeats)
• The strengths of the available subsidised NRT patches will be 21mg per 24 hours and 15 mg per 16 hours
• NRT patches will still be available over the counter, but not at the subsidised price
• Doctors should only prescribe patches to smokers who have entered a comprehensive support and counselling program or smokers who are entering a comprehensive support and counselling program during the consultation at which the patches are requested
• If a patient is unsuccessful in quitting using NRT, they will still be able to access the other smoking cessation therapies on the Pharmaceutical Benefits Scheme (PBS) (Champix and Zyban) during that 12-month period

Additionally, more good news regarding other cessation medicines:

• From 1 February, 2011 Champix is available for an additional 12 weeks of subsidised therapy per year. That’s on top of the already available 12 weeks, taking the maximum subsidised course to the full, recommended 24 weeks treatment per year. Patients will need to return to their doctor to get their second 12 week course of treatment.

Mental Health Nurse Incentive Program

The Mental Health Nurse Incentive Program (MHNIP) continues to receive funding from the Department of Health and Ageing
The MHNIP provides a non-MBS incentive payment to community based general practices, private psychiatrist services, Divisions of General Practice and Aboriginal and Torres Strait Islander Primary Health Care Services who engage mental health nurses to assist in the provision of coordinated clinical care for people with severe mental disorders.

Which patients are eligible for referral to the Mental Health Nurse?
The intent of the MHNIP is to ensure that patients with severe and persistent mental illness in the private health system receive adequate case management, outreach support and coordinated care.

General practitioners and psychiatrists will determine which patients have a severe mental health disorder and would benefit from receiving services provided under this initiative, based on the following criteria:
• The patient has a diagnosis of a mental health disorder (according to ICD-10 Chapter V, or DSM-IV); and
• The disorder causes significant disablement to the patient’s social, personal and occupational functioning; and
• The patient has experienced at least one episode of hospitalisation for treatment of their mental health disorder, or is at risk of requiring hospitalisation in the future if appropriate treatment and care is not provided; and
• The patient is expected to require continuing treatment and management of their mental health disorder over the next 2 years; and
• The general practitioner or psychiatrist is principally responsible for the patient’s clinical mental health care; and
• The patient provides consent to treatment from a mental health nurse

The patient will no longer be eligible for services under this initiative when:

• The mental health disorder no longer causes significant disablement to the patient’s social, personal and occupational functioning; or
• The patient no longer requires the clinical services of a mental health nurse; or
• The general practitioner or psychiatrist is no longer principally responsible for the patient’s clinical mental health care

How to refer to the Mental Health Nurse

• A GP Mental Health Treatment Plan (MBS Item 2710 or 2702) must be developed by the patient’s general practitioner, or an equivalent plan must be developed by psychiatrists.
• A general practitioner or psychiatrist must regularly review the plan (MBS Item 2712) in collaboration with the mental health nurse.

Requirements for Mental Health Nurses

• Mental health nurses engaged in this program must be currently credentialed with the Australian College of Mental Health Nurses (ACMHN).
• Mental health nurses are required to use the Health of the Nation Outcomes Scale (HoNOS) for each patient on entry to the MHNIP
• Measures must be taken every 90 days, to measure changes in a patient’s symptoms and functioning, and at the exit from the initiative.

Functions of the mental health nurses
Under the MHNIP, mental health nurses are working in collaboration with private psychiatrists and general practitioners to provide services which include:

• periodic reviews of patients’ mental states
• medication monitoring and management
• information on physical healthcare to patients
• contributing to the planning and care management of the patient
• integrated services from GPs, psychiatrists and allied health workers (such as psychologists) including arranging access to interventions from other health professionals when these are required.

Locating a nurse to recruit
The ACMHN offers a service on their website (www.acmhn.org) that allows general practices to advertise for a MH Nurse to take part in this initiative. Simply select “career resources” then “recruitment”.