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The Repeal of Item 319 and Associated Restrictions.

Open letter from NAPP President to Colleagues
11 December 2000

Dear Colleague

Since it was established 4 years ago the National Association of Practising Psychiatrists (NAPP) has spoken out against health policy which we believe is contrary to the interests of our patients and to the practise of ethical psychiatry.

We have been able to change some things for the better and prevent some adverse changes from occurring eg when NAPP forced the reinstatement of rebates for child therapy.

But our profession will only survive if it remains grounded in clinical practise based on sound clinical skills. The continued existence of Item 319 (which limits availability of treatment based on arbitrary criteria) and associated restrictions (like Item 316, or the push to become "consultants") can only serve to erode our skillsbase, and erode our unique identity as the only clinicians using the biopsychosocial model. Further, Item 319's continued existence is perilous for patients as it sets a dangerous precedent – selective rationing of the chronically ill's entitlement under Medicare to appropriate medical treatment.

If we are to remain true to our patients' interests, and to abide by our ethical code of practice, we have no choice but to pursue a complete repeal of this discriminatory and stigmatising policy and related regulations.

You may not be aware that it was NAPP that played the leading role in initiating recent joint negotiations between NAPP, the AMA, and the RANZCP.

Our members and office bearers have worked tirelessly preparing submissions and expert evidence to support the repeal of Item 319 and associated restrictions.

These joint meetings were highlighted in Australian Medicine, 2 October 2000.

Subsequently, and unfortunately, the RANZCP saw fit to withdraw from the joint position and have embarked on a different course of discussing broader access issues.

Our understanding is that the RANZCP General Council was concerned that pushing for the repeal of Item 319 would "rock the boat" and could jeopardise other MBS rebates. Dr Kerryn Phelps, Federal President of the AMA, strongly supported the NAPP initiative to proceed on a united front.

NAPP is firm in its resolve that it has a duty of care to advocate for our patients as well as for ethical practise. In our view, Item 319 contravenes the College Code of Ethics: Principle 2: "Psychiatrists shall provide the best possible care for their patients"; Principle 9 - Annotation: (3) "Psychiatrists shall be prepared to act as advocates..." and Annotation (5) "Psychiatrists shall take appropriate action if services, by reason of fiscal restriction, fall below minimal standards".

We live in a democratic country and our elected leaders need to be informed in the clearest possible way when their decisions hurt our patients, either intentionally or unintentionally.

I urge you to stand with us and support, through your actions, the repeal of item 319 and associated restrictions. Read the enclosed material while you consider this.

Listed below are some options you can take to support our stand.

1. Telephone your Federal Member of Parliament or Senator (details can be found at http://www.aph.gov.au/house/members/index.htm and http://www.aph.gov.au/senate/senators/index.htm ) and make an appointment to see your Member or Senator to discuss the impact of Item 319 and other issues affecting your patients. Unless we communicate they will never know. (Please send us a letter on the outcome of your meeting.)

2. Write a personal letter to your Federal Member of Parliament or Senator pointing out your concern over Item 319 and any other related issues. Remember to ask for a response to your concerns.

3. Send a signed copy of the attached proforma letter re item 319 to your Federal Member of Parliament or Senator

4. Send a signed copy of the attached proforma letter re item 319 to any influential Colleagues and Councillors.

5. Send a signed copy of the attached proforma letter re item 319 to the Federal AMA, PO Box E115, KINGSTON ACT 2604

6. Join NAPP and lend your support in this endeavour to safeguard the integrity of our profession; we can do it alone but it's easier if you help by joining our organisation.

Fax or e-mail a copy of your correspondence to NAPP at 02 9567 4681 or admin@napp.one.net.au

Yours faithfully

Dr Gil Anaf

encl: Letter re Item 319 to post to others Dec_2000_letter_proforma.rtf (5 kb)

encl: Ethics and Feedback papers

(Posted December 2000)


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