from page 1

Under the new standards, it will also be mandatory for practices to ensure their clinical teams can“ exercise autonomy, to the full scope of their practice … when making decisions that affect clinical care”.

Over the coming years, 80 % of practices are expected to be accredited against the fifth edition standards. However, practices can still undergo accreditation against the fourth standards until November next year.

Standards of General Practice, 5th edn: bit. ly / 2gF5krj

from page 1

probably better pills to do it with than others. We know that some progestins are better at maintaining the cycle than others— most doctors know which ones.”

These included norethisterone, gestodene, dienogest, and nomegestrol acetate, she said.

At present just two combined oral contraceptives on the Australian market are designed for extended preparation. These are not listed on the PBS.

These“ formal” extended preparation pill packets— Seasonique and Yaz Flex were both good options— said Dr Foran.

However, she said the same effect could be achieved with cheaper PBSlisted versions.

“ What I like about this is that it puts the control back into to the hands of the woman. If she wants to have her period every month, then that’ s fine, but if she wants to have periods every three months she can organise that too,” Dr Foran said.

Many of her patients opted for a menstrually signalled method of taking a break, whereby if they bleed for three days while taking the pill everyday, they would take a four-day break.

Dr Foran said while it would be helpful if pill packaging were updated, this was unlikely to happen.

RACHEL WORSLEY A GP practice has been ordered to pay $ 4000 in compensation for unfairly dismissing a practice nurse diagnosed with multiple sclerosis.

Danielle Logan was diagnosed with MS shortly before starting her part-time job in April 2009 at the Colchester Medical Practice in Victoria.

The GPs allowed her to use an electric wheelchair and gave her time off when required.

However, her condition quickly deteriorated and the practice made a notification to AHPRA in September 2016, stating that Ms Logan was too impaired to work as a nurse.

The notification was based on the GPs’ observations that she had developed a serious hand tremor, had trouble with her gait and balance, and could no longer manage emergency situations. They did not arrange for Ms Logan to attend an independent medical examination.

Two months later, AHPRA cleared Ms Logan to work based on reports from her treating practitioner that there was nothing to suggest her condition was affecting her ability to practise.

The clinic then drew up a revised job position restricting her duties to administrative and clerical work, such as driving to nursing homes to complete non-clinical paperwork for the GPs.

In May this year, Ms Logan was invited to a meeting with the practice manager, a lawyer acting for the practice and an Australian Nursing and Midwifery Federation representative to discuss 13 alleged incidents of poor workplace performance.

It was claimed that Ms Logan threw out vaccines within their use-by dates, failed to record and check vaccines used by the practice and incorrectly completed dozens of care plans.

Following the meeting Ms Logan was sacked, after which she filed an unfair dismissal claim to the Fair Work Commission.

Last week, the commission found that the practice should not have dismissed her based on her medical capacity as there was no independent medical evidence that suggested Ms Logan could not perform the inherent requirements of her job.

However, the commission found that many of the allegations of poor performance were true and that the practice could dismiss her on the basis of her poor workplace performance.

The problem was that the practice had failed to give Ms Logan sufficient time to respond to the allegations against her.

The Fair Work Commission ordered Colchester Medical Practice to pay Ms Logan compensation of $ 4240 plus superannuation.

ANTONY SCHOLEFIELD RISING indemnity premiums are forcing GPs to stop offering procedural work, the RACGP is warning.

Prohibitive insurance costs are partly to blame for fewer GPs performing obstetric procedures or inserting intrauterine devices in recent years, the college says in its submission to the Federal Government’ s review of the Indemnity Insurance Fund.

A discussion paper on the review, released by the Department of Health states that indemnity premiums have remained stable since 2002 and suggests it is time to consider rolling back the subsidies introduced 15 years ago.

However, the college disputes that premiums have not risen, claiming they have grown by 8-12 %, while Medicare rebate indexation has been frozen.

During the same period there has been a decline in GPs undertaking

It’ s claimed the nurse, who was diagnosed with MS, threw out vaccines within their use-by dates.

procedural interventions, the college notes.

“ This decline can partially be attributed to the rise in premiums, as insurance costs are becoming prohibitive to providing procedures,” it says.

Indemnity premiums for procedural GPs in rural areas are about $ 8000 a year compared with about $ 4000 a year for non-procedural GPs in the same area, according to data from the Australian National Audit Office.

Premiums for rural GPs who provide obstetric work were about $ 15,000 a year in 2013 / 14, the data show.

The RACGP says making any changes to the Premium Support Scheme( PSS), would deter rural GPs from doing procedural work.

The PSS provides an average of

$ 3000 to rural procedural GPs and $ 8000 to rural obstetric GPs to help them pay premiums.

“ A significant amendment to or removal of the PSS could specifically prevent rural or remote GPs from practising in these locations.” the collge’ s submission says.

However, indemnity provider MDA National says its market data shows there has been no decline in procedural general practice.

Submissions from the RACGP, AMA and indemnity providers all warn that any cuts to the the government’ s Indemnity Insurance Fund, which costs $ 100 million annually, could price doctors out of practice and risk a repeat of the 2002 indemnity crisis.

The AMA says it was surprised when the government decided to restrict the High Cost Claims Scheme with no notice last year.

The changes, which come into force in 2018, will see premiums rise by about 5 %, according to indemnity providers.

4 | Australian Doctor | 3 November 2017 www. australiandoctor. com. au