The President's Message – 17 April 2020

It is pleasing to note that new COVID-19 case curves in both nations continue to show signs of declining. We are hopeful that as increased testing, tracing and local response measures are ramped up we may avoid some of the harrowing scenes from overseas. But nothing about this disease can be taken for granted and we must remain prepared in case the worst eventuates as we go into winter.

Unfortunately, we are still hearing concerning reports from members about access to PPE, care for patients and problems with billing requirements for telehealth items. Despite conversion of local manufacturers to production of masks, sanitiser, gloves and gowns, you are telling us that distribution and availability and appropriate use of PPE particularly across Australia continues to be a significant problem for you.

In some instances, access by patients to basic diagnostic procedures is also proving problematic. Fear still seems to be driving some clinical decisions. In Australia for example, we have been told of one case of a patient being refused from five separate practices while trying to get a chest x-ray, due to concern over the patient’s exposure to another potential COVID-19 patient.

Via the Australian Indigenous Doctors Association, we are also hearing disturbing accounts of Indigenous Australians facing heightened racism and discrimination in seeking access to COVID-19 related care. In addition, the billing requirements for new MBS telehealth items for members in private practice is continuing to cause concern for a lot of our members – including geriatricians, paediatricians and other specialties.

We continue to escalate these issues on your behalf on a daily basis with key Government and health service decision makers and expect further announcements in the coming days. 

A reminder to our members that our COVID-19 webpage is constantly being updated with the latest resources and information regarding the pandemic, in particular the latest clinical advice for physicians.

Training principles

Some trainees appear not to have seen the link included in previous messages to our set of education and training principles which guide our decision-making during the pandemic and provide our position on potential impacts to training. I’ve included the link here again for those who wish to view it.

The College Education Committee has also decided on a range of interim measures for training and accreditation as a result of the impacts of COVID-19.

EGM and elections

College operations and governance processes have continued, adapting to the restraints imposed by the pandemic. As many of you will have seen, yesterday’s EGM was held in full compliance with the College Constitution, a quorum of members being present in both Sydney and Auckland while in observance of regulations governing social distancing and gatherings in both countries. The meeting was also webcast.

All resolutions calling for the removal of three current Directors were defeated. As a result, we can now provisionally announce election results and the composition of the 2020-2022 Board.

President – Professor John Wilson AM

4 May 2020 – May 2022

President-Elect – Dr Jacqueline Small

4 May 2020 – May 2022

President Aotearoa New Zealand – Dr George Laking

4 May 2020 – May 2022

Trainee Director – Dr Tina Ahluwalia

4 May 2020 – May 2022

Member Director – Professor Paul Komesaroff

12 May 2018 – May 2021

Member Director – Professor Jennifer Martin

4 May 2020 – May 2022

Hon Treasurer and Community Director – Mr Tony Tenaglia

30 July 2018 – May 2021

 

Community Director – Ms Monica Schlesinger

6 May 2019 – May 2022

Community Director – Mr Rob Stewart

6 May 2019 – May 2022

These appointments will be declared and take effect from the end of the Annual General Meeting on 4 May 2020. Please join me in congratulating John and his Fellow Directors.

Staff support and restructure

College staff have been working tirelessly from home to support members during the pandemic. They’ve taken a few minutes to put together a short video recognising the tremendous efforts of members on the clinical frontline in both nations.

Our College Chief Executive Officer Peter McIntyre has also completed an operational restructure of the organisation to improve its focus on core College business and our strategic imperative. As part of that restructure Peter will be seeking to bring a Fellow with interest in people, culture and strategy onto the College’s Senior Leadership Team, reporting to him.

Recruitment for that position will be announced shortly via an Expression of Interest to all Fellows.

Kind regards,

Associate Professor Mark Lane
RACP President


COVID-19 telehealth update

In the April 6 update to its COVID-19 Temporary MBS Telehealth Services factsheet, the Department of Health announced that four new specialist and consultant physician items will be provided with telephone and telehealth equivalent item numbers. This brings the total number of physician and paediatrician items covered under telehealth to 13. Other physician and paediatrician items already allocated telehealth and telephone equivalent item numbers are 104, 105, 110, 116, 119, 137, 135, 90261 and 90267.

The four new items (and their telephone and telephone equivalent item numbers) are ones typically billed by consultant physicians for extended consultations and by geriatric medicine physicians. These are summarised below.

Service                            

Existing item

Telehealth item

Telephone item

Consultant physician. Initial assessment, patient with at least 2 morbidities, prepare a treatment and management plan, at least 45 minutes

132

92422

92431

Consultant physician, Subsequent assessment, patient with at least 2 morbidities, review a treatment and management plan, at least 20 minutes

133

92423

92432

Geriatrician, prepare an assessment and management plan, patient at least 65 years, more than 60 minutes

141

92623

92628

Geriatrician, review management plan, more than 30 minutes

143

92624

92629

 

We note that it is still a legislative requirement that the new telehealth services must be bulk-billed for the following groups:

  • commonwealth concession card holders
  • children under 16 years of age
  • patients who are more vulnerable to COVID-19.

Regarding the last category, patients who are more vulnerable are defined as patients who belong to one of the following groups:

  • is required to self-isolate or self-quarantine in accordance with guidance issued by the Australian Health Protection Principal Committee in relation to COVID-19
  • is at least 70 years old
  • if the person identifies as being of Aboriginal or Torres Strait Islander descent – is at least 50 years old
  • is pregnant
  • is the parent of a child aged under 12 months
  • is being treated for a chronic health condition
  • is immune compromised
  • meets the current national triage protocol criteria for suspected COVID-19 infection.

Usual billing practices to the telehealth items can apply to patients who do not fit the above criteria. Providers are expected to obtain informed financial consent from patients prior to providing the service; providing details regarding their fees, including any out-of-pocket costs.

We are continuing to advocate to the Department for additional specialist items and seek clarification on billing practices.


National COVID-19 Clinical Evidence Taskforce

RACP is a member of the National COVID-19 Clinical Evidence Taskforce (the Taskforce), which is comprised of Australia’s peak health professional bodies whose members are caring for people with COVID-19. Convened by the Australian Living Evidence Consortium, the Taskforce works closely with Commonwealth, State and Territory Governments, as well as its community partner, the Consumers Health Forum of Australia, to ensure that Australians receive the best possible care during the COVID-19 outbreak.

Teams of researchers, experts and clinicians have been working around the clock to deliver national guidelines for the clinical care of people with COVID-19 across primary, acute and critical care settings. On 4 April, the Taskforce announced the launch of its new living guidelines. These guidelines provide evidence-based direction to clinicians caring for people with COVID-19.

The initial focus of the guidelines are on:

  • definitions of disease severity
  • monitoring and markers of clinical deterioration
  • antiviral medications and other disease modifying treatments
  • respiratory support.

The Taskforce will work weekly with its members, partners and other stakeholders to monitor emerging evidence and expand the scope of the guideline recommendations in response to the most pressing needs of clinicians seeking to provide the best possible care during COVID-19. Members are also encouraged to provide their own feedback and suggestions to the Taskforce.

Find out more


Webinar: A practical guide to dealing with the financial and staff-related issues caused by COVID-19

To help explain the impacts the coronavirus pandemic has on employment issues, you're invited to a webinar to be held on Tuesday, 28 April from 7pm to 8pm (AEST). Co-hosted by RACP and the Professional Medical Practice, you'll hear from George Sotiris, Director of Health Industry Employment Services (HEIS) and Scott Lindeblad, Manager at William Buck. A recording of this event will be posted to our coronavirus webpage post-event.

Topics include:

  • strategic ways to restructure your practice to keep staff employed
  • change an employee’s usual duties
  • change an employee’s location of work
  • how the Job Keeper payment will support you and your staff
  • standing down an employee (including reducing hours or days of work)
  • how to maximise your government stimulus benefits
  • commercial rental arrangements
  • cashflow boost stimulus for employer.
Register now

New interim COVID-19 measures for training and accreditation  

The College Education Committee has decided on a range of interim measures for training and accreditation as a result of the impacts of COVID-19. The decisions have been made after reviewing the recommendations of the COVID-19 Training and Accreditation Advisory Group and the results of a trainee survey on COVID-19 which are now available.

All decisions have been made in accordance with our new Education and Training Principles to try and minimise the disruptions to settings and to progression through training. The interim measures are available on our website and will be reviewed in six months’ time. 


College Bodies expressions of interest open

Expressions of Interest (EOI) are now open across all of our College Bodies for various positions on councils and committees. View listings for more information on the positions on offer.

You are invited to express your interest in the below categories:

The RACP Reflect Reconciliation Action Plan

We are pleased to launch our Reconciliation Action Plan (from present until February 2021). The Action Plan provides a structure for the RACP to support the national reconciliation movement and focuses on relationships, respect, opportunities and governance. It is part of the College’s broader aims set out in the Indigenous Strategic Framework, including reducing health inequities between Aboriginal and Torres Strait Islander peoples and non-Aboriginal and Torres Strait Islander people, increasing the number of Aboriginal and Torres Strait Islander physicians and creating a culturally safe college for Aboriginal and Torres Strait Islander people.

We encourage you to read the Reconciliation Action Plan.

Read now


Physician Training Survey results now available

The results of the 2018 Physician Training Survey are now available to RACP Members through an online interactive dashboard. You will need to use your MyRACP login to access the dashboard.

Thank you to all trainees and educators who took part in this important activity. Participation is vital to help us improve our understanding of how our training programs are working and how we can improve training experiences.

The results provide a snapshot of physician training from the perspective of over a third of our trainees and a fifth of our supervisors. They have already enabled us to work with training settings to make improvements to physician training programs and training experiences.

A summary report of the results is also available. The key findings of our 2018 survey align with the more recent 2019 Medical Training Survey results for RACP Australian trainees which were published earlier this year. If you have questions about the results dashboard or wish to provide feedback, please email trainingsurveys@racp.edu.au.

Request for input: College submission to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability

Disability and the NDIS has been a key ongoing policy priority for the College and the broader health sector. The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (the DRC) was established in April 2019 in response to community concern about widespread reports of violence against, and the neglect, abuse and exploitation of, people with disability.

The DRC’s terms of reference cover what should be done in all settings such as the home, schools, out-of-home care, the justice system, as well as in the disability support system to:

  • prevent, and better protect, people with disability from experiencing violence, abuse, neglect and exploitation
  • achieve best-practice in reporting and investigating of, and responding to violence, abuse, neglect and exploitation
  • promote a more inclusive society that supports the independence of people with disability and their right to live free from violence, abuse, neglect and exploitation.

The DRC has released four issues papers to date:

The RACP’s Policy and Advocacy team have developed a draft submission which covers a range of areas that the DRC is interested in and that the College has a position on.

Members are encouraged to provide feedback, with particular regard to the sections where it is noted that there are no College positions yet. Please provide feedback to Rebecca Randall, Senior Policy and Advocacy Officer, via RACPConsult@racp.edu.au by close of business Friday, 24 April 2020. We look forward to receiving your valuable feedback.

Access draft submission


Alcohol in the time of a pandemic: reducing harm, lowering the baseline

Forget toilet paper, alcohol is the new commodity Australians are hoarding in the time of crisis. Market research shows that liquor retailers are experiencing days where sales growth reaches 300 per cent. In the week of 27 March 2020, spending at liquor stores was up 86 per cent. After offsetting the impact of the closure of food and entertainment venues, that week Australians spent 34 per cent more on alcohol than at the same time in 2019.

Following the initial move by the Western Australian government, liquor stores across Australia introduced limits on the amount of alcohol customers can purchase. Beer, cider and premixed spirits are limited to two cases, wine to 12 bottles, and cask wine and bottled spirits are limited to two items per customer.

Professor Michael Farrell of the National Drug and Acohol Research Centre at the University of NSW is one of many public health experts to express concern over excessive use of alcohol during the pandemic, especially among the vulnerable and heavy drinkers. Professor Farrell calls for better regulation and potential further rationing of sales. He also notes that draconian restrictions such as closing bottle shops would see thousands of people going into involuntary detox at the time when the system could not cope with such presentations.

But there are other effective ways to reduce the harm of the problematic use of alcohol during the crisis:

  • Expanding and promoting telephone and online services for counselling and treatment.
  • Ensuring that online delivery is properly regulated and cannot be accessed by the underaged. Liquor retailers widely promote 'contactless' delivery, which for some operators includes leaving alcohol without checking ID. This and similar loopholes must be urgently closed.
  • Encouraging governments across Australia to consider tailored restrictions to trading hours that are community-specific and based on intelligence from local health and police services.

In the UK, health professionals are calling on the government to ‘lower the baseline’ in addition to flattening the curve. The campaign argues for improving the NHS’ ability to tackle COVID-19 through systemic public health interventions such as the introduction of minimum unit pricing (MUP) on alcohol across the country (Scotland and Wales already have MUP) as well as further speed limits, acceleration of tobacco controls and provision of warm and secure housing. This opinion piece in BMJ outlines the goals of the campaign and the excellent animation on the campaign website demonstrates how these goals might be achieved.

Read more about and the College’s advocacy efforts for minimum pricing and trading hour restrictions and revisit the RACP alcohol policy.


Insurance: Protection for our physicians at risk of COVID-19 exposure

On 27 March 2020, reports emerged that an insurer was considering excluding COVID-19 from their new life insurance policies. The College responded instantly, issuing a media release condemning this proposal and affirming the importance of healthcare workers being able to treat patients during this pandemic without having to worry that their life insurance would be compromised by their risk of exposure to COVID-19.

The media release called on all insurers to do the right thing in this pandemic and rule out attempts to limit cover because of COVID-19.

This strong response has been met with a positive response. On 6 April 2020, the Financial Services Council (FSC) announced a commitment on behalf of its member companies that frontline healthcare workers will not be prevented from obtaining life insurance cover, subject to higher premiums or subject to a COVID-19 risk exclusion purely because of their exposure, or potential exposure, to COVID-19. The press release also confirmed for people with life cover in place before 11 March 2020 (when the World Health Organisation declared COVID-19 to be a pandemic) that there will be no exclusions hindering payouts for death claims related to COVID-19 if government travel advice is followed. TAL, the insurer the College originally responded to, has also issued a press statement on 6 April 2020 that they are committed to ensuring frontline medical workers, who do not currently have cover or have only a low level of cover, are able to access all types of life insurance cover regardless of their exposure, or potential exposure, to people who have COVID-19.


My Health Record - Physicians' toolkit

Discover how the online My Health Record provides a central place for the key health information of your patients and their family. Learn how to keep and update the My Health Record, and how your patients, other healthcare providers and Medicare can update this record.

Access now


The Resourceful Physician

Have you recently come across an educational resource, tool, course or reading that you would love to share with your colleagues? We invite you to do so through our new curated collection, The Resourceful Physician. Here you can also browse member submissions, or suggest a topic for a resource you want developed.

Access now


RACP Foundation Research Awards 2021

On Friday, 1 May 2020, applications open for research funding for 2021. The RACP Foundation  annually offers upwards of 50 awards with a total value of over $2.5M to support medical research careers across the different award categories: 

Applications for two other award categories, Research Development Scholarships and Travel Grants will open Monday, 1 June 2020.

The awards are open to Fellows and trainees, its Divisions, Faculties and Chapters across Australia and Aotearoa New Zealand. Please refer to the RACP Foundation website for information on specific eligibility requirements for each award.


We are preparing to deliver Congress 2020 to you online

So you can still learn from each other, engage with experts and your peers and contribute to the conversation we are now preparing to deliver Congress online. RACP Congress 2020 Balancing Medical Science with Humanity online program will explore the theme and deliver shared sessions and selected stream sessions for you to access from your computer or device.

You will be able to watch orations, interact with experts through webinars and listen and contribute to panel discussions via podcasts.

Details about the sessions and how you can access the program will be announced soon.


The Internal Medicine Journal

The April 2020 issue of the Internal Medicine Journal is out now. The Editor's Choice is a Clinical Perspectives article titled Parenteral nutrition in adults during acute illness.
 
Key highlights from the issue are:

  • Pill testing at music festivals
  • Parenteral nutrition during acute illness
  • Equity of sexes in medical specialties and congresses
  • Iron status among young women
  • Enterococcal bacteraemia – ‘silent but deadly’
  • Neurotoxicity in chronic lithium poisoning
Read now

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