June 2019 - In brief June 2019 - In Brief

For links to resources, clinical updates and more, visit news.wapha.org.au

In the wake of COVID-19, WA Primary HealthAlliance has been working to understand theimmediate needs of GPs and their practices andsupport GPs to maintain a viable practice andproductive workforce. We recognise that WA GPs are experiencingbusiness and financial pressures due to a rangeof issues, and that thanks to social isolationmeasures, many have been quieter than usual. For some, there is concern that patients may beneglecting their regular medical care or notattending for appointments that are necessaryfor screening, prescriptions or immunisations. Our See Your GP campaign has been developedto provide your patients with reassurance aboutsafety and a reminder not to neglect theirhealth.  By doing so, we seek to support GPs bypromoting the availability and safety of primarycare, emphasise the importance of ongoing care,and raise awareness of alternative appointmentoptions such as telehealth. North Perth GP Dr Belinda Wozencroft says thecampaign has helped to reassure patients thatit’s safe to come back to the practice. “People were wise to be cautious in thebeginning, but are starting to feel morecomfortable with face to face GP visits as theyknow practices are taking care to keep visitingpatients safe,” Dr Wozencroft said.

Getting your patientsback into the practice

There is a range of See your GP resourcesavailable to remind your patients of theimportance of regular medical appointments andreassure them of the availability of safe, essentialhealth care. This includes flyers, social mediaposts and videos you can download and share onyour channels. You can also continue to reach out to patientsthrough your own regular communicationschannels, such as newsletters, SMS reminders, viayour online booking page or on your website toreinforce the campaigns key messages. Since launching in late April, the campaign hasreached about 1 million people across WAthrough Google advertising, Facebook,Instagram,state and regional newspapers (including a fullpage feature in The West Australian) and radio,as well as in- practice screens.

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E O I s s o u g h t f o r M e n t a lH e a l t h I n i t i a l A s s e s s m e n ta n d R e f e r r a l P r o j e c t

GPs who have expertise and/or experiencein primary mental health careGPs who work with people experiencingsignificant disadvantage and barriers toaccessing appropriate mental health careGPs who are committed in improving theseservices irrespective of expertise and/orexperience.

WA Primary Health Alliance is seekinginterested GPs to join an Advisory Group thatwill contribute to a co-design process to developand pilot a new Initial Assessment and Referralservice for GPs managing patients with or atrisk of mental illness, who can be appropriatelymanaged in primary care. The Group will provide input into the servicedesign through contributing to key decisionmaking and identifying preferred solutions tobuild the basic service model architecture. WAPHA is particularly keen to involvepractitioners who work with peopleexperiencing significant socio-economicdisadvantage and/or are from identified prioritypopulations (ATSI, CaLD, LGBTI) such as:

As practices are now starting to see anupward trend in presentations, WAPHAwill look to refocus the campaign on otherareas of need, such as mental health,screening, flu and other immunisations. If you would like to know more or requiresupport, please contact your PrimaryHealth Liaison or the Practice Assist teamvia email practiceassist@wapha.org.au orphone 1800 227 747.

Getting your patientsback into the practice (cont)

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GP Hospital Liason Updates

Members will receive a participation payment.Download the EOI for more information or applyhere by Friday 26 June 2020.

S C G H O u t p a t i e n t R e f e r r a l s

Sir Charles Gairdner Hospital’s extensive reviewof outpatient services includes centralising thereceipt of urgent referrals from GPs. After patients have been discussed andaccepted by a speciality clinician for urgent carewithin seven days, referrals should now beemailed to SPoRT@health.wa.gov.au unlessotherwise directed. Referrals for a specialist outpatientappointment not requiring care within sevendays should continue to be sent to the CentralReferral Service (CRS). You can escalate the urgency of a referralpreviously submitted by resubmitting throughCRS and highlighting your concerns. CRS canthen prioritise and escalate the referral. If the patient needs immediate care (withinseven days) contact the speciality clinician viaswitchboard for direction. Dr Christine PascottHospital Liaison GP, Sir Charles GairdnerHospitalchristine.pascott@health.wa.gov.au0401 675 400

Click here to read about the freeWA Primary Health Alliance

General Practice Wellness Program.

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R P H C a r d i o m e t a b o l i c C l i n i c– p a t i e n t s o n E v o l o c u m a b

Have heterozygous or homozygous familialhypercholesterolaemia (FH) or non-familialhypercholesterolaemia; andFail to achieve guideline recommendedcholesterol targets on maximally tolerated dosesof statins and ezetimibe (including those who are statin intolerant); andHave previously received PBS-subsidisedtreatment with this drug for these conditions.

Local injection site reactionsNasal congestionBack ache

In the future, GPs will be asked to take overmanagement of patients withhypercholesterolaemia who have remained stablewith minimal side effects after more than 6 monthsto one year of Evolocumab (Repatha) injections. Evolocumab is a well-tolerated, injectablemonoclonal antibody against proprotein convertase subtilisin/kexin type 9 (PCSK9) withstreamlined PBS authority listings that GPs canutilise for patients who:

Evolocumab is well tolerated, the most commonminimal reported side effects are:

Handover to GPs seeing patients on Evolocumabwill occur by letter including target lipids. Patientswill also be asked to see their GP for repeatprescriptions of Evolocumab, and to monitortherapeutic efficacy and side effects. TheCardiometabolic Clinic will provide additionalsupport as required. For further information andsupport, please contact the Cardiometabolic Clinicon 9224 8092. GPs may be interested in the “Hyperlipidaemia” and “Familial Hypercholesterolaemia”HealthPathways. Dr Jacquie Garton-SmithHospital Liaison GP, Royal Perth HospitalJacquie.Garton-Smith@health.wa.gov.auGenerally available Mondays and Thursdays

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N e w F S H R a p i d A c c e s sT h y r o i d C l i n i c

Thyroid mass and:Sonographic ATA intermediate or highrisk of thyroid cancerCytology showing malignant thyroidcancer or suspicious thyroid cancerFDG-PET positive thyroid noduleRapid nodule growthSymptomatic airway compromise orstridorUnexplained hoarseness or voice change.Cervical lymphadenopathyPersonal history of neck irradiationFamily history of thyroid cancer orendocrinopathy

Severe Graves’ disease that is medicallyuncontrollable.

Hyperparathyroidism with severehypercalcemia over 3.0.Hyperparathyroidism in pregnancy.

Adrenocortical cancer or highlysuspected adrenocortical cancerLarge adrenal mass ( over 4cm)Pheochromocytoma or paragangliomaCushing’s syndrome

A new Rapid Access Clinic for assessment ofurgent endocrine surgical patients within oneweek of referral is now available at FionaStanley Hospital (FSH). Referral for the following conditions should be discussed and sent directlyto the hospital via the Urgent Endocrine SurgicalReferrals process (below): Thyroid:

Parathyroid

Adrenal:

Lymph node:• Lymphadenopathy and suspectedlymphoma For urgent endocrine surgical referrals,directly contact the Endocrine SurgicalRegistrar via the FSH Helpdesk on 61522222. Once accepted these should bemarked “Urgent Rapid Thyroid AccessClinic” and emailed torapidaccessthyroidclinic@health.wa.gov.auor faxed to 6152 9762.

This referral information isalso available on the “Acute EndocrinologyAssessment” HealthPathway.  See also “ThyroidNodules and Goitre”, and “Neck Lumps”. Most of these patients will be seen within 30days and assessment will be made using a one-stop model where appropriate. This involvessame-day clinical assessment, ultrasound, FNAand cytology. Routine endocrine surgical referralsshould be sent via CRS in the usual manner. Dr Monica LaceyHospital Liaison GP, Fiona Stanley Hospitalmonica.lacey@health.wa.gov.au(08) 61524731Mondays and Thursdays

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GP Hospital Liason Updates(cont)

Clinical Updates

P B S C h a n g e s t o O p i o i dP r e s c r i b i n g P B S

Pharmaceutical Benefits Scheme (PBS)listings for opioid medicines have changedas of 1 June 2020. Changes include reducedpack sizes of immediate-release opioids forshort-term acute severe pain. In addition,patients that need long-term opioids (morethan 12 months) must also be reviewed byan alternative prescriber with the name ofthe practitioner and date of the consultationprovided to the PBS with every authorityapplication. Visit the PBS website for more information.

S t a y i n g i n f o r m e d a b o u tC O V I D - 1 9

WA Primary Health Alliance is continuing towork with general practice to respond to theoutbreak of COVID-19. GPs can find thelatest information and resources on thePractice Assist website and subscribe to ourtwice weekly dedicated COVID-19 GPUpdate. The GP Update is brought to you inpartnership with WA Department of Health,Royal Australian College of GeneralPractitioners WA, Australian MedicalAssociation (WA), Rural Health West, WAPrimary Health Alliance, Australian Collegeof Rural and Remote Medicine, and WAGeneral Practice Education and Training.

Working remotely, but still herefor you In an effort to reduce the riskpresented by busy workplaces to ourstaff and frontline health workers, WAPrimary Health Alliance will continueto restrict our face-to-faceinteractions.  We want to ensure that practicesremain and feel supported, so we areencouraging our practice support teamto reach out to you using otherchannels to identify your needs andconcerns. We have released a detailed FAQ onour approach to working remotely andplanning ahead, that can be foundhere. For further assistance please contactyour Primary Health Liaison or thePractice Assist team via emailpracticeassist@wapha.org.au or 1800 227 747.

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F r e e b r e a s t s c r e e n i n gr e s u m i n g i n r e g i o n a l a r e a s

BreastScreen WA's four mobile screeningunits have started to resume countryscreening. Commencing across the Midwestin June and then throughout WA into 2021. Women aged 40 years or over are eligible tohave a FREE screening mammogram atBreastScreen WA every two years. You candirect your patients to the BreastScreen WAwebsite to make a booking.

Clinical Updates (cont)

R e l e a s e o f t h e J u l y 2 0 2 0M B S X M L F i l e

The July 2020 Medicare Benefits ScheduleMBS XML file has been released and isavailable on MBS online. The MBSindexation factor for 1 July 2020 is 1.5 percent. Indexation was applied to most ofthe general medical services items, alldiagnostic imaging services, exceptnuclear medicine imaging and magneticresonance imaging (MRI) and twopathology items (74990 and 74991).  For more information please view the MBSJuly 2020 News page.

e P r e s c r i b i n g c o m i n g s o o n

The Australian Digital Health Agency hasadvised Electronic Prescribing will soon beavailable for practices who would like to sendfully digital scripts to patients via SMS or emailinstead of traditional paper scripts. The WA Primary Health Alliance PracticeSupport team will be contacting all practiceswith a checklist of requirements to help ensurethat they are prepared to start usingePrescribing when it is released. For further information on ePrescribing, pleasevisit the Digital Health site or the Practice AssistElectronic Prescriptions page. You can alsocontact the My Health Record Team onmyhealthrecord@wapha.org.au. L u n g F o u n d a t i o n C O P Dw i n t e r c a m p a i g n r e s o u r c e s

To support GPs to keep patients withChronic Obstructive Pulmonary Disease aswell as possible during winter and reducethe need for emergency medicalintervention, the Lung Foundation haslaunched it’s  ‘Come Prepared’ wintercampaign. Download resources here orview the COPD HealthPathway.

E n d o f l i f e a n d p a l l i a t i v ec a r e e d u c a t i o n a n d t r a i n i n g

In response to recommendations of the JointSelect Committee from the My Life, My ChoiceReport and the WA End of Life Palliative CareStrategy, the WA Cancer and Palliative CareNetwork, End-of-life and Palliative Care Projecthas developed education and training resourcesfor GPs caring for patients with life limitingillness. Download from the Department of Healthwebsite

I m m u n i s a t i o n P r o g r a mc h a n g e s f r o m 1 J u l y 2 0 2 0

Introduction of meningococcal B vaccinationand changes to meningococcal ACWYvaccinationHepatitis A vaccination schedule points forAboriginal and Torres Strait Islander childrenin NT, Qld, SA and WA will change inconsideration of the introduction of themeningococcal B vaccine.Pneumococcal vaccination schedule willchange to reflect the current best clinicalevidence in preventing pneumococcal diseasein adults and in people with conditions thatincrease their risk of disease.

From 1 July 2020, there are a number of changesto the National Immunisation Program coming intoeffect to improve protection againstmeningococcal and pneumococcal disease:

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N e w h e a l t h y l i f e s t y l ep r o g r a m f o r t h e M i d w e s t

Let's Prevent provides your patients with theinformation and support they need to makepositive, sustainable lifestyle changes that willultimately help them delay or avoid a chroniccondition. Already established in the South West for overtwo years, the program will soon be available toresidents of the Midwest. It can help participantslose weight, reduce their blood pressure andcholesterol and work towards their health goals. Let’s Prevent is funded by the Department ofHealth WA free for people who are at risk ofheart disease, stroke or type 2 diabetes. It is currently available online and through face toface workshops in the near future. To find outmore call 1800 001 880 or emailprevention@diabeteswa.com.au. N o m i n a i t o n s o p e n f o rR A C G P A w a r d s c e l e b r a t i n ge x c e l l e n c e i n g e n e r a lp r a c t i c e

The RACGP Awards focus on exceptionalindividuals in Australian general practice for theiroutstanding achievements and contribution tothe health of their community. Nominations are now open for the 2020RACGP Awards. If you know an extraordinaryGP, GP in training, GP supervisor, or generalpractice going above and beyond to improvetheir health of the community, nominate them foran award here.

Clinical Updates (cont)

N P S M e d i c i n e W i s e t o p i c sn o w a v a i l a b l e o n l i n e

NPS MedicineWise are offering virtual visits viavideo call for its current therapeutic topicPaediatric asthma: breathing new life intodiagnosis and management. Just like practice visits, virtual visits areapproved activities under the RACGP &ACRRM CPD programs. The visiting material issent to you prior to a virtual visits via a Skype,FaceTime, ZOOM, Health Direct, or Scopia. Topics can be delivered in just 30 minutes andcan be scheduled at a mutually convenient time– including before or after standard work hours. Schedule a virtual visit appointment throughthe NPS MedicineWise website or emailBookAVisit@nps.org.au.

These pages may be of particular interest to GPsinvolved in aged care planning and coordination,and policy development.

N e w e v i d e n c e - b a s e dg u i d a n c e o n m e n t a l i l l n e s so f o l d e r p e r s o n s a t t h e e n do f l i f e

palliAGED has developed new online resourceson understanding and caring for older personssuffering from mental illness and approachingthe end of their life. The new resources include the Mental IllnessPractice page which lists evidence-based tools,links, and other information to guide healthprofessionals involved in planning and providingcare. The Mental Illness Evidence pages provide asummary and in-depth synthesis of thelatest evidence and research on caring forolder persons suffering from depression,anxiety, schizophrenia, and suicidality.

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Online Education

Care planning during a pandemicRACGPThursday 11 June 2020, 5pm–6pm This webinar presented by local GP, DrFermin Blanco Mayo, provides an updateon advance care directives,advance careplans and enduring guardianship NDIS and Mental HealthTransition Support Project, FlindersUniversityJune 11, 16 and 20 An Education session for clinicianssupporting people with psychosocialdisability to access the NDIS. Upcoming National Immunisation Programchanges: what you need to knowThe National Centre for ImmunisationResearch and SurveillanceTuesday June 16 2020, 11am – 1pm This webinar will provide an overview ofthe upcoming changes to the NationalImmunisation Program recommendation forpneumococcal, meningococcal andhepatitis A vaccination.

F r e e G P e L e a r n i n g f r o m t h eI n s i d e O u t I n s t i t u t e f o r e a t i n gd i s o r d e r s

Hepatitis C in Primary CareAustralasian Society for HIV, ViralHepatitis & Sexual Health MedicineTuesday 16 June 2020, 4:30pm - 7pm Provides an overview of the managementof hepatitis C in primary care settings andcovers case finding,testing and diagnosis,patient assessment and treatment. Management of breast lumpsRACGPTuesday 23 June 2020, 5pm This interactive webinar presented byspecialist endocrine, breast and generalsurgeon, Dr Amro Labib, uses case studydiscussions to provide GPs with an updateon strategies for breast cancermanagement. Prescribing Pre-Exposure Prophylaxis(PrEP) for HIV in WA general practiceRACGP and ASHMTuesday 30 June 2020, 5.00–7.30pm This RACGP member webinar explores thestrategies available for the prevention ofHIV transmission, focusing on pre-exposure prophylaxis (PrEP). Presented byWA GP and HIV s100 prescriber, Dr RicChaney.

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The Australian Government Department of Healthis providing free access for 5000 Australianclinicians to undertake the Essentials: TrainingClinicians in Eating Disorders Essentials program. It meets the basic training requirements of theNational Eating Disorders Collaborationcompetency framework and will also help GPs tomeet the requirements for providing servicesunder the new MBS Eating Disorder Itemnumbers. Register here for no cost using the codeWAESSENTIALSPRIVATE.National