Wednesday, December 19, 2007
Doctors forced to turn away patients
PHILIPPA DUNCAN
http://www.news.com.au/mercury/story/0,22884,22935448-921,00.html
December 17, 2007 12:00am
UP to two-thirds of Tasmania's GP practices are turning away new patients.
An issues paper has revealed one third of the state's GPs have closed their books entirely.
The paper – prepared for the inaugural Tasmanian GP Workforce Summit held this month – said only one third of GP practices were accepting new patients, without restrictions.
Australian Medical Association state president Haydn Walters said appointments were going to become harder to get.
"In Tasmania there are 58 (GP) vacancies," he said yesterday.
"In the next five to 10 years a third to a half of all GPs are due to retire."
Prof Walters said modelling showed 100 of Tasmania's 300 GP positions would be empty.
"There is a bulge of GPs aged 50 and over," he said.
"One third of positions will be vacant.
"If you think we are short now, it is going to get a lot worse."
The issues paper said 24 of the vacancies were in Hobart, 12 in Launceston and 22 in rural areas.
Last week, the announcement Richmond doctor Eric Colquhoun planned to retire next month, leaving 5000 locals without a doctor, highlighted Tasmania's GP shortage.
Dr Colquhoun said he had spent three years searching for a doctor to buy and take over the business. He said that the problem was endemic.
"I've been trying to recruit someone since 2004, I've had a few people come but they've had to go for various reasons.
"Finding a doctor is like pulling a rabbit out of a hat."
Prof Walters said Tasmania needed to start preparing for the shortage now and state and federal governments needed to work together more closely on doctor training.
Claremont GP Graeme Alexander said more needed to be done to convince doctors to stay another week or month before retiring.
He said the figures were much worse, because many doctors were burnt out and considering retiring early.
"The average rural GP is 57 or 58. They are the ones finding it really really hard.
"At the moment everyone is flooding out of general practice, but no one is asking why.
"The existing workforce we need to stay longer to train the new workforce."
The issues paper said there were reports of people having to travel significant distances to get access to a GP in Glamorgan Spring Bay, Kingborough and West Tamar.
It asked how much of the increased number of presentations to emergency departments could be attributed to the GP shortage.
It predicted a number of rural hospitals may soon be heavily reliant on locum GPs.
Dr Alexander said the Medicare system also needed reform.
Reasons for Rob Fassett's departure
The Examiner 18 December 2007
DANIELLE BLEWETT looks back at the departure of Professor Rob Fassett as the LGH's director of medicine.
ON Friday, November 16, Rob Fassett was out on an early morning bike ride when he spotted a newspaper poster that read: "Fassett told to go". It made him pedal faster.
"I had already resigned and I was always planning to go," he said.
The hospital's long-standing director of medicine did not go quietly.
But what triggered Professor Fassett's move to speak publicly about his concerns for the future of the LGH?
Aged 55, with 21 years at the hospital and 16 years as its director of medicine, he was well- equipped to speak about the hospital.
Regularly during 2007, he has brought the hospital to the front pages of this newspaper.
A good day, says the hospital's chief executive Stephen Ayre, is a day when the hospital isn't on the front page of The Examiner.
In April, when a senior Hobart bureaucrat asked one of his Northern colleagues how they could stop all the negative publicity surrounding the hospital. The reply was: "Simple: Give them the $10 million they are under budget."
Prof. Fassett laments that meaningful change still isn't on the horizon.
"The only regret I have is that we weren't listened to," he said.
"I have absolutely no regrets about speaking out publicly.
"I know I have not had the full support of my colleagues who may not realise for some years that I was right.
"I certainly had no support from the Health Department or the Government.
"The reassuring thing is that people say `thank you'. But I haven't really achieved much. It's disappointing to have to say that nothing has changed."
Wins by the Australian Nursing Federation in November, got the hospital another 29 nurses.
But the LGH continues to be stretched and many staff are still at breaking point.
The emergency department is constantly functioning on the cusp of disaster, according to a staff specialist.
Elsewhere, failure to recruit means the hospital is still short two oncologists, an interventional cardiologist, an endocrinologist and a renal locum.
The centralising of vascular surgery to the Royal Hobart Hospital was the starting point for Prof. Fassett.
He has seen many cycles of bust and boom within his hospital.
"I never got over the fact that we lost vascular," Prof. Fassett said.
"It was like a stone in my shoe. Such poor planning to allow that to happen. That was the baseline of my discontent. They can say that the LGH has not been downgraded but anyone who says we are not being downgraded is deluding themselves."
Prof. Fassett lost all trust in the Health Minister or the Health Department after the release of the Clinical Services Plan in May.
"I was deluded when I believed the Health Minister was listening to us when they were consulting for the Clinical Services Plan.
"They did not listen. They just paid us lip service. When the document came out I could see clearly in black and white that we were being downgraded to make way for the new Royal Hobart Hospital.
"A few weeks after the CSP was released we had bed closures. It was then blatantly obvious that we had been tricked.
"The document was the real trigger. The CSP made it obvious what the government's plan was for the North of the State.
"This was quickly accentuated by the CSP's ham fisted implementation in the North-West. It was handled with rhetoric not reality.
"If that is the way the rest of the plan is going to happen, that doesn't inspire confidence."
By August, Prof. Fassett was clear he would not continue as director of medicine in 2008.
He announced his resignation from the hospital's executive, effective October 2008, to pursue 36, ongoing research projects and work in private practice.
He anguishes over leaving the director's job during a crisis.
"One flaw I see in myself is `Rob' is fine when things are going really well. When I see my department being degraded and staff not being recruited and find we are being downsized and I leave at that point; I wonder should I stay with the ship? There are certain points in your career when it comes time to move on."
Being outspoken has caused friction with some of his colleagues.
He says they are angered that as one of the most ardent sticklers to the hospital's code of conduct he has broken all of the rules.
"There has been some conflict. When you have conflict with your managers and something as substantial as the bureaucracy it would be crazy to say it has had no impact on me," he said.
"I am a clinician not an administrator. That is a difficult blend. Your decisions have an impact on people's lives and it brings a conscience to your decision making."
Prof. Fassett, who travels to Burnie every Thursday to provide a renal clinic, says the fight to improve services at the LGH didn't quite overshadow his year.
"It has consumed some degree of my energy but I still see patients, still bike ride, still drink coffee.
"The only cost has been my relationship with some of my colleagues, particularly those who didn't see the world the same way I see it. Some have been critical of me that I have been vocal when the rules say I shouldn't."
It's almost a year since Prof. Fassett first went public with his fears about centralising of vascular surgery.
"I believe it was worth it because the number of people who came up to me on the street or in consultation who would say "thank you" for what your have done. That makes me more clearly believe it was worth it.
"The majority of people in Launceston believe they are not getting a fair deal in Northern Tasmania.
"We might not be getting an outcome now but by 2010 hopefully when they are voting the politicians will get their judgment."
He remains totally unimpressed with the performance by Bass Labor MHAs Michelle O'Byrne and Jim Cox who have been silent all year.
The only politician he believes actually "got it" with the LGH was defeated Bass Liberal MHR Michael Ferguson.
After 16 years in one of medicine's most powerful roles, Prof. Fassett has no regrets.
"I will miss not having some input into the way services develop in Northern Tasmania. However, I won't miss dealing with the bureaucracy and I won't miss aspects like paper work and conflict resolution (among staff).
"I will miss my team: Andrea, Karen and Catherine.
"But this is only one part of my job. I am a clinician and the greatest impact I can have is taking the time to consult with patients."
DANIELLE BLEWETT looks back at the departure of Professor Rob Fassett as the LGH's director of medicine.
ON Friday, November 16, Rob Fassett was out on an early morning bike ride when he spotted a newspaper poster that read: "Fassett told to go". It made him pedal faster.
"I had already resigned and I was always planning to go," he said.
The hospital's long-standing director of medicine did not go quietly.
But what triggered Professor Fassett's move to speak publicly about his concerns for the future of the LGH?
Aged 55, with 21 years at the hospital and 16 years as its director of medicine, he was well- equipped to speak about the hospital.
Regularly during 2007, he has brought the hospital to the front pages of this newspaper.
A good day, says the hospital's chief executive Stephen Ayre, is a day when the hospital isn't on the front page of The Examiner.
In April, when a senior Hobart bureaucrat asked one of his Northern colleagues how they could stop all the negative publicity surrounding the hospital. The reply was: "Simple: Give them the $10 million they are under budget."
Prof. Fassett laments that meaningful change still isn't on the horizon.
"The only regret I have is that we weren't listened to," he said.
"I have absolutely no regrets about speaking out publicly.
"I know I have not had the full support of my colleagues who may not realise for some years that I was right.
"I certainly had no support from the Health Department or the Government.
"The reassuring thing is that people say `thank you'. But I haven't really achieved much. It's disappointing to have to say that nothing has changed."
Wins by the Australian Nursing Federation in November, got the hospital another 29 nurses.
But the LGH continues to be stretched and many staff are still at breaking point.
The emergency department is constantly functioning on the cusp of disaster, according to a staff specialist.
Elsewhere, failure to recruit means the hospital is still short two oncologists, an interventional cardiologist, an endocrinologist and a renal locum.
The centralising of vascular surgery to the Royal Hobart Hospital was the starting point for Prof. Fassett.
He has seen many cycles of bust and boom within his hospital.
"I never got over the fact that we lost vascular," Prof. Fassett said.
"It was like a stone in my shoe. Such poor planning to allow that to happen. That was the baseline of my discontent. They can say that the LGH has not been downgraded but anyone who says we are not being downgraded is deluding themselves."
Prof. Fassett lost all trust in the Health Minister or the Health Department after the release of the Clinical Services Plan in May.
"I was deluded when I believed the Health Minister was listening to us when they were consulting for the Clinical Services Plan.
"They did not listen. They just paid us lip service. When the document came out I could see clearly in black and white that we were being downgraded to make way for the new Royal Hobart Hospital.
"A few weeks after the CSP was released we had bed closures. It was then blatantly obvious that we had been tricked.
"The document was the real trigger. The CSP made it obvious what the government's plan was for the North of the State.
"This was quickly accentuated by the CSP's ham fisted implementation in the North-West. It was handled with rhetoric not reality.
"If that is the way the rest of the plan is going to happen, that doesn't inspire confidence."
By August, Prof. Fassett was clear he would not continue as director of medicine in 2008.
He announced his resignation from the hospital's executive, effective October 2008, to pursue 36, ongoing research projects and work in private practice.
He anguishes over leaving the director's job during a crisis.
"One flaw I see in myself is `Rob' is fine when things are going really well. When I see my department being degraded and staff not being recruited and find we are being downsized and I leave at that point; I wonder should I stay with the ship? There are certain points in your career when it comes time to move on."
Being outspoken has caused friction with some of his colleagues.
He says they are angered that as one of the most ardent sticklers to the hospital's code of conduct he has broken all of the rules.
"There has been some conflict. When you have conflict with your managers and something as substantial as the bureaucracy it would be crazy to say it has had no impact on me," he said.
"I am a clinician not an administrator. That is a difficult blend. Your decisions have an impact on people's lives and it brings a conscience to your decision making."
Prof. Fassett, who travels to Burnie every Thursday to provide a renal clinic, says the fight to improve services at the LGH didn't quite overshadow his year.
"It has consumed some degree of my energy but I still see patients, still bike ride, still drink coffee.
"The only cost has been my relationship with some of my colleagues, particularly those who didn't see the world the same way I see it. Some have been critical of me that I have been vocal when the rules say I shouldn't."
It's almost a year since Prof. Fassett first went public with his fears about centralising of vascular surgery.
"I believe it was worth it because the number of people who came up to me on the street or in consultation who would say "thank you" for what your have done. That makes me more clearly believe it was worth it.
"The majority of people in Launceston believe they are not getting a fair deal in Northern Tasmania.
"We might not be getting an outcome now but by 2010 hopefully when they are voting the politicians will get their judgment."
He remains totally unimpressed with the performance by Bass Labor MHAs Michelle O'Byrne and Jim Cox who have been silent all year.
The only politician he believes actually "got it" with the LGH was defeated Bass Liberal MHR Michael Ferguson.
After 16 years in one of medicine's most powerful roles, Prof. Fassett has no regrets.
"I will miss not having some input into the way services develop in Northern Tasmania. However, I won't miss dealing with the bureaucracy and I won't miss aspects like paper work and conflict resolution (among staff).
"I will miss my team: Andrea, Karen and Catherine.
"But this is only one part of my job. I am a clinician and the greatest impact I can have is taking the time to consult with patients."
Burns unit in crisis
Article from: The Mercury
http://www.news.com.au/mercury/story/0,22884,22952847-3462,00.html
LUKE SAYER
December 20, 2007 12:00am
CHILDREN with serious burns will have to be transferred to Melbourne because of a critical staff shortage in Tasmania's only burns unit.
The unit's director says the staff problem has been ignored by senior management at the Royal Hobart Hospital for three years.
Burns unit director Craig Quarmby said the burns unit was severely limited in the services it could provide.
"We are putting all our efforts into clinical work, with no time for prevention or education," Mr Quarmby said.
"To date we haven't had any adverse outcomes, but we are tottering on the brink.
"We've been in discussion with senior management for three years."
Mr Quarmby said he had done everything possible to avoid having to look at transferring patients.
In recent times he has discussed the situation with the three previous heads of the unit, to try to find an alternative. But he said without extra support, the unit had to act.
"With pediatrics we have noticed we are battling to give the level of care that we want to give, and that Tasmanians deserve," he said. "Before it turns into a catastrophe it is our duty to do something."
He said the transfer of burns patients would not place them at any greater risk.
"We believe it has got to the stage where they (pediatric patients) will have better outcomes due to our short staffing."
Royal Hobart Hobart chief executive Craig White said pediatric burns patients received treatment through the burns unit unless their injuries were severe enough to require treatment at the Royal Children's Hospital.
"The RHH has a co-operative agreement with the RCH to transfer burns patients who are beyond the capacity and capability of the Tasmanian health system," Dr White said.
He said this arrangement worked very well and ensured Tasmanian patients received the most appropriate care.
"In the past few years, the number of pediatric patients transferred to the RCH is low," Dr White said.
He said the Royal was actively considering staffing for the burns unit, including the recruitment of a specialist burns nurse.
But Dr Quarmby said the unit would be transferring all but minor cases to Melbourne, because they would not compromise patient safety.
"As of yesterday the situation has changed, due to a lack of response from senior management, and we cannot continue treating pediatric cases," Dr Quarmby said.
Dr Quarmby said pediatrics had been chosen because the patients were not located centrally in the burns unit.
This meant they were usually under the care of pediatric staff, who didn't always have burns training.
But he said the employment of one key staff member could turn the situation around.
"We need a specialist burns nurse who can co-ordinate the unit," he said.
http://www.news.com.au/mercury/story/0,22884,22952847-3462,00.html
LUKE SAYER
December 20, 2007 12:00am
CHILDREN with serious burns will have to be transferred to Melbourne because of a critical staff shortage in Tasmania's only burns unit.
The unit's director says the staff problem has been ignored by senior management at the Royal Hobart Hospital for three years.
Burns unit director Craig Quarmby said the burns unit was severely limited in the services it could provide.
"We are putting all our efforts into clinical work, with no time for prevention or education," Mr Quarmby said.
"To date we haven't had any adverse outcomes, but we are tottering on the brink.
"We've been in discussion with senior management for three years."
Mr Quarmby said he had done everything possible to avoid having to look at transferring patients.
In recent times he has discussed the situation with the three previous heads of the unit, to try to find an alternative. But he said without extra support, the unit had to act.
"With pediatrics we have noticed we are battling to give the level of care that we want to give, and that Tasmanians deserve," he said. "Before it turns into a catastrophe it is our duty to do something."
He said the transfer of burns patients would not place them at any greater risk.
"We believe it has got to the stage where they (pediatric patients) will have better outcomes due to our short staffing."
Royal Hobart Hobart chief executive Craig White said pediatric burns patients received treatment through the burns unit unless their injuries were severe enough to require treatment at the Royal Children's Hospital.
"The RHH has a co-operative agreement with the RCH to transfer burns patients who are beyond the capacity and capability of the Tasmanian health system," Dr White said.
He said this arrangement worked very well and ensured Tasmanian patients received the most appropriate care.
"In the past few years, the number of pediatric patients transferred to the RCH is low," Dr White said.
He said the Royal was actively considering staffing for the burns unit, including the recruitment of a specialist burns nurse.
But Dr Quarmby said the unit would be transferring all but minor cases to Melbourne, because they would not compromise patient safety.
"As of yesterday the situation has changed, due to a lack of response from senior management, and we cannot continue treating pediatric cases," Dr Quarmby said.
Dr Quarmby said pediatrics had been chosen because the patients were not located centrally in the burns unit.
This meant they were usually under the care of pediatric staff, who didn't always have burns training.
But he said the employment of one key staff member could turn the situation around.
"We need a specialist burns nurse who can co-ordinate the unit," he said.
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