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Dear SPPP members,
Welcome to our first Newsletter for some time. In this edition you will find:
1. The SPPP discussions at the recent MAC meeting, most importantly our discussions to increase the voice of private psychiatry on College committees.
2. Psychiatry Medicare Item Numbers Quick Guide
3. Prescribing Psychedelics in Australia Update
4. Committee for Research (CfR) Grants - Grants open
For further details, please read on.
Dr Michelle Atchison,
Chair, Bi-national Section of Private Practice Psychiatry Committee
1. Members Advisory Council meeting of the College, held just before Congress and decisions to take our issues forward within the College.
Section Committee Membership and Recent Face-to-Face Meeting.
The SPPP has been meeting regularly over the past 12 months by video and had its first chance to meet face-to-face in nearly three years on 24 April 2023. A full day of discussion was valuable and allowed the Committee to develop a work plan for the coming year. We did note that at least half the Committee will finish their terms in May and discussed the loss of corporate knowledge that will come with this. Since this time, we have been able to keep some committee members as co-opted members but have said goodbye to A/Prof Jeff Looi. The SPPP committee thanks him for all his hard work and input during his term.
Issues discussed at the recent MAC meeting included:
a) Methods of increasing private practice representation on College committees - the Section of Private Practice Psychiatry (SPPP) recommends that there is a position for a private practice psychiatrist on each of the Branch Committees and the NZ Committee and this will be submitted to the Corporate Governance and Risk Committee. The SPPP recommends that at least one Board member should be a psychiatrist in private practice and that that Board member should be paid, recognising the significant impact that it will have on the person’s capacity to earn income and this will be submitted to the Board.
b) Concerns around managed care continue, with Aurora Health Care announcing a partnership with Medibank.
c) Supporting an MBS item number for collaboration between GPs and psychiatrists and this will be submitted to the Practice, Policy and Partnerships Committee.
d) Supporting a push towards including private practice experience in training. There is a clear deficit in our psychiatry training, which is largely focussed on low prevalence disorders and does not prepare trainees for the reality of private psychiatry. Along with the Faculty of Adult Psychiatry, we hosted a webinar on 9 May about increasing training opportunities in private practice psychiatry - the SPPP recommends that there is at least three (3) months of private practice psychiatry experience during training and this will be submitted to the Education Committee.
e) Difficulties attracting psychiatrists to look after inpatients in private hospital. This has been raised through the Private Hospitals Association and the Committee has been told about private inpatient wards closing around Australia because of the lack of psychiatrists. We note that there is around a 30% difference in income between seeing an outpatient and an inpatient - the SPPP recommends that the College advocates for increased noGap payments for inpatient psychiatry consultations and this will be submitted to the Practice, Policy and Partnerships Committee.
f) The SPPP raised concerns about the Mood Disorders Guidelines, especially the lack of support for psychodynamic psychotherapies - the Committee determined that these guidelines are not fit for clinical practice and this will be submitted to the Future of Clinical Practice Guidelines Review Group and the Mood Disorders Evidence Review Group.
Section Involvement in College Matters
The Committee continues to provide input to college submissions and policies. We were pleased to have been specifically invited to two recent working groups, Sustainability, and the Psychedelic Assisted Therapy Steering Group. The Committee welcomes recognition that the private psychiatry voice is often missing from key College decisions and committees, and opportunities to redress this. It has been clear from discussion in WhatsApp groups recently that the Fellowship sees the input of private psychiatrists into College decisions as essential.
The Section of Private Practice Committee continues to collaboratively work to improve the private practice participation across the College.
The College and Medibank have recently met, as an introductory meeting for our CEO Sharon McGowan. The meeting was helpful in providing more background regarding the Medibank/Aurora Joint Initiative. Medibank are currently recruiting a new CMO, and once in place, it has been agreed that further meetings should take place with members of the SPPP Committee. We will keep members informed.
In other developments, the SEN is updating its guidelines on rTMS to support psychiatrists, service providers, other clinicians using this treatment, whilst efforts continue jurisdictionally and in New Zealand to improve availability of rTMS services in both private and public settings.
The SPPP were keen to talk to SEN about rTMS in private practice and to make sure any MBS descriptors took this into account.
2. Psychiatry Medicare Item Numbers.
A special thanks goes out to Dr Nathan Jacob for sharing his MBS summary of commonly used psychiatry Medicare items. The SPPP notes that there will be changes to the MBS schedule in 2024 that take into account the College’s lobbying, for example an increase in the number of consultations rebated for carer consultations from four to ten. The SPPP will keep you informed about these upcoming changes.
A special thanks goes out to Dr Nathan Jacob for sharing his MBS summary of commonly used psychiatry Medicare items. The SPPP notes that there will be changes to the MBS schedule in 2024 that take into account the College’s lobbying, for example an increase in the number of consultations rebated for carer consultations from four to ten. The SPPP will keep you informed about these upcoming changes.
3. Prescribing Psychedelics in Australia.
The following is a brief overview by Dr George Blair-West who represents the SPPP on the RANZCP’s Psychedelic-Assisted Therapy (PAT) Steering Group, chaired by Prof Richard Harvey.
As of 1 July 2023, Australia is leading the world in PAT by allowing the prescription of MDMA to assist in treating post-traumatic stress disorder (PTSD) and psilocybin to assist in treating treatment resistant depression (TRD).* Prescribing can only be undertaken by a psychiatrist who has obtained ‘Authorised Prescriber’ status through Human Research Ethics Committee approval and Therapeutic Goods Administration approval. The prescribing psychiatrist then carries overall responsibility for the course of treatment.
The College is acutely aware of the potential for unintended consequences while using psychedelics clinically and, accordingly, has adopted a “safety first” approach. The contextual therapy is currently considered just as important, if not more so, than the direct action of the psychedelics.
Amongst a range of considerations is the need for high-level clinical support, not just in session, but in both preparation and follow-up. It is envisaged that in session support could require up to eight hours of clinical supervision with two clinicians e.g., a registered nurse, psychologist along with a psychiatrist on hand, if not actually present for the entire session. Ongoing work is required to develop effective protocols and thoroughly train clinicians to safely deliver these novel therapies.
While the out-of-pocket costs of PAT are unknown, estimates range between $15,000 to $20,000 for a course of treatment. How funding will be managed is unclear.
The College will be looking to collect country-wide data, at least early on, to inform best practice going forward.
* The RANZCP uses the term treatment resistant depression in line with regulatory frameworks but acknowledges that difficult-to-treat depression or other terms many be preferred.
Resources
College webinar Psychedelic-assisted therapy: A clinician’s perspective
4. Committee for Research (CfR) Grants- Grants open
There are three early researcher grants now open for applications.
· The Beverley Raphael New Investigator Grant
Next Edition
If there is anything you would like to see included in future newsletters please contact membership@ranzcp.org
Thank you for reading.
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