Climate change among advocacy targets

Anational strategy linking health and climate change was among the policy documents to which AMA(SA) Council responded in recent months.

The AMA(SA) submission noted that the ‘National Climate and Health Strategy – Consultation Paper’ focuses almost solely on reducing the impacts of the health system on climate change, and does not propose much-needed actions and policies needed to reduce the impacts of climate change on the health of individuals and communities.

The AMA(SA) recommended that the immediate and long-term impacts on physical health, mental health, and the ability access services of emergencies such as the Riverland floods of late 2022 to early 2023 form a significant, additional section of the Strategy. It proposes to address the mental health impacts of climate change and ‘climate anxiety’, especially among younger people.

The submission put forward amendments to the strategy objectives to Identify and audit the contributors the health system’s contributors to greenhouse gas emissions and accelerate the reduction of greenhouse gas emissions from the health system. It also proposes an objective to Encourage the participation of governments, institutions, health providers and staff, and patients and communities, in reducing the health system’s greenhouse gas emissions.

The AMA(SA) submission said many of the strategies to reduce emissions, such as transitioning to renewable energy sources, improving energy efficiency, and adopting sustainable transportation, can also improve air quality, reduce pollutionrelated diseases, and enhance overall health outcomes. These actions can lead to cost savings in healthcare and improve the well-being of both patients and healthcare workers. However, if ‘Tackling health inequities’, ‘Population health and prevention’ and ‘One Health’ are to be ‘Principles’, underpinning the Strategy, the AMA(SA) suggested the Strategy must focus more on impacts of climate change on health.

The AMA(SA) observed that the public system has a major role in reducing the overall carbon footprint of the system, as about 40% of health system waste emanates from hospitals. The submission also pointed to the need for education programsfrom hospitals to small practices - to change behaviours such as turning off lights and reducing printing. The health sector has a role to play in setting modelling behaviours and AMA(SA) continues to advocate for a Sustainability Unit within the Department of Health (SA Health).

AMA(SA) Council suggested research to explore and record the impacts of the health sector on climate change, and vice versa. This would also record the immediate and long-term effects of bushfires, floods and other disasters on individuals, communities, and their health services.

Midwife prescribing

The AMA(SA) submission on a proposal to enable midwives to prescribe in public health services supported the principle that midwives should be appropriately credentialled and monitored in their use of scheduled medicines that are commonly used in their particular context. It also broadly supported the approach to enable each facility or LHN to decide which drugs a midwife may prescribe, noting that this should be determined with medical oversight.

The submission also pointed to the need for regular assessment of the skillset and scope of prescribing midwives by a body independent of the nursing community. The AMA(SA) favours a GP team approach where midwives work within their scope of training, recognising that it is important that GPs remain central to post-natal care and early infant care.

Draft clinical prioritisation criteria for outpatient clinics

AMA(SA) members provided comments on several draft clinical prioritisation criteria developed by SA Health for GPs referring patients to outpatient clinics at public hospitals.

Submissions to SA Health covered criteria for:

• endocrinology

• hepatology

• plastic and reconstructive surgery

• geriatrics

• gynaecology

• neurosurgery

• ophthalmology (adult and paediatric)

• urology.

The AMA(SA) welcomed measures to improve the quality of communication between referring doctors and hospitals to promote timely access to outpatient services.

GPs raised concerns about the protocols replacing personal communication with specialists, especially if the diagnosis is complex. They said that while the protocols provide a useful filter, it is important to ensure there is appropriate support for GPs to manage patients who do not neatly fit the outpatient criteria. ‘Many issues can be resolved in a matter of minutes if GPs have rapid access to high-level advice from a consultant or senior registrar,’ they said. ‘It’s important to be able to talk and discuss with experienced colleagues rather than merely referring to emergency departments.’

The AMA(SA) raised concerns around cost shifting for pathology services implicit in the requirement of certain tests before the referral is accepted for triage.

The submission noted that there is an unrealised opportunity to engage the private sector to take on Outpatients where there is no additional capacity to do so within the department and a formal partnership between the public and private sector has the potential to significantly reduce waiting lists.