Archway Development and Consulting Ltd is
EnglandCompany No 3326461Registered
OfficeC21 Herbal Gardens9 Herbal HillLondon EC1R 5XB
An Australian co registration to follow.
ABN 13 342 157 130
System: Views after
8 months working at just one polyclinic.
The difference with the UK is sun and SPACE and
cheaper land. Australia has a small population of just 21
most of the inhabitants are on the eastern side of the continent, and
within 100km of the coast. But even that
is a vast area.
Cairns itself is 130 years old, but
has only really
developed in the last 30 years; the area has about 150,000
people. There is only one road linking it to
Brisbane and the South. This road gets
flooded every wet season, cutting Cairns off for days.
The space makes Australia appear to look like
America, but to me it
is neater and more modern than the latter. This available
space means that the Polyclinic
model is possible, since it occupies the area of a decent supermarket,
ample free car parking; each space is large enough for a 3 ton truck.
This is a six doctor practice. In the UK,
the rent and rates payable on
such a site would not allow it to be economically viable. All
shops are quieter, since they can still
make profits on a fraction of the turnover a UK
shop requires to pay their fixed
road leading to the centre facing Cairns Some of the
The health service is different. The people seem to
appreciate it. To them, that is better than the NHS, since
they can usually get what they [the patients] want when they want
it. They would not want an entirely socialised
and, to them, a restrictive service. The
private sector is fully integrated. Private insurance also
tops up Medicare
payments for hospital care. Insuring for
primary care is forbidden by law, to prevent increase in fees.
It is understood that patients have to pay for
services. If you are under 16 then the
Medicare programme supplies the bulk of care and primary care is
free. Drug costs are subsided for all, but within a
limited list. The concept of top-up is
understood, and even appreciated.
Microgynon is available on the Pharmaceutical Benefits Scheme (PBS),
many patients are happy to pay for Yasmin.
This is liberating for both the GP and patient. You can go
off formulary if the patient is
happy to pay, and they usually are.
There is a limit to the cost patients have to carry for chronic
dieseaes. After reaching a limit the cost of drugs
become free for the rest of the year.
There is no patient list for GPs. Patients can ring any
appointment, and they do just that. In
this practice, at least third of the patients I see have come in
could not get an appointment at their local practice at their
is like a UK walk in centre, Urgent care Centre or Darzi Clinic.
Here patients will come in for a second
opinion on the same day....and not tell you that is what they are
doing. The disadvantage of this is that chronic
disease management is terrible. The
average life expectancy of an aboriginal male is still 57.
Diabetes is rife. I have had a patient tell me he gets his BP
medication from one practice, his diabetic drugs from another, and gets
tests here this third practice, and he has run out of one of his
is seeing me. I have no record of his
care. Retinal eye photography is not
done. There were no tuning forks in the
building. There is a CT scanner of
course, where I can order a pulmonary flow CT scan, there and then, for
The Government and some GPs are aware of this deficiency,
and there is a move to pay doctors for an enrolment system (aka GP
List). This had been resisted by the profession who
prefer the fee for service approach, and patient groups do not like not
able to go where they please. Recent polls suggest a majority of GPs
support the idea.
GP are not involved in repeat prescriptions. You get one
month’s supply and up to 5
repeats from the pharmacy. Even antibiotics
default to one repeat by the clinical computer.
The clinical IT system at the clinic is terrible compared to UK
Some older GPs in towns have had in effect a list of
patients. Cairns, with its high
turnover, and my high turnover practice (worse as a new GP in the
given me a dimmer view of chronic disease management which may not be
fair. Out of town centres is in effect a list
system, as there are no other GPs around.
Because patients can move about, some drugs on the
Pharmaceutical Benefit Scheme (https://www.pbs.gov.au/html/home)
require you to make a phone call to get permission to prescribe.
A code is given to go onto the script. This
use of the dug on a central
database. This makes sense for expensive
or abused drugs, as it prevents patient shopping around and building up
as they are recorded centrally. Changing the amount of medication on a
can take the medication off PBS, and a phone call is needed to approve
indication or such a change.
Some very odd things are missing from the benefits scheme:
dressings for leg ulcers, Thiamine for alcohol.
Odd drugs, even quite cheap ones, need permission for no
reason. Gabapentin for pain control can only be a
private prescription. Antihistamines are
not on the PBS at all.
This small population dispersed over a wide area cannot
easily support a generic drug market.
Simvastatin is quite expensive compared to the UK. There is
no pressure to use the cheaper dugs,
as often they are not that much cheaper as the generic supply is weak
relatively expensive. GPs do not have an
indicative drug budget, as no “list” of patients.
The pharmacist can switch brands and use generics, unless a
box is ticked on the script forbidding it.
So the necessity for GPs to use generic names is reduced.
Patients and GPs only know drugs by the brand
names – which I really struggle with.
The clinical computer system’s drug database is electronic
Mims! It attempts to force non-generic use. Putting
Naproxen, forces you to search
through every brand of Naproxen (some are allowed on the PBS, others
having chosen the PBS one, you can then force the system to print it
generically, which is what you typed up in the first
Finding Thiamine 100mg is impossible: the
system lists every brand and every vitamin pill and OTC medicine
quantity of thiamine. In fact, what I
want is called Betamin. So I have to
put in Betamin 100mg and then I can force the computer to print a
for Thiamine 100mg. The
house, converted to use a as a conference and wedding reception centre,
drug company sponsored meetings.
All clinical meetings
seem to be drug company sponsored with
“advertorials”. Above was the place of
first drug company sponsored
dinner. The last time I had anything
like that, an entirely drug company sponsored event was back in
1995. I think we have gone too far in restricting
drug company access to such marketing tools in the UK.
There are good effects of the Australian medical
system. A doctor is upset if he does not have a
day as that means less income. Other
doctors in the building will not object to you taking an afternoon off,
simply increases their income.
Doctors want to want to see
patients. I suspect that this may have an effect of
doing what pleases, so it seems that more antibiotics are given to
is reasonable: I found that all otitis
media is always treated with antibiotics, with a repeat prescription
It is not in your interest to spend a long time with a
patient with an URTI explaining its correct management, in order to
them not to darken your door again with such a complaint
again. It could be a waste of time doing full health screen on
every new patient. You may never see
The clinical system used here does not
prompt for missing BP, smoking habits and so on. Coding is
terrible and not really done. Family history is free text,
The payment and Medicare system means that I can do more for
patients. An 8-year old child comes in,
having fallen over at school. An X-ray
performed in the clinic shows a green stick radial fracture, so I can
put on a
U slab. That is a fee for the
consultation and X-ray and another fee for the plaster (I cannot
Futura splint, and none were available anyway).
there is a BCC, or SCC to remove. There are no
about GPs removing
all skin cancers. They have to: there is
nobody else to do it. A full melanoma
screening / micro-photography service is in place at the centre.
Some of the
spins down samples Courier
service every 2 hours 8am-6pm
A patient comes in
with a Colles’ fracture, only aged 38.
So I organise a bone density scan, and bloods, and expect to see her in
a month. Three patients later she is
sitting there with an envelope. The scan
is completed and blood results popping up on the computer.
The patient is sorted within hours.
Otherwise it is primary care as per the UK. The
vaccinations schedule is wider,
including Hepatitis B at birth, and herpes zoster and RSV . Gardasil is
administered to the under 20s. The
vaccinations are held centrally on a national recall / recording
system. Patients can log in to print out when and
what vaccinations they have had. There
is still a full screening / child development checks system at regular
intervals to 5 years old, which has to be performed by doctors.
and gym in the surgery Acupuncture:
Claimable on Medicare.
It will take me a little longer to appreciate the benefits
of the system. Some of my views are prejudiced
by what is familiar and I need to be open minded. The one
is certain. Every country’s system is not
Australia’s may be much better than most, and
may be more able to control costs than the NHS.
The polyclinic, acute medical/walk-in model does not seem good for
chronic disease management.