To market to market went my PHN
when somebody threw a tomato tha'd b'en  
all soft and squishy; ‘twould not hurt the skin
But alas, I'm afraid, this was wrapped in a tin

July 1st 2018 marked the first day of the next phase in the North Coast Primary Health Network’s transition to a commissioning body. The transition began two years ago and the latest development sees a major change to the organisation’s structure.

In line with the Coalition's philosophy of competitive markets PHNs are gradually devolving their activities through a tendering mechanism to external parties. The government believes this has worked well in telecommunications, aged care and disability services. It brings market forces to bear on the provision of human services of all types.

“To sleep, perchance to dream”
- Hamlet, William Shakespeare

Sleep apnoea almost seems like an Australian invention. Its physiology was poorly understood in the 1970s and contemporary treatment owes a lot to the pioneering work of Dr Colin Sullivan on positive airway pressure (PAP) treatment at Royal Prince Alfred Hospital in Sydney.

Since then the extent  of the problem has grown considerably and reflects the increase in the body mass of Australians. Obesity, and sleep apnoea, one of its consequences, is now a major industry around the world.

The clinical significance of the problem has been debated and recent studies suggest that our current approach in Australia has led to over-treatment.

Dr Bronwyn Hudson is the founder and principal GP at the Yellow Gate Medical Clinic in Banaglow. She specialises in addiction medicine and runs an outpatient opioid treatment program.

In good news for the medication assisted treatment of opioid dependence (MATOD) in general practice, the recently updated NSW Clinical Guidelines: Treatment of Opioid Dependence 2018 provide a number of measures that make treating opioid dependence in the community more practical and flexible.

The new guidelines aim to increase access to MATOD by expanding the role that GPs play in opioid replacement therapy. The guidelines also place a greater reliance on non-government organisations as well as community pharmacies.

Paper, paper, everywhere
And there’s smudging of the ink
Paper, paper, everywhere
It’s time to change, you’d think.

Everybody wants your data. Each organisation has its own form they want completed. It’s time consuming and expensive for staff to do it, so they pass it off to the customer. It’s the modern way. The client does the work and you take the money.

In 2016 I started work at Lismore Base Hospital after moving from Royal North Shore Hospital in Sydney. Having been involved in teaching and education, particularly at the resident and registrar level, I was keen to get involved in a similar scene in Lismore. It didn’t take me long to track down my old supervisor from my time as a trainee registrar in Lismore, Dr Adam Blenkhorn, who had been evolving the Basic Physician Training  program over the years at Lismore. One of the key milestones he was keen to achieve was to run the national Physicians exam locally. This was no mean feat, but with the support of the new Department of Medicine, this aim is being achieved.