BIRTH TRAUMA INQUIRY
Important outcomes for all doctors
PROTECTING PRIVATE PRACTICE
AMA wins legislative changes
CUTTING THE RED TAPE
Improving access to medicines
READY FOR ACTION
DR KATHRYN AUSTIN Meet your
Avant knows GPs
It’s why more than 50% of GPs trust our local medico-legal and risk expertise, backed by our national strength
Local support from Avant Law nationwide
Our on-the-ground solicitors are experienced in your state’s laws.
Medico-legal experts and resources
Access our advisers, 24/7 in emergencies, plus educational resources for safer practice.
GP-specific support
Risk Advisory and Avant Assist services help you identify and reduce common risks for GPs.
Premium savings and deductions for eligible members
Our Getting Started in Private Practice Program# offers substantial savings over the first four years. Plus, receive premium deductions through our Loyalty Reward Plan*
Dr Melanie Hattotuwa
Avant member
IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82
471, AFSL 238 765 (‘Avant Insurance’). The information provided by Avant Insurance is general advice only and has been prepared without taking into account your objectives, financial situation and needs. You should consider these, having regard to the appropriateness of the advice before deciding to purchase or continue to hold these products. For full details including the terms, conditions, and exclusions that apply, please read and consider the relevant Product Disclosure Statement or policy wording, which are available at avant.org.au or by contacting Avant Insurance on 1800 128 268. *Eligible members receive a deduction off the base premium ranging from 4% to 12% depending on their individual tenure with Avant. Not all members are eligible for a Loyalty Reward Plan (LRP) reward. Please see eligibility criteria, categories and rates on the website avant.org.au/lrp. The provision of any future LRP reward is not guaranteed. #The GSIPP discounts do not apply to previous or existing members of the Getting Started in Private Practice scheme and only apply from the first year a member becomes eligible and subject to eligibility rules. For the eligibility rules and full details, please read the Getting Started in Private Practice Member Eligibility Rules at avant.org.au/new-private-practice or by contacting us on 1800 128 268. Avant Law Pty Limited’s liability is limited by a scheme approved under
practitioners employed by Avant Law Pty Limited are members of the scheme. 03/24 (MIM-378)
Whilst
EDITOR’S
APPRECIATION FOR THE PROFESSION
“Doctors are funny souls. They want to appear rational and logical but underneath they are hopeless romantics, giving their all for a happy ending.”
BRIONY SCOTT, CANCER SURVIVOR.
It was with great excitement that I sat down with AMA (NSW)’s new president - obstetrician and maternal fetal medicine specialist - Dr Kathryn Austin to chat about her plans for her presidency. Of course, I knew Kathryn well from numerous dealings including many intense sessions surrounding the NSW Upper House Inquiry into Birth Trauma, but it turns out there was much I didn’t know. Everyone knows doctors are busy, but it’s not often you get to hear exactly what an average day looks like. For Kathryn, Monday began with a snatched opportunity to spend time with her son at 5.30am swimming training “I sit for about an hour on my laptop and catch up on patient letters or emails. It’s great to watch the sunrise coming up and be there with him.” But her day didn’t really start there, she’d been called in at 2am for a birth “It was really beautiful. The mother had no pain relief. She was amazingly stoic. She was delighted and the baby came out perfectly healthy,”
she told me. Once the sun came up Kathryn’s morning was spent doing ward rounds in the public system. Then there was a full day of consulting with private patients, knowing at any moment there could be a call out to attend to a patient flown in from somewhere in the state with complications that couldn’t be dealt with anywhere else.
For those not in the system, the true dedication of the thousands of doctors in this state is something to behold. Medical students and junior doctors who have spent years with minimal income to gain the skills required to practice in their profession. Doctors who are required to work huge hours then squeeze in extra time studying to increase their skills. Doctors who routinely give their all to keep the system running. At AMA we are here for you.
dr.
Rahni Sadler, Editor
rahni.sadler@amansw.com.au www.facebook.com/amansw
The Australian Medical Association (NSW) Limited ACN 000 001 614
STREET ADDRESS
69 Christie Street
ST LEONARDS NSW 2065
MAILING ADDRESS
PO Box 121, ST LEONARDS NSW 1590
Telephone (02) 9439 8822
Outside Sydney Telephone 1800 813 423
Email magazine@amansw.com.au members@amansw.com.au www.amansw.com.au
The NSW Doctor is the quarterly publication of the Australian Medical Association (NSW) Limited.
Views expressed by contributors to The NSW Doctor and advertisements appearing in The NSW Doctor are not necessarily endorsed by the Australian Medical Association (NSW) Limited. No responsibility is accepted by the Australian Medical Association (NSW) Limited, the editors or the printers for the accuracy of the information contained in the text and advertisements in The NSW Doctor. The acceptance of advertising in AMA (NSW) publications, digital, or social channels or sponsorship of AMA (NSW) events does not in any way indicate or imply endorsement by the AMA.
AMA (NSW) BOARD
Dr Kathryn Austin, President
Dr Fred Betros, Vice President
Dr Brian Fernandes
Dr Michael Bonning
Dr Costa Boyages
Dr Amandeep Hansra
Dr Jacqueline Ho
Dr Theresa Ly
Dr David Malouf
SECRETARIAT
Chief Executive Officer, Fiona Davies
Director, Workplace Relations
Dominique Egan
Director, Membership Engagement and Commercial Partnerships
Gary White
Editor
Rahni Sadler rahni.sadler@amansw.com.au
Staff Writers
Isabella Angeli Isabella.angeli@amansw.com.au
Ally Chandler Ally.chandler@amansw.com.au
Design
Rebecca Strahan
Advertising enquiries
Kirsty Smith Kirsty.smith@amansw.com.au
Cover image
Hayden Brotchie Photography
Dr Amani Harris Recent
DR KATHRYN AUSTIN
PLAYING THE LONG GAME
I am the fourth ever female president and the first female specialist to hold the role of AMA (NSW) President and I am deeply honoured to be trusted with this title.
AS THE INCOMING PRESIDENT, I would firstly like to thank our outgoing president, Dr Michael Bonning for his service. He is one of the most passionate doctors I know and for so many of us, he has been a most supportive colleague and passionate advocate for the profession. He has left me a strong and well-respected organisation with a platform to continue to expand our representation of doctors. I very much look forward to working with Dr Fred Betros who joins the leadership team as Vice President. Dr Betros is a general surgeon who is held in the utmost esteem by both colleagues and patients. He brings decades of experience in the field of medicine and years of wisdom as a member of the AMA board.
I will start with a little about me, I am an obstetrician and maternal fetal medicine (MFM) sub-specialist. I am outcomes focussed and driven and have used these skills to deliver many political and leadership wins since my early involvement with the AMA as a medical student.
Practising the art of the MFM subspeciality has taught me the value of true situational leadership. An empathetic, compassionate and collaborative leadership approach to delivery of healthcare is often times essential. We are able to provide the best medicine when we work as a team, in collaboration with allied health, pharmacists and nursing staff so doctors can focus on delivering excellent truly evidence based medical practice.
We must also care for ourselves and each other as our work can be intense and all-consuming at times. Leading by example with an empathetic and supportive approach to each other demonstrates that doctors’ health and wellbeing is paramount. Maintaining and supporting a healthy medical workforce across our state is essential for not only us but our patients.
In the current medico-political climate we have inquiries into all aspects of our health care services, with more than an undercurrent of an attack on the cornerstones of our medical practices. We have not asked for this attack or assault, but I know we will rise together to meet these challenges. Balanced with an empathetic approach, it is an authoritative leadership practice that will serve us well as we work with government, the ministry and indemnity providers to ensure that poor health policy, the undermining of evidenced based clinical care and an erosion of medical led treatment is simply not acceptable to our profession.
As you know, each AMA president will bring their own agenda for how they wish to deliver health leadership. As we face formal inquiries into birth trauma, the healthcare system and indemnity across public and private hospitals, I feel I am uniquely placed to address each of these areas. We have faced a tsunami of attacks on our obstetrics, anaesthetic and neonatal colleagues with the Select
Committee into Birth Trauma and have been able to provide sound, evidenced based opinion that will deliver the best possible care to our patients of NSW. The inquiry into obstetric practice can be seen as an early indicator of the challenges to come in relation to issues like indemnity for our procedural specialists of anaesthetics, neurosurgery and orthopaedics as well as others which will no doubt bring challenges our professional practice. We will prepare a strategy to represent and support doctors as the needs arise and I encourage all doctors to be part of the AMA to give the uniting voice of the profession. As a frontline doctor working daily within our public and private hospitals, there is much that can and needs to be done to protect our professional practice. I am cognisant that in conjunction with hospital practice, GP practice must be supported as we know that no element of medical practice exists in a vacuum. Without this, NSW healthcare outcomes will decline. We will not stand for this as an organisation and the government should be prepared for this. As doctors, we know we can do what is hard and will continue to achieve what is great. I look forward to serving as your AMA (NSW) President. dr.
President@amansw.com.au www.linkedin.com/in/ kathryn-austin-a2920073/ www.facebook.com/amansw
A LEGACY TO LOOK BACK ON
Let’s stand together as a profession, to advocate loudly as one for the NSW health system.
Fiona Davies CEO, AMA (NSW)
fiona.davies@amansw.com.au
www.facebook.com/amansw
THE WIDOW OF ONE OF our members recently contacted us to provide her late husband’s files of his time in medical advocacy. She delivered long kept minutes from meetings of the Medical Staff Council. I recognised some of the names of doctors giving their time to make the system better. The records were relevant for another reason, they were from the early 1980s, a time of great significance to the medical profession, the Doctors Dispute. It was a time in which there was some divide in the profession, between Staff Specialists and Visiting Medical Officers (VMOs). Thankfully, since then - for many members, staff specialists and VMOs have simply become valued and respected colleagues, both with important roles and contributions to the public hospital system.
Recently, I have started to see some seeking to exploit the
differences again with claims of “Well VMOs don’t or can’t” or a lack of support when VMOs are attacked. I understand some of the motivation. In times of critical budget shortage, it can seem that the best way to get an advantage is to take away from another group. The problem with such an approach is that it does not take away from VMOs or staff specialists, it takes away from doctors and demonises the entire profession. We are heading for even harder times. By the time this edition of NSW Doctor is released, we will know what the next state budget holds. Predictions are for more bad news. This makes it critical to stand strongly together as a profession, to recognise the values of all doctors and to advocate loudly as one for the NSW health system. That is the legacy we would want for now and to look back on. dr.
MEET OUR NEW PRESIDENT
READY FOR ACTION
Dr Kathryn Austin has stepped up to the AMA (NSW) Presidency after two years as vice-president. Dr Austin has been involved in advocacy since her school days and is a passionate advocate for the AMA, the medical profession and her patients.
Q: DESCRIBE YOUR specialty and the highs and lows that come with it. I am a staff specialist in obstetrics and sub-specialist in maternal fetal medicine at Royal North Shore Hospital. The hospital’s maternal fetal medicine service covers Northern Sydney LHD and we also are involved with transfers of women to our service for some of the most complex pregnancies
across the state. I also practice in the private setting in obstetrics as a VMO through North Shore Private Hospital. I am a director of a private women’s health practice offering obstetrics, gynaecology, midwifery, psychology and physiotherapy.
Obstetrics is an excellent foundation for an AMA presidency. It has procedural elements, continuity of care, hospital work, running a private practice – with all of the joys and challenges that brings.
Obstetrics is often at the front line of the threats facing the profession, we are often the canary in the coal mine for the challenges facing the medical profession. We are in the midst of the rise of consumerism over quality and evidence based care, litigation is a major issue, private health funding and an outdated MBS to name a few of the challenges.
Q: What makes you most proud of your profession?
To see doctors working collaboratively to get the best for their patients. I see my colleagues staying back after hours, working together in teams to absolutely get the very best outcomes for the patient in front of them. The incredible sacrifices they’ve all given Images: Supplied
to be there at that very moment is humbling. It’s the birthdays they miss to be on call and the family dinners they miss to stay back to look after someone because their patients come first. Seeing the incredible amount of dedication at every level of medicine and seeing colleagues give their all in every part of medicine just makes me so incredibly proud to be part of this profession.
Q: What does the AMA mean to you?
The AMA is the representative group of doctors for the profession. It is all that is best about the profession, and we take seriously the work we do to care for doctors and patients. Most doctors probably don’t realise the work that is funded by their membership fees to safeguard our profession - by monitoring and responding to every policy change, responding and appearing at government inquiries, to be in the rooms where decisions are made, all so we can keep practicing and caring for our patients.
The AMA is about all aspects of being a doctor. When I set up my practice, I used the AMA’s incredible Workplace Relations Service, which I didn’t fully appreciate until I needed it. I continue to use it regularly, most recently for advice on part of my staff specialist contract in the public hospital and in my private practice for our staff contracts and practice governance support. There is nowhere better to offer professional, thoughtful advice with an understanding of the intricacies of the medical system.
Q: What will be your priorities as President?
My main priority is how we fight to ensure that our health system and our patients have the resources we need. Medicare is woefully out of pace with the costs of healthcare and not fit for purpose.
“The AMA is the representative group of doctors for the profession. It is all that is best about the profession, and we take seriously the work we do to care for doctors and patients.”
This leads to out-of-pocket costs and unfair blame on doctors. This is an important priority for state and federal AMA.
While change and reform are necessary, I am deeply fearful of the short-sighted hospital funding solutions being considered in place of quality care.
I am worried about our indemnity landscape, not simply the cost but the emotional burden and how much claims distort good
clinical practice.
It is vital that we improve the standing of GPs in our state health system to ensure it is inclusive of their needs.
I want to continue to try to support and influence the Special Commission into Healthcare Funding. Being in the room, offering advice and speaking for doctors and patients will be critical.
I have a strong passion for leadership, particularly but not only
women’s leadership.
I think I’m in a unique position to be able to lead at a time when obstetrics and gynaecology services are being transformed and I hope to help lead and direct them to a place where we can provide a safe and sustaining service both psychologically and physically. I also hope to advocate to expand women’s health services across all aspects of pregnancy care as this is the cornerstone of the foundations for a healthy society.
Q: You are well known for being decision and outcomes oriented. What frustrates you with our public hospital system?
Big systems create great bureaucracy and the challenge is that the individual delivery of patient services is usually outstanding, but it’s often the nonclinical distractions that get in the way. Time constraints that take people away from frontline services,
such as administrative burdens that actually don’t provide better patient outcomes. Situations where they’re under resourced, and therefore have seen significant challenges of time constraints and not having
those teams in place behind them to support the care that’s required. Doctors can provide excellent clinical care and should be supported to be providing that care without those challenges that make those jobs incredibly and unnecessarily difficult.
Q: In your view, what is the state of the NSW public hospital system?
It’s like a house of cards. Most of the time that house of cards is stable simply because of the goodwill of the treating professionals. But you see when those holes in the system line up, how incredibly fragile it is, and how challenging it is for those workers on the front line to try and provide that care needed. It is just so taxing to do that in the current circumstances. NSW offers an exceptional level of care if you’re very unwell. But that comes at the cost of large numbers of other areas of the health service being pulled and pressured and pushed. And that’s where the challenges and gaps arise. I think that’s something that we need to look at very carefully - how do we resource that appropriately? dr.
AMA (NSW) Vice President Dr Fred Betros and AMA (NSW) President Dr Kathryn Austin
Prof. Saxon Smith presents Dr Austin with the AMA (NSW) President’s Award for Contribution to Medicine in 2015
Images: Supplied
By Dr Kathryn Austin, AMA (NSW) President
FEATURE BIRTH TRAUMA INQUIRY IMPORTANT OUTCOMES
AS WE COMMUNICATED to members at the time, the inquiry was driven by considerable social media input, often from those with a direct financial benefit from pushing the agenda.
The outcome of this inquiry could have been disastrous, with a significant and real risk of new legislation around obstetric procedures, an outcome which would have made practicing obstetrics impossible.
As an obstetrician I saw firsthand the impact of this attack on my colleagues in obstetrics. I also saw the risks the Inquiry presented not just to obstetricians but doctors in all specialities as well as for our midwifery and nursing colleagues. Obstetrics is often the canary in the coalmine and this
On Wednesday 29 May, the Upper House Inquiry into Birth Trauma handed down its report into Birth Trauma. The Inquiry had been called following the formation of a minority government in the wake of the March 2023 NSW election.
inquiry was a perfect example.
AMA (NSW) responded to the challenges this inquiry posed. We knew that this was a matter of defending our profession and our standards without diminishing the experiences of those who had experienced trauma or difficulties with their pregnancy or birth.
AMA (NSW) prepared a detailed submission1 which was submitted on August 15th 2023.
I, along with AMA (NSW) CEO Fiona Davies and AMA (NSW) Media, Communications & Policy Manager Rahni Sadler set up a series of meetings at State Parliament with MPs on the Committee. These briefings proved critical in conveying to committee members the dedication of doctors, midwives, nurses and health
workers in maternity, obstetrics and paediatrics. We also explained the necessary role of interventions and the complex legal issues impacting on doctors.
On October 9th I appeared before the inquiry, along with Fiona Davies. I provided an opening statement2 explaining that doctors want what expectant parents want, a birth that
AMA (NSW) Councillor Eveline Staub giving evidence to the Committee.
“We knew that this was a matter of defending our profession and our standards without diminishing the experiences of those who had experienced trauma or difficulties with their pregnancy or birth.”
DR KATHRYN AUSTIN
is medically and psychologically safe for both mother and child. I described the best outcomes as being achieved by a collaborative, multidisciplinary team-based model of care, with each profession supporting and respecting the opinion and approach of others. I called for realistic pathways to adequate antenatal education but just as importantly post-natal education as to why interventions may have been necessary. I called for better training and resourcing for such education and those who provide it. I warned that the result of this inquiry could be highly detrimental to the specialty of obstetrics stating, “If the inquiry
results in recommendations that are not safe for those working within the system, this could lead to a catastrophic failure to attract and retain the workforce we so desperately need across the state.” I then answered questions on my statement and was asked to provide answers to questions on notice3 which we did following the hearing. We then arranged for AMA (NSW) Councillor neonatologist Dr Eveline Staub to appear. In preparation for her appearance we were asked to provide a submission4 on her behalf. Dr Staub appeared before the committee on the 8th of April 2024. She gave an opening statement5 and in questioning provided powerful evidence on the dedication involved in achieving exceptional outcomes in maternal care and the tragic impact for the children and families who have poor outcomes in labour. Dr Staub noted that most parents who experience admission to the NICU (Neonatal intensive care unit) express distress about the lack of warning they were given during the ante-natal
period that their child could end up with significant complications from birth. AMA (NSW) was again asked to provide answers to questions6 on notice, which were submitted shortly after the hearing. The final report7 was released with references to the AMA’s input on most pages. While the Chair tried to continue her attacks, the body of the report contained limited or reasonable recommendations and critically, stopped the worst of the harms. Without the input of AMA (NSW) we believe the outcomes could have been far more detrimental to doctors, not just in obstetrics, but across the profession. These outcomes were achieved through significant work over many months, work only made possible with the support of you, our members. dr.
I will continue to work with the ministry and government for the next steps following the Birth Trauma Inquiry Report and in formulating an AMA (NSW) Response. Members are invited to email president@amansw.com.au to express opinions or comments.
Scan the QR code for references.
Dr Austin and AMA (NSW) CEO Fiona Davies giving evidence at the Upper House Committee on Birth Trauma
Birth trauma inquiry chair Emma Hurst spoke of her disappointment after the report was handed down.
FEATURE
Greater Protections Against Assaults and Violence for Private Practice
Doctors in private practice finally receive the same protections as the rest of the profession.
WHEN THE NSW PARLIAMENT passed legislation providing greater protections for frontline workers in October 2022 the Australian Medical Association (NSW) commended the change. GP, Dr Michael Bonning was AMA (NSW) President at the time.
“Improved safety for frontline workers is something the AMA has championed for many years. The need for greater protections became more urgent and more obvious during the Covid pandemic.”
DR MICHAEL BONNING
“While we welcomed the change, right from the first reading in June 2022, we were disappointed. The legislation covered first responders, public health workers, National Parks and Wildlife officers and pharmacy staff. What it didn’t include were doctors in private practice and their staff. So, GPs, other private specialists, practice nurses, receptionists and
other administrative staff, - all excluded from the legislation.”
“I think doctors felt it was quite a snub because when it comes to patient assaults, they’re the ones who you hear about so often. There have been several high-profile cases of doctors being assaulted in their practice rooms, not only in NSW. There was an assault on a GP in South Australia and terrible cases of community doctors and private specialists in Victoria being attacked and a horrendous one in Tasmania.”
Dr Bonning said.
AMA (NSW) approached NSW Health to ask why the legislation
In early 2023 AMA (NSW) surveyed all its private practice members.
The Crimes Legislation Amendment (Assaults on Frontline Emergency and Health Workers) Bill 2022 introduced penalties from 12 months to 14 years for offences including:
• Hinder or obstruct;
• Incite another person to hinder or obstruct;
• Assault, throw a missile at, stalk, harass or intimidate;
• Wound or cause grievous bodily harm to;
• Be reckless as to cause actual bodily harm to; a frontline emergency or health worker in the course of the worker’s duty.
excluded doctors in private practice and their staff. The answer – there wasn’t information to understand the scope of the issue in private practice. They had the data on hospital doctors but they didn’t have the data on private practice so private practices weren’t included.
Dr Bonning, as AMA President wrote to then Health Minister Brad Hazzard who indicated that there was not evidence to justify extending the new laws but did refer the matter to the then Attorney General. “So, we set about finding the data. We surveyed all our private practice members. The results sadly underlined our concerns.”
Of 378 medical practices in NSW 88% reported experiencing verbal aggression from a patient such as swearing or shouting, while 37% reported experiencing physical aggression including slapping, scratching, spitting and punching of doctors and medical staff. Some staff required medical treatment after patient assaults.
We conveyed the results to the Minister and the department, along with the results of the Medicine in
Australia: Balancing Employment and Life longitudinal survey conducted between 2010 - 2011 of almost 10,000 Australian doctors, which found 70.6% reported experiencing verbal or written aggression, and 32.2% reported experiencing physical aggression in their previous 12 months of practice. GPs reported slightly lower rates than hospital colleagues in that survey, but incidents were still high – 54.9% verbal aggression, 23.4% physical aggression. Along with private communications we made sure the issue was raised and remained in the eye of the public through mainstream and social media.
“I kept talking to journalists, I kept posting about it and doctor colleagues and others continued to repost the message.” Dr Bonning said.
“I was trying to get lawmakers to understand what it’s like for doctors. There is something inherently unsafe about being in a consulting room, just you and one other person. In your consulting room, if something goes wrong, it’s you and them. And that can be pretty scary.” Dr Bonning said.
Dr Bonning related an experience he had while working at a private medical practice. A 40-yearold man walked in late at night demanding medication.
“The prescription he wanted was for an opioid medication –something we wouldn’t lightly prescribe and certainly would never prescribe on the first consultation
FEATURE
Of 378 medical practices in NSW 88% reported experiencing verbal aggression from a patient such as swearing or shouting, while 37% reported experiencing physical aggression.
with a new patient.” When during the consultation Dr Bonning questioned the patient, the man became agitated before coiling up and lunging to take a swing at him.
“I’m six foot five, 100 kilos – I’m not a small person and not usually intimidated by many things, but to feel scared in your own place of work – to feel like there is a real risk of harm to yourself is just horrible, like your heart is beating out of your own throat.”
“And it’s not just the physical abuse. It’s the verbal abuse, which became relentless during the Covid pandemic and sadly has remained at an inappropriate level.”
When there was a change of government in March 2023 Dr Bonning made it a priority to raise the issue in his first meeting with new Health Minister Ryan Park.
“I was like, ‘Look, this is a place where the government can do something meaningful to connect the entire clinical community so that everyone has the same protections, recognising that we are all one team.”
“I outlined all of the issues we had been campaigning on and I think it carried a lot of weight with the minister. He understood, and we had data to back it up. We had a cohesive story to tell, and he could see that it was an important one.”
In passing the amendment Minister Park said, “I want to thank the NSW Australian Medical Association for their advocacy for this change, especially Dr Michael Bonning.”
Late on the evening of May 9th the NSW Parliament passed the Amendment of Crimes Act 1900 No 40 2024 as part of the Health Legislation Amendment (Miscellaneous) Bill 2024. The amendment expands the definition of frontline workers to include doctors, nurses, reception staff and other health workers employed in private practice.
“It is unfortunate these added protections are necessary, but we are grateful for them.” Dr Bonning said.
“On behalf of the doctors and their staff in NSW we thank Minister Park and the NSW Parliament.
“Legislative change is not easy. It takes policy, data, networking, lobbying and relentless advocacy.
I am very proud of all the doctors and the team at AMA (NSW) who stood behind and carried this campaign.” Dr Bonning added. “AMA (NSW) hopes this new legislation will further discourage what is a minority of patients from abusing, harassing or, in the worst cases, assaulting the hard-working private sector doctors of this state”. dr.
FEDERAL BUDGET A MISSED OPPORTUNITY TO TACKLE HEALTH SYSTEM ISSUES
After laying a strong groundwork in last year’s budget and reaching an important agreement at the December 2023 National Cabinet meeting, this budget is a lost opportunity to make further progress in addressing key health system challenges, including greater funding and support for patients to access care in general practice.
AUSTRALIAN MEDICAL ASSOCIATION
President Professor Steve Robson said there was little that was new in this year’s budget, and this represented a real loss of momentum towards a more efficient and sustainable health system.
“MyMedicare provides the government with a real platform to reform general practice and improve access and affordability for patients, but the extra funding needed to build on this initiative was missing in this budget,” Professor Robson said.
“More urgent care clinics are not a long-term strategic solution, and the government keeps looking to fund more of them without proper evaluation of their impact. What we need is reform that enables general practice to deliver the primary care that our patients need, not piecemeal announcements and changes that further fragment the system.”
Professor Robson said every general practice has the capacity to provide urgent care and the AMA would have liked to see the government improve funding arrangements for general practice so patients can see their usual GP when they need to, including out of normal business hours, along with changes to encourage more doctors to take up general practice.
“Australia has a GP shortage that will only get worse. We need to encourage more doctors to take up general practice by ensuring GP trainees are offered equitable employment conditions in comparison to their hospital counterparts. And we need an independent planning agency to ensure that the future health workforce meets community need.”
Professor Robson said the AMA was disappointed the federal government, together with the states and territories, had not detailed how they would tackle the blowout in planned surgery waitlists in public hospitals.
“Just weeks ago, we released a report showing planned surgery wait times in our public hospitals are now the longest on record, and emergency departments remain strangled by access block,” he said.
“The additional investment through the next hospital agreement is very welcome but we have hundreds and thousands of Australians waiting in pain for planned surgery. Unless the Commonwealth and the state and territories come up with a funded plan to address this, patients
“What we need is reform that enables general practice to deliver the primary care that our patients need, not piecemeal announcements and changes that further fragment the system.”
PROFESSOR STEVE ROBSON, AMA PRESIDENT
FEATURE
will continue to suffer, with their conditions getting worse, their quality of life significantly impacted and the long-term cost to the health system being higher.”
Modest relief for patients through the freezing of the PBS co-payment is very welcome although the decision to phase out the optional $1 discount on patient co-payments will further entrench the anticompetitive arrangements in the pharmacy sector that review after review has called out.
The budget sends some welcome signals on women’s health with the announcement of new Medicare items for longer consultations for complex conditions such as endometriosis and pelvic pain and a commitment to review the adequacy of Medicare funding for long-acting reversible contraceptives and diagnostic imaging procedures.
An additional 24,100 home care packages for 2024/25 is also a welcome measure to help support older Australians remain in their homes for longer.
The budget details some additional funding for mental health services but we are concerned to see that the critical role of general practice in caring for patients with complex physical and mental health needs will be undermined by the removal of specific Medicare items for the review of a mental health care plan, which is often undertaken as part of a broad assessment of a patient’s physical and mental health needs.
The decision to introduce indexation of Medicare funding for some pathology services is a step in the right direction and we are pleased to see additional funding for nuclear medicine.
Professor Robson said preventive health was again the loser in this year’s budget, with the government missing an opportunity to raise billions of dollars for preventive health by introducing a sugar tax on sugary drinks.
AMA WELCOMES COALITION’S COMMITMENT TO GENERAL PRACTICE FUNDING
In his budget reply speech, Opposition leader Peter Dutton committed to investing $400 million towards addressing a concerning lack of parity in employment conditions for GP registrars.
Mr Dutton made it clear that he would work directly with the AMA to address the pay and conditions gap for GP registrars, which has had a significant negative impact on recruitment into the GP training program over several years.
Professor Robson said the AMA had been highlighting these issues for many years. “We are pleased the Coalition has listened to our calls and acknowledged the many challenges our GPs are facing around the country,” Professor Robson said.
“Primary care is meant to be the backbone of our health system, but Australia is facing a shortage of more than 10,600 GPs by 2031, which is little wonder because a trainee entering general practice training today will generally take an immediate pay cut and face the prospect of inferior conditions and leave entitlements.”
Professor Robson said Mr Dutton was right to label this situation “concerning” and welcomed his commitment to also further increase prevocational training places and strengthen the general practice training pipeline. dr.
“Primary care is meant to be the backbone of our health system, but Australia is facing a shortage of more than 10,600 GPs by 2031”
PROFESSOR STEVE ROBSON, AMA PRESIDENT
Go for GOLD hospital cover
At Doctors’ Health Fund, we’re proud to:
• Lead the industry in the number of medical services covered with no gap*
• Have delivered an average premium increase that’s lower than the big health funds** Get up to 15 weeks free^ across your first two years when you join on any hospital and extras by 30 June.
^Terms and conditions apply. Must join by 30 June 2024 on combined hospital and extras cover to receive 15 weeks free across your first two years (10 weeks free in your first year and 5 weeks free in your second year) and two-month waiting periods on extras waived. Existing Avant members receive 15 weeks over the first two years, non-Avant members receive 8 weeks free in the first year. New members only. Check eligibility in the full terms and conditions at www.doctorshealthfund.com.au/silvertogold. *Private Health Insurance Ombudsman, State of the health funds report 2023, Ombudsman’s website. **Big health funds: BUPA, HBF, HCF, Medibank, & NIB. Information on average increases
Dr Emily Stevens Member since 2017
BY ISABELLA ANGELI
PUBLIC HOSPITAL REPORT CARD 2024
For nearly two decades, the Australian Medical Association (AMA) has been issuing its annual Public Hospital Report Card, drawing insights from the Australian Institute of Health and Welfare to shed light on the performance of Australia’s public hospital performance. Each year, the report serves as a tool to pinpoint areas of concern and urge health ministers to act. The year 2024, however, marks a grave moment in the history of Australia’s public hospital performance
THIS YEAR’S REPORT CARD paints a sobering picture. Emergency department wait times have reached alarming levels, exacerbated by widespread hospital bed blockages. Concurrently, elective surgery wait times have soared, subjecting patients to prolonged discomfort and exacerbating health conditions. The capacity of our public hospitals is dwindling, even more concerning when you factor in the ageing population.
The proportion of public hospital beds for every Australian over 65 has yet again fallen to the lowest point on record at just 14.3 beds per 1000 people, compared to 32.5 beds in 1991-92 .
Advocating tirelessly for these reforms across all levels, the AMA remains steadfast in its commitment to securing funding and implementing policies aimed at enhancing patient access and alleviating the strain on our dedicated doctors and hospital staff.
NEW SOUTH WALES REPORT:
While NSW remains the best performing state in a number of key metrics, 2022-23 saw the state reclaim the unwanted title of longest median wait time for planned surgery. People from NSW are now waiting over twice as long for planned surgery as they were twenty years ago. NSW was also one of the two states to fall in performance across all four metrics; category 3 ED on time, 4-hour rule, median surgery wait, and category 2 surgery wait.
EMERGENCY DEPARTMENT PERFORMANCE
NSWs emergency department performance has declined since the previous reporting period. Despite remaining a national leader in the percentage of emergency patients seen within the recommended time and above average performance the “four-hour rule”, NSW public hospitals are failing to keep up with demand and bounce back from the effects of COVID-19.
✖ NSW has fallen from 75% of ED patients seen within 4hours or less in 2016-17 to 59% now
PLANNED SURGERY PERFORMANCE
Historically long waiting times for planned survey remain a struggling area for NSW public hospitals. On average a patient now waits more than twice as long as they did for planned surgery twenty years ago, making NSW the worst performing state in this metric in 2022/23. NSW
The proportion of public hospital beds for every Australian over 65 has yet again fallen to the lowest point on record at just 14.3 beds per 1000 people, compared to 32.5 beds in 1991-92.
leads the nation in the proportion of Category 2 planned surgery patients admitted within the recommended timeframe.
✖Pre-COVID over 95% of category 2 planned surgery patients were admitted within the recommended time frame, compared to under 75% within this report.
WHERE TO NEXT?
The workforce pressures that have been apparent for some time in NSW were exacerbated by COVID, and the growing differential between the terms and conditions available under VMO, Staff Specialist and Doctor-in-Training arrangements, compared to those offered by other jurisdictions and the private system.
As a result, patients are waiting for treatment, surgery, appointments and basic care because of underresourcing and an attitude that our system is “good enough”. The current workforce is exhausted due to chronic understaffing.
NSW doctors are amongst the lowest paid in Australia, as the government continues to fail to address the need for reform of terms and conditions. Award conditions must be updated to attract and retain staff in the NSW public hospital system.
In September, the state’s health system was dealt a further blow by the newly elected Minns government’s first budget. At a time when the health sector and medical services needed an urgent investment of cash, this budget
provided almost nothing.
These figures should be a wakeup call for the NSW government. The health system is crumbling under unprecedented demand, while staff try to manage with fewer health dollars.
There is a view that health is a cost to be managed, as opposed to an investment to be made, which has resulted in a healthcare system that responds to poor health outcomes rather than actively preventing them. It is time to reframe our thinking and expand our focus. NSW’s drastically overburdened health workforce cannot continue to perform under these conditions. dr.
By Jill O’Meara, Principal Communications, Medical Council of NSW - NSW Heath Professional Councils Authority
DON’T LET FEAR OF MANDATORY NOTIFICATION RUIN YOUR HEALTH
Mandatory reporting is rare and it’s rarely career-ending
After laying a strong groundwork in last year’s budget and reaching an important agreement at the December 2023 National Cabinet meeting, this budget is a lost opportunity to make further progress in addressing key health system challenges, including greater funding and support for patients to access care in general practice.
SHAME, A CULTURE OF INVINCIBILITY
and the difficulty a doctor can have in separating their professional identity from their whole self, can stop them getting help and treatment early on. This can negatively impact a doctor’s care for their patients but also mean, their own health can be put at risk.
But perhaps the most worrying barrier in the way of a medical practitioner or student getting support when they become unwell is fear of a mandatory notification to the Australian Health Practitioner Regulatory Authority (Ahpra).
This is of deep concern to the Medical Council of NSW, because it means a doctor or medical student
may suffer in silence and potentially become more unwell because of a delay in accessing the support and care they need and are entitled to.
In this article we explain the high bar required for a mandatory notification, what happens if you receive one if you practise in NSW, and why it’s rarely career ending.
FEAR FACTOR IN MANDATORY NOTIFICATION
According to the Medical Council’s medical director, Dr Penelope Elix, there is still a prevalent and unfortunate myth attached to mandatory notifications. She suggests that some in the profession continue to think that a treating
doctor will automatically report their practitioner-patient to Ahpra.
“There is still a view amongst doctors, if you experience symptoms of poor mental health, don’t tell your colleagues or seek help from a health professional because they’ll lodge a mandatory notification”.
“This is simply not the case, because the bar for mandatory notification is a high one”, says Dr Elix.
If you suffer from a mental health condition, such as depression and you are getting treatment and support, then it is not something that should be subject to a mandatory notification.
HIGH THRESHOLD FOR TREATING PRACTITIONERS
The threshold for when a treating practitioner is required to make a mandatory notification relating to impairment, intoxication or practice that departs from accepted professional standards was raised in 2020.
A treating practitioner is required to make a mandatory notification about their practitioner-patient
A treating practitioner is required to make a mandatory notification about their practitioner-patient only when there is substantial risk of harm to the public.
only when there is substantial risk of harm to the public.
This high threshold means the circumstances for justifying this reporting by a treating practitioner is likely to be infrequent.
HOW
ARE MANDATORY
NOTIFICATIONS
MANAGED IN NSW?
While a mandatory notification must be initially lodged with Ahpra, if it relates to a NSW doctor or student, it will be referred to the Medical Council of NSW for assessment.
The Council has a well-regarded health program. It involves working with doctors to identify if there is an impairment putting patients at risk and, if so, putting in place guard rails and support, so a doctor continues to practise where possible. This might include
arranging an independent health assessment initially to understand the health condition and its impacts more fully. The Council may then, subject to this and other information, including from the doctor, place conditions on a doctor’s registration. The Council, might for example, require a doctor with an addiction disorder, to participate in regular drug screening and engage with an addiction specialist while still enabling the doctor to continue to practise.
The national regulatory framework guiding the Medical Council is not a punitive one. The paramount goal, always, is to ensure the public is protected, not to punish doctors.
It is also important to remember too that illness does equal
impairment when it comes to mandatory notifications.
In order for the Medical Council to be satisfied a doctor’s health is impaired, it must also be satisfied that their illness detrimentally affects (or is likely to) the doctors’ ability to practice. This will generally only be the case when there is a substantial risk to patient safety.
In 2022/23, less than 4% of all complaints received by the Council related to a mandatory notification (either sexual misconduct, intoxication, health impairment, or departure from professional standards). dr.
For further information scan the QR code.
IMPROVING PATIENT ACCESS TO INNOVATIVE MEDICINES
We already have world-class doctors and healthcare professionals in Australia. Now it’s time to ensure our health workforce has access to top-of-the-line technology and medicines, writes Anne Harris, Board Member of Medicines Australia and Managing Director of Pfizer Australia & New Zealand.
had not increased between 1994 and 2011, the number of hospital days per 100,000 population would have been 10.6% higher, and that the 1994–2011 increase in the number of PBS drugs was associated with a reduction in the number of hospital days in 2019 of 2.48 million.4
AUSTRALIAN PATIENTS ARE being left behind by a system that has failed to keep up with innovations in medicines and technology.
It takes on average 466 days from when a medicine is approved by the Therapeutic Goods Administration (TGA) to patients being able to access it through the Pharmaceutical Benefits Scheme (PBS).1
This is almost 100 days slower than the OECD average and more than 300 days slower than Japan, Germany and the UK.2
Timely access to medicines and vaccines can have a life-saving impact. New treatment options not only improve patient health outcomes – they may also take pressure off our healthcare system by keeping Australians out of hospitals.
Research by Prof Frank R. Lichtenberg, published in 2023, found increasing the number of new medicines reduced premature mortality and hospital utilisation. Between 1992 and 2021, the number of medicines available on the PBS increased by 49%. The report estimated that each additional medicine on the PBS for a disease reduced the Years of Life Lost from the disease before age 85 by about 2%.3
In addition, the report estimated the number of hospital days per 100,000 population declined by 4.3% between 2002 and 2019. Lichtenberg estimated that, if the number of PBS drugs
As evidenced in the AMA’s latest public hospital report card, this has never been more important. In the report, AMA President Prof Steve Robson states, hospitals are at “breaking point”. The ability for public hospitals to treat patients on time is in decline – the proportion of people in all triage categories who completed their emergency presentation in four hours or less in 2022-23 was at just 56%, a 5% drop from last year and the lowest number since 2011.5
Bed block, overburdened emergency departments, and ambulance ramping are also symptoms of the impact of Australia’s ageing population who are increasingly presenting to hospitals with complex chronic health conditions.
In 2022, Australians over 65 represented 17.1% of Australia’s total population (compared to 15.9% in 2019), yet this demographic represented 47% of the total patient days occupying beds within public hospitals, according to ABS data.6
The need for vaccines and medicines that keep people living well and out of hospital is critical if we are to alleviate a stretched healthcare system and protect overworked healthcare professionals.
OP ED
#StrongerPBS
Our Pharmaceutical Benefits Scheme provides subsidised access to 928 different medicines in 5,261 brands, making healthcare more affordable for Australians.7 Every day, more than 800,000 prescriptions are filled across the country.8
But the way in which medicines and health technologies are assessed for inclusion on the PBS has not been comprehensively reviewed in more than 30 years. In this time, science and innovation has evolved significantly.
Consequently, our assessment system is no longer fit for purpose and new technologies that do not align within existing assessment structures and criteria are excessively delayed.
A review of Australia’s Health Technology Assessment (HTA) policy and methods commenced in 2023, with the aim of ensuring our assessment policies, methods and processes keep pace with rapid advances in health technology and barriers to access are minimised. More than 300 organisations and individuals made submissions and provided input into this review, including the Australian Medical Association. Doctors, patients, patient advocacy groups, healthcare companies and consumer health groups have aligned to call for faster access to medicines.
The HTA Review Reference Committee finalised its report and submitted its recommendations to Health Minister Mark Butler on 4
May. The date of publication for the committee’s report and the timeline for the Government’s response has not yet been announced.
To advocate for PBS reform, Medicines Australia launched its #StrongerPBS campaign in mid2023. The campaign has reached more than 2 million Australians and aims to educate people about the PBS and barriers to accessing new medicines. Healthcare professionals are encouraged to support the campaign, by following the campaign social media channels or sharing your own experiences by getting in touch with Medicines Australia.
We already have a world class health workforce in Australia – it’s up to us to ensure you also have the best medicines available to treat your patients when they need them.
And for every Australian, time is life. Medicines Australia needs your help to create a Stronger PBS, so Australians are not waiting to access new medicines that are available much faster overseas. dr.
Anne Harris is a member of the Medicines Australia Board and Managing Director for Pfizer Australia & New Zealand. She believes healthcare spending is an investment in the health and economic prosperity of our nation, not a cost, and that “time is life”.
“Timely access to medicines and vaccines can have a life-saving impact. New treatment options not only improve patient health outcomes – they may also take pressure off our healthcare system by keeping Australians out of hospitals.”
Anne Harris, Managing Director for Pfizer Australia & New Zealand
REFERENCES
1. Medicines Australia, 2023, ‘Medicines Matter 2022: Australia’s access to medicines 2016-2021’, https://www.medicinesaustralia. com.au/wp-content/uploads/ sites/65/2023/04/MedicinesMatter-2022-FINAL.pdf. Accessed 19.04.2024.
2. Ibid.
3.Lichtenberg F. R. (2023).
Number of drugs provided by the Pharmaceutical Benefits Scheme and mortality and hospital utilization in Australia, 20022019. SSM - population health, 24, 101514. https://doi.org/10.1016/j. ssmph.2023.101514
4. Ibid.
5. Australian Medical Association, 2024, ‘2024 Public Hospital Report Card’, www.ama.com.au/sites/ default/files/2024-04/2024-publichospital-report-card.pdf. Accessed 19.04.2024.
6. Ibid.
7. Pharmaceutical Benefits Scheme (PBS). (2023, June 30).
PBS Expenditure and Prescriptions Report 1 July 2022 to 30 June 2023. PBS. https://www.pbs.gov. au/info/statistics/expenditureprescriptions/pbs-expenditureand-prescriptions-report-1-july2022-to-30-june-2023. Accessed 9.05.2024.
8. Department of Health. (2019). Department of Health Annual Report 2018-19. Retrieved from Department of Health Annual Report. Accessed 09.05.2024.
Significant
regulations changes for doctors treating injured workers
FEATURE
In 2022, without consultation with the AMA or other stakeholders, the then NSW Government amended the State Insurance and Care Governance 2015 (the Act) and the State Insurance and Care Governance Regulation 2021 to empower SIRA to regulate Health and Related Service Providers who do not comply with the legislation and relevant guidelines.
THE AMENDMENTS, AMONG OTHER THINGS, created a regulatory framework for doctors and other healthcare professionals providing services to injured workers and those injured in motor vehicle accidents.
Then SIRA CEO Adam Dent said “While most health service providers do the right thing, there are other providers who engage in poor practices like overcharging and overservicing. The new regulations that come into effect give SIRA the power to take action against these providers by issuing directions to make sure their practices are in line with the objectives of the workers compensation or motor accident legislation.”
The legislation followed a dubious series of inquiries and reviews and of course, the long and troubled history of iCare and workers compensation in NSW. AMA (NSW) immediately raised concerns with SIRA regarding the legislation and particularly the risks to doctors.
Ms Davies, AMA (NSW) CEO said “We have worked with SIRA and its previous iterations for many years. We have always been clear that doctors should practice appropriately in keeping with existing and robust professional standards set by independent regulators. So, to have a regulatory framework imposed without consultation or justification was disappointing”
AMA (NSW) immediately wrote to SIRA to express concerns with the
legislation. SIRA agreed to delay the implementation of the legislation pending consultation with the AMA and other groups such as ASOS.
On Friday 8 December 2023 SIRA issued the Guidelines for the Provision of Relevant Services (Health and Related Services).
“We’re also concerned that in some respects some of the decisions to be made by SIRA are without reference to what a peer might consider to be appropriate in a particular circumstance.”
Dominique Egan, AMA (NSW) Director, Workplace Relations
While AMA (NSW) secured some changes to the Guidelines during SIRA’s consultation processes, AMA (NSW) continues to have concerns for doctors providing services to injured persons.
The new powers allow SIRA to to provide directions to Relevant Service Providers and publish details
of service providers and directions provided to those providers on a public register.
Dominique Egan, AMA (NSW) Director Workplace Relations said “There are many problems with the legislation and the Guidelines. The first is that they assume doctors know that they are a relevant service provider and know of the Guidelines. Doctors do not opt in to the Workers Compensation or Motor Accidents Schemes, and most doctors provide services to patients under these schemes because the patient before them needs care or treatment just as any other patient.
Ms Egan conveyed this warning “The consequences for noncompliance with the requirements of the Regulatory Scheme are quite significant and can include excluding a practitioner from providing any services under the scheme, one of the schemes or both of the schemes and publishing the names and details of those practitioners on a public register.
“These are very serious consequences if they come to pass for a practitioner but while they’ve legislated powers for SIRA, they
WHO IS A RELEVANT SERVICE PROVIDER?
A person, organisation or body providing a relevant service (with some exceptions) A relevant service includes medical services provided in connection with a claim under the workers compensation or motor accidents legislation.
haven’t legislated any protections for medical practitioners. The concept of rights to be heard on the part of that practitioner are non-existent.
“We’re also concerned that in some respects some of the decisions to be made by SIRA are without reference to what a peer might consider to be appropriate in a particular circumstance.” Ms Egan said. The directions that SIRA can issue to a medical practitioner are as follows:
1) The provision of information: a written direction provided to a medical practitioner, asking them to provide data to SIRA. This power is an administrative tool for SIRA to collect information from service providers.
2) The provision of services: a written direction to a medical practitioner requiring a medical practitioner to:
• Take specified action or provide specified information regarding specified relevant services;
• Requiring The medical practitioner to provide relevant services in a
COLUMN
specified way;
• No longer provide certain, or any, relevant services.
Failure to comply with a written direction regarding the provision of services may result in the publication of the medical practitioner’s name and other information on a public register.
“What was and remains concerning is the power of SIRA to make a direction to a medical practitioner to provide specified medical services in a specified way. This interferes with the medical practitioner’s independence.” Ms Egan said.
One of the fundamental professional obligations of a medical practitioner is to exercise their independent professional judgement to provide medical care in the best interest of that patient before them. The suggestion that somebody could come in and direct how that might be done really undermines that professional
“One of the fundamental professional obligations of a medical practitioner is to exercise their independent professional judgement to provide medical care in the best interest of that patient before them.”
Dominique Egan, AMA (NSW) Director, Workplace Relations
“What was and remains concerning is the power of SIRA to make a direction to a medical practitioner to provide specified medical services in a specified way. This interferes with the medical practitioner’s independence’.”
Dominique Egan, AMA (NSW) Director Workplace Relations
independence of a practitioner. When a direction is issued, it must set out certain information for the practitioner including:
• the reasons why the direction is being made;
• the effective date that the direction comes into play, and for how long it will be in place,
• what action a medical practitioner might be required to take or refrain from taking as the case may be,
• the fact that information is going to be published in the Public Register,
• a statement that non-compliance may result in further penalty to the medical practitioner and
• the medical practitioner has a right of review in relation to the decision of SIRA to issue the written direction.
SIRA has published guidelines on its website. In the materials, SIRA suggests relevant conduct that may result in the issuing of a written direction may include:
• the provision of medical reports that don’t comply with the applicable guidelines
• the delivery of services without the required pre-approval in place
• billing of amounts more than the maximum fee provided by SIRA
practitioner is not qualified to provide.
SIRA says it will be mostly focused on matters when it’s provided with evidence of a pattern of non -compliance with the requirements of the schemes or where there are business models in place that aren’t serving the best interests of the injured people.
Dominique Egan said, “I don’t think that provides anybody with a lot of certainty as to who or what they’ll be looking into.”
There are limited rights for medical practitioners under the legislation if a written direction is issued.
Doctors should be aware that where they seek a review of a direction, the direction remains in place and whatever is on the Public Register remains in place until the internal review has been determined.
The possible outcomes from an internal review are confirmation of the original decision, revocation of the original decision or a variation of the original decision. If a medical practitioner is dissatisfied with an internal review, there is a right of review to the NSW Civil and Administrative Tribunal.
“I don’t think that provides anybody with a lot of certainty as to who or what they’ll be looking into.”
Dominique Egan, AMA (NSW) Director, Workplace Relations
The above is provided for general information only. Please contact a member of the AMA(NSW) Workplace Relations Team for advice about your particular circumstances at workplace@ amansw.com.au or (02) 9439 8822.
COLUMN
MEMBERS HAVE THEIR SAY....
AMA (NSW) has heard from some members who have decided to no longer provide care for injured workers. Members who are concerned about the obligations of this legislation or who are seeking further advice are encouraged to contact the Workplace Relations Team at AMA (NSW). A few of the questions we have been asked are as follows.
Q: Do I have a right to decline to provide medical services to compensable patients under the workers compensation or motor accidents schemes?
A: Save for an emergency, medical practitioners are not obliged to accept any patient for care or treatment. As such, a medical practitioner is not obliged to provide medical services to a patient under the workers compensation or motor accidents scheme.
If you are minded not to provide medical services to compensable patients, you may wish to give consideration as to how you communicate this to individual patients and more generally.
Q: Can I immediately stop providing medical services to compensable patients currently under my care?
A: You do need to consider the effect it may have on the patient’s care and treatment, and whether it is your intention to bring the doctorpatient relationship to an end entirely or only in relation to workers compensation services (noting of course, the decision to cease providing workers compensation services may result in a choice by the patient to transfer all aspects of their care elsewhere).
Medical practitioners are reminded of their obligations under the Medical Board of Australia’s Code of Conduct, to take reasonable steps to transfer the care of the patient to another medical practitioner.
It is advisable to engage in discussion with the patient about why you have made your decision and provide them with an opportunity to ask any questions.
Q: If I work for NSW public hospitals in an emergency department or on-call, can I decline to provide medical services to compensable patients?
A: If you are engaged to provide emergency medical services at a NSW public hospital, you need to continue to provide those services, including to patients who may make a claim under the Workers Compensation scheme or Motor Accidents scheme.
AMA (NSW) is currently in discussions with the Ministry of Health regarding remuneration arrangements for these services.
Q: Can I continue to provide medical services to compensable patients but choose not to bill those services under the workers compensation or motor accidents scheme?
A: If a claim has been made and accepted under either scheme, you must bill for those services in accordance with the requirements of the relevant scheme. You must not directly bill the patient.
Q: What should I do if I receive a letter from SIRA about my compliance with the Guidelines?
A: Please seek advice from your professional association or medical defence organisation as soon as possible. dr.
“It takes courage of a rare order to bring to light the reticence of many of one’s colleagues in controversial issues. You have not let blowback restrain you.”
DR MICHAEL NICHOLSON
DOES THE LAW HAVE A HEART?
A Cardiologist’s search for the legal profession’s pulse
A book by AMA (NSW) member Dr John England
HAVE YOU EVER WONDERED what it’s like to be a juror in a high-profile case? Have you ever considered the impact such a role can have on a juror for the rest of their life?
Dr John England, an expert witness for the coroner was inspired to collect 30 years of medico-legal cases to reveal what happens in the jury room.
“The impetus for this book came originally from a court case in Katoomba in which the accused was found guilty of murder (later manslaughter) in the death of a friend who made an unwanted and rather aggressive sexual advance to him.” Dr England said.
Dr England has treated many patients scarred by legal trials, among them three jurors from the case quoted above. Each suffered PTSD and nightmares after they touched the weapon used in the crime.
“Jurors can’t “unsee” what happened in the courtroom for the rest of their lives.” Dr England said. “And they are just a handful of those who suffer lifelong effects from serious crime.
“The favourite bookstore novels are crime fiction, but this book actually gives the reader the real “nitty gritty” of true NSW cases as it recounts what happened after the crime. There is the legacy of PTSD of the survivors but little access
to rural psychiatric help beyond Telehealth. Forensic medicine has retreated to the coastal cities and the rural magistrates no longer conduct coronial inquests.”
Dr England told The NSW Doctor.
“Over 50 years medical prescribing of psychotropic medications has changed extensively. Initially mental health patients were treated as inpatients under a psychiatrist who initiated treatments for psychosis, depression and anxiety disorders and case workers tracked patients.
“Currently in some practices 1 in 6 patients are on mood-altering drugs. The withdrawal of a very regular medication has changed a person’s response to provocation and resulted in uncharacteristic subsequent criminal behaviour.”
This book draws on the experiences of journalists who pushed for the John Sacker judicial inquiry into gay bashing deaths and hate crime. Further sections explore police taser deaths from a cardiologist’s perspective; eventually mediating “Hurt on Duty” claims for police officers suffering mental stress and heart attacks leading to a medical discharge pension for life.”
Dr England said. dr.
Dr John England is a 50-year member of AMA (NSW). He is a full time physician and cardiologist in Lithgow, Mudgee and Gulgong.
MEMBER UPDATE
Member Messaging
NEWS
AMA (NSW) HAS LAUNCHED a new member newsletter called Vital Signs. Keep an eye out for it in your inbox. This more news-focused update will complement our much-loved fortnightly Feel Good Friday newsletter.
Multiple media releases were produced including on the NSW Bureau of Health Information (BHI) data released in March for the Oct – Dec 2023 period. Then AMA (NSW) President Dr Michael Bonning said that the figures should be a wakeup call.
Upon the release of the BHI’s next quarterly release in late May, new AMA (NSW) President Dr Kathryn Austin warned of “a catastrophe waiting to happen” with results revealing record demand on our health system.
AMA (NSW) welcomed the Government’s introduction of the Conversion Practices Ban Bill 2024, with Dr Bonning describing it as compassionate and balanced approach to ensuring suitable clinical relationships while also protecting individuals.
AMA (NSW) also welcomed the Human Tissue Act Amendment (Ante-Mortem Interventions) Bill, commending the Hon. Greg Piper, the government and the opposition for their support of the bill.
In March, the AMA (NSW) Workplace Relations (WR) team launched the newly updated ‘What You Need to Know Guides’ to our valued members. These guides cover a range of topics including dealing with concerns, finding help and support, and guidance on accessing leave and remuneration
entitlements. The WR team also released an update on the minimum award rate increase for private practice staff.
The AMA (NSW) Events Team released an update in April including the launch of the AMA (NSW) Run Club Network, calling members to join the City2Surf team. It also provided details on WR events, including the Practice Administration Masterclass and Advanced Practice Managers Masterclass in Nowra. We have since held the Practice Managers Masterclass in Tamworth. The year’s third Workplace Wednesday webinar was hosted by WR Advisor Melanie Fayad. The free webinar, in conjunction with corporate partner Cutcher & Neale, empowered attendees to take control of their financial future.
SPECIAL COMMISSION OF INQUIRY INTO HEALTHCARE FUNDING (SCOI)
AMA (NSW) Director of Workplace Relations, Dominique Egan, continues to update members. In April members were informed of hearings in Wagga Wagga and Sydney and told that the Counsel Assisting the Commission met with AMA (NSW) Board Members and Councillors and that Ms Egan will continue to meet with Counsel Assisting.
In May Ms Egan provided another email update, telling members that AMA (NSW) has continued to meet with members and facilitate meetings for them to ensure doctors’ voices are heard. She noted that for many, there are concerns about the consequences of speaking with the Commission
and advised that AMA (NSW) is liaising with the Commission regarding the ways in which doctors’ voices can be heard.
Ms Egan advised members that she met with Counsel Assisting the Commission in May to discuss VMO arrangements, regional and rural challenges, and complaints processes.
In May, the Commission held hearings in Dubbo and Broken Hill. AMA (NSW) Councillors, Dr Ai-Vee Chua, and A/Prof Ashish Agar gave evidence at the public hearings.
Dr Chua, a GP and practice owner in Dubbo, gave evidence about the realities of being a rural GP including workforce pressures and the need for greater collaboration between primary care and the hospital system.
A/Prof Agar, Ophthalmologist providing services as a VMO in Sydney, Broken Hill and Bourke gave evidence about the ophthalmology services in Broken Hill, the flexibility provided by VMO arrangements, the importance of providing trainees with the opportunity to work and the importance of access to specialist services in regional and rural communities.
Hearings in June will be held in Sydney and will include Hospitalspecific case studies, including Concord Hospital, Hawksbury Hospital, St Vincent’s Health Network, and the Sydney Children’s Hospital Network. Hearings focused on training and innovation will be held in late June to early July.
If you have matters you would like to raise with the commission, please contact Ms Egan at workplace@amansw.com.au dr.
WHAT YOU NEED TO KNOW ABOUT TIME OFF INSTEAD OF PAYMENT FOR OVERTIME
Some private practices prefer to use a ‘Time off instead of payment for overtime’ arrangement, (commonly known as “time off in lieu” or TOIL) but did you know that there are specific obligations under the awards that cover employees working in private practice, that as an employer you are required to meet?
IF YOU USE TIME OFF IN LIEU arrangements at your practice, you need to make sure you comply with these obligations.
Time off instead of payment for overtime needs to be by agreement
A time off instead of payment for overtime arrangement needs to be agreed between the employer and employee. The arrangement needs to be a genuine agreement between both parties. The employer must not exert undue influence or pressure on the employee in relation to a decision by the employee to make, or not make, an agreement to take time off instead of payment for overtime.
Health Professionals and Support Services Award 2020 (HPSSA)
For those covered under the Health Professionals and Support Services Award 2020 (HPSSA), the agreement needs to be in writing and the subject of a separate agreement for each occasion that time off is granted instead of the payment of overtime. You will need a separate written agreement each time.
The agreement must state:
1. the number of overtime hours to which it applies and when those hours were worked;
2. that the employer and employee agree that the employee may take time off instead of being paid for the overtime;
3. that if the employee requests payment at any time, the employer must pay the employee for overtime covered by the agreement but not taken as time off, at the overtime rate applicable to the overtime when worked;
4. that any payment, (requested by the employee as above) must be paid in the next pay period following the request.
Schedule G within the HPSSA includes an agreement form that you may wish to use as an ‘Agreement for Time off instead of payment for overtime’. There is no requirement to use this form of agreement. An exchange of emails between employee and employer or other electronic means is also acceptable, provided it includes all the required information.
The employer must keep a copy of any agreements for time off instead of payment for overtime as part of the employee’s records.
Nurses Award 2020
Under the Nurses Award an employee and employer may agree to the employee taking time off instead of being paid for overtime that has been worked by the employee. However, unlike the HPSSA the Award does not specify the need for a separate written agreement on each occasion.
How is the time off to be taken?
Under the HPSSA, the time that an employee is entitled to take off is the same as the number of overtime hours worked.
For employees covered by the Nurses Award, the time that an employee is entitled to take off is equivalent to the overtime payment
that would have been made. For example, if a nurse works 1 hour of overtime, (at an overtime payment rate of 150%) then they would be entitled to take 1.5 hours as time off instead of payment for overtime. Under both Awards, time taken in lieu must be taken within 6 months after the overtime is worked at a time or times agreed by the employer and employee. If the time taken in lieu is not taken within 6 months, the employer must pay the employee for the overtime in first pay period after the expiry of the 6 months at the applicable overtime rate for the time worked.
If the employee requests at any time to be paid for the overtime covered by the agreed arrangement that has not been taken as time off, the employer must pay the employee for the overtime in the next pay period following the request, at the overtime rate applicable to the overtime when worked.
What happens to the time off in lieu if employment is terminated?
On the termination of the employee’s employment, time off for overtime worked by the employee to which the agreement applies has not been taken, the employer must pay the employee for the overtime at the overtime rate applicable to the overtime when worked. dr.
KNOW THE DIFFERENCE: THE HEALTH PROFESSIONALS AND SUPPORT SERVICES AWARD (HPSSSA) 2020 AND NURSES AWARD 2020
Employees in private practice are generally covered by the HPSSA 2020 or Nurses Award 2020.
• Examples of positions under the HPSSA 2020 include practice managers, receptionists, medical secretaries, orthoptists, and more.
• Examples of positions under the Nurses Award 2020 include nursing assistants, enrolled nurses, student enrolled nurses, registered nurses, nurse practitioners, and more.
While there are many shared provisions between the two Awards, it’s important to be aware of key differences to ensure compliance with minimum entitlements.
If you would like to know more about time off instead of payment of overtime, please contact our Workplace Relations team on (02) 9439 8822 or via email at workplace@amansw.com.au.
While there are many shared provisions between the two Awards, it’s important to be aware of key differences to ensure compliance with minimum entitlements.
Speak to our AMA (NSW) Workplace Relations team if you’re unsure which Award applies to your employee.
ANNUAL LEAVE
• Nurses Award 2020:
Full-time employees receive 5 weeks annual leave per year, and full-time employees that meet the definition of a shift worker [see clause 22.2 (b) of the Award for definition] receive 6 weeks annual leave per year.
• HPSSA 2020:
WORKPLACE RELATIONS
MEAL BREAKS
• Nurses Award 2020:
Employees who work more than 5 hours will be entitled to an unpaid meal break of 30 to 60 minutes which needs to be taken between the 4th and 6th hour after beginning work.
Full-time employees receive 4 weeks annual leave per year as set out under the National Employment Standards, however full-time employees that meet the definition of a shift worker (see clause 2 of the Award for definition) receive 5 weeks annual leave per year.
Part-time employees receive the pro-rata equivalent under each Award.
PART-TIME EMPLOYEES
• Nurses Award 2020:
Both the employer and employee need to agree in writing:
- The guaranteed minimum number of hours to be worked and the rostering arrangements which will apply to those hours.
- Rosters are a fixed weekly or fortnightly schedule which sets out the employee’s daily ordinary hours and start and finish times. Rosters need to be made available to employees at least 7 days before the commencement of the roster period.
• HPSSA 2020:
Both the employer and employee need to agree in writing:
- The regular pattern of work including the number of hours to be worked each week, days of the week the employee will work and the start and finishing times of each day.
- If an employee is required by the employer to be on duty during a meal break, the employee will be paid overtime for all time worked until the meal break is taken.
- If an employee is required by the employer to remain available during a meal break but is free from duty, the employee will be paid at ordinary rates for a 30-minute meal break.
• HPSSA 2020:
Employees who work more than 5 hours will be entitled to an unpaid meal break of 30 to 60 minutes and the timing of the meal break can be varied by agreement between employer and employee.
OVERTIME RATES
• Nurses Award 2020:
Ordinary hours referred to below are set out in clause 13 of the Award.
- Full-time and part-time employees receive for hours worked in excess of the ordinary hours on any day or shift.
- Part-time employees will receive overtime for all hours worked in excess of the rostered daily ordinary full-time hours.
- Casual employees receive overtime for hours worked in excess of the ordinary hours on any day or shift.
• HPSSA 2020:
When stating ‘their ordinary hours’ below, it is in reference to the employee’s hours in their written agreement.
- Full-time employees receive overtime for hours worked in
excess of their ordinary hours OR in excess of 10 hours per shift.
- Part-time employees receive overtime for hours worked in excess of their ordinary hours except where there is a written variation agreement (see clause 10.3 of Award), AND/OR for hours worked in excess of 10 hours per shift, AND/OR for hours worked in excess of an average of 38 hours per week in a fortnight or 4-week period.
These differences while being the key differences are not exhaustive and it’s important to review the applicable Award carefully. dr.
The AMA (NSW) Workplace Relations Team is here to help you select the correct Award and assist with interpretation and application. For more information, please email workplace@amansw.com.au or call (02) 9439 8822.
AMA IN THE NEWS
By maintaining a strong and ongoing presence on mainstream and social media AMA (NSW) ensures that the association remains firmly at front of mind as the state’s peak body for doctors. We’d like to thank all the doctors who have contributed to our media coverage in recent months.
APRIL 7, Channel 9 Today:
Dr Bonning spoke about the new RSV vaccines for pregnant women and those over 75.
‘‘Every pregnant woman should receive a dose of a pertussis-containing vaccine in each pregnancy, and anyone who will be in close contact with a newborn infant should check their pertussis vaccination history because the most at risk are newborns and very young children.’’ DR MICHAEL BONNING
APRIL 23, PARLIAMENT PRESS CONFERENCE: AMA Vice President Danielle McMullen and AMA Emergency Medicine
Representative Dr Sarah Whitelaw spoke about the AMA 2024 Public Hospital Report Card.
APRIL 27, SKY NEWS: AMA President Professor Steve Robson told Sky News Breakfast Australia’s out-ofhospital health care system is a ‘dogs breakfast’
APRIL 27, DAILY TELEGRAPH :
Dr Fred Betros told The Daily Telegraph leaked documents that show that mastectomy and hysterectomy patients are to be pushed out of hospital beds was a strategy fraught with risk.
MAY 15,TEN NEWS Claims Ozempic reduces your chance of heart attack by 20%.
MAY 21, TODAY EXTRA: AMA Vice President Dr Danielle McMullen warned of an incoming wave of respiratory illnesses including influenza, RSV and even cases of whooping cough, reminding people to get their flu vaccine ASAP.
MAY 10, ABC RADIO SYDNEY: Dr Michael Bonning spoke with Craig Reucassel regarding the new amendment AMA had long advocated for to protect private practicing doctors and their staff from abuse, harassment and assault.
AMA IN THE NEWS
APRIL 28, SUN HERALD: Manning Base Hospital apologised after AMA(NSW) intervened to allow junior doctors to catch up on sleep on overnight shifts saying that it is vital that DITs are supported properly to provide the best possible patient care.
‘‘The Minns government must ‘adequately fund public hospitals for timely elective surgery’.”
DR MICHAEL BONNING
MAY 13, NEWCASTLE HERALD: Dr Michael Bonning discussed public patients receiving elective surgery in private hospitals.
“These figures should be a wake-up call to the government that the system is at breaking point. It is the patients of NSW who will continue to suffer, and at increasing rates.”
DR
KATHYRN
AUSTIN
AMA IN THE NEWS
MAY 29: The BHI quarterly figures reveal record demand on hospitals.
Dr Kathryn Austin spoke widely about the issue in newspapers, and on radio and tv.
15 MAY, THE AUSTRALIAN: AMA President Steve Robson provided his reaction to The Australian Budget 2024, stating that reform is needed to enable general practice to deliver the primary care that patients need.
MAY 4, PODCAST: On “Your Energy Answers” podcast, AMA (NSW) Councillor Dr Kim Loo engaged in a comprehensive discussion about the intricate relationship between climate change and public health.
JUNE 5, AUSTRALIAN COMMUNITY MEDIA: AMA (NSW) Councillor GP Dr Anju Aggarwal described as ‘very concerning’ the fourfold increase of walking pneumonia cases she was seeing, given the shortage of medication to treat the respiratory virus.
Image: Hayden Brotchie Photography
HEALTH HERO
DR CONRAD WINER
LL.B, MRCS, LRCP, MBBS, DRCOG, DPRM, MLCOM, EACRM, FAFRM (RACP), FACLM
By Ally Chandler
ON FRIDAY 3 MAY, Team AMA (NSW) joined hundreds of others in the annual Coastrek hike to raise money for The Heart Foundation. The team included AMA (NSW) member, 93-year-old Dr Conrad Winer, who led the walk at a cracking pace. The hike began at Long Reef beach and followed Sydney’s beautiful coastline all the way to Balgowlah Heights. The team was met with the beginning of what would be a two-week rain event, meaning shoes, socks and pretty much everything else were soaked through for most of the 22 kilometres.
The AMA team members kept their spirits up, buoyed by a constant stream of compliments and applause from other participants for Dr Winer, the oldest participant in Coastrek’s sixteen-year history. Over six hours we became firm friends with Conrad. It took a bit of prodding, but we were fascinated by tales of his inspiring career. In his early years he underwent training in obstetrics and gynaecology
in the UK and shortly after, he was conscripted to work as a medic in Hong Kong. He spent his time delivering the babies of the wives of the soldiers. After settling in Australia, Conrad pioneered musculoskeletal medicine and was the Director of the Department of Physical Medicine and Rehabilitation Medicine at the Royal Prince Alfred Hospital in Camperdown for 19 years. Dr Winer was awarded an Order of Australia in 2022 for his commitment to medicine. Now, at 93, he runs half marathons and enjoys weekly dances at his local RSL club!
Conrad says his tips to staying fit and healthy are simple. Exercise regularly, fill up on fresh fruit and vegetables, and try to stay happy and content. dr.
It was a pretty hairy climb up the last couple of kms but there was no question this team was going to finish.
Spectacular landscape between Sydney’s northern beaches.
Be it day or night, the smile didn’t leave Conrad’s face.
Pictured with AMA (NSW) Policy Officer
Isabella Angeli
Our new best friend and inspiration
Celebrating Women in Medicine High Tea
By Ally Chandler
THE AMA (NSW) CELEBRATING WOMEN in Medicine High Tea was held on Saturday 9 March at NSW Parliament House, as part of International Women’s Day 2024.
60 attendees joined AMA (NSW) in the Strangers Room at Parliament House to celebrate the women who make outstanding contributions to the medical profession. The audience heard from guest speaker radio host and TV presenter Deborah Knight. Deborah spoke about her journey smashing the glass ceilings, and what it was like for women navigating the modern media landscape. Interviewed by former colleague Rahni Sadler, AMA (NSW) Media and Communications Manager, Deborah gave attendees the inside scoop on off and onscreen life as a female journalist, from interviewing Hugh Jackman at the Met Gala to batting away viewer criticism for presenting morning television at 35 weeks pregnant.
Guests were served with high tea from Parliament House, menu items featuring native Australian botanicals including finger lime tarts and blueberry scones. Three lucky participants won the gift voucher door prizes, thanks to our sponsor Doctors Health by Avant. Thank you to our other sponsors HWL Ebsworth Lawyers and Medi Financial. dr.
Doctors enjoyed catching up with colleagues and making new connections.
THE STITCH UP
By Dr Ashna Basu
Dr Ashna Basu is a 3rd year Psychiatry Registrar working in Sydney. She serves as the Chair of the Young branch of the Medical Women’s International Association, the President of the Medical Women’s Society of NSW, the NSW rep on the RANZCP Binational Committee of Trainees, and as a member representative of AMA (NSW) DITC.
1. Abbreviation used to describe fundamental skills required to independently care for oneself
6. 1987 Act in NSW, and a term granting someone decisionmaking capacity for another person
7. Twins that are monozygotic
9. Transparent lidded dish used to culture cells
11. Pruritic sensation
12. Any substance that causes the body to make an immune response against that substance
13. Brand name for common loop diuretic
14. Abbreviation describing a vascular condition that may occur on long haul flights
15. Disease in which tissue similar to the lining of the uterus grows outside the uterus
19. Position where baby is lying bottom-down in the uterus
21. ____ hole, neurosurgical procedure
22. Located between the ventricles and outflow vessels. They close at the beginning of diastole, producing the second heart sounds DOWN
1. Class of blood- thinning medication
2. Abbreviation of a class of anti-depressants that includes phenelzine, selegiline and tranylcypromine
3. Recreational drug first synthesized in 1912 by Anton Köllisch, rescheduled in Australia as S8 when used in the treatment of PTSD
4. Life-threatening acute hypersensitivity reaction
5. Cranial nerve II
6. Clusters of nerve cell bodies found throughout the body
8. Lincosamide antibiotic
10. A group of small bones in the foot; a thin sheet of fibrous connective tissue which supports the edge of each eyelid
16. A class of medications used to treat HIV
17. Caused by vitamin C deficiency
18. Smooth tissue membrane of mesothelium lining the contents and inner walls of body cavities
20. Chickenpox and MMR are examples of ____ vaccines
MemberBecome a today
MEET OUR NEW LEADERSHIP TEAM
Join AMA (NSW) today to be part of the collective voice advocating for the best health system for doctors and patients.
VICE PRESIDENT
Dr Kathryn Austin PRESIDENT
DR KATHRYN AUSTIN
Obstetrician & Gynaecologist, and maternal-fetal medicine specialist
Dr Fred Betros
DR FRED BETROS
General Surgeon providing surgical services in public and private sectors
Support us to support you! Scan the QR code to join us today!
