Sharon Monagle
Statewide Elective Surgery Reference Group (seconded from ACAES)
21/09/2005

This was the last of the scheduled meetings of the SESRG for 2005.  The reference group has largely fulfilled it's terms of reference, but will continue to be consulted during 2006 as some of the more detailed work is undertaken.

The meeting focussed on discussion around the document: The Alfred Centre - SESRG Planning Outcomes.  This outlines the key outcomes achieved by the SESRG and the ongoing role of the group in the future. 

Issues of interest:
* The Alfred Centre will commence operation in early 2007.  It is anticipated that it will provide 10,000 separations per year by 2008.  Of these, 7,000 will represent existing Alfred Hospital work and more than 3000 will be additional separations (i.e. new surgical capacity) arising from Statewide demand.  
* The surgical work will be derived from current high demand areas, in particular ENT, Orthopaedic, Urology and General Surgery.  Endoscopic procedures will also be performed at the Centre.
* GPs will be able to refer directly to the Alfred Centre.  In the first instance this will only be for diagnostic radiology and Endoscopic procedures. In the future, however, GPs will be able to refer to a broader suite of diagnostic and therapeutic procedures (e.g. minot laparoscopic surgery, cystoscopy, bronchoscopy).  This is likely to be protocol driven. This work will be undertaken over the next 12 months. It will be essential that DHS maintains good GP input to this process to ensure that it is realistic, accessible and acceptable to GPs.  
* As the centre will provide services to a Statewide catchment, there are some specific issues that will arise around transfer back to local/regional services.  In particular, these include funding for post op follow up/rehab and clinical governance throughout the patient's episode of care.  To date it has been agreed that clinical governance will sit with the Alfred whilst the patient is under the care of the Centre.  Governance arrangements for post op care need to be clarified and this work will be undertaken during 2006.
* The Centre will be characterised by a Patient Services Centre, which will act to schedule all patient appointments and to pro-actively plan their care.  The PSC will also work to avoid duplication of effort and unnecessary outpatient appointments.  Outpatient appointments will be protocol driven, with clear exit criteria.  All referrals to the Centre will be referred back to general practice; this will also be backed up by protocols.
* In view of the workforce challenges that this Centre will pose, DHS are looking at new/different models of care and team functions.  These are yet to be developed, but might (for example) include nurse endoscopists/nurse anaesthetists.

The SESRG has been a very productive group, well chaired.  I have experienced some communication problems, whereby I have not received agenda and meeting notes on 2 occasions.  This has been through oversight.  One of the key risks with the Alfred Centre is that it will be subsumed into the Alfred Hospital and will not actually provide much statewide activity.  The SESRG have continually challenged DHS about this and they continue to provide assurances that this will not be the case.  Nevertheless, it will be important to continue to hold DHS to this.

Dr Sharon Monagle
September 2005

James Antoniadis
RACGP GP Psychiatry Liaison

Discussed the importance of:
* Benzodiazepines in the treatment of anxiety and the need to report their long term use by psychiatrists in many patients.
* The need for more varied BOiMH level 2 training.
* The subsidisation of the newer hypnotics such as Stilnox or Imovane.
Next meeting: 23 November 2005
 

James Antoniadis
September 2005