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Members: Prof R Essop, Dr R Kinsley (Cardiothoracic
Surgery representative), Dr TA Mabin, Prof T Mathiva, Prof
P Mntla, Prof R Scott Millar and Dr S Vithilingum.
The committee met on several occasions to consider the format
of the annual SA Heart congresses. An annual meeting, organised
as the Durban Congress has been, was favoured. However, the
proposed change to a biennial general meeting, interspersed
with a meeting organised by one or more of the Special Interest
Groups has been accepted, because of the practical difficulties
of organising a large general congress every year.
The format of the Cert. Cardiology (SA) exams is under review.
Requests from HPCSA for advice regarding registration of
individuals as cardiologists, have been considered on an ad
hoc basis by the committee, usually via e-mail.
Prof R Scott Millar, Chairperson
Full
Time Salaried Practice Committee
Members: Prof AF Doubell (Chairperson), Dr E Brice,
Prof P Manga, Dr J Brink, Dr D Schutte, Prof K Sliwa.
The committee met (teleconference) twice during the year
– on the 4th December 2003 and on the 28th April 2004.
The following matters were focussed on:
1. Training regulations
2. Education Subcommittee for Heads of training institutions
3. Academic recognition
4. Promotion of Research
a. Cardiovascular Research Fund
5. Staffing in State Hospitals.
Training regulations. Although the current three-year
training program for the subspecialty cardiology was implemented
four years ago, there is continued concern regarding the discrepancy
between the three-year training period and the two-year minimum
requirement set by the Health Professions Council of South
Africa (HPCSA). A presentation to the HPCSA to change the
minimum statutory requirement to three years to bring it in
line with the actual training requirements was turned down
in 2003. Following further correspondence the HPCSA requested
that College of Medicine of South Africa (CMSA) consult with
the accredited training units to recommend a consensus training
period to HPCSA. Two meetings were subsequently held with
CMSA on this matter on the 19th January 2004 and 21 June 2004.
SA Heart was represented by AF Doubell, P Manga (adult cardiology),
JR Harrisberg, JB Lawrenson and AM Cilliers (paediatric
cardiology). As a result of these meetings CMSA resolved:
“That the Subcommittee for Postgraduate Education and
Training (Medical) be notified and that the Colleges of Medicine
of South Africa strongly supports the application of the SA
Heart Association to have the period of education and training
for the subspecialty cardiology extended to three years.”
Education Subcommittee for Heads of training institutions.
The Education Committee of SA Heart carries the responsibility
of implementation of the training regulations referred to
above. These recommendations regarding training regulations
were initiated by the Committee for Heads of training institutions,
a subcommittee of the Education Committee. It was noted that
the Committee for Heads of training institutions did not meet
during the past year and resolved to initiate more regular
meeting of this committee.
Academic recognition. The need was identified to
bring new appointments, promotions, graduations etc. to the
attention of the broad spectrum of SA Heart members. Prof
Sliwa undertook to liase with members in every province to
collect information of this nature. This information will
then be sent to the Editor of the SA Heart Journal for publication.
Promotion of Research. The committee recognized their
responsibility in this regard and undertook to lobby SA Heart
exco to extend current initiatives such as Travel Scholarships
and Research scholarships. A problem of obtaining funding
from the Cardiovascular Disease Research Fund for research
not dealing with atherosclerosis was noted. The feeling was
that atherosclerosis, although an emerging problem in South
Africa, was still a relatively rare condition amongst the
South African black community and that research in very common
conditions such as rheumatic heart disease, idiopathic dilated
cardiomyopathy or tuberculous pericarditis should also be
supported. The committee of the Cardiovascular Disease Research
Fund was neither prepared to change the name of the fund (to
atherosclerosis research fund) nor prepared to broaden the
scope to support research of other cardiovascular conditions
common in South Africa. The concerns of the committee was
conveyed to the Board of the Cardiovascular Disease Research
Fund via the SA Heart exco. Although their official policy
has not been changed in response to the concerns raised, we
have been informed that the scope of projects that are being
considered for funding has been broadened.
Staffing in State Hospitals. The staff shortages
in many cardiology departments in teaching hospitals was addressed
but no solutions were forthcoming.
On that sobering note I conclude the 2004 annual report of
the Fulltime Salaried Practise Committee.
Anton Doubell, Chairperson
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Ethics and
Guidelines Committee
Guidelines are time consuming and expensive
to produce. Sponsorship from vested interests can lead
to allegations of bias and lack of objectivity. At the last
AGM it was agreed that the SA Heart Association will seek
Affiliate Membership of the European Society of Cardiology
and follow and recommend the Guidelines of the European Society.
The Constitution of the European society has been duly
amended and we await the ratification of our membership.
The committee had one telephonic conference
during the year under review.
Now that special interest groups have incorporated into SA
Heart it will be important to have these groups contribute
to modifications of Guidelines to suit the South African situation.
Several pocket guidelines are available from the European
Society and members should avail themselves of these.
Abdul Mitha, Chairperson
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Private Practice
Committee
It was a busy year with the winds of change blowing through
the local medical world. The changes proposed will change
the practice of medicine at every level in South Africa. In
essence these changes are due to the government's vision for
the how medical care should be made available to all South
Africans. Essentially a private/public partnership is being
mooted with the main purpose being equality of care, cross
funded from private to public. In order to protect the private
interest the following strategies have been proposed:
It is felt that medicine should have a clear direction.
Long-term goals should be identified and worked towards steadily.
The following issues were identified as areas for consideration:
Funders and the CMS are working towards the establishment
of a basic benefits package, to which will be added supplementary
packages. This will mean that every citizen will have basic
benefits but will decide on which supplementary benefits they
desire or can afford. The National Health Reference Price
list (NHRPL) will set the minimum fees. It should be remembered
that the intention of the Act is to provide affordable care
for all. The NHRPL will only be binding if a contract exists
with the funder i.e. beware of contracts.
The certificate of need (CON) will apply to public
and private sector doctors. The act only mentions an institution
but each doctor has a practice which is an institution and
hence covered by the Act. Regulations governing this aspect
of the Act are to be promulgated. SAMA may be able
to influence this aspect. Information, including how this
issue is being dealt with internationally is vitally important.
Many doctors are leaving the country and this should
be investigated and solutions sought to stem the flow.
The Healthcare value chain. This involves the GP as
a gatekeeper to health services. The lines are not distinct
between the different levels of care. In reality there are
multiple gatekeepers e.g. pharmacists, primary healthcare
workers, the midlevel care workers (only in hospitals). Adaptation
to this would require a process of deskilling and deskilling
by traditional gatekeepers. The value chain drives the cost.
Appropriate level and application of care requires a certain
cost.
New business models will be required to enable funding
of suitable level and to cultivate and nurture patient relationships.
The doctor may become a coordinator. Doctors need to respond
and not to react. Areas of coordination/involvement
are:
Positioning of the profession as coordinator and defining
scope of practice
Consultations
Benefit structuring
Appropriate inflator
Scientific determining of RVU’s
Practice costs
Professional value
Professional liability (Risk Indicator).
A further issue is the value of consultations. A questionnaire
was sent out, by SAMA, earlier in the year, and hopefully
cardiologists have filled these in as these values will be
set whether or not we participate.
Doctors should be able to work through a central body to influence
HPCSA and CMS to improve practice conditions. Our aim should
be constructive engagement and not a stance of ‘turf
protection’.
Guides have been issued regarding designated Service Providers.
Prescribed minimum benefit will not be revised by the CMS
until an impact study has been completed.
The idea from CMS is a time based system, with 10 minute
intervals and the creation of risk corridors with a proposal
of a 5% difference. This would mean that x thousand rand was
earmarked for consultations and should the quarter-by-quarter
analysis show that this was being exceeded then the RCF would
be halved for the rest of the year. The funders have sufficient
reserve to cushion this impact. Patients will be empowered
and peer review is built in.
The issue of peer review is high on the agenda. We
should put systems in place to allow cardiologists to conduct
their peer review through the SA Heart Association. This will
require a shift in our thinking. Our methods of practice should
be evidence based and open to review. Industry has practice
profile information which would be best utilised by a peer
review committee of cardiologists at SA Heart Association.
The information could be used to guide practice rather than
to punish. We could have access to this information if we
allow a link from our website but this requires your agreement.
All in all these are interesting times but feedback is needed
for the PPC to comment meaningfully. My opinions are not important
but those of the cardiology fraternity should guide our response
to these changes.
Anthony Stanley, Chairperson
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