NAPP Newsletter 2023

Dear Colleague

This Newsletter provides you with information about what has been happening at NAPP over the past
six months since our last Newsletter in 2022. NAPP has been quite active during this time and I outline
the issues that have been covered one by one.

Contents

1. Australian Medical Council Accreditation Review of RANZCP
2. Deed of Settlement with Honeysuckle Health
3. Medicare Item Number Review
4. Telehealth Phone-only Item Number
5. Webinar on Challenges and Opportunities for Psychiatry
6. Guide for the Management of Gender Dysphoria in Young Persons
7. Extended Treatment Psychodynamic Psychotherapy
8. AMA CPD Home
9. RANZCP President-Elect Election
10. WhatsApp Chat Groups
11. Membership

Australian Medical Council Accreditation Review of RANZCP

The majority of NAPP psychiatrist members hold RANZCP membership. In 2022 the Australian Medical
Council reviewed the College to determine whether it could be re-accredited as a training organisation
from March 2023. NAPP provided the AMC with a written submission on 11.9.2022 and the executive of
NAPP met members of the AMC Review Committee for a discussion of our submission on 21.11.2022.
In March 2023 the AMC provided its accreditation report on the College. This report outlined a number
of concerning features of the College’s current training programmes and made recommendations for the
future. Many of the critical comments made by the AMC were entirely consistent with the concerns that
NAPP had raised about the College training program. The AMC recommendations reflected suggestions
that NAPP had made to improve the College training program going forward. Some of these concerns and
recommendations are summarised below.

The AMC was concerned about the barriers to transparency within the College created by the Deeds of
Undertaking that prevent members of College Committees and the Board communicating with College
members and with trainees. The AMC recommended removing these barriers to transparency as much
as possible.

The AMC was concerned about how the College managed actual and perceived bias in decision making
and recommended a greater involvement of trainees in the College governance structure.

The AMC required the College to review and implement an enhanced curriculum content including
explicit learning and minimum clinical experience in the psychotherapy of high prevalence disorders and
to prepare trainees for practising in private practice and community settings.

The AMC recommended that the College expand its educational purpose in order to reflect community
need for non-acute mental health services across a range of settings including non-acute and office-based
practice as well as longitudinal continuity of care with the necessary expansion of skills for trainees to
manage high prevalence low acuity disorders.

The AMC requested that the College have a heightened awareness and responsiveness to the value of
trainee contributions to the training program and to enhance support for those trainees experiencing
personal and professional difficulties. This included a centralised pathway to document and monitor
allegations of discrimination, bullying and harassment with procedures to provide support to trainees in
these situations.

The AMC required the College to develop ways of formally obtaining and monitoring feedback on the
performance of individual supervisors and directors of training to identify areas for improvement and
underperformance and to ensure that safe and confidential pathways for trainees are available to provide
feedback without them being discriminated against. This included particular attention to the conflicts
inherent in supervisors undertaking both supervisory and assessment roles of trainees in the workplace.
The AMC required the College to implement and monitor mechanisms to improve the relatively low
examination and other assessment pass rates for overseas specialist graduates.

The AMC asked the College to increase the term of the trainee Board Director to have parity with other
Board directors of the College.

Many of these recommendations and demands by the AMC were particular points that NAPP raised in our
submission and in our face-to-face meeting with the AMC Review Committee.

Deed of Settlement with Honeysuckle Health

NAPP was a major player in the challenge to the Australian Competition and Consumer Commission’s
(ACCC) authorisation of the Honeysuckle Health application to introduce American style managed care
into Australian private health insurance. NAPP negotiated a Deed of Settlement with Honeysuckle Health
under the auspices of the Australia Competition Tribunal in mid-2022 which eliminated the objectionable
clauses in proposed contracts that would have limited the capacity of psychiatrists to make independent
treatment decisions for the benefit of their patients.

Since all parties signed the Deed of Settlement last year, we have not seen any obvious attempts to breech
the terms of the agreement. However, we must remain vigilant. It is possible that some agreements
between health insurers and private hospitals may put pressure on specialist doctors including
psychiatrists to conform to clinical decision behaviours that might compromise patient care. NAPP is
keeping a close eye on any developments in this area and is open to member feedback regarding how to
capture this data across different private hospital systems and clinician networks. A survey of specialists
in private hospital care is being undertaken to identify any breaches of the Dead of Settlement.

Medicare Item Number Review

NAPP was involved with the review of the Medicare Item Numbers in psychiatry, with representation on
the Medicare Implementation Liaison Group (ILG) committee. The ILGC met through 2022 with the focus
of implementing the Medicare MBS Review Taskforce’s recommendations. This included the
recommendations relating to Item 319, which provides for up to 160 sessions of 45 minute plus
psychotherapy consultations per year. Removal of item 319’s reference to diagnostic categories and
removal of the use of the DSM-4 Impairment Rating Scale were supported by NAPP as they achieved
greater patient confidentiality in that specific psychiatric conditions do not need to be recorded for a 319
Item, relevant in this era of multi-party access to electronic medical records, nor does the severity of the
illness need to be rated with an instrument. These requirements had contributed to significant stigma.

The recommendations from NAPP regarding the re-definition of the item 319 descriptor and the
requirement for equivalent telehealth access were supported by the Medicare Item ILG Committee and
have been sent forward to Medicare and the government for consideration.

Telehealth Phone-only Item Number

NAPP was involved in advocating for retention of the 45 minute plus telephone telehealth Medicare item

This item number facilitated psychiatric access for some of the most vulnerable psychiatric
patients, including access to essential ongoing psychotherapy treatment.

Data collected by NAPP demonstrated that MBS 91840 provided 24,304 psychiatric consultations to
patients outside of Metropolitan Areas between 13 March 2020 and 30 September 2022, including
patients from regional centres, small, medium and large rural towns, remote and very remote
communities.

While telehealth consultations using video for 45 minutes plus (MBS 91830) have continued to be
subsidised by Medicare, the rebate for item 91840 ceased. NAPP highlighted that this package fails to
address the needs of more than 2.5 million vulnerable Australians with internet access and affordability
issues who face ongoing discriminatory exclusion from vital mental health services and are being placed
at risk.

NAPP recommended that the Medicare rebate for item 91840 continue and provided a submission to the
government, supported by testimonies from Lived Experience Australia, but so far we have not seen a
successful outcome on this particular matter.

Webinar on Challenges and Opportunities for Psychiatry

NAPP ran a webinar on 20.3.2023 on the topic of “Challenges and Opportunities for Psychiatry”. The two
speakers were Prof Philip Morris AM and Dr Pia Brous. This informative webinar was well attended and
has given NAPP experience in running webinars in the future.

The next webinar to be conducted by NAPP will be on Monday, 19 June, at 7 pm AEST. This webinar will
cover the topics of suicide prevention using a text message application, ethical issues and iatrogenic
injuries surrounding the treatment of gender dysphoria in children and adolescents, protecting
independent clinical decision-making in psychiatry, and building a broad-based and enhanced skill
development training program for psychiatric registrars. The presenters at this webinar will be Dr David
Horgan, A/Prof George Halasz, Prof Philip Morris AM and Dr Pia Brous.

This webinar will be programmed to include activities that will fulfil new CPD requirements for
‘reviewing performance and measuring outcomes’. Attendees will be provided a certificate of
participation for CPD records.

Guide for the Management of Gender Dysphoria in Young Persons

NAPP has published a Guide on the management of gender dysphoria in children and adolescents. The
guide is published on the NAPP website and updated regularly. The approach outlined in the Guide is
consistent with advice given by medical advisory bodies concerning this clinical area to government
departments of health in the United Kingdom, Sweden, Finland, Norway and France. The Guide is being
published in brochure form to be distributed to state and federal members of parliament and to medical
associations and colleges.

Extended Treatment Psychodynamic Psychotherapy

NAPP has supported members of the RANZCP who have been concerned about the devaluation of
psychodynamic psychotherapy for patients with mood disorders. These concerns arose out of the way
that the Clinical Practice Guideline on Mood Disorders, endorsed by the College, belittled the role that the
long term / intensive psychodynamic psychotherapies has in the treatment of patients with mood
disorders, especially depression.

NAPP was supportive of members of the College who requisitioned a Members Requisition General
Meeting and helped the requisitioners develop four resolutions asking the College to reverse its
endorsement of this section of the Clinical Practice Guideline. This meeting was held in May 2022 and the
four resolutions were passed overwhelmingly. Unfortunately, the College has not acted on the
resolutions.

The College has taken a long time to provide a response. In early 2023 the College appointed a review of
the evidence for the psychodynamic psychotherapies in mood disorders that is being overseen by a
committee led by Professor Bruce Singh. So far it is unclear which professional group will be
commissioned to conduct the actual review and no timeline has been made clear about when the review
and its recommendations will be made public to members of the college. NAPP will continue to support
the valid concerns of psychiatrists regarding this issue and will advocate with the College and other
organisations on their behalf.

AMA CPD Home

NAPP has begun to explore a potential collaboration with the Australian Medical Association CPD Home
for the delivery of a platform for recording CPD activities for the purposes of medical registration and to
develop a CPD program within the CPD Home that would be relevant for psychiatrists.

Preliminary discussions have begun. The goal would be to have a CPD Home through the AMA for
psychiatrists who wish to have that organisation as their CPD Home for recording their CPD activities and
to be a place to be able to participate in CPD activities relevant for psychiatrists through programs
supported by the CPD Home. The cost for a psychiatrist using the AMA CPD Home as their CPD home
would be $440 p.a. for those psychiatrists who are members of the AMA or $880 p.a. for those
psychiatrists who are not members of the AMA.

RANZCP President-Elect Election

NAPP was active during the recent election for the President-Elect of the RANZCP. Two NAPP members
stood for election as President-Elect. While both were not successful, the policies put forward by these
two candidates were taken up by other candidates and were prominent in discussions amongst college
fellows. NAPP has been influential in setting out policy directions for candidates aspiring to be the
College President-Elect. NAPP will continue to make contact with RANZCP regarding potential
collaborative projects.

WhatsApp Chat Groups

During the campaign period for President-Elect a number of independent WhatsApp chat groups became
much more active and provided a platform for psychiatrists and trainees who would otherwise not have a
voice to put their ideas forward. We recommend you consider looking at and possibly joining the
following WhatsApp groups.

Membership

NAPP relies on its members in order to be an effective advocate for the profession of psychiatry, our
members, and our patients. It is essential that we continue to grow our membership base. If you are a
member of NAPP we would very much appreciate you re-joining each year. Also please invite your non-
NAPP colleagues to join NAPP and participate in the activities that we are providing for psychiatrists and
trainees. The annual fee is very modest. Membership applications and membership renewals can be
made through our NAPP website:

I look forward to meeting you at our next NAPP General Meeting which will be held in May and I look
forward to meeting you at our webinar in June. There is great opportunity to become involved in NAPP
advocacy work, both for trainees and psychiatrists.

Yours sincerely,

Prof Philip Morris AM
President NAPP