Practice Connect #36

Welcome to Practice Connect, a fortnightly update for practice managers, nurses and practice administration staff on relevant issues, upcoming events and education.


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Accreditation tips

Healthcare associated infections

In a recent report provided by Australian General Practice Accreditation Limited (AGPAL), a common non-compliance by Western Australian general practices being surveyed against the RACGP Standards for General Practices (4^th edition) was Criterion 5.3.3H which relates to all individual practice team members, and is intended to minimise the risk of healthcare associated infections.

The reasons for non-compliance were:

• Members of the practice team (medical, clinical and administration) indicated that they were not invited to have their immunity assessed and/or offered immunisation on commencement with the practice.
• Evidence of the immunity status of all practice staff was not available for review.

This Criterion is also addressed in the recently released 5th edition Standards as C3.5.B. Both editions of the Standards adhere to the same principles, however, in the 5th edition, the word ‘must’ is now utilised to demonstrate that the indicators are mandatory.

Practices must:

• Record the natural immunity to vaccine-preventable disease or immunisation status of practice team members if known (with their consent).
• Offer staff members’ immunisations recommended in the Australian immunisation handbook, as appropriate to their duties.
• Encourage members of the practice team to be immunised in order to protect the team from being infected with vaccine-preventable infectious diseases and from transmitting such infections to patients. The exact immunisation requirements will depend on the risk of infection based on the practice’s location, patient population and each practice team member’s duties.

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Medicare Professional Services Review

Medicare's Professional Services Review watchdog has recouped more than $3 million from GPs during November 2017 for inappropriate claims.

Seven GPs voluntarily repaid funds from Medicare Benefits Schedule (MBS) claims including individual repayments of some $650,000, $600,000 and $480,000. Most admitted to inappropriately claiming item 23 and item 36 — the level B and level C consultation items.

MBS items for writing and reviewing care plans were also well-represented in the latest update from the Professional Services Review (PSR) committee. Four other GPs argued their case in front of the PSR committee but were ultimately ordered to repay their billings.

One GP repaid $366,000, related in part to skin excision items where no records existed of the type of lesion or the method of wound closure.

“In some circumstances, the practitioner billed pre‑procedural and post-procedural work as independent consultation items where a procedural item was also billed,” the PSR report notes.

“The committee found it was inappropriate to bill a consultation item in these circumstances given there was no discrete clinical content to justify billing the consultation item, as all work towards the procedure was part of the procedural service.”

Other GPs who were found to have claimed MBS funds inappropriately included:

• A GP who wrote a chronic disease management plan with generic goals such as "improve mood", without any clinical benchmarks to measure improvement. The GP also claimed MBS items for electrocardiography without any clinical indications.
• A GP who claimed, "team care" arrangements without involving any other practitioners and claimed urgent after-hours items for non-urgent patients. He also claimed vitamin D and B12 tests without the appropriate clinical indications.
• A GP who claimed spirometry items without three acceptable pre- and post-bronchodilator results and no records showing what history or examination findings caused the practitioner to perform spirometry.

None of the GPs were named in the PSR update.

If a GP in your practice has any queries regarding MBS items and billing, the Practice Assist Medicare resources may assist to clarify these queries. These resources can be found in the Practice Assist resource library by searching for Medicare resources.

Alternatively, the Practice Assist team can be reached on 1800 2 ASSIST (1800 2 277 478) or emailed at support@practiceassist.com.au.
 

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Digital Health update

Changes to Shared Health Summary Report for CAT4

An update has been released for CAT4 which includes changes to the Shared Health Summary upload report.

Concerns have been raised over the accuracy of the reports as some practices have not been able to match the report numbers with the reported number from the Digital Health Agency. These concerns have been investigated by the vendor PenCS and whilst the numbers being shown in the reports were actually correct, PenCS did accept that displaying the patient numbers (and requiring practices to calculate the total) rather than just the total uploads may have been confusing.

They have since released an update to include an upload total for the period of the report as shown below. This is the number practices can now refer to for their total Shared Health Summary uploads, for the period of the report.
 
Practices should be careful however in making sure that the ‘Date Range (Results)’ tab is used rather than the Visits tab and that the correct time period is selected.
 

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HealthPathways update

HealthPathways WA have now reach 349 pathways. The most recently published pathways are:

• Huntington’s Disease
• Online Mental Health Therapy for Adults
• Infective Endocarditis Prophylaxis
• Refugee Health Assessment
• Female Genital Cutting/Mutilation (FGC/M)
• Medications in Chronic Pain
• Migrant and Refugee Support Services
• Genetic Health Advice

To access HealthPathways please contact your WAPHA Primary Health Liaison or email the HealthPathways team for login details at healthpathways@wapha.org.au.
 

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NPS MedicineWise update

Practices looking to qualify for the 2017/2018 Quality Prescribing Incentive PIP still have time to book their NPS educational visits before the end of April 2018. Visits can be delivered at your practice or online as an interactive virtual visit.

Two NPS MedicineWise topics are currently on offer:

1. Osteoarthritis: practical tools for diagnosis and management
2. Neuropathic Pain: touchpoints for effective diagnosis and management (to be delivered from March 2018)

Further information is available on the NPS website.

To book an NPS MedicineWise educational visit for your GPs, contact Nicole Humphry, NPS MedicineWise Coordinator at WAPHA on 08 6272 4921 or email Nicole.Humphry@wapha.org.au.
 

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Local Primary Care Nursing Networks

Are you interested in having a Primary Care Nurse Network in your region? Networks allow primary health care nurses to build relationships, share knowledge, and share experience at a meeting which includes cost effective education, available locally.

For further information about the benefits of Nursing Networks please visit the Australian Primary Health Care Nurses Association (APNA) website.
 
If you require additional assistance in your practice, please speak to your local Primary Health Liaison. Your local Primary Health Liaison can be found on the Practice Assist website.
 

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Human resources manual

The Chamber of Commerce and Industry WA have released a new manual to cover the lifespan of employment, from recruitment to termination and everything in between.

The manual, which is available in MS Word format so it can be customised to suit your business, includes core HR documents such as a suite of critical policies that businesses need, contracts of employment, performance management forms, written warning letters and termination letters.

The manual is available from the CCI WA for $299 or $199 for members.

For more information or to purchase this investment, visit the CCI WA website.

An additional range of free resources for general practices including template position descriptions for general practitioners, practice nurses, medical receptionists and practice managers can also be found in the Practice Assist Resource Library by filtering the topic Human Resources and Staff Management.
 

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Recalls and Reminders

A common question in practices is often around the best practice management of recalls and reminders. There is no universal answer, however, there are a few key points that practitioners and workplaces should consider when establishing or reviewing recall and reminder protocols.

Nurses play a key role in implementing effective preventative health services in primary health care, and often lead the team in the management of recalls and reminders. A systematic approach to how preventative care is implemented in individual workplaces is essential, as we know higher levels of preventive services are likely to reduce morbidity and mortality from preventable diseases. 

When establishing or reviewing your recall and reminder system, it is imperative that everyone (including administration staff) is aware of and understands at a minimum, the difference between recalls and reminders, and for nurses and practitioners, what constitutes clinical significance.

In the establishment or review of the recalls and reminder system, ensure your workplace is following the relevant recommended guidelines or accreditation standards around the management of recall and reminder systems, such as:

• Aged care – Quality of Care Principles
• Correctional health – National Commission on Correctional Health Care Standards
• General practice – Standards for general practices (4^th or 5^th edition) including Interpretive guide for Aboriginal and Torres Strait Islander health services

Ensuring that risk is mitigated while managing the daily requirements of the workplace and workload are taken into consideration can be a fine balancing act. If each member of the team is aware of differences between a recall and a reminder, this can certainly help in reducing the workload of everyone involved. Ensuring practical elements of the process are considered is crucial to the recall and reminder process.

To read more of this article, please visit the Australian Primary Health Care Nurses Association (APNA) website.
 

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WA Country Doctors’ Awards

The WA Country Doctors’ Awards are presented by Rural Health West and the WA Country Health Service, and recognise rural doctors across a range of areas, including:

• People’s Choice – a doctor who has had a significantly positive impact on their rural town(s).
• Medical Leadership – a doctor who has had impact on change management or service improvement in the areas of patient safety/care/satisfaction, medical research or improved access to primary care services.
• Procedural GP/District Medical Officer of the Year – a doctor who has improved access/sustainability of procedural services in a rural location.
• Rising Star – an emerging doctor who shows a strong commitment to pursuing a rural medical career and had a positive impact on patient safety/care/satisfaction.
• GP of the Year – a GP who is currently practising and living in a rural location, and has done so for two or more years.      

For the complete category criteria and nomination terms, and to complete a nomination form please visit the Rural Health West website.

Nominations close Friday 9 February 2018.
 

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2018 APNA Nurse Awards

The 2018 APNA Nurse Awards are presented by the Australian Primary Health Care Nurses Association (APNA) and recognise primary health care nurses who excel in their roles and communities. There are two awards open for nomination including, APNA Nurse of the Year and APNA Recently Graduated Nurse of the Year.

APNA are looking for nominees who give their best and have made a substantial contribution in their field. That person might be you. Or you might know of a nurse who is an exceptional leader, an inspiration to have around, and often advocates on behalf of the local community. APNA welcome all award nominations.

The award winners will be presented at our 10th annual APNA National Conference: Nurseforce for the Future in Brisbane in May 2018, after which they will act as ambassadors for your profession.

For more information about the 2018 APNA Nurse Awards and to nominate, please visit the APNA website.

Applications close 23 February 2018.

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Education and training

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Antenatal Risk Questionnaire training – 1 February

The Antenatal Risk Questionnaire (ANRQ) will ensure Australian women have their emotional wellbeing routinely checked by clinicians during and after pregnancy. This free workshop, for midwives and practice nurses, led by Professor Marie-Paule Austin, will enable participants to use the psychological risk assessment and scoring.

Date:               Thursday, 1 February 2018
Time:              2pm – 5pm
Venue:            Function Room, Level 3, St John of God Subiaco Medical Clinic
Register:        To register, please visit the event weblink. For further information, please see the event flyer.
 

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Antenatal Risk Questionnaire GP training – 1 February

The Antenatal Risk Questionnaire (ANRQ) will ensure Australian women have their emotional wellbeing routinely checked by clinicians during and after pregnancy. This free workshop, for GPs, led by Professor Marie-Paule Austin, will enable participants to use the psychological risk assessment and scoring.
Date:               Thursday, 1 February 2018
Time:              6pm – 8pm
Venue:            Function Room, Level 3, St John of God Subiaco Medical Clinic
Register:        To register, please visit the event weblink. For further information, please see the event flyer.
 

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Fremantle Nurses Network – 22 February

The Fremantle Nurses Network meetings are held the third Thursday of each month, 6pm to 8:30pm. The next meeting will have two local Fremantle health professionals presenting, including Murray Richards an Exercise Physiologist from Reps Movement in East Fremantle & Canning Vale and Cheryl Laird, Diabetes Education Nurse from Black Swan Health.
Date:               Thursday, 22 February 2018
Time:              6:30pm – 8:30pm
Venue:            Our Lady of Fatima Parish Hall, 10 Foss St Palmyra WA 6157
Register:        To register, please email your details to June Walker at junea@westnet.com.au.
 

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Fiona Stanley Hospital and WAPHA GP Education Update CPD Event –10 March

Topics for this education update will be confirmed in the next edition. This event has 40 Category 1 QI&CPD points attached.
Date:                Saturday, 10 March 2018
Time:               Registration from 8am; Presentations from 8.30am to 3.30pm
Venue:             Fiona Stanley Hospital, Education Building, 11 Robin Warren Dr, Murdoch 6150
Catering:          Morning tea and lunch will be provided
Register:          For more information and to register, please go to the event page on HealthPathways                                      
 

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Speed date your WAPHA service providers – Mandurah

This event will provide attendees with the opportunity to: learn more about the services WAPHA has commissioned; ask questions about the services; meet the people providing the services on the ground; and understand referral pathways. This event is intended for General Practitioners, Practice Managers, Nurse Managers and Nurses.
Date:               Wednesday, 14 March 2018
Time:              (5:30pm arrival) 6pm - 8:30pm
Venue:            Mandurah Quay Resort, 40 Marina Quay Drive, Erskine WA 6210
Catering:        Canapes and drinks provided
Register:        RSVP by Wednesday, 7 March 2018 to Bethany Goodall, South West Regional Coordinator at bethany.goodall@wapha.org.au or 0459 883 533. View the event on the WAPHA website.
 

Health promotion events in February

Is your practice looking for a health promotion activity for your practice?  Each month we provide a list of upcoming health promotion activities for the next month along with resources and contact details.

Ovarian Cancer Awareness Month - February

This year, Ovarian Cancer Australia are encouraging women to #KnowAskAct as part of Ovarian Cancer Awareness Month. Women should KNOW the signs and symptoms of ovarian cancer, ASK for help if they have symptoms or ask others if they have symptoms and, ACT by participating in an Ovarian Cancer Awareness activity to continue to support women with ovarian cancer. This website contains ovarian cancer resources and information on symptoms, risks and treatment, as well as how to register for an event.
Website:          https://ovariancancer.net.au/ovarian-cancer-awareness-month/