Transcript Manual section 6.1

Orientation to Australian health system
and working in Western Australia
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
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)
Australian time zones
(Manual section 7.1)
 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
Australian healthcare system
(Manual section 1.1)
 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.
Australian healthcare system
Three levels of Government
Australian Government
State Government
Federal Government
Medicare Australia
Medicare
Public hospital
Other programs
PBS
Private patient –
hospital treatment
Private practice
Other programs
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
Department of Veterans’ 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.
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Veterans’ Home Care
public and private hospital care
respite care
community nursing
Medicare
(Manual section 1.1)
What is Medicare?
 Australia's universal health insurance scheme
 ensures all Australians have access to a range of
medical services, lower cost prescriptions and free care
as a public patient in a public hospital
 individuals are free to choose private health services
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.
Medicare cards
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.
Medicare cards
Medicare cards are also issued to eligible visitors and
non-permanent residents.
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.
Medicare services
 The Australian Government Department of Human
Services provides on-line learning modules and other
information resources for health professionals
http://www.humanservices.gov.au/health-professionals/subjects/education-services-for-health-professionals
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
www.mbsonline.gov.au
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.
www.pbs.gov.au
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).
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
http://www.humanservices.gov.au/health-professionals/subjects/education-services-for-health-professionals?utm_id=9
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.
http://www.humanservices.gov.au/health-professionals/forms/?utm_id=9
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.
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)
Western Australian health system
(Manual section 2)
 Topics covered
 WA Government and structure of public
health system
 metropolitan health services
 country health services
 other health service providers in WA
 Emergency service providers
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, comprises:
 Public health, clinical services and research, system policy
and planning and resources
 Mental health
 Hospital and community care services
 Health centres and nursing posts
 Aboriginal health
 Population health and aged care services
WA public health services
Public health services are provided through the following
health services:
 Metropolitan Health Service
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Child and Adolescent Health Service
North Metropolitan Health Service
South Metropolitan Health Service
East Metropolitan Health Service (1 July 2016)
 WA Country Health Service (WACHS)
 Seven health regions
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
 1 July 2016 : East Metropolitan Health Service
 RPH, Bentley, Kalamunda and Armadale.
 St John of God public hospital Midland
WA Country Health Service
(Manual section 2.3)
 Services over 542,000 people
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Region of over 2.5 million km2
 Manages 70 hospitals, 38 nursing
posts, provides community and
mental health services.
 Seven health regions
 Goldfields
 Kimberley
 Midwest
 Pilbara
 Great Southern
 South West
 Wheatbelt
WA Health – other services
(Manual section 2.4 - 2.7)
 Community Health supports patients in their home to
retain independence and minimise hospital admissions.
 Dental Health provides emergency and general dental
care for eligible persons.
 Public Health Division develops and coordinates delivery
of statewide public health policy and programs.
 Mental Health services are provided through public
hospitals and health services.
 Aboriginal Health provides policy leadership to deliver
health services equitably for the WA Aboriginal population.
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.
 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.
 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.
Other health service providers
 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.
www.ahcwa.org
 Disability Services Commission (DSC): provide
support to people with disability, their family and carers.
www.disability.wa.gov.au
Emergency service providers
 Newborn Emergency Transport Service (NETS):
coordinates the transfer of newly born babies from their
hospital of birth to tertiary care in Perth. Can also be
contacted for clinical advice.
1300 638 792
 Poisons Information Centre: provide toxicological advice to
doctors and general public.
13 11 26
 Royal Flying Doctor Service (RFDS): provide aero-medical
evacuation, emergency and primary health care services.
1800 625 800
See Orientation Manual for additional listings
Communication and cultural awareness
Manual section 3
 Topics covered
 Australian society
 Aboriginal Australians
 Australian patients
 cultural awareness
 communication
 professional conduct
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
http://www.border.gov.au/Trav/Life
Aboriginal Australians
(Manual section 3.2)
 Aboriginal and Torres Strait Islander people are the original
(indigenous) inhabitants of Australia.
 Aboriginal people, as a whole, experience disproportionate
levels of disadvantage and poorer health compared with
other Australians.
 Life expectancy at birth may be around 10 years lower and
infant mortality is around 3 times higher.
 In remote WA, Aboriginal populations may have higher
rates of cardiovascular and respiratory disease, as well as
diabetes and infectious diseases. Children are prone to ear
infections, resulting in hearing loss.
 Aboriginal Health Workers can assist doctors to
communicate with patients if there are language and/or
cultural barriers.
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.
http://www.border.gov.au/Trav/Life/Tran
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.
Communication
(Manual section 3.5)
 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
Cultural awareness training
(Manual Section 3.6)
 Cultural training helps participants to understand
Aboriginal culture and history and develop awareness of
the key issues facing Aboriginal people.
 All WA Health staff must undertake online training
modules in cultural awareness.
 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
 Combined Universities Centre for Rural Health (CUCRH)
 Reconciliation Australia website “Share our Pride”
http://lms.cucrh.uwa.edu.au/login/index.php
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
 respect for patients
 standards of care
 professional conduct
 clinical research and teaching
 doctor’s role in society
 the dying patient and
transplantation
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.
Mandatory reporting of child abuse
 Under the Children and Community Services Act 2004,
doctors 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.
See Orientation Manual for information on reporting child neglect
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
 Women have the same rights as men.
 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.
Registration of doctors in Australia
(Manual section 5.0)
 Topics covered
 AHPRA and Medical Board of Australia
 Health assessment
 Monitoring
 Australian Medical Council
 medical registration pathways
 Competent Authority
 Specialist pathway
 Standard pathway
 professional development
 professional organisations
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.
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.
http://www.medicalboard.gov.au/Registration-Standards.aspx
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
 AMC administers 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.
http://www.amc.org.au
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.
http://www.medicalboard.gov.au/Registration/International-MedicalGraduates/Competent-Authority-Pathway.aspx
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 AMC.
 As of 1 July 2014, IMGs apply directly to the specialist
medical college for the Specialist Pathway.
 Transitional arrangements are in place for competent
authority pathway IMGs with limited registration.
http://www.medicalboard.gov.au/Registration/International-MedicalGraduates/Specialist-Pathway.aspx
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.
 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, multistation multidisciplinary structured clinical assessment
OR
Workplace-based assessment (limited availability)
http://www.medicalboard.gov.au/Registration/InternationalMedical-Graduates/Standard-Pathway.aspx
Workplace-based assessment
(Standard Pathway)
 Program of clinical assessment in everyday clinical
practice setting to assess
 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.
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.
 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.
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
Professional organisations
 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
Support organisations
 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/
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
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 Australiantrained graduates.
Working in hospitals
(Medical education pathway and position titles)
Working in hospitals
(Common medical position titles)
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
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
Discharge planning
(Manual section 6.1)
 Clear and appropriate communication with communitybased 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
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communication with GPs
transport arrangements
follow-up appointments
pharmacy requirements
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
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.
http://www.health.gov.au/internet/main/publishing.nsf/Content/casemix-EDtriage+Review+Fact+Sheet+Documents
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)
 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
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 PMH and KEMH undertake two rotations of
between 12-13 weeks
 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.
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>
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>
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.
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 Pharmaceutical Services Branch has
produced:
 The Schedule 8 Medicines Prescribing Code
 Legal requirements for the prescribing of schedule
8 medicines under the Poisons Act 1964 and the
Poisons Regulations 1965
 Power point for education purposes
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.
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.
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.
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.
Notifiable conditions
(Manual section 6.9)
 Medical Practitioners practising in WA are legally
required to report a number of diseases and medical
conditions.
 This information is vital to assist the Department of
Health to monitor medical events and develop
appropriate health responses and policies.
 The Public Health Unit deals with
reporting of a number of notifiable
conditions which are listed
on their website:
http://www.public.health.wa.gov.au/3/287/2/statutory_notifications_and_a
uthorisations.pm
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.
Medico-legal issues
(Manual section 6.9)
Advanced Health Directive
 “living will” that gives direction on health matters and
comes into force if they are 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.
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) and Occupational
Safety & Health Act 1984 (WA)
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.
 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.
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).
 DonateLife coordinates all organ and tissue donor activities
across WA.
 Professional Education Package
http://www.donatelife.gov.au/donatelife-western-australia
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 if they
work in a District of Workforce Shortage.
 To gain limited registration with MBA, IMGs must work in
an Area of Need, where there is a recognised shortage of
medical practitioners and medical positions remain
unfilled.
http://corporate-cm.hdwa.health.wa.gov.au/Articles/U_Z/What-is-an-area-of-need
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.
 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.
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.
Living in Western Australia
(Manual section 7.0)
 The Orientation Manual provides general information on the
following topics:










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
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
Questions?