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GPs warned on fentanyl scripts
PAUL SMITH THE RACGP has advised GPs to avoid prescribing fentanyl patches for chronic non-malignant pain.
The call comes amid growing concern over inappropriate prescribing of fentanyl and its use as a drug of abuse.
In September, a WA coroner investigating a fentanyl-related death declared the patches should only be prescribed in the community on the recommendation of anaesthetists or pain specialists.
The latest data from Melbourne’ s Penington Institute shows the patches were linked to almost 600 accidental deaths between 2011 and 2015.
The college’ s latest advice forms part of new clinical guidelines on opioids released at its annual conference last week.
Dr Evan Ackermann, chair of the RACGP expert committee on quality care, said:“ There was a debate when we were putting the guidelines together about whether we should use stronger language, whether we
GP17, THE RACGP CONFERENCE FOR GENERAL PRACTICE
PAUL SMITH AND GEIR O’ ROURKE Sydney, 26-28 October 2017
should say GPs‘ should not’ be prescribing the patches [ for chronic non-malignant pain ]. But we felt there are a small number of cases where they can help patients and the patches are then appropriate.”
The potency of fentanyl patches— where a 25mcg dose is close to 60-80mg of morphine— was still often underestimated, Dr Ackermann said.
“ It’ s a very high dose, given very quickly and there is a deceptive feel about it.”
GEIR O’ ROURKE THE RACGP will finally be handed back control of GP training after if was farmed out to a Federal Government quango more than 15 years ago.
The declaration was made by Minister for Health Greg Hunt at the college’ s annual conference in Sydney.
Mr Hunt confirmed GP training would be placed back in the hands of the RACGP and ACRRM.
There were some details to hammer out but the“ decision was
However, Dr Ackermann stressed that for the treatment of malignant pain the drug had been a“ godsend”.
The college’ s new opioid guidelines were released along with a‘ 12 point challenge to GPs’ to reduce opioid prescribing. The challenge urges doctors to:
• Prioritise non-opioid options for people who have been on longterm low-dose codeine preparations. If opioids are necessary for severe acute paint to limit prescription to three days supply
College back in charge of GP training
Mr Hunt says the colleges will take over full responsibility by 2022. made and the direction set”, he told delegates.
“ The college is back in charge of training where it should always have been.”
Mr Hunt said there would be a three-year transition starting from 2019, with the college and ACRRM taking full responsibility for the GP training program by 2022.
In a major blow to its status, the college was stripped of its role running GP training in 2001, along with millions of dollars in government funding.
‘[ Fentanyl ] is a very high dose, given very quickly and there is a deceptive feel about it.’
— Dr Evan Ackermann chair of the RACGP expert committee on quality care
• To avoid opioid therapy for chronic non-cancer pain in patients with an active history of past substance use disorder or unstable psychiatric disorder
• Where opioid therapy is necessary, ascertain responsiveness to a dose equivalent to below 50mg morphine per day, and seek assistance well before the equivalent of 100mg morphine per day is reached.
See News Review, page 11
The job was handed to a new government agency called General Practice and Education Training( GPET), which was tasked with setting up the regional training system.
GPET was eventually scrapped in 2014 to save money, and since then, the training program has been funded and managed by the Department of Health.
There are no details yet on the amount of funding the colleges will receive from the government to run the training program.
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President defends College’ s new advocacy role
RACGP president Dr Bastian Seidel says GPs had been“ sold out over and over again” before the college took on political advocacy for the specialty. In his opening address to the conference, he said people had warned the college against moving beyond its role in education and training.“ Some people say … let others represent general practice. But we’ ve tried this in the past and it did not work. GPs were sold out over and over again,” he told delegates. The RACGP signed a pre-budget pact with the Federal Government on health reform in May.
Hunt backs WA mandatory reporting model
FEDERAL Minister for Health Greg Hunt has pledged to tell the states to end mandatory reporting and change their laws in line with the WA model. Mr Hunt said doctors should be able to seek help“ without fear or favour” and should only be reported to AHPRA in cases of an identified threat to patients.“ Anybody should be able to seek help for mental health challenges and if that can’ t apply to the medical profession, then who can it apply to,” he said.
New name, old journal THE RACGP’ s journal of record is set to change its name for the second time in its history. From next January, the college’ s monthly journal Australian Family Physician( AFP) will be known as the Australian Journal of General Practice. The journal, which was first published in 1956 as Annals of General Practice, has been known as AFP since 1972. The college says the new moniker is a better fit for today’ s primary healthcare profession.
Charity founder wins RACGP’ s award for 2017 GP of the Year
GEIR O’ ROURKE A RURAL doctor who founded two charities dedicated to helping the needy has been named the RACGP’ s 2017 GP of the Year.
Dr Amanda Bethell, a GP from Port Augusta, SA, was recognised for her outstanding commitment to the speciality and her focus on providing care to disadvantaged patients.
Dr Bethell raises money for Cambodian orphanages in her spare time and runs the Monthly Multicultural Meal, an event designed to build relationships between migrants and locals.
Presenting the award at the RACGP’ s annual conference in Sydney, college president Dr Bastian Seidel said:“ Dr Bethell believes in empowering her patients to make informed choices and works closely alongside marginalised and
disadvantaged groups to ensure their voices are heard.
“ She has been an outstanding advocate for rural general practice and a leading light in the delivery of primary healthcare to the Port Augusta community.”
Meanwhile, hours spent in their on-site gym meant GPs at Atticus Health Medical Centre in Carrum, Victoria, had no trouble lifting the 2017 General Practice of the Year award.
Atticus Health, which is based on the Mornington Peninsula, received the top honour for its“ complete focus” on preventive healthcare since its inception in 2013.
Named after Atticus Finch, the heroic lawyer from To Kill a Mockingbird, the practice operates on the principle that all patients should be treated as individuals— never judged, ordered about or stereotyped.
Atticus Health owner Dr Floyd Gomes took his holistic approach to the next level a year ago when he installed a gym for staff and patients.
Access to the gym, which is staffed by a full-time exercise physiologist, is free to any patient who has had cancer.
“ This is the level of care Australian patients deserve. The people of Carrum are in great hands,” Dr Seidel said. Other honours went to:
• Hobart GP Dr David Knowles, who was named GP Supervisor of the Year and also received the Rose- Hunt award for service to the college
• Queensland GP Dr Denise Powell who won the top rural gong, the Brian Williams Award
• Adelaide GP Dr Adelaide Boylan, who was named registrar of the year. Dr Amanda Bethell is‘ an outstanding advocate’ of rural general practice, the college says.
6 | Australian Doctor | 3 November 2017 www. australiandoctor. com. au