Healthy North Coast Practitioner Newsletter by Healthy North Coast

June 2015| Edition 12

Healthy North Coast practitioner newsletter

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GP Focus

AMS Focus

AgedCare Focus

Pharmacy Focus

AlliedHealth Focus

inside 3. GP Focus 10. AMS Focus 11. Aged Care Focus 12. Pharmacy Focus 13. Allied Health Focus 14. News 16. Events 18. Classifieds

Would you like a hard copy of this newsletter? If so, please email your name and postal address to healthynorthcoast@gmail.com and write “Copy of Healthy North Coast Practitioner Newsletter” in the subject line.

GPFocus eHEALTH Budget 2015

HealtheNet is now live in NSW

The Abbott government announced $485 million in funding for eHealth in the 2015 budget, signifying a commitment to the continued operation of a national eHealth system. The opt-in Personally Controlled eHealth Record (PCEHR) will be transformed to an opt-out myHealth Record, commencing with trials of the opt-out system. It will be made more user-friendly and will better reflect the needs of health professionals, including improved alignment with existing clinical workflows within practices. Participating clinicians will receive hands-on training and follow-up support to build their confidence and understanding in using the system. Additionally, the National eHealth Transition Authority, NEHTA, will be replaced by the Australian Commission for eHealth from July 2016, and a transition taskforce will be established to manage the transition.

Clinicians in NSW Hospitals now have easy access to a patient’s recent medical history thanks to the introduction of HealtheNet. HealtheNet is a project funded by the Ministry of Health, NSW. It improves communication and patient care by enabling a patient’s important medical information to be shared between hospitals, general practitioners and community health services.

It has been identified that a fullyfunctioning national eHealth system will not only improve patient health outcomes, but could also save taxpayers $2.5 billion per year within a decade by reducing inefficiencies, with an additional $1.6 billion in annual savings also delivered to the states.

With HealtheNet available in NSW, clinicians in NSW hospitals can now see a consolidated view of a patient’s summary clinical information from all NSW Local Health Districts (LHDs), as well as the patient’s national Personally Controlled eHealth Record (PCEHR) via the NSW Clinical Portal. NSW hospitals are also now sending patient discharge summaries electronically and securely using nationally agreed standards to three places: • •

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directly to a patient’s nominated GP via secure messaging to the NSW Clinical Portal for access by NSW clinicians with an electronic medical record system connected to HealtheNet discharge summaries will also go to a patient’s Personally Controlled eHealth Record (PCEHR), where the patient has a record

Planning is currently underway to connect NSW Health community health clinicians to HealtheNet through local electronic community software. The HealtheNet platform was built by eHealth NSW in collaboration with the LHDs, Medicare Locals, Primary Care and Community Health Networks, consumer groups and a range of industry partners to ensure that the best possible service is provided.

eHealth training guides and videos for your clinical software Best Practice: http://ow.ly/Nq2oV MedicalDirector: http://ow.ly/Nq2rq Genie: watch training videos at http:// ow.ly/Nq2sY and find the Genie user manual, which features a PCeHR guide, at http://ow.ly/Nq2u8. Practix: review your February 2015 release notes for information about eHealth upgrades, and access Practix user support via the Help function in your software. For further assistance with eHealth, please contact your NCML Provider Assistance Liaison team: Tweed Valley 07 5523 5500 Northern Rivers 02 6622 4453 Mid North Coast 02 6659 1800 Hastings Macleay 02 6583 3600

GPFocus PAL UPDATE

New Smartphone Palliative Care App Decision Assist has developed a new smartphone app, palliAGED, to help GPs who are caring for older palliative patients living at home or in residential care. As most deaths are expected, death can be planned for and the required care delivered in a pre-emptive fashion. The palliAGED app makes use of a framework of care which starts with a GP considering if they would be surprised if this patient died in the next 6 to 12 months. The app informs of key clinical processes such as advance care planning, case conferencing and terminal care management. It also provides prescribing support for common symptoms that patients experience in the terminal phase. The palliAGED app is free and one of a suite of resources for GPs on palliative care and advance care planning developed by Decision Assist. For further details, including where to download the app, go to http://ow.ly/Nq0Lp.

New Medical Certificate Cause of Death The NSW Registry of Births, Deaths and Marriages introduced a new Medical Certificate Cause of Death (MCCD) in December 2014. For GPs completing the MCCD for persons in the community, the phase-in period ended in mid-March 2015. Where an old MCCD is received, the Registry will write to the health practitioner and copy to the relevant stakeholders requesting submission of the new MCCD for the death. The Registry will register a death regardless of which MCCD is submitted, in order to not inconvenience customers, but will expect that the health practitioner submits the correct MCCD retrospectively. Visit http://ow.ly/Nq2Wh for more information and order instructions.

Transport in Sydney for rural and regional patients Country Care Link, part of the Sisters of Charity Outreach program, has been assisting rural families since 1992. The Service provides support and hospitality 4

to people from rural New South Wales visiting Sydney for medical purposes:

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free transport from volunteer drivers from the airport/railway station to accommodation/medical service phone numbers for possible accommodation close to a hospital visits (on request) to rural patients in hospital

Coordinator: Sister Jan O’Grady Phone: 1800 806 160 or 02 8382 6434 Email: ccl@stvincents.com.au (if possible, please give 48 hours’ notice) Visit http://ow.ly/Nq3we for more information.

Men’s Health Week 15-21 June Men’s Health Week is a great time to raise awareness and support the health and well-being of the men in our local community. Andrology Australia offers clinical and patient resources via their website, including promotional material for Men’s Health Week. Visit http://ow.ly/ Nq37R for more.

New Australian Clinical Trials website The Australian government has launched the Australian Clinical Trials website, an online one-stop shop of information relating to clinical trials for patients and clinicians. Visit http://ow.ly/Nq3Ac.

HIV Testing Week 1-7 June - who else should you test for HIV? Groups to test for HIV include gay and other men who have sex with men, sex workers and people who inject drugs. There are however other groups that you should consider testing. In NSW during 2014, 14% of all HIV notifications were from heterosexual people (1) and it is estimated there are currently 620 heterosexual people infected with HIV who are undiagnosed (2).

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should also be tested for HIV, as they are at increased risk for infection. Abby, 26, had trouble even getting a test from her doctor, with the doctor dismissing her concerns. “I had a new partner and just had a feeling…..When I asked my doctor for a test she just said ‘Abby, you are a young straight woman, living in Australia…why would you need a test?’ She did test me and I was HIV positive. Of course it was a shock but finding out early was the best thing for my health.” Associate Professor Catherine O’Connor, Director of the Sexual Health Service at Sydney Local Health District, advises that GPs should be testing for HIV. “As GPs are the front line health services most accessed by the general community, it is important that GPs are aware of who is at risk of HIV infection. Sexual Health Services can provide support to GPs who are making HIV diagnoses.” Pozhet is the Heterosexual HIV Service for NSW. It provides programs and services to improve the wellbeing of the diverse heterosexual community of people living with HIV, their partners, family and friends. Visit http://ow.ly/Nq3Um for more information or call the Heterosexual HIV Information Line on 1800 812 404. You can find a list of North Coast NSW sexual health services at http://ow.ly/Nq1tB. References: 1.

NSW Ministry of Health (2014), NSW HIV Strategy 2012- 2015: A new era, 2nd Annual report on progress, snapshot, available from: http://ow.ly/Nq1ds, accessed 26 March 2015.

Jansson J., Kerr C. C., Wilson D. P., (2014), Predicting the population impact of increasing HIV testing and treatment in Australia.

Heterosexual people who are: • •

sexual or injecting partners of people who live with HIV frequent or long term travellers, particularly those who have recently travelled to Africa or Asia

people who inject drugs those who are chronically unwell, where no explanation can be found people whose sexual partners are from high prevalence countries or regions, e.g., Africa or Asia heterosexual men having sex with men

GPFocus PAL UPDATE

Tonic Health Media and Healthy North Coast: Joint Value Provision Improve practice revenue and efficiency The system includes a series of videos and announcements that encourage patients to take action in areas such as chronic disease management, immunisation, and mental health plans, and you can complement these with your own ads. Through a partnership with Tonic Health Media (THM), Healthy North Coast is pleased to offer its practices an evidence-based patient education and entertainment TV system designed specifically for medical waiting rooms. The foundation program, Tonic, is evidence based, broadcast on ABC News 24, and hosted by Australia’s leading medical journalist, Dr Norman Swan. The content is produced in association with the National Prescribing Service (NPS), and covers a wide range of health related topics relevant to all ages and demographics.

Screen time for practices THM also provides each practice with screen time to communicate directly to consumers watching the system, by way of six free 30-second text ads. These ads can be used to communicate programs or services you offer, to direct patients to your website, or about specific campaigns you are running e.g. flu immunisation or diabetes awareness. We also provide you with your own on-line portal so that you can update your ads as often as you like. A word from a well regarded QLD practice manager:

To hear Dr Norman Swan explain the benefits of the system, visit: www.tonichealthmedia.com.au/clinics/registration

At Garden City Medical Centre, we have been utilising the Tonic Health Media system for approximately 18 months. During this time, we have found that our patients have a very positive attitude towards the system. Patients are actively engaged and enjoy watching the programs. They like the broad range of content and variety of formats in which it’s presented. The duration of the stories are suitable and appropriate to the healthcare setting to retain a patient’s interest. We believe that our patients seem to genuinely appreciate hearing health advice in the waiting room. Sharon Knight, General Manager, Garden City Medical Centre, Mt Gravatt

Having the system in your waiting room will enable you to demonstrate a commitment to providing high quality health information, aimed at improving health literacy. The system supports practices to meet patient information requirements in RACGP standards for general practices, and is provided FREE OF CHARGE to practices with 3 or more GPs (a small co-payment exists for smaller practices). 5

Enquire about a screen for your practice, and start improving practice efficiency, revenue, and health outcomes today. Please contact your HNC representative, or Shaun Christie-David, Client Relations Manager, Tonic Health Media on P: +61 2 9281 5940 or M: +61 458 877 358.

GPFocus IMMUNE RESPONSE Infection control With the flu season upon us, it is timely to review some infection control guidelines and in particular, the issue of toys and magazines in practices. Margaret Jennings, Microbiologist and Infection Control Consultant/Educator, shared some tips on ensuring safer environments for clients and staff in the 2015 Infection Control April Newsletter #3: •

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consider a selection of washable toys for the waiting and clinic rooms and wash them weekly in detergent (and immediately if children are observed mouthing them) wipe over any wall hung activity remove toys if there has been mouthing suggest parents bring their own toys for their children to play with, e.g., on your on-hold message ask parents not to share toys when children are sick or if there is a significant infectious outbreak in the community in the event of an outbreak, consider removing toys altogether and/or have some clean second hand toys that could be given away to the child

While the risk may be low, as long as there is an infectious dose of viable microorganisms transmitted to a portal of entry in a susceptible person, then infection can occur. Mouth contact from toys and magazines via fingers enables this. Most infection transmitted is self-limiting e.g., a cold; however, it would be good practice to remove contaminated items for use by others. Hand hygiene is the single most important method of preventing the spread of infections and good hand hygiene practices are critical for this to be effective: • • • • • 6

wash hands with soap and water regularly before, during and after preparing food before eating after using the toilet after changing nappies

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after caring for a sick person between clients after blowing your nose, coughing and sneezing after handling animals or rubbish when you come home use hand sanitiser when soap and water are not available cough or sneeze into a tissue or your elbow rather than your hands

HPV The National HPV Vaccination Program Register has released preliminary estimates of HPV vaccination coverage for 2013. Please note that this data is sourced from state/territory Departments of Health and that caution should be exercised in making comparisons between jurisdictions due to different methods for calculating coverage. Visit http://ow.ly/ Nq59g for more information.

Influenza news The NSW Health Immunisation Unit has advised, “The seasonal influenza vaccine used under the National Immunisation Program is a trivalent influenza vaccine (TIV) which contains three virus strains. A quadrivalent influenza vaccine (QIV) is also available through the private market. It is anticipated that the National Immunisation Program 2015 TIV will offer good protection against the influenza strains prevalent in the 2015 influenza season, especially as the current strains known to be circulating in NSW are all included in the TIV and globally 99% of viruses currently circulating are covered by TIV.” According to the Immunise Australia fact sheet, TIV typically provides protection against laboratory-confirmed influenza in approximately 60–85% of vaccine recipients. The level of protection from TIV is lower in the elderly and in people who are immunocompromised, and when there is a mismatch between the vaccine and circulating influenza virus strains. QIV is expected to be at least as effective as TIV and may offer additional benefit through protection against the additional B strain. The extent of any additional

benefit will depend on which B strains are circulating and how much cross protection there is between B strains. Reminder: if clients who have received the TIV request the QIV, they should receive this at least four weeks after the TIV dose. Visit the flu tracker website at http:// ow.ly/Nq5eX for more information. Visit http://ow.ly/NGWl2 to access the HealthPathways Influenza Immunisation page.

Australian Government announcements on childhood immunisation On 12 April 2015, the Prime Minister and the Minister for Social Services jointly announced that the Australian Government is introducing strengthened immunisation requirements for parents receiving family and childcare payments. From 1 January 2016, parents who don’t immunise their children (vaccine objectors) will not be eligible to receive Child Care Benefit, Child Care Rebate or the Family Tax Benefit Part A end of year supplement. The Department of Social Services (DSS) has a fact sheet on this initiative, available at http://ow.ly/Nq5ox. Following this announcement, there has been an increase of parents bringing their children for catch up. The Public Health Unit can assist in catch up schedules and the Immunise Australia website also has supportive tables to assist. Visit http:// ow.ly/Nq5qK to learn more. Visit http://ow.ly/NGWGv to access the HealthPathways Childhood Immunisation page.

GPFocus IMMUNE RESPONSE

Timing of immunisations

Immunisation and pregnancy

Reminder: the earliest a child can get their 12-month vaccines is at 11 months. Recent cases where the vaccine was given a few days less than 11 months have not been accepted by ACIR. If the child is travelling and needs the protection earlier, s/he can have the MMR, but it will need to be repeated at or after 12 months of age.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has recently released a communiqué, Pertussis Immunisation in Third Trimester of Pregnancy, which is available on their website http://ow.ly/Nq6fR and the NSW Health pertussis website http://ow.ly/ Nq6mv.

Pertussis news NSW Health has released a list of FAQs on Pertussis Vaccination. Q. What is the recommendation for women who have received a pertussis vaccine prior to their current pregnancy? It is preferable to leave at least 12 months between doses of a pertussis containing vaccine (e.g., Boostrix). A repeat dose can be given later than 28 weeks in the third trimester, if a gap of around 12 months between doses can be achieved.

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Visit http://ow.ly/NGWZF to access the HealthPathways Pertussis Vaccine for Pregnant and Postpartum Women page.

Hepatitis B serology - all pregnant women should be recommended to have hepatitis B screening in pregnancy. Women found to be chronic carriers of hepatitis B should have an assessment of their antigen and viral replicative status (viral load) with liver function tests performed, and be referred for specialist support.

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The RANZCOG statements on revised Pre-pregnancy Counselling and Routine Antenatal Assessment in the Absence of Pregnancy Complications are available at http://ow.ly/Nq6wI. Key vaccination and immunisation points from these statements are highlighted below:

Varicella - where there is no history or uncertain history of previous illness, consideration should be given to checking varicella antibodies at the first visit. Visit http://ow.ly/NGXmW to access the HealthPathways Varicella and Pregnancy page.

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Vaccination - influenza vaccination of pregnant women is strongly recommended. Data suggests pertussis vaccination during pregnancy is more effective in reducing the risk of pertussis in young infants than vaccination of the mother post partum. dTpa vaccine is recommended as a single dose during the third trimester of each pregnancy. The optimal time for vaccination is early in the third trimester, between 28 - 32 weeks*.

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Q. Do infants of pregnant women who receive pertussis vaccine during pregnancy require an 18-month booster dose? The NHMRC now recommends that ALL children receive a booster dose at 18 months of age. This is due to the waning immunity observed in all infants, resulting in an increased number of pertussis cases in 2-3 year olds. This recommendation is also contained in the new NHMRC pertussis chapter of The Australian Immunisation Handbook (10th edition) and has been endorsed by the Pharmaceutical Benefits Advisory Committee (PBAC), but not yet funded by the Australian Government. Therefore, parents could be prescribed either a DTPa vaccine, or if this is not available, a DTPaIPV vaccine. Visit http://ow.ly/Nq5YM for more information on the NSW Antenatal Pertussis Vaccination Program. Visit http://ow.ly/NGWTu to access the HealthPathways Pertussis page.

circulating in the community to boost women whose levels may fall below that of protection.

Women planning pregnancies should be aware of their vaccination status and, if uncertain, liaise with their general practitioner. Vaccination history for measles, mumps, rubella, varicella zoster, diphtheria, tetanus and pertussis should be checked and maintained as per recommendations published by the relevant Australian and New Zealand Government bodies. Rubella and varicella immunisation should be considered for women with incomplete immunity. Pregnant women should be immunised against influenza. dTpa vaccine for pertussis is recommended as a single dose during the third trimester of each pregnancy. The optimal time for vaccination is early in the third trimester between 28 and 32 weeks*.

During antenatal care: •

Rubella antibody status - all women should have their rubella antibody titre measured for each pregnancy. Although the past antibodies titres from previous pregnancy screens may have been used to exclude a further antenatal test, there is evidence that levels may decline, particularly following immunisation as compared to natural infection. This is particularly so given the low level of wild virus

*Australian Government, The Australian Immunisation Handbook (10th Edition), 2013, In: Department of Health, http://ow.ly/Nq6Yv

GPFocus IMMUNE RESPONSE

ACIR

Healthy Minds flying high

Three new reports will be released by ACIR in June to support GPs, practice nurses and midwives in vaccination adherence.

The Healthy Minds program was established as the central referral point for mental health services for vulnerable people on the North Coast of NSW. Healthy Minds turns service delivery upside down, shaking the mental health providers out of their private offices and placing them in community organisations.

The ACIRO21A Due/Overdue Report by Medicare GP The existing ACIR021A report will be modified to allow individual GPs, midwives and nurse practitioners to identify children with overdue vaccinations, based on MBS services they provided. It will: • • •

break the report down by a single location (or all locations of the practitioner) break the report down by children identified as overdue for a particular disease (e.g., measles) increase the usability of some of the date fields (e.g., date of birth ranges, etc.)

The ACIR011A Modified Report Due/Overdue Report by locality The ACIR011A report identifies children by their locality (postcode or postcode range). The modified report will enhance the date of birth search function and allow greater flexibility in search functions including searching for: • • •

children coming due for their vaccinations (e.g., due next 30 days) children overdue for specific antigens children with no vaccination history recorded on ACIR

The ACIR011B Due/Overdue Report by immunisation provider

The program is currently working in partnership with 24 community organisations from the Queensland border to Port Macquarie. Mental health professionals contracted to the Healthy Minds Program provide sessions on site at these partner organisations. These partnerships double the number of access points for psychological services across the region. Each community service organisation is committed to supporting their clients to see a GP to improve their physical and mental health. If a patient of yours requests a Healthy Minds referral, it may be that they are connected with one of our partner organisations. Healthy Minds is funded by the Australian Government Department of Health, using both ATAPS (Access to Allied Psychological Services) and Better Access funding. After nearly twelve months of implementation, the number of referrals received has more than tripled, local GPs are on board to complete the required mental health treatment plan and clients are seeing the mental health professional while being supported by the community organisation. This enables Healthy Minds to reach vulnerable groups, including people at risk of homelessness and suicide, children, and Aboriginal and Torres Strait Islander people.

The ACIR011B report uses the last immunisation provider on ACIR to allocate a child to the report. The modified report will enhance the date of birth search function and allow greater flexibility in search functions including searching for:

Healthy Minds accomplishes two major aims:

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children coming due for their vaccinations (e.g., due next 30 days) children overdue for specific antigens service delivery date

All reports will be available from the ACIR secure site and can be generated once, weekly, monthly or on a quarterly basis, as per the practitioner’s request. More information on the changes to the ACIR reports is available by calling the ACIR internet enquiry line on 1300 650 039. NCML and the PHU encourage all practices doing childhood immunisation to register with ACIR. A cheat sheet for enrolling with ACIR can be requested from smoore@ncml.org.au or marianne.trent@ncahs.health.nsw.gov.au.

MENTAL HEALTH

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it takes mental health services into community organisations where health services have not traditionally resided, thus bringing social support and clinical care together it also places mental health professionals in primary care practices, ensuring that mental health services are together with other clinical services, e.g., in Aboriginal Medical Services

These actions help lessen the stigma that is often associated with receiving mental health care in traditional mental health office settings. It also distributes mental health services across the entire sector, opening up multiple entry points for care. Healthy Minds is a free mental health service for people of all ages who are on a Health Care Card or in severe financial distress. Referrals to Healthy Minds can be made on the downloadable referral form located at http://ow.ly/Nqa5V and should be supported by a Mental Health Treatment Plan. Visit http://ow.ly/Nqa2x to access the Healthy Minds Practitioner Online Portal. For more information please contact Manpreet Kooner, Intake Officer for Healthy Minds, on 1300 137 237.

GPFocus NEW TO HEALTHPATHWAYS MAY 2015 • • • •

Notifiable Diseases Toothache Medication Management Service Combined Hormonal Contraceptives

The number of total published pathways currently stands at 105, with a further 60 in various stages of development. For further details please see the HealthPathways project management website: http://ow.ly/NqaBi Username: manchealth Password: conn3ct3d

HealthPathway service of the month - Referral to Oral Health Services Accessing appropriate oral health services can be confusing for patients and GPs alike. The Referral to Oral Health Services Pathway for Mid and North Coast provides information to make referral of patients to private and public Oral Health Services easier, including: •

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Locating a Private Dentist in your area - links to the Australian Dental Association website. This link enables you to search for a dentist in your current or surrounding areas. Private Dentist for Children - Medicare Child Dental Benefit Scheme (CDBS). This service funds private dental services for children and lists eligibility criteria. Public Dental Clinics - Dental. Provides referral information for general dental services for patients 5 years and over. Public Dental Clinics - Dentures. Provides information for patients’ assessment for eligibility to the services.

Pathway drafting process – in brief

The Mid and North Coast HealthPathways team is seeking General Practitioners to join current and future workgroups. The work of the workgroup is time limited and provides the opportunity to engage with others who are interested in making things

work better for GPs and their patients. The process for developing a high-quality HealthPathway is interesting and rigorous. Usually a workgroup (generally comprised of general practitioners, specialists, allied health practitioners and nurses) is formed to develop a draft HealthPathway. The draft is forwarded to Streamliners, a technical writing company based in New Zealand. Once written, the draft is uploaded to the DRAFT HealthPathways website for review by the workgroup members. The workgroup meets a few times until the Pathway and its content is agreed upon by the members. In tandem, the HealthPathways team gathers all the local specialist and service information referred to in the Pathway. Once all of this is compiled, the Pathway is then sent out to a range of clinicians for wider consultation and feedback. The last stage is a final review by the HealthPathways Clinical Leads prior to publication on the Mid & North Coast HealthPathways Website.

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Mental Health: Depression, Mild Anxiety, Moderate Anxiety, Suicide Prevention Musculoskeletal: Osteoporosis, Osteoarthritis, Acute Lower Back Pain Antenatal: Heart Conditions in Pregnancy, Skin Conditions in Pregnancy, Miscarriage

Northern NSW Workgroups in Northern NSW are currently the following pathways: • • • • • •

Dementia: Cognitive Impairment Mental Health: Psychosis, AntiPsychotic Depot Medication Renal: Haematuria Drug & Alcohol: Set of Alcohol related pathways Cancer: Lung Cancer Antenatal: Antenatal Shared Care

Other topics which are prioritised and being progressed are Telehealth and Stroke.

Contact your local HealthPathways team for more information if you are interested in participating in Pathway development.

For further information or to suggest a future pathway topic please contact:

Visit the Mid and North Coast HealthPathways website:

Fiona Ryan (02) 6583 3600 fryan@ncml.org.au (Mid North Coast)

http://manc.healthpathways.org.au Username: manchealth Password: conn3ct3d

Mid North Coast Celebrations have taken place to mark twelve months of HealthPathways on the Mid North Coast. This coincided with a COPD education event held in Port Macquarie on 14 May attended by 95 local clinicians. Workgroups in Mid North Coast are localising the following pathways: • • •

Cardiology: Atrial Fibrillation, Heart Failure, Acute Chest Pain Paediatrics: Child with a Limp, Developmental Dysplasia of the Hip (DDH) Cancer: Prostate Cancer

Kerrie Keyte (07) 5523 5507 kkeyte@ncml.org.au (Northern NSW)

AMSFocus

Background Artwork by Alison Williams

ABORIGINAL HEALTH Core of Life: Education for a positive parenting future The Core of Life Program is a joint initiative of North Coast Medicare Local, Northern NSW Local Health District and Youth and Family Education Resource Program. As an innovative approach to providing interactive, evidence-based information about pregnancy and parenting topics in the North Coast region, the Core of Life program has been delivered to a number of schools in the region this year. Focusing on the realities of pregnancy, birth and early parenting, the program is run over three hours using teaching methods such as role play, story telling and multimedia. Local support services are discussed so young people are aware of these networks, should they or their friends need to access them now or in the future. To support the roll-out of the Core of Life program in the North Coast region, a Facilitator Training Workshop will be offered in Ballina on June 25 & 26, with limited places available (http://ow.ly/NqcfB). This two day workshop teaches the skills required to co-present the Core of Life program to adolescents in schools or in the community. The training is suitable for Aboriginal Health Workers, youth workers, teachers and other health professionals who work with teenagers and families in the local community. Following on from the training, participants are required to assist with the provision of the Core of Life program to young people in their local area, especially Aboriginal and Torres Strait Islander youth and families. If you would like to learn more about becoming a Core of Life trainer, please contact Program Coordinator Claire Malseed at NCML on cmalseed@ncml.org.au or (02) 6622 4453.

For information on transport in Sydney for rural and regional patients, refer to page 4.

For tips on infection control, pertussis and influenza news, immunisation and pregnancy advice, as well as announcements on childhood immunisation and new ACIR reports supporting vaccination adherence, refer to pages 6-8.

AgedCareFocus PAL UPDATE

IMMUNE RESPONSE

New Smartphone Palliative Care App

Influenza news

Decision Assist has developed a new smartphone app, palliAGED, to help GPs who are caring for older palliative patients living at home or in residential care.

The NSW Health Immunisation Unit has advised “The seasonal influenza vaccine used under the National Immunisation Program is a trivalent influenza vaccine (TIV) which contains three virus strains. A quadrivalent influenza vaccine (QIV) is also available through the private market. It is anticipated that the National Immunisation Program 2015 TIV will offer good protection against the influenza strains prevalent in the 2015 influenza season, especially as the current strains known to be circulating in NSW are all included in the TIV and globally 99% of viruses currently circulating are covered by TIV.”

As most deaths are expected, death can be planned for and the required care delivered in a pre-emptive fashion. The palliAGED app makes use of a framework of care which starts with a GP considering if they would be surprised if this patient died in the next 6 to 12 months. The app informs key clinical processes such as advance care planning, case conferencing and terminal care management. It also provides prescribing support for common symptoms that patients experience in the terminal phase. The palliAGED app is free and one of a suite of resources for GPs on palliative care and advance care planning developed by Decision Assist. For further details, including where to download the app, go to http://ow.ly/Nq0Lp.

Smart Technologies Bootcamp From 27-28 August, Feros Care is hosting a Smart Technologies Bootcamp to enable the aged and community sector to share information and to review the ‘trials and errors’ other organisations have experienced in rolling out new technologies. The Bootcamp will include seminars and workshops on various technologies utilised by aged care providers and give attendees the opportunity to share knowledge on issues they have encountered to allow the sector to deliver the highest quality care for seniors in Australia. The bootcamp will run over two days covering virtual case management, m-health, social connectedness, falls and mobility, dementia technologies and telehealth. Registrations are now open. Book before 25 June 2015 and receive 15% off the ticket price. Bootcamp details: Date: 27-28 August Location: Twin Towns Clubs and Resorts, Tweed Heads Cost: From $520 (for early-bird bookings) Visit www.smarttechnologiesbootcamp.com.au for more information.

According to the Immunise Australia fact sheet, TIV typically provides protection against laboratory-confirmed influenza in approximately 60–85% of vaccine recipients. The level of protection from TIV is lower in the elderly and in people who are immunocompromised, and when there is a mismatch between the vaccine and circulating influenza virus strains. QIV is expected to be at least as effective as TIV and may offer additional benefit through protection against the additional B strain. The extent of any additional benefit will depend on which B strains are circulating and how much cross protection there is between B strains. Reminder: if clients who have received the TIV request the QIV, they should receive this at least four weeks after the TIV dose. Visit the flu tracker website http://ow.ly/Nq5eX for more information. Visit http://ow.ly/NGWl2 to access the HealthPathways Influenza Immunisation page.

PharmacyFocus PAL UPDATE Blood Pressure

Heart Foundation Walks

High blood pressure is the most frequently managed problem in Australian primary care. In the 2011–12 Australian Health Survey, 1 in 3 adults had high BP (defined by use of BP lowering treatment [1 in 10] or BP measured as ≥140/90 mmHg [1 in 5]). While high BP is a significant risk factor for cardiovascular disease, it only forms part of the picture. All patients should be encouraged to adopt healthy lifestyles, and decisions about whether a patient needs pharmacotherapy should be based on their absolute cardiovascular risk - not just a single risk factor.

The Pharmacy Guild has partnered with the Heart Foundation to promote the importance of physical activity and cardiovascular health, and assist pharmacies to become ‘Walk Organisers’. As part of a ‘move more, sit less’ campaign launched by the Heart Foundation recently, national program manager Michelle Wilson said community pharmacies were in an ideal position to promote the messages of the campaign. The Guild said pharmacists could raise awareness of health issues during walks and start groups targeting issues or populations. The Heart Foundation offers support and resources, including insurance cover, merchandise and promotional material. For more information on becoming a Walk Organiser, go to http://ow.ly/Nwwwb.

North Coast Medicare Local has recently partnered with NPS MedicineWise to deliver training in Tweed Heads and the Northern Rivers on Blood Pressure: what’s changing in how we measure, manage and monitor. For details of the upcoming Northern Rivers event in June, please visit http://ow.ly/Nwwas. If unable to attend, pharmacists can consolidate knowledge on blood pressure, brush-up on current guidelines and practices and earn CPD points through NPS’ online learning activities at http://ow.ly/NwwkQ.

IMMUNE RESPONSE Training Are you a registered pharmacist looking to acquire the knowledge and skills to establish and deliver a successful immunisation service in community pharmacy? The Pharmaceutical Society of Australia is offering training in Port Macquarie, 14 June 2015. Visit http://ow.ly/NwwKk for more information. The Guild also offers a course in Conduct Immunisation Services within Community Pharmacy Environment – visit http://ow.ly/ NwwO0 for upcoming dates.

AlliedHealthFocus PAL UPDATE

Core of Life: Education for a positive parenting future The Core of Life Program is a joint initiative of North Coast Medicare Local, Northern NSW Local Health District and Youth and Family Education Resource Program. As an innovative approach to providing interactive, evidence-based information about pregnancy and parenting topics in the North Coast region, the Core of Life program has been delivered to a number of schools in the region this year. Focusing on the realities of pregnancy, birth and early parenting, the program is run over three hours using teaching methods such as role play, story telling and multimedia. Local support services are discussed so young people are aware of these networks, should they or their friends need to access them now or in the future. To support the roll out of the Core of Life program in the North Coast region, a Facilitator Training Workshop will be offered in Ballina on June 25 & 26, with limited places available. This two day workshop teaches the skills required to co-present the Core of Life program to adolescents in schools or in the community. The training is suitable for Aboriginal Health Workers, youth workers, teachers and other health professionals who work with teenagers and families in the local community. Visit http://ow.ly/ NqcfB to register. Following on from the training, participants are required to assist with the provision of the Core of Life program to young people in their local area, especially Aboriginal and Torres Strait Islander youth and families. If you would like to learn more about becoming a Core of Life trainer, please contact Program Coordinator Claire Malseed at NCML on cmalseed@ncml.org.au or (02) 66224453.

Directors sought for Allied Health Association The North Coast Allied Health Association (NCAHA) is seeking to appoint two new Directors to its Board. The Association would welcome applications from people with a variety of professional backgrounds, not exclusively allied health professionals. NCAHA was formed last year with support from North Coast Medicare Local. Itâ&#x20AC;&#x2122;s the peak body for allied health professionals across the North Coast region. A public company limited by guarantee, NCAHA is focused on improving patient care and the health status of people living on the North Coast of NSW. The NCAHA Board is responsible for the strategic direction of the company and its effective governance structures. The current Board of Directors is comprised of Chair, Professor Susan Nancarrow from Southern Cross University, who has a podiatry background; occupational therapist Luisa Eckhardt and physiotherapist Robert Curry. To apply, complete the application form at http://ow.ly/NaoXP. Email the form with an up to date curriculum vitae by 5pm Monday 29 June. Contact Shay Ataii on 6618 5429 for more information.

HNCNews Networking Platform for Health Professionals

ealthy North Coast’s new online network allows you to communicate, network and collaborate in a private and professional environment, with colleagues from across the North Coast without leaving your office.

Residents of the North Coast are invited to submit entries to North Coast Medicare Local’s latest PITCH: the SNAPPED Photography Competition.

The Healthy North Coast Network is based on the functionality of other familiar social networking platforms like Facebook, LinkedIn and Twitter.

NCML wants to see your take on what “good health” means to you. Send us a photo that visually completes the phrase: “Good health is…”

With over 130 regional and professionbased networks available, the Healthy North Coast Network is ready for you to join right now. Health professionals can register for the Healthy North Coast Network by visiting http://bit.ly/VsrO2s. Full instructions for the platform are available at http://bit.ly/1sJgRI7.

SNAPPED: The PITCH Photography Competition 2015 The competition is part of North Coast Medicare Local’s PITCH innovation series. PITCH stands for Practical Ideas to Change Health Care. Theme: “Good health is…”

Images could relate to diet, fitness, meditation, friends, family, pets – whatever “good health” means to you. Snap a picture and show us what “good health” looks like! Check for competition updates at www.healthynorthcoast.org.au/competition.

HNCNews Doctors in crisis as working conditions fuel psychological distress Australia has a serious problem, beyondblue Chairman The Hon. Jeff Kennett AC has said, because many of the medical professionals who the public turns to for help are overworked, stressed, depressed, dependent on alcohol or other substances and are at risk of suicide. Mr Kennett has urged all Australians to watch Four Corners on the ABC as the program investigates the pressure Australian doctors face in the workplace. (Editor’s note: the program aired in late May and is available to watch on iView until midJune.) The investigation follows the known sudden deaths of four young doctors this year and reports of improper working conditions, sexual harassment and bullying within the health system. In 2013, beyondblue conducted a world-first survey of doctors’ and medical students’ mental health and discovered that they experience much higher rates of suicidal thoughts and psychological distress than the general community. Read the full story at: http://healthynorthcoast.org.au/top-stories-312/

Spike in Whooping Cough cases on Mid North Coast The North Coast Public Health Unit has issued an alert in response to a recent spike in cases of whooping cough in the Coffs Harbour and Bellingen areas of the Mid North Coast.

NSW Health and the Aboriginal Health and Medical Research Council (AH&MRC) have launched a new framework that aims to reduce smoking rates in Aboriginal communities across NSW.

The number of reported whooping cough cases has climbed steeply in the past fortnight, with 25 cases reported in the past two weeks and 81 cases (including five infants) reported so far in 2015.

The ATRAC Framework: A Strategic Framework for Aboriginal Tobacco Resistance and Control in NSW, launched at the Aboriginal Health College of NSW, is a best practice guide for health service providers that develop and deliver services to reduce smoking rates among Aboriginal people.

North Coast Public Health Unit Director Paul Corben said this was well above the 27 cases reported over the same period in 2014. “Bellingen and Coffs Harbour local government areas are the focus of this recent increase, with all other parts of the NSW north coast remaining below five-year averages at this time. Most cases are amongst school-aged children and a number of local schools have been affected,” Mr Corben said. “Vaccination is still the single best way to prevent whooping cough although not everyone will get an immune response and immunity wanes with time. This means that people can still get whooping cough if they have been vaccinated or if they have had previous infection. “Because of the waning of protection, epidemics of whooping cough occur about every three to four years, as community immunity wears down. The last outbreak was in early 2012 and we are seeing signs that indicate we are starting to experience another one,” Mr Corben said. Read the full story at: http://healthynorthcoast.org.au/top-stories-313/

New guide to lower smoking rates in Aboriginal communities

NSW Health Executive Director of the Centre for Population Health, Dr Jo Mitchell, said tackling high smoking rates among Aboriginal people was a key priority for NSW Health. “Smoking rates among Aboriginal people in NSW are unacceptably high, reaching 36.8 per cent in 2013, which is more than double the smoking rate of the general population,” Dr Mitchell said. “This Framework will encourage best practice approaches to tobacco control in Aboriginal communities with the aim of lowering rates of smoking and associated chronic disease. “It aims to achieve this by building strength and capacity across government, health service providers and community organisations to deliver culturally appropriate tobacco control programs and services.” Read the full story at: http://healthynorthcoast.org.au/top-stories-310/

HNCEvents Hastings-Macleay

Tweed

2 June - Sterlisation / Infection Control Workshop, Port Macquarie

2 June - Aboriginal & Torres Strait Islander Cultural Awareness Training for Health Professionals, Tweed Heads

3 June - Sterlisation / Infection Control Workshop, Kempsey 16 June - Quitting Cannabis – Clinical Intervention, Port Macquarie 19-20 June - Explain Pain, Port Macquarie 17 July - Being with Dying – An inaugural workshop for health professionals, Port Macquarie 31 July - Working with Young People – Building Resilience, Port Macquarie

Mid North Coast 2 June - Double Whammy – Co-occurring Mental Health and Alcohol and Other Drug Disorders, Coffs Harbour

3 June - Improving Mental Health in Pharmacy, Tweed Heads 10 June - Tweed Valley Clinical Society Meeting 19 June - Building Resilience to Mood Disorders: Risk reduction, relapse prevention & maintenance strategies, Tweed Heads 11 June - eHealth Update, Tweed Heads 12 June - Conservative Sharp Debridement in Wound Management, Gold Coast 20-21 June - Certificate in Primary Care Dermatology for GPs, Gold Coast 20-21 June - Certificate in Primary Care Skin Cancer Medicine for GPs, Gold Coast 24 June - Dementia Carer Education, Tweed Heads

4 June - Sterlisation / Infection Control Workshop, Coffs Harbour

31 July - Pedorthic Footwear Modifications, Gold Coast

19 June - Legal & Ethical Aspects to Suicide Risk Assessment, Coffs Harbour

26-28 August - Smart Technologies Bootcamp, Tweed Heads

20 June - Suicide Risk & Substance Use, Coffs Harbour 15-16 July - Accidental Counsellor, Coffs Harbour

June-August 2015 You can view the full North Coast Practitioner events calander at: www.healthynorthcoast.org.au/practitioner-events

HNCEvents

June-August 2015 You can view the full North Coast Practitioner events calander at: www.healthynorthcoast.org.au/practitioner-events

Northern Rivers

Other Events

2 June - Anaphylaxis Recognition and Treatment Simulation Workshop, Lismore 9 June - Blood Pressure: what’s changing in how we measure, manage and monitor, Wollongbar 9 June - eHealth Update, Grafton 10 June - eHealth Update, Lismore 11 June - CIS Breakfast, Goonellabah 11 June - Ballina Byron Clinical Society for GPs and Specialists, Ballina 15-19 June - Focus on Feeling Fabulous Retreat for Nurses, Byron Bay 16 June - The WHS Importance of Understanding Vicarious Trauma – for Managers, Lismore 16 June - Working with Young People – Self Harm / Self Injury Behaviours, Ballina 17-18 June - Mental Health First Aid, Goonellabah

3 June - Working with Health Consumers in Primary Health Care Forum, Sydney 4 June - Webinar: eHealth – Data Quality and Privacy 10-11 June - Aboriginal Cultural Awareness, Sydney 13 June - Urology in General Practice Symposium, Melbourne 13 June - Hepatitis C s100 Prescriber Course, Surry Hills 17 June - Webinar: Managing Back Pain in Primary Care – Incorporating New Research Findings into Clinical Practice 18 June - Using Mobile Apps and Wearable Devices in Clinical Practice, Melbourne 29-30 June - The Body Remembers: Integrating Body and Mind for Trauma Recovery, Melbourne 13-14 July - The Body Remembers: Integrating Body and Mind for Trauma Recovery, Brisbane

23 June - LGBTI Aged Care Training, Grafton

16-17 July - The Body Remembers: Integrating Body and Mind for Trauma Recovery, Sydney

23 June - Changed Behaviours and Transition to Care, Goonellabah

20 July - Webinar: Sleeping Better – Understanding Common Sleep Problems and Strategies to Assist People to Sleep Better

24-25 June - Introduction to Motivational Interviewing, Goonellabah

25-28 August - 2015 TheMHS Conference, Canberra

25 June - Cultural Awareness Training, Alstonville 25-26 June - Core of Life Facilitator Training, Ballina 2 July - North Coast Aged Care Symposium – The Many Facets of Neurodegenerative Disorders, Ballina 14 July - Aboriginal & Torres Strait Islander Cultural Awareness Training for Health Professionals, Mullumbimby 29 July - Chronic Hepatitis C – Treat now or wait? Preventing Liver Disease, Lismore

1-4 June - Resolving Vilification Workshop, Brisbane

28 August - Nurse Education Day, Newcastle

HNCclassifieds FOR SALE Medisafe Vaccine Fridge HB80L (small) for sale, $1,500 ONO. Brand new, never been used. Valued at over $2000. Contact Sally Moore at NCML smoore@ ncml.org.au or Jane Conway jconway@ncml.org.au

HMED CONSULT - GRAFTON, FRACGP • • •

Full-time Part-time Locum

After completing all the required examinations and clinical studies, I have recently earned my credentials as a Certified Hand Therapist [CHT] by HTCC [recognised specialist in Hand Therapy Certification worldwide], becoming the only such qualified therapist between Newcastle and the Gold Coast. A Certified Hand Therapist is recognised as an expert in Upper Limb Rehabilitation, having achieved the highest international recognition of competency in the profession. Working with a CHT gives assurance of the therapists’ skill and knowledge, and is thus highly beneficial to patients and physicians, as any loss of hand function through injury or disease can have devastating impact on lives.

The perfect place to balance work and lifestyle? The beautiful provincial city of Grafton! A newly established and modern clinic located within a busy complex positioned in a prime location in Grafton.

Skills include, but are not limited to, examination, diagnosis, treatment protocol development of:

HMED Consult is looking for FRACGPs, with AHPRA registration, to assist in building a culture of positive patient outcomes for the Grafton community.

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This bulk billing clinic offers a wide range of services and ensure providers have the autonomy to deliver appropriate care. We offer flexible working conditions, competitive percentages and experience in managing medical centres. HMED Consult Recruitment Manager Cascie Kambouris 0401 942 442 Cascie@hmedconsult.com.au

COSMETIC DOCTOR WANTED BYRON/KINGSCLIFF Cosmetic Laser Clinic in Byron/Kingscliff seeking a doctor with knowledge of fillers/injectables to work five days a week building the business alongside other technician/practitioner. Work would also include vascular and pigmented lesions, veins etc. Phone Jacqui on 0403 353 036.

SHOULDER AND HAND CLINIC COFFS HARBOURS

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multi-traumatic and post-surgical care: tendon repairs, fractures, dislocations, etc. elective surgery: joint replacements, corrective surgery, etc. wound care; scar management; oedema control tendonopathies of wrist, hand, elbow, shoulder nerve repairs, entrapements [CTS, Cubital or Radial Tunnel Syndromes] arthritis: bracing, management and advice CMC, wrist, RA hands, etc. customised thermoplastic and soft splint fabrication fracture casting and management: EXOS braces CRPS

For any specific problems, please contact: Faye Wiffen Certified Hand Therapist Master Health Science [Manip. Therapy] BaSc. [Physio] 175 Rose Ave Coffs Harbour 2450 Ph 02 66511745 Fax 02 66518029

Would you like to post a local classified ad in this newsletter? Email the details to healthynorthcoast@gmail.com before the 25th of each month. There is no cost associated with these ads.

HNCclassifieds MID NORTH COAST ARTHRITIS CLINIC The Mid North Coast Arthritis Clinic will be closed from June 8 - 16 2015. Dr Hanish Bagga and Dr Peter Wong will be out of the country attending an international conference. Patients will be advised to contact their GP or present themselves to their local hospital if they are experiencing ill health during this time. Dr Peta Petoney, an advanced trainee in Rheumatology, will join the Mid North Coast Arthritis clinic in early August, on rotation from RPA in Sydney for 6 months. New appointments with Dr Pentoney will be offered from early August.

CERVICAL CANCER STUDY There has been extensive debate on delaying cervical screening in young women. We invite you to participate in an anonymous survey examining practice patterns, attitudes, and barriers associated with HPV vaccination and the renewal of cervical screening guidelines in young women. The outcomes of this survey will assist with completion of a scholarly selective project being undertaken at the University of Melbourne and has the potential to provide feedback to policy makers regarding the views of General Practitioners, GP registrars and Nurse Practitioners. The survey is being conducted by researchers at the Royal Women’s Hospital, Melbourne.

Are you passionate about Allied Health? Would you like to deliver high quality training for a leading National Training organisation? North Coast Institute of TAFE are currently recruiting for new part-time casual teachers and subject matter experts in the area of Allied Health and Aboriginal and Torres Strait Islander primary health care. Training and delivery will be centred on the new Joint Health Education Facility in Port Macquarie. Anyone with industry experience and qualifications who meets the selection criteria is encouraged to apply. We are seeking applications from Allied Health care professionals who have a capacity to deliver training in one or more of the following program areas: •

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Allied Health Assistant with specialisations in: Physiotherapy, Occupational Therapy, Podiatry, Community Rehabilitation, Speech Pathology, Nutrition and Dietetics Dental Assisting Pathology Collection Pathology Assistance Sterilisation Services Medical Practice Assisting Optical Dispensing Audiometry Aboriginal and Torres Strait Islander Primary Health Care

Please visit http://ow.ly/NwCTE to complete the survey. It should take around 15 minutes.

Please apply by clicking the links below.

An unaccredited CPD activity has been developed for GPs at the end of the survey. It contains a fact sheet on the revised guidelines, which may be of interest.

Part Time Casual Teacher of Allied Health & Life Sciences.Closes: Sunday 7 June 2015, 11:59 pm. Visit http://ow.ly/NwxK3.

VIDEO CONFERENCE SURVEY The University of Queensland is conducting an anonymous survey on the use of videoconferencing by healthcare providers and appreciate your input as you and your colleagues have knowledge on what barriers may exist in providing videoconferencing healthcare services to Indigenous communities and rural and remote communities. Your input would be appreciated. Please click the button below to start the survey of 8 questions. http://ow.ly/NwCiP Thanks in advance. 19

ALLIED HEALTH TEACHING POSITIONS

Part Time Casual Teacher of Aboriginal and Torres Strait Islander Primary Health Care. Closes: Sunday 7 June 2015, 11:59 pm. Visit http://ow.ly/NwxO0.

HNCclassifieds GPS WANTED, POTTSVILLE GENERAL PRACTITIONERS • • •

Sessions, part-time and full time opportunities available Attractive Remuneration and Benefits Inner city location

Calling all GPs in the Northern Rivers and North Coast region. An exciting opportunity for local GPs who are interested in a change of scenery, career direction or even an additional source of revenue.

The Aboriginal Medical Service (AMS Redfern) was established in 1971 and was the first Aboriginal Community Controlled Health Service in Australia.

Central Pottsville Medical Centre, located in beautiful Pottsville, is looking for GPs to join our team on full-time or part-time basis.

We see health as: “Not just the physical well being of the individual but the social, emotional and cultural well being of the whole community, this is a whole-of-life view and also includes the cyclical concept of life-death-life” (National Aboriginal Health Strategy 1989).

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To be successful in this role you will need: • • • • • •

Bachelor of Medicine (MBBS) or equivalent Fellowship or awaiting Fellowship experience in Aboriginal Health experience in managing chronic disease experience in working as part of a multidisciplinary team a current driver’s licence

Aboriginal and/or Torres Strait Islander people are encouraged to apply. Please send a current resume to: Monique Bright - HR Manager mbright@amsredfern.org.au Phone: 02 9319 5823 Applicants are required to have the right to work in Australia.

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Please contact Asitha: asitha@pottsvillehealthcare.com.au Phone: 0422421750

MOBILE SPEECH PATHOLOGY Speak Volumes speech pathology, run by speech pathologist Amber Allen offers in-clinic and mobile speech pathology services for adults and children across Northern NSW. The practice can help clients with: • • • •

SOUTHERN CROSS SKIN CANCER CLINIC Dr Hilton Beck of Southern Cross Skin Cancer Clinic at 9 Murdock Street, Coffs Harbour, is pleased to advise that Dr Garth Plunkett will be joining the Practice as of Tuesday 19 May. Other Associates working with Dr Beck include Dr Daniel Martin, Dr Joanne Walker and Dr Annemarie Winters.

Very attractive terms for suitable candidates, including future partnership. No binding contracts. Flexible hours. Ample support in a friendly environment. A great multi-disciplinary team. Amazing potential.

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pronunciation, stuttering and voice problems developing, understanding and using language verbal and nonverbal social communication (body language, eye contact, facial expression) cognitive communication including executive functioning skills such as organising thoughts, paying attention, remembering, planning and/ or problem solving paediatric feeding difficulties, eg due to prematurity, sensory processing difficulties, tongue tie, ‘fussy eating’ and/or developmental disabilities reading assessments to determine the reason behind why a person is struggling to read, followed by evidence-based intervention.

Bulk billing is available for clients with a valid concession card and Medicare referral. Phone Speak Volumes on 6676 0854.

Contact NCML Head Office Suite 6, 85 Tamar Street Ballina NSW 2478 Phone: 02 6618 5400 Fax: 02 6618 5499 Email: enquiries@ncml.org.au Northern Rivers Tarmons House St Vincentâ&#x20AC;&#x2122;s Campus 20 Dalley Street East Lismore NSW 2480 Phone: 02 6622 4453 Fax: 02 6622 3185 Email: nr@ncml.org.au Tweed Heads 8 Corporation Circuit Tweed Heads South NSW 2486 Phone: 07 5523 5501 Email: tv@ncml.org.au

Hastings Macleay 53 Lord Street Port Macquarie NSW 2444 Phone: 02 6583 3600 Fax: 02 6583 8600 Email: hm@ncml.org.au Mid North Coast Suite 6, 1 Duke Street Coffs Harbour, NSW 2450 Phone: 02 6659 1800 Fax: 02 6659 1899 Email: mnc@ncml.org.au