Here’s an update on a few of the issues AMA Victoria is working on for members, including:
Meetings with Health Minister Ingrid Stitt
Specialist clinic referral restrictions and system coordination
Drugs, poisons and controlled substances regulations.
Meetings with Health Minister Ingrid Stitt
AMA Victoria met Health Minister Ingrid Stitt twice last week, first to discuss the public hospital doctors’ enterprise agreement and then mental health reform.
The agreement meeting followed almost 12 months of bargaining without an offer being put to doctors and the commencement of the first protected industrial action by Victorian public hospital doctors in 20 years.
The mental health discussion drew on a paper prepared by AMA Victoria’s Section of Psychiatry and focused on people with severe and acute mental illness. We raised concerns about pressure on acute services, inadequate bed capacity, including in Melbourne’s rapidly growing south-east, and the continuing difficulty many of the sickest Victorians face accessing specialist care.
There has been considerable reform activity since the Royal Commission, but timely specialist care remains out of reach for too many of these patients. AMA Victoria will continue to press the Minister and Department for the workforce and bed capacity needed to meet demand, and for clearer accountability for whether reform is improving care.
Specialist clinic referral restrictions and system coordination
AMA Victoria has written to Health Minister Ingrid Stitt raising concerns about reports that the Royal Melbourne Hospital may return specialist clinic referrals for patients outside its local catchment where it considers another health service to be closer.
This is a statewide capacity and coordination problem. A restriction at one hospital does not create care or reduce demand. It shifts pressure elsewhere, including to health services already facing much longer waits. The Age reports that the average wait for a routine first general surgery appointment is 107 days at Melbourne Health, compared with 929 days at Western Health. With disparities of this order, GPs and patients have legitimate reasons to look beyond the nearest hospital for more timely care, service availability and continuity.
When a referral is returned without another service having accepted responsibility, the patient is sent back to the beginning. It creates additional, largely unfunded work for the GP and risks further delay and deterioration for the patient. Nor is the geographically nearest hospital necessarily the most accessible, particularly where family members provide transport or assist with care.
We are also concerned that the change appears to have been communicated as a final decision rather than developed through a coordinated process with GPs and affected health services.
AMA Victoria has asked the Department to urgently review the change and clarify whether it complies with statewide referral policy. No clinically appropriate referral should simply be returned because of a patient’s postcode. Where another service is more appropriate, the referral should be transferred directly once that service has agreed to accept responsibility.
Better coordination must be supported by adequate workforce and recurrent funding. It cannot compensate for capacity that does not exist.
AMA Victoria has requested a meeting with the Minister and Department to work through these practical issues. With members across specialties, sectors and levels of seniority, we are uniquely placed to bring doctors together and help develop a coordinated, workable referral system.
Drugs, poisons and controlled substances regulations
Ahead of the 2027 remake of the Drugs, Poisons and Controlled Substances Regulations, the Department of Health has invited feedback on proposed changes as part of its Regulatory Impact Statement. AMA Victoria has provided feedback on two of the proposals: requiring medicinal cannabis to be supplied by prescription, and expanding pharmacist notification requirements.
The first proposal would generally require medicinal cannabis to be supplied by prescription so that it is recorded in SafeScript. Medical practitioners can currently supply Schedule 4 and Schedule 8 medicinal cannabis directly without recording that supply in SafeScript. AMA Victoria supports, in principle, steps to improve oversight of medicinal cannabis prescribing and supply. Any exceptions should be clearly defined.
The second would extend an existing notification requirement from Schedule 8 poisons and Schedule 4 drugs of dependence to all monitored supply poisons, including gabapentin, pregabalin, quetiapine, tramadol, zolpidem and zopiclone. Where a pharmacist believes a patient was supplied with the same or a similar medicine by another prescriber during the previous eight weeks, they must take all reasonable steps to inform the current prescriber unless they believe the prescriber is already aware.
Contact between pharmacists and prescribers can be clinically important. However, the expansion may materially increase notifications, including where prescribing by more than one practitioner is legitimate and clinically appropriate.
An earlier, broader proposal would also have required prescribers and suppliers to take all reasonable steps to contact other prescribers identified through SafeScript. AMA Victoria and members strongly opposed it, and its omission from the current package is a welcome outcome.
AMA Victoria has asked the Department to establish the likely increase in notifications, the time required of pharmacists and prescribers, how often notifications result in changes to treatment or prevent harm, and the consequences where contact cannot be made. The analysis should also identify the additional benefit where the relevant information is already available through SafeScript.
The regulatory cost of new processes must include the clinical time they consume. Additional obligations should proceed only where a demonstrated patient safety benefit justifies that cost.