Transcript What is Medicare?

Living and working in WA
An orientation guide
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Australian healthcare system
(Manual section 1)
Topics covered
 Australian Government and key health
organisations
 Medicare
 Pharmaceuticals Benefit Scheme
 Department of Veterans’ Affairs
 private health services
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Australian states and territories
Australia is a Federation of 6 states
and 2 territories:
States
New South Wales (NSW)
Queensland (QLD)
South Australia (SA)
Tasmania (TAS)
Victoria (VIC)
Western Australia (WA)
Territories
Australian Capital Territory (ACT)
Northern Territory (NT)
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Australian time zones
(Manual section 1)
There are 3 time zones in Australia:
 Australian Eastern Standard Time (AEST)
 Greenwich time add 10 hours
 Applies to ACT, NSW, VIC, TAS, QLD
 Australian Central Standard Time (ACST)
 AEST subtract 30 minutes
 Applies to SA and NT
 Australian Western Standard Time (AWST)
 AEST subtract 2 hours
 Applies to WA
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Australian healthcare system
(Manual section 1)
The Australian healthcare system is complex and comprises a
mix of public and private service providers supported by
legislative, regulatory and funding arrangements.
 Funding is provided by all levels of government, health insurers,
non-government organisations and individuals.
 The Australian Government is responsible for the three national
health subsidy programs: Medicare, Pharmaceutical Benefits
Schemes and the private health insurance rebate.
 State and territory governments are responsible for delivery of public
health services including public hospitals, population health, public
and community health services and mental health.
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Australian healthcare system
Three levels of Government
Australian Government
State Government
Federal Government
Medicare Australia
Medicare
Public hospital
Other programs
PBS
Other programs
Private patient –
hospital treatment
Private practice
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Federal Government funding provides
 Medicare
 Pharmaceutical Benefits Scheme
 aged care services (e.g. nursing homes)
 primary care services (e.g. general practice)
 Private health insurance rebate
 health services for specific population groups
 Defence Force personnel through
Department of Veterans’ Affairs
 Aboriginal communities
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Department of Veteran’s Affairs - DVA
(Manual section 1.4)
 Supports those who serve or have served in Australian
Defence Forces.
 Provides a broad range of health care and support services to
eligible veterans and their dependants through DVA and
various health service providers.
 Veterans’ Home Care
 public and private hospital care
 respite care
 community nursing
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The Gold Card Repatriation Health Card - For All Conditions
Gives you access to a wide range of public and
private health care services, for the treatment,
at the department’s expense, of all your health
care conditions whether war or service related
or not.
The White Card Repatriation Health Card - For Specific Conditions
Gives access to a wide range of public and
private health care services for the treatment,
at the department’s expense, of your disabilities
and conditions accepted as war or service
related.
The Orange Card Repatriation Pharmaceutical Benefits Card
Gives access to subsidised pharmaceuticals
and medicines under the Repatriation
Pharmaceutical Benefits Scheme (RPBS). The
Orange Card is issued to Commonwealth and
allied veterans and mariners who meet the
eligibility criteria.
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Medicare
(Manual section 1.1)
What is Medicare?
 Australia's universal health insurance scheme
 A range of medical services, lower cost prescriptions and free
care as a public patient in a public hospital
How is Medicare funded?
 Australian taxpayers contribute through the taxation system
 Medicare levy – 2% of taxable income
 Medicare levy surcharge – taxpayers with a certain level of
taxable income who don’t have private health insurance
may pay additional tax
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Medicare cards
(Manual section 1.1)
Issued to all people eligible to access health services under
Medicare and is used when
 visiting a doctor and using electronic claiming
 submitting a claim form at a Medicare office
 making enquiries with Medicare
 seeking treatment as a public patient in a public hospital
 filling a prescription at a pharmacy.
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The Green Medicare Card
The standard Medicare card for Australian citizens and
permanent residents. This card is issued to individuals or
families who are eligible to receive a rebate of medical
expenses under the Australian Medicare system when they
are treated privately by a doctor with a provider number.
The Yellow Medicare Card
For visitors from reciprocal countries. The countries with
reciprocal health card agreements are: New Zealand, the
United Kingdom, the Republic of Ireland, Sweden, the
Netherlands, Finland, Italy, Belgium, Malta, Slovenia and
Norway. Visitors from these countries are covered
immediately for necessary health care in Australia, because
these countries cover Australians in the same way when
they visit their country.
The Blue Medicare Card
A visitor or interim card, for a person who has temporary
residency and is applying for permanent residency. There
are no restrictions on these cards, except that they are
usually issued for a twelve month period. The expiry date
must be checked for validity.
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Access to Medicare services
 Eligible patients can access free public hospital services and
after-care provided through the hospital. The hospital assigns
the treating doctor.
 Patients can opt to be admitted as a private patient in a public
hospital
 can select their own doctor
 patient will be charged hospital
and medical fees by the public
hospital
 medical insurance may cover
these costs.
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Medicare services
 The Australian Government Department of Human Services
provides on-line learning modules and other information
resources for health professionals
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Medicare Benefits Schedule
 The online Medicare Benefits Schedule - MBS Online provides the latest MBS information
 Can search the MBS by Item numbers and/or key words
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Pharmaceutical Benefits Scheme
(Manual section 1.2)
 Subsidy scheme for prescription medicines. Eligible
people can access certain prescription medicines at
reduced cost.
 Approximately 80% of prescriptions dispensed are
subsidised through the PBS.
 Only drugs listed on the Pharmaceutical Benefits
Schedule (‘the Schedule’) are subsidised.
 The Schedule details clinical conditions and other criteria
to be met for a patient to qualify for a PBS medicine.
 Doctors must ensure that PBS medicine is prescribed in
accordance with PBS requirements.
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PBS restrictions on prescribing
 Unrestricted: can be prescribed without PBS restrictions on
therapeutic use in accordance with the Therapeutic Goods
Administration (TGA)
 Restricted: can be prescribed if the prescriber is satisfied the
patient's clinical condition matches the therapeutic uses listed
in the Schedule
Authority Required (two categories):
 Authority Required - requires prior approval from the
Department of Human Services or DVA
 Authority Required (Streamlined) - does not require prior
approval from Department of Human Services or DVA but
must have the relevant streamlined Authority code included
on the prescription (can be done electronically).
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Patient categories under the PBS
 General category: pay the cost of dispensed medicines up to
a maximum amount per item, PBS pays cost of the drug over
that level.
 Concessional category: pay significantly less than general
category for PBS prescribed drugs. Must be eligible for
Medicare and meet specific criteria that qualify them to be
declared disadvantaged.
PBS online learning
 The Australian Government Department of Human Services
provides educational resources on prescribing and using the
PBS correctly
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Provider and prescriber numbers
To provide services funded by Medicare, doctors must apply for
provider and prescriber numbers.
Medicare provider number
 Used for referral and diagnostic test requests.
 Identifies the medical practitioner and the location where they
work. Doctors can have multiple provider numbers.
PBS prescriber number
 Must be included on prescription when prescribing under PBS.
 Is automatically issued with the initial provider number.
Doctors have one prescriber number throughout their career.
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Private health system
(Manual section 1.3)
• Works in tandem with Medicare to reduce the demand on
public hospital services.
• Includes privately operated hospitals and health care centres
which provide services to fee-paying patients.
• Some private hospitals are contracted by the State
Government to provide services to public patients.
• Private hospitals currently providing public patient services in
WA are:
– Joondalup Health Campus (northern metropolitan)
– St John of God Midland Public Hospital (eastern
metropolitan)
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Western Australian health system
(Manual section 2)
Topics covered
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WA Government and structure of public health system
metropolitan health services
country health services
other health service providers in WA
Emergency service providers
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WA public health system
(Manual section 2.1)
In June 2015 the estimated WA population was 2.5 million.
 Most people (80%) live in the Perth metropolitan area with the rest
of the population spread across country areas.
The public health system, known as WA Health, consists of:
 The Department of Health
 Five Health Service Providers (HSPs)
 Health Support Services
The Department of Health is led by the Director General and provides
leadership and management of the whole health system.
The HSPs are governed by Health Support Boards.
Each HSP is responsible for their local areas and communities.
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WA public health services
WA public HSPs include:
 Metropolitan Health Service
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Child and Adolescent Health Service
North Metropolitan Health Service
South Metropolitan Health Service
East Metropolitan Health Service
 WA Country Health Service (WACHS)
 Seven health regions
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Metropolitan Health Service
(Manual section 2.2)
Child and Adolescent Health Service
 Princess Margaret Hospital for Children (PMH)/Perth Children’s
Hospital
 Community health and mental health services (CACH, CAMHS)
North Metropolitan Health Service
 4 tertiary hospitals (SCGH, KEMH, Graylands, Joondalup)
 3 secondary hospitals
South Metropolitan Health Service
 2 tertiary hospitals (RPH, FSH)
 3 secondary hospitals
East Metropolitan Health Service
 RPH, Bentley, Kalamunda and Armadale
 St John of God public hospital Midland
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WA Country Health Service
(Manual section 2.3)
 Region of over 2.5 million km2
 70 hospitals
 A number of smaller health centres
and nursing posts
 Indigenous health, population health,
mental health and aged care
services.
Seven
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health regions
Goldfields
Kimberley
Midwest
Pilbara
Great Southern
South West
Wheatbelt
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WA Health - other services
(Manual section 2.4 – 2.8)
 Health@Home supports patients in their home to retain
independence and minimise hospital admissions.
 Dental Health Service provides emergency and general dental care
for eligible persons.
 Public Health and Clinical Services Division develops and
coordinates delivery of statewide public health policy and programs.
 Mental Health services are overseen by the Mental Health Unit.
 Private health services include a network of private hospitals and
general practice clinics
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Community-based health services
(Manual section 2.9)
 Aged Care Assessment Team (ACAT): teams of health
professionals who assist older people and their carers determine the
level of care needed to enable the older person to remain at home
or find alternate care.
 Disability Services Commission (DSC): a government department
responsible for advancing opportunities, community participation
and quality of life for people with disability.
 Home and Community Care (HACC): provides basic support
services to some older people, people with a disability and their
carers to assist them to continue living independently at home.
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Community-based health services
(Manual section 2.9)
 Hospital in the Home (HITH): provides hospital care in the patient's
own home, under the care of the hospital doctor, receiving the same
treatment that they would have received had they been in a hospital
bed.
 Silver Chain: provides a range of clinical and health care services
to assist people of all ages and their carers, including the elderly
and people with disabilities, illness and injury, to maintain their
health at home in metropolitan as well as country and remote WA.
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Other organisations
(Manual section 2.9)
 Aboriginal Health Council of WA (AHCWA): the peak body for the
21 individual Aboriginal Community Controlled Health Services that
are run by local Aboriginal people and their communities to manage
their own health and well-being in accordance with protocols and
procedures determined by their community members.
 Sexual Health Quarters (SHQ): an independent, non-profit
organisation and the leading provider of sexual and reproductive
health services in WA offering a range of services.
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Emergency service providers
(Manual section 2.9)
 Poisons Information Centre (WAPIC): a specialised unit that
provides expert advice on the management of poisonings or
suspected poisonings. Contact: 13 11 26
 Newborn Emergency Transport Service (NETS): coordinates
emergency transfer of newly born babies from their hospital of birth
to PMH or KEMH for intensive care. Contact: 1300 638 792
 Royal Flying Doctor Service (RFDS): is a not-for-profit service
providing aero medical retrievals and transfers, as well as 24 hour
emergency services, telehealth, mental health and primary health
care services. Contact: 1800 625 800.
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Emergency service providers
(Manual section 2.9)
 St John Ambulance Australia (SJA): is the primary provider of
pre-hospital care services in WA. Patients are charged for services
provided, for both emergency and non-urgent ambulance transfers
and treatment. Contact: 000 for emergency services
 Sexual Assault Resource Centre (SARC): provides a 24 hour
emergency service in metropolitan Perth involving medical care,
forensic examination and counselling support to people who have
been sexually abused in the previous 14 days. SARC offers a free
confidential service. Contact: 1800 199 888 or 6458 1828
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Communication and cultural awareness
(Manual section 3)
Topics covered
 Australian society
 Aboriginal Australians
 Australian patients
 cultural awareness
 communication
 cultural awareness training
 professional conduct
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Australian society
(Manual section 3.1)
 Australia has a democratic, culturally diverse society which elects a
government every 3 to 4 years.
 Australian principles and values are based on a premise of equal
opportunity, mutual respect and tolerance.
 As a multicultural society there are few social customs which are
specific to Australia.
 People are generally informal with friends and work colleagues,
referring to each other by their first name.
 Detailed information about Australian culture is available on the
Department of Immigration and Border Protection website
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Aboriginal Australians
(Manual section 3.2)
 Aboriginal and Torres Strait Islander people are the original
(indigenous) inhabitants of Australia.
 Aboriginal people tend to be more visual and verbal in communication,
and there is much emphasis on imparting knowledge and culture
through art, rituals and story‐telling.
 Aboriginal people, as a whole, experience disproportionate levels of
disadvantage and poorer health compared with other Australians.
 In 2012–13, nearly half (47%) of Aboriginal Australians aged 18 years
and over had a disability or restrictive long term health condition.
 The “Closing the Gap” reform agenda aims to close the life expectancy
gap between Aboriginal and non- Aboriginal Australians within one
generation and provide a better future for Aboriginal children.
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Aboriginal patients - resources
(Manual section 3.2)
 Newly arrived medical practitioners are encouraged to develop links
with a local community representative and an Aboriginal health
worker to assist in their care of Aboriginal patients.
 Byalawa: research-based multimedia learning and teaching
resources to facilitate appropriate, culturally-safe interviewing and
case history taking skills.
 Aboriginal Primary Health Care is a comprehensive, technical
resource on best-practice management of the major health
problems facing Aboriginal peoples and Torres Strait Islanders.
 The Remote Primary Health Care Manuals website provides online
access to five manuals.
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Australian patients
(Manual section 3.3)
 Patients are becoming better informed and expect medical staff to
inform them of treatment options, risks and benefits, and tests
required.
 Consumer organisations exist which challenge health providers and
policy makers.
 No “typical” patient in multicultural Australia.
 Free interpreter services are available to assist patients who have
difficulty understanding English.
 Using an interpreter, rather than family or friends, helps to maintain
patient privacy.
 The Health Translations Directory is particularly useful for health
practitioners working with culturally and linguistically diverse
communities to find reliable translated health information.
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Cultural awareness
(Manual section 3.4)
 Australians come from many cultural backgrounds so medical
staff should be mindful of the range of values and beliefs that
may be held by patients.
 Medical practitioners should be mindful of their own beliefs
and values and be aware that these may potentially conflict
with those of their patient.
 Be aware of potentially sensitive areas such as
 termination of pregnancy
 process of dying
 substance abuse
 Codes of Conduct exist which guide medical practitioners to
manage patient care appropriately. This may include referring
the patient to a colleague.
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Cultural awareness training
(Manual section 3.5)
 Cultural training helps participants to understand Aboriginal
culture and history and develop awareness of the key issues
facing Aboriginal people.
 All WA Health employees are required to undertake the online cultural awareness training module within the first three
months of their employment.
 Some WACHS regions conduct Aboriginal cultural training
specific to local population groups. Sessions may be
presented by representatives from the local Aboriginal
community.
 External agencies also provide training modules.
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Communication
(Manual section 3.6)
 Cultural differences can impact significantly on the
relationship between the patient and the doctor.
 Be polite, honest and direct, and confirm with the patient that
they fully understand your proposed actions.
 Good communication is essential to good medical practice
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assume difference until similarity is proven
check your assumptions
delay judgement until you have had time to observe
remain sensitive to the other person’s viewpoint
• Australian College of Emergency Medicine Indigenous Health
and Cultural Competency program
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Professional conduct of doctors
(Manual section 3.7)
 Doctors in Australia are expected to protect and promote the health
of communities and individuals.
 The Medical Board of Australia has documents to guide medical
practitioners working in Australia
 Good Medical Practice
 Medical - Guidelines for Mandatory Notifications
 Sexual Boundaries: Guidelines for doctors
 The AMA Code of Ethics outlines core principles to guide doctors in
their professional conduct
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respect for patients
standards of care
professional conduct
advertising
 clinical research and teaching
 doctor’s role in society
 the dying patient and transplantation
 professional independence
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Working with children
 Children are among the most vulnerable members of society
and WA Health has a duty of care to provide a safe
environment.
 WA Health employees whose duties potentially involve
contact with children, must undertake a Working with Children
Check.
 Specific categories defined in Working with Children (Criminal
Record Checking) Act 2004:
 a public or private hospital ward in which children are ordinarily
patients
 a community child health service
 a counselling or other support service.
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Mandatory reporting of child abuse
 Under the Children and Community Services Act 2004,
and the Children and Community Services Amendment
(Reporting Sexual Abuse of Children) Act 2008 doctors,
midwives, nurses, teachers and police officers are listed
as mandatory reporters of child sexual abuse.
 Medical practitioners must make a report if they form a
reasonable belief that child abuse has or is occurring.
 WA Health employees should follow the Guidelines for
Protecting Children 2015.
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Child neglect
 Suspected cases of child neglect can be referred to the
Child Protection Unit (CPU), a specialised unit within PMH
 Cases that would be appropriate for referral include:
 Injuries or have had previous injuries that may be inflicted injury e.g.
fractures, bruises, lacerations, burns
 Non-organic failure to thrive
 A concern of sexual abuse, neglect and induced/fabricated illness
 A previous unexplained infant death in the family
 Believed to be at risk due to the mental or physical ill health of the
parents
 Believed to be at risk due to domestic violence, alcohol abuse or
drug use
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Australian law
(Manual section 4.0)
 Everyone in Australia is expected to obey all Australian laws.
 Crime is defined as any behaviour that is against the law and
may result in punishment
 Domestic or family violence
 Sexual assault: in WA the legal age of consent is 16 years of age
for males and females
 Women have the same rights as men, and it is illegal to
practice female genital mutilation.
 The human rights of children are protected by law.
 There are many laws about having possession of and using
drugs.
 It is illegal to buy alcohol and tobacco if you are under 18 years
of age.
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Registration of doctors in Australia
(Manual section 5.0)
 Topics covered
 AHPRA and Medical Board of Australia
 Initial registration
 Health assessment and monitoring
 Guidelines and registration standards
 Australian Medical Council
 medical registration pathways
 Competent Authority
 Specialist pathway
 Standard pathway
 professional development
 professional organisations
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AHPRA and Medical Board of Australia
(Manual section 5.1)
 The Australian Health Practitioner Regulation Agency
(AHPRA) is responsible for registration and accreditation of
14 health professions across Australia.
 In WA, AHPRA's operations are governed by the Health
Practitioner Regulation National Law Act 2010, (National
Law).
 The Medical Board of Australia (MBA) is one of the Boards
supported by AHPRA.
 Every doctor practicing medicine in Australia must be registered
with the MBA.
 Registration categories include: general, provisional, limited,
specialist and non‐practicing.
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Registration with the MBA
 IMGs applying for initial registration must show evidence that
they are eligible under one of the pathways:
 Competent Authority pathway
 Specialist pathway
 Standard pathway
 Must prove proficiency in the English language through
satisfactory completion of English assessment process.
 Primary qualifications must be verified through
the Electronic Portfolio of International Credentials (EPIC)
service.
 Revised registration standards from 1 July 2016:
http://www.medicalboard.gov.au/Registration-Standards.aspx
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Australian Medical Council
(Manual section 5.2)
 The AMC is an independent national standards body for
medical education and training.
 The AMC conducts the assessment process for IMGs in the
Standard Pathway only, administering exams for IMGs to
ensure they meet the standard of knowledge, skills and
attitudes expected of Australian medical graduates following
internship.
 AMC oversees the workplace-based assessment program
(WBA) in WA and other states.
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Competent Authority Pathway
(Manual section 5.3)
 CA Pathway is intended for non-specialist IMGs, but is
available to specialists, including general practitioners.
 The current AMC-designated competent authorities are
 United Kingdom - General Medical Council
 Canada - Medical Council of Canada
 United States - Educational Commission for Foreign Medical
Graduates
 New Zealand - Medical Council of New Zealand
 Ireland - Medical Council of Ireland
 As of 1 July 2014, IMGs who are eligible may apply for
provisional registration via the Competent Authority Pathway
 Subject to MBA IMG supervision guidelines
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Specialist Pathway
(Manual section 5.4)
 This pathway is open to specialists who
 have overseas qualifications which are partially recognised by
an Australian medical specialist college
 seek to work as an Area of Need specialist
 wish to train in Australia for a limited period
 Primary qualifications must be internationally recognised and
verified through the online ECFMG’s EPIC.
 IMGs must establish an AMC portfolio.
 As of 1 July 2014, IMGs apply directly to the specialist
medical college for the Specialist Pathway.
 The MBA makes the final decision on granting registration.
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Standard Pathway
(Manual section 5.5)
 Generally for non-specialist IMGs seeking general registration
in Australia and who do not qualify for the Competent
Authority Pathway.
 Subject to MBA IMG supervision guidelines
 These IMGs can progress to AMC Certificate and general
registration via AMC exams
 Part 1: Computer Adaptive Test Multiple Choice Questionnaire
(CAT MCQ)
 Part 2: Clinical Examination through an integrated, multi-station
multidisciplinary structured clinical assessment
OR
Workplace-based assessment (limited availability)
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Workplace-based assessment
(Standard pathway)
 Program of clinical assessment in everyday clinical practice
setting to assess at end of PGY1 (intern) level
 integration of clinical knowledge and skills
 safe and effective clinical judgement
 managing patients and working in multidisciplinary teams
 WBA is being implemented in several states, overseen by
members of the AMC Board of Examiners to ensure
consistency in format and standards.
 Duration of the WA program is
12 months. IMGs enrolled in the
program complete the supervised
practice requirement during the
assessment program.
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Professional development and education
(Manual section 5.6)
 Diversity of clinical practice in Australia means medical practitioners
must undertake life-long learning to ensure they maintain their
clinical knowledge.
 Continuing Professional Development (CPD) is mandatory to
maintain medical registration. New standards:
http://www.medicalboard.gov.au/Registration-Standards.aspx
 Specialist medical colleges provide CPD activities to members and
many professional organisations offer training workshops and
education sessions.
 Seeking advice is part of the learning process. Most colleagues will
have faced similar situations in their work experience and be happy
to advise you.
 These interactions with colleagues will help you to build a strong
collegiate network.
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Professional organisations
 Specialist medical colleges
http://www.cpmc.edu.au
 Australian Doctors Trained Overseas Association provides
information on Australian medical registration, exams and study,
courses, colleges and work, as well as political and legal issues.
http://www.adtoa.org
 Australian Medical Association (AMA) a political and industrial
association representing doctors in public and private practice, aims
to maintain professional and economic wellbeing of its members.
www.amawa.com.au
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Professional organisations
 Australasian Medical Writers Association (AMWA) peak body for
promoting excellence in health and medical communications in
Australia and New Zealand through conferences, continuing
education, networking and mentoring
http://www.medicalwriters.org/
 Australian Society for Medical Research (ASMR) peak
professional society representing Australian health and medical
research
http://www.asmr.org.au/
 Rural Health West the rural workforce agency in WA, works
collaboratively with other organisations to develop a high-quality,
sustainable health workforce in rural WA.
www.ruralhealthwest.com.au
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Support organisations
 Bush Support Services: 24 hour telephone counselling service for
ALL remote health workers/service providers and their families
1800 805 391
 Doctors Health Advisory Service: confidential 24-hour telephone
support service in times of personal crisis.
(08) 9321 3098
 DoctorConnect: website for IMGs providing information about
Australian society and the health system.
www.doctorconnect.gov.au/
 Rural Doctors Association of Australia (RDAA): a national body
representing the interests of rural medical practitioners around
Australia and comprises the RDAs of each State and Territory.
http://www.rdaa.com.au/
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Working in Western Australia
(Manual section 6)
 Topics covered
 working in hospitals
 occupational safety and health
 imaging and pathology
 prescribing and schedule 8
 medical credentialing
 infection control
 taxation and insurance
 medico-legal issues
 deaths in hospital
 working in general practice
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Working in hospitals
(Manual section 6.1)
 WA hospitals operate with multidisciplinary teams comprising
doctors, nurses and allied health staff.
 Hospital employment provides valuable clinical experience to
enhance knowledge and technical skills.
 Interns and resident medical officers (RMOs) undertake supervised
rotations across a range of clinical settings.
 Many hospitals have regular education sessions which support
career development of IMGs and Australian-trained graduates.
 All new medical staff must be provided with an orientation to the
hospital which includes
 hospital layout, services and how to access these
 emergency procedures and escalation protocols
 online mandatory training modules via hospital intranet site
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Working in hospitals
(Medical education pathway and position titles)
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Working in hospitals
(Common medical position titles)
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Hospital doctors: role, training, supervision
(Manual section 6.1)
 RMOs play a key role in day-to-day management of patients
whilst enhancing knowledge and clinical skills.
 Liaise with other medical staff, nurses and allied health staff and
play a central role in patient management.
 Ensure patient records are maintained, tests are ordered, results
reviewed and discharge plans created.
 Participate in education sessions and are regularly assessed by
their supervising clinician during the clinical placement.
 The Australian Curriculum Framework can guide you to set
learning goals with your supervisor to the standard of clinical
competence expected of Australian graduates.
http://curriculum.cpmec.org.au
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Communication and handover
(Manual section 6.1)
 Communication among members of the multidisciplinary team
is essential for good patient management.
 Includes discussions with nursing and allied health staff and
doctors who may be covering your patients.
 WA Health uses the ISOBAR handover protocol
I - introduce self (name, role, contact number) and patient (name, birth date,
gender)
S - explain situation: presentation, diagnosis, principle problems, reason for
making contact
O - most recent observations, drips and drains
B - background to the patient: medications, allergies, test results, social
A - agree a plan: what is the urgency, who does what, when
R - read-back the situation: clarify shared understanding, clear on roles/tasks
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Handover prompt – points to consider
(WACHS)
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Discharge planning
(Manual section 6.1)
 Clear and appropriate communication with community-based
health practitioners is essential to support the patient
following discharge. GPs, allied health etc.
 Commence discharge planning early to ensure timely
discharge, particularly for patients living in rural WA.
 Consider the patient’s personal status and support network and
their access to rehabilitation and long-term care.
 Discharge planning should include




communication with GPs
transport arrangements
follow-up appointments
pharmacy requirements
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Discharge planning
(Manual section 6.1)
 Discharge summaries must be completed for all patients.
 Prior to discharge, if the patient consents, written
communication should be prepared for the patient’s GP to
advise of follow-up treatment and medications required.
 Arranging follow-up by the following services should be
considered when preparing to discharge the patient:

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

ACAT geriatric assessment
HACC assessment
Silver Chain services (nursing and home help)
Allied health services (physio and occupational therapy, social
work, speech and hearing etc.)
 Outpatient appointments at hospital clinics
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Discharge planning
(Manual section 6.1)

The Admission, Readmission, Discharge and Transfer Policy for WA Health
Services provides a framework, containing detailed rules and criteria to
enable accurate and timely information about the care we provide, ensuring
that our health services are adequately funded for the services they provide.

The WA Health Statewide Discharge Summary Policy was introduced on 1
July 2016 to help standardise policy and practice to ensure a consistent
system across the whole of WA Health.
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Hospital emergency departments
(Manual section 6.1)
 Emergency departments in public hospitals provide free 24 hour 7
day emergency care.
 Patients are always seen in order of clinical urgency according
to triage score
 triage 1 = most urgent
 triage 5 = least urgent
 The Australian Government Department of Health has developed an
Emergency Triage Education Kit.
 The Emergency Telehealth Service uses telehealth technology to
provide specialist emergency medicine support to clinical staff
treating acute patients in WACHS.
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Hospital support for doctors
(Manual section 6.1)
 Junior doctors who experience professional or personal
difficulties can access a number of support options

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Clinical supervisor
Director of Clinical Training (DCT)
Medical administration staff
Director of Medical Services (DMS)
Director Postgraduate Medical Education
Medical Officer representative
Postgraduate Medical Council of WA (PMCWA)
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Rosters and salary
(Manual section 6.1)
 Junior doctors work a mix of day, night and weekends.
 Interns and RMOs at RPH, SCGH, FH rotate through five terms of
approximately 10 weeks duration.
 Rotations may be in outer metropolitan and rural sites.
 RMOs at KEMH undertake rotations of between 8-9 weeks across 6
terms
 RMOs at PMH undertake 12-14 week rotations across 4 terms
 Employment conditions for junior doctors in WA public hospitals are
set out in industrial agreements signed between the AMA (WA) and
Minister for Health.
 Copies can be obtained from the AMA (WA) or your employing
hospital.
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Occupational safety and health
(Manual section 6.2)
 WA Health has comprehensive OSH programs in place at all
sites.
 Success of the OSH program relies on hospital staff reporting
potential dangers and adverse incidents using the correct
reporting mechanisms.
 The OSH Officer for this hospital is:
 <name> <contact number>
 Report forms are available from:
 <insert location>
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Imaging and pathology services
(Manual section 6.3)
 Imaging and pathology investigations should be ordered in
terms of how they influence medical decision making.
 Request forms should be written clearly specifying the range
of investigations to be performed. Additional reports can be
ordered (e.g. copy to the GP).
 Specimens must be fully labelled including time and date of
collection, type of specimen and site.
 Indicate clearly if investigations are urgent and notify the
service in advance to facilitate processing. Contacts in this
hospital are
 Pathology: <contact number> <name>
 Radiology: <contact number> <name>
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Prescribing medications
(Manual section 6.4)
 National Medicines Policy encourages the use of generic
medicines to reduce pressure on the PBS.
 Medications are generally referred to by their brand/generic
name rather than active ingredients. These may be very
different to the names you are used to.
 Resources to assist you to identify Australian brand and
generic names are provided in the Orientation Manual.
 Specific protocols and forms exist for prescribing drugs of
dependence (Schedule 8 drugs).
 When preparing to discharge a patient ensure they know to
consult their GP for community-dispensed prescriptions for
any ongoing medications.
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Schedule 8 medications
(Manual section 6.5)
 Medicines and poisons are classified based on level of
toxicity and their use.
 Schedule 8 / Controlled Drugs require restriction to reduce
abuse, misuse and physical or psychological dependence.
 The Medicines and Poisons Regulation Branch has
produced:
 The Schedule 8 Medicines Prescribing Code
 Legal requirements for the prescribing of schedule 8
medicines under the Medicines and Poisons Act 2014 and
the Poisons Regulations 1965.
 PDF package for education purposes
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Medical credentialing and scope of practice
(Manual section 6.6)
 Medical practitioners providing hospital services are
credentialed to ensure they hold suitable qualifications.
 Scope of practice is set based on these credentials.
 Doctors must show evidence that they are maintaining their
skills to retain their credentialed scope of practice.
 In setting scope of practice, the hospital Credentialing
Committee consider:
 individual’s credentials, competence, performance and
professional suitability
 the needs and capabilities of the organisation to support
the practitioner’s scope of clinical practice
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Infection control
(Manual section 6.7)
 Infection prevention and control is covered in a mandatory training
module for all WA Health staff.
 Be aware of hand washing; wearing gloves; handling sharp
implements and exposure to blood and body fluids.
 All WA hospitals have protocols to be followed in the case of
exposure to risk of infectious diseases. Medical practitioners should:
 Adhere to infection control guidelines and protocols
 Have the recommended immunisations early in their career
 Be aware of and follow post-exposure protocols
 Doctors treating a health care worker for exposure to an infectious
disease should consider whether that person’s practise should be
reviewed. Seek advice if unsure.
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Taxation and insurance
(Manual section 6.8)
 A tax file number is issued by the Australian Taxation Office (ATO)
and is provided to your employer to withhold the minimum required
tax. Apply directly to the ATO for a tax file number: www.ato.gov.au
 Salary packaging uses pre-tax income to purchase benefits thereby
reducing the amount of tax paid. Access to salary packaging
depends on employment arrangements.
 Superannuation is money set aside to provide for your retirement.
Employers must contribute 9.5% of salary payments and employees
can make pre-tax contributions.
 To maintain registration, medical practitioners must have
professional indemnity insurance for all areas of practise.
 All subclass 457 visas granted on or after 14 September 2009 are
subject to condition 8501. Visa holders who fail to comply may have
their visas cancelled.
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Medico-legal issues
(Manual section 6.9)
 In both public and private practice, all medical treatment must be
documented in the patient’s medical record. Information should
include:
 patient identification, presenting problem and medical history
 physical exam, diagnostic and treatment orders
 observations, findings, diagnosis and discharge summary.
 Except under specific legal requirements, medical practitioners must
keep all patient information confidential.
 While working for WA Health, requests from lawyers for legal reports
or patients wishing to make a complaint should be referred to
Medical Administration.
 Minimise potential risks through good communication and accurate
patient records.
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Notifiable conditions
(Manual section 6.9)
 Medical Practitioners practising in WA are legally required to
report a number of diseases and medical conditions.
 The Legal Policy Framework specifies the requirements that
all hospitals must comply with in order to ensure an effective
and consistent legal approach across the WA health system.
 This information is vital to assist the Department of Health to
monitor medical events and develop appropriate health
responses and policies.
 The Regulatory Support Unit, Public Health deals with
reporting of a number of notifiable conditions which are listed
and detailed on their website.
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Patient consent
(Manual section 6.9)
 You must obtain consent from the patient before any surgical
or invasive procedure.
 Doctors must adequately explain all proposed treatment,
highlighting benefits, risks and consequence of no treatment.
 In many instances children will require parental consent.
 In some circumstances a child may be considered a “mature
minor” and can grant their own consent.
 The scope of consent for medical treatment varies based on
the level of responsibility held by appointed guardians.
 Use a professional interpreter to gain consent from patients
with limited English, particularly of medical terminology.
 To protect patient confidentiality avoid using family or friends.
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Medico-legal issues
(Manual section 6.9)
Advanced Health Directive
 “living will” that gives direction on health matters and comes
into force if patient is unable to make reasonable judgments
about their treatment later on.
Guardianship
 Protects the rights of adults with decision-making disabilities
which may be the result of intellectual disability, mental
illness, acquired brain injury or dementia.
Freedom of information
 Patients can obtain access to their medical records by
submitting a written request to the hospital.
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Sexual harassment and bullying
(Manual section 6.9)
 WA law makes it unlawful to discriminate against a person on
the basis of such things as
 gender, marital status, race, pregnancy, sexual orientation,
family responsibility and status, impairment and age, religious or
political conviction.
 WA Health has policies in place to uphold this law and to
prevent bullying, violence and aggression in the workplace.
 Equal Opportunity Act 1984 (WA)
 WA Health Substantive Equality Policy OD 0634/15.
 Occupational Safety & Health Act 1984 (WA)
 WA Health Preventing and Responding to Workplace Bullying
Policy OD 0437/13.
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Deaths in hospital
(Manual section 6.10)
 All Health Services have protocols for certifying deaths.
 Medical practitioners should know how to access the
necessary forms and information for this process.
http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=13018
 Numerous circumstances have been identified which, if they
occur, result in a death being considered “reportable”.
 Those aware of a “reportable death” are legally obliged to
report this to the Coroner or the Police.
 If there is any doubt, the Coroner’s advice must be sought.
 An inquest is a formal hearing into a “reportable death” in WA.
 The State Coroner, the Deputy Coroner and all magistrates can
conduct coronial investigations.
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Organ transplantation
(Manual section 6.10)
 In Australia, State and Territory health services provide solid organ
transplant services for heart, lung, kidney, liver and pancreas
transplantation.
 Australia has an “opting in” system of organ and tissue donation.
 In WA the legislation dealing with the donation of organs and tissue
after death is defined in the Human Tissue and Transplant Act 1982
(Amended 1997).
 The Australian Organ and Tissue Donation and Transplantation
Authority and DonateLife work in partnership with state and territory
governments to coordinate all organ and tissue donor activities.
 Professional Education Package
 Donor Coordinators are available 24 hours on 08 9346 3333
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Working in general practice
(Manual section 6.11)
 IMGs who first gained general registration after July 1997 have
restricted access to a Medicare provider number for 10 years (known
as the 10 year moratorium).
 To gain a provider number exemption must be sought under section
19AB of the Health Insurance Act 1973.
 IMGs can access provider and prescriber numbers from the Australian
Government if they work in a District of Workforce Shortage.
 To gain limited registration with MBA, IMGs must work in an Area of
Need as determined by the state or territory, where there is a
recognised shortage of medical practitioners and medical positions
remain unfilled.
 In WA, AoN for GPs is generally restricted to rural and outer
metropolitan regions.
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Rural general practice in WA
(Manual section 6.11)
 Working as a GP in rural WA can be immensely challenging and
rewarding.
 Many GPs work in group practice and enjoy the support of their
colleagues. Some GPs work as solo practitioners and rely on the
support of locum doctors to take time away from work.
 If granted admitting rights as a Visiting Medical Practitioner, GPs
can treat patients at the local hospital but must abide by all hospital
policies and procedures.
 Depending on their scope of practice and the hospital’s facilities,
GPs may provide emergency services, as well as surgical,
anaesthetic and obstetric services.
 Services provided by the VMP are contracted by WACHS and the
conditions and rates of pay are set out in the Medical Service
Agreement.
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Support for country doctors
(Manual section 6.11)
 WACHS salaried doctors and rural GPs can access clinical
advice from doctors in metropolitan hospitals.
 Perth-based medical specialists may provide services to
country hospitals through the visiting specialists program.
 Country doctors should be familiar with the schedule of
visiting specialists and know how to access clinical support
from Perth-based colleagues.
 Many country hospitals have well-established referral patterns
which new doctors should become familiar with.
 WACHS has established a telecommunications network and a
Telehealth program to provide specialist clinical support to
remote locations.
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Living in Western Australia
(Manual section 7.0)
 The Orientation Manual provides general information on the
following topics:

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
visa requirements
what to do soon after arrival
housing and utilities
private health insurance
education
employment for partners
childcare
emergency services
transport
information for seniors
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Other useful information
(Manual Appendix 1 and 2)
 The Appendices in the orientation manual provide the
following information
 Medication terminology used in WA
 Dose frequency and timing
 Route of administration
 Unit of measure
 Dose forms (including latin terms)
 Dangerous abbreviations
 Health industry acronyms
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Questions?
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