ASMS Direct - Issue 2010-16
19 October 2010
Dear Member
We welcome any feedback on the contents of the 16th issue for 2010 of ASMS Direct.
Members are encouraged to consider attending the ASMS Annual Conference in Wellington on 18-19 November. There are still some delegate positions available, including in the larger DHBs such as Auckland, Counties Manukau, Waikato, Capital & Coast (1), and Canterbury. If you are interested in attending please contact Membership Support Officer, Kathy Eaden at ke@asms.org.nz.
This copy of ASMS Direct focuses on:
- 1. Green MPs initiative strengthens new Quality & Safety Commission
- 2. World Medical Association: Doctors should engage public in “battle” to improve health care
- 3. MECA Variation: CME Expenses and Laptops (and electronic aids)
- 4. World Medical Association: Doctors remain best qualified to prescribe
1. Green MPs initiative strengthens new Quality & Safety Commission
The ASMS has congratulated Green MP and health spokesperson, Kevin Hague for his successful amendment to the bill currently before Parliament seeking to amend the Public Health and Disability Act. A positive feature of the government’s amendment bill is that it establishes an important much needed new organisation (Quality & Safety Commission) to actively promote quality improvement and safety in the health system. Unfortunately the new commission would have been undermined by a requirement in the bill that it should become self-funding. This would have risked making it financially unviable and compromise its independence and integrity because of the danger of being beholden to its funders.
However, Mr Hague demonstrated insight and successfully proposed an amendment (through a process known as a ‘supplementary order paper’) seeking to remove this self-funding requirement. His amendment was adopted by Parliament last week. While it is good that the government took the initiative to establish the Quality & Safety Commission, Mr Hague’s successful initiative helps ensure that it is not doomed to failure. The high level of multi-party support (including Labour) for the establishment of the new commission is also gratifying as it ensures its continuation beyond a change of government.
The ASMS is also pleased that Mr Hague was significantly influenced by our submission to Parliament on the bill which highlighted this risk caused by self-funding. As a former DHB chief executive, he also had his own experience to draw upon.
2. World Medical Association: Doctors should engage public in “battle” to improve health care
The outgoing President of the World Medical Association, Dr Dana Hanson has issued a public call for physicians (doctors) to engage the public in the battle to improve health care. In his valedictory speech as President at the WMA's annual Assembly in Vancouver, Dr Hanson said that financial crises often resulted in slashed health budgets “but why is there no outcry by the public that the disease burden remains the same or greater?”
He said that during his year as President, the WMA had highlighted health and the environment – “something which regardless of causes will touch untold millions of people in a very real and concrete way when it comes to their health.” But he asked why patients were so surprised when physicians pointed this out to them in their clinics and hospitals.
Dr Hanson said these were just two examples of where the WMA had a role in partnership with national medical associations in engaging the public to realise that in order to address their individual concerns they must be partners with the medical profession and other healthcare professionals. Governments across the world had not been educated by the right people when it came to heath issues. Why, he asked, did the climate change conference in Copenhagen last year have no reference to health in its final draft? Why were 80% of the observers industry based and only a handful, health care representatives and environmentalists?
Dr Hanson added:
Why did governments always listen to the World Bank and the International Monetary Fund about our economic health often to the detriment of public and individual health? Why were health systems seen as a cost centre when they had been proven to be a positive economic investment? And why with a resurgence of infectious diseases and drug resistance were there common drug shortages and a paucity of new drug innovation?
Part of the answer to these vital questions is that we, along with the public, have not educated governments and industry. They have only heard part of the story. Yet the public and the medical profession together represent a powerful force that no government could oppose. The World Medical Association and national medical associations have a vital role in society not just at the bedside but indeed well beyond.
3. MECA Variation: CME Expenses and Laptops (and electronic aids)
One of the features of the recent ‘variation’ agreed to by the ASMS and the DHBs to the national DHB MECA was the inclusion of a new clause covering the use of CME expenses for the purchase of laptops and electronic aids. It is important that the new clause is fully understood. It states:
Where a DHB agrees that employees may use their accrued CME expenses to purchase and own laptops and electronic aids this shall be where the main purpose is to support their continuing education…
Prior to this agreement some DHBs (including larger ones such as Waikato and Capital & Coast) permitted the use of CME expenses in a manner consistent with this new provision. Some others did not with some of them using the misleading argument that because it was not in the MECA it could not be done. However, this conveniently ignored the point that the MECA provides minimum (not maximum) terms of employment. The effect of this agreement is that it makes it explicit that using CME expenses in this manner is acceptable under the MECA. It removes a fallacious argument.
It still does require DHB agreement. The ASMS is pursuing this with each of the insular looking or overly cautious DHBs through our Joint Consultation Committees.
The ASMS does have a concern that some DHBs or individual managers might endeavour to raid CME expenses to pay for resources (‘tools of the trade’) that the DHB should be providing directly. Consequently the above new clause is written in the way it is to help prevent this.
4. World Medical Association: Doctors remain best qualified to prescribe
On 16 October the World Medical Association announced its new policy on drug prescribing and revised guidelines on the relationship between doctors (physicians) and pharmacists based on the principle that the right to prescribe medicine should be competency based and ideally the responsibility of the doctor. Although nurses and other healthcare workers cooperated in the overall treatment of patients, the doctor was the best qualified individual to prescribe independently.
The policy statement states:
In some countries, laws may allow for other professionals to prescribe drugs under specific circumstances, generally with extra training and education and most often under medical supervision. In all cases, the responsibility for the patient's treatment must remain with the physician. Each country's medical system should ensure the protection of public interest and safety in the diagnosis and treatment of patients. If a system fails to comply with this basic framework due to social, economical or other compelling reasons, it should make every effort to improve the situation and to protect the safety of the patients.
Although physicians are the best qualified individuals to prescribe independently, they must recognise their limits and look for guidance and help when necessary. When unsure about prescribing a drug, physicians should look for guidance from a senior colleague, pharmaceutical formulary and/or published literature.
The new statement declares that inappropriate drug prescription without proper knowledge and accurate diagnosis might cause serious adverse effects on the patient's health. It added:
Prescription of drugs should be based on a correct diagnosis of the patient's condition and should be performed by those who have completed a curriculum on disease mechanisms, diagnostic methods and medical treatment of the condition in question.
In the relationship between doctors and pharmacists the WMA said that the two professions had complementary and supportive responsibilities and this required communication, respect, trust and mutual recognition of each other's professional competence. Collaboration between the two professions was imperative, particularly on the development of training and information sharing with one another and with patients. It was necessary to keep an open and continued dialogue between doctors' and pharmacists' representative organizations in order to define each profession's respective functions and promote the optimal use of drugs within a framework of transparency and cooperation, all in the best interests of patients.
In its media statement announcing the new policy the WMA observed:
The debates we had at our Assembly demonstrated quite clearly that the issue of prescribing is viewed differently in different parts of the world. The WMA's job is to assist physicians with guidelines on best practice and to ensure that health care for patients is of the highest quality.
Our patients will be served best when pharmacists and physicians collaborate together, recognizing each other's roles, to ensure that medicines are used safely and appropriately to achieve the best health outcome.
Ian Powell
EXECUTIVE DIRECTOR
executive director
