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Dr John Alvarez Dr Scott Blackwell Ms Michele Kosky Dr Joe Kosterich Dr Alistair Vickery Dr Olga Ward
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Letters to the Editor
Thoughts on ETS at Northam
Dear Editor ,
RE : Rural ETS , A Teleheath Notion ( June ). Initially , I felt great relief with the arrival of ETS in Northam . We were busy . At the time , we were rostered for 24-hour shifts ; 12 hours on duty , 12 hours on call ( usually on-site and working for a minimum 14-18 hours ). For a variety of reasons , presentations were on the increase ( with this work now covered by at least three doctors ) and we were also taking more phone calls from peripheral hospitals suffering from a shrinking pool of GPs across the Wheatbelt .
Once ETS started and removed the bulk of our phone calls , we could concentrate on the physical presentations in Northam casualty across busy periods . It certainly made a difference , despite not being a 24-hour service . Patients presenting to the peripheral sites were being managed more efficiently and effectively by the ETS team , who actually had time to listen to the nurses ’ assessments ! I suspect patients began to realise if they presented during ETS operating hours they would be ' seen ' by both a nurse and doctor . I ' m sure both of these factors led to less phone calls to us during non-ETS hours . It was a welcome relief .
For the Northam ED with a duty doctor present , ETS was touted as a valuable resource but , as reported , initial uptake was slow . I think this was natural and related to familiarity . Reform leaders initially intended to make discussion with ETS mandatory , prior to transfer of all patients from Northam to Perth , but after further thought it remained the suggested approach . Having someone else arrange liaison with the receiving hospital and transfer was very valuable in freeing us up to focus more on managing the patients still in the department .
An ETS bombshell came prior to the hospital ’ s well publicised clinical incident review . The word ‘ mandatory ’ returned , without discussion ; the doctor in Northam must discuss with ETS ATS1 & 2 cases , abnormal ECGs , ' sick ' and febrile children < 6 months , and re-presentations . Cases that had been managed competently for years , now mandated discussion . But if we didn ’ t know an ECG was abnormal , how could we discuss ? Furthermore , ETS was never meant to be a 24-hour service , which meant that towards the end of a busy day , when ETS has gone home , when I am tiring and my competence is waning , I am OK to cope alone and manage these patients ?!
These new stipulations put a lot of GPs working in rural areas off-side and may have contributed to the ongoing , unusually low uptake of the ETS by GPs . Following the hospital review , the structure of the Northam ED medical workforce changed considerably and I think has resulted in a further reduction in the use of ETS here , both due to a lack of familiarity from the now mostly locum workforce and the frequent availability of an on-site FACEM . Ironically , there is probably now the physical workforce day-to-day to resume taking phone calls from peripheral sites but let ' s not upset a well-established service now !
For peripheral hospitals I can see ETS has brought a fresh ray of hope . These hospitals were surely at risk of becoming redundant as patients were coming to Northam having bypassed the local hospital at their own discretion , or after being told to by ambulance or nursing staff . Attracting nursing staff to work in
the face of little medical support was surely tenuous . I think the value of ETS to these hospitals is well documented and we should continue to hear the good stories as a result . Long live Royalties for Regions and the WA mining boom !
Dr Matt Archer , GP Anaesthetist at Northam & Merredin , living in York .
I am not a cost to the system
Dear Editor ,
I have recently read many articles featuring government ministers and various health bureaucrats talking about GPs ‘ double dipping ’ by claiming rebates for consultations undertaken at the time of doing GP management plans . I can ’ t believe their cheek !
A patient travels maybe 50km each way to see me in a rural clinic . Or for that matter an urban clinic . They spend half an hour with our practice nurse getting the basics of their care plan fleshed out . I then spend another half hour checking that over and typing letters to allied health professionals , containing as per the template all the relevant information that ’ s been expanded into the GP management plan .
Then the patient , who by this stage is very bored with all the paper spewing out of the printer to just get their toenails done or their back seen to , asks for repeat scripts , two referrals , a full skin check and wants to know about the new lump in their breast that they just noticed last week .
As far as the patient is concerned , an hour wasted on a physio referral is not good time management for them and they want their money ’ s worth . Sure , I could ask them to drive the 100km again tomorrow and the next day to sort it out , but then they would need to get an appointment too !
After all these years of BEACH studies , is it not abundantly clear to those in government that we deal with at least six things most visits ?
With all the ridiculous tick-a-box templates and mandatory requirements for a stingy five assorted visits to allied health attached to the GPMP , it ’ s a wonder any of us do them at all , except as a favour to our pensioners who can ’ t afford the allied health any other way .
Why does some Medicare bureaucrat always assume we are trying to rort the system ? All I want is that my patients get a fair rebate for the services provided , and at some stage someone to trust me that I have provided the services for which I have billed . It doesn ’ t seem to be rocket science . I get the feeling that we are never considered to be a service provider , we are simply a system cost . And I really object to that !
Dr Olga Ward , Medical Adviser , Rural Health Wes
We want to hear what you think . Send in your letters by July 10 to editor @ mforum . com . au
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