Caring for those who served – what every GP registrar should know
- For a GP registrar who has never treated a veteran patient before, what are the most important things they should know walking into that first consultation?
With more than 580,000 veterans in Australia, you may have already treated a veteran and not known it. Identification is most important – ask the question “Have you ever served?”. The answer allows you to ask more specific questions or utilise veteran specific supports or funding.
Don’t worry about needing special skills- you have people treatment skills already. Start with building rapport. Consider a discussion about confidentiality – some experiences have national security implications – you may be able to reassure about what you don’t need to know and still be able to treat them.
Those who have recently transitioned from the Australian Defence Force (ADF) may need additional support navigating the civilian healthcare system – in the ADF all healthcare including dental is provided and organised.
Before your first consultation with a veteran, try the quick guides at the Department of Veterans’ Affairs (DVA). This will help you understand veteran white and gold cards, how to figure out what the veteran in front of you is eligible for and what extra is funded for veterans, like allied health care.
If the patient is in your room before you find out they are a veteran try going to your local HealthPathways and look up “veteran” – most PHNs have a pathway for “Veteran Health”. (If your’s doesn’t, contact your PHN to ask for it to be included.)
Billing for veteran care is a little different but uses your usual practice billing system – if you are billing a DVA number, this must be direct billed without a gap fee, however the rebate is generally 15% higher than the equivalent MBS item number. In addition, you can add the Veteran Access Payment (VAP) for time-based items, which is like the bulk billing incentive. The Coordinated Veterans’ Care (CVC) program supports complex patients who require extra care coordination.
DVA can be billed for all clinically necessary care provided to veterans with a gold card and for treatment related to the patient’s accepted conditions on a Veteran card, or for mental health conditions (under non-liability mental health care arrangements).
- What are the most common mental health presentations registrars are likely to encounter in veteran patients, and how does Open Arms support GPs in managing these?
Like civilians, the most common mental health conditions among veterans are anxiety disorders including PTSD, followed by affective disorders including depression, at about the same prevalence. Leaving service (Transition) can be a time when these problems worsen, as veterans are adjusting to a major life event, with changes in identity, community, work and social connections. A Veterans’ Health Check can help you carefully explore this with them. Musculoskeletal and hearing issues are also common presentations.
Open Arms offers a free counselling service to veterans and families of veterans. Open Arms staff are trained to understand the demands of military service, with some having military experience themselves.
Open Arms also has other services complementary to GP mental health care – group programs in managing anger, recovery from trauma, couples’ connection and more, as well as lived experience peer support. Peer support can be a very useful step into or down from more intensive mental health services. For your clients needing a bit of extra support, Open Arms can help with care coordination.
They also offer a 24 crisis support line, and a 24 hour anonymous support line – useful for any clients who are worried about revealing their names.
- How can registrars access Open Arms and refer patients to their services – and what does that referral pathway actually look like in practice?
Patients can be referred to Open Arms via phone, email, fax, or self-referral. All the details are available on the Open Arms website or through the Referral and Support section of the Veteran HealthPathways. So you can complete a written referral, or you may choose to call and do a warm handover with the veteran or family member in the room with you, to make sure they are connected in. With appropriate consent, Open Arms will communicate with you about treatment.
If veterans don’t want to use Open Arms, DVA also has non-liability mental health care for veterans, meaning DVA will fund treatment of all mental health conditions even if they have not been linked to their service. This includes psychological treatment, prescribed medications, relevant allied health treatment as part of a veteran mental health management plan and more.
- The VETs HeLP platform is a free resource for GPs. What would you highlight as the most useful modules or webinars for a registrar just starting to build their knowledge in veteran healthcare?
This depends on their stage of training and what they already know. VETs HeLP, is a great resource for the veteran health and military medicine components of the RACGP curriculum, which may come up in the exam. As well as being free, all content is CPD-accredited by RACGP and ACRRM.
All the activities have been specifically designed to have immediate use in primary care. If you are trying to figure out how to bill DVA for the care you provide then “Understanding veterans’ healthcare” is a great place to start. If you have been asked to complete a veteran compensation report, “Supporting veterans’ compensation claims” would be helpful. If you see a lot of mental health clients, veteran or not, then “Complex mental health conditions” could be for you.
If you are new to veteran patients, the quick guides are another way to rapidly understand DVA essentials. They can be found at Quick guides and tools | Department of Veterans’ Affairs. This includes information about eligibility, billing for First Nations veterans and much more.
- You mentioned some new VetsHelp webinars on Transition and Lifestyle Medicine coming soon – can you give registrars a preview of what to expect and why these topics are particularly relevant to their training?
The VETs HeLP webinars are led by experienced GPs and other health care professionals, and supported by other veterans, making them really fascinating and practical. Webinars are often very applicable to other patients as well – people going through major life transitions or needing lifestyle modifications are commonly seen in General Practice!
The Transition webinar was held on Tuesday (21 April). The webinar featured Dr Natalie Boulton, a Navy veteran and GP along with Sean Hewitt, an Army veteran and Lived Experience/Community Peer at Open Arms.
The webinar on Lifestyle Medicine for Veterans is scheduled for Tuesday 26 May at 7pm AEDT. The webinar will include Dr Sam Manger, a GP and Lifestyle Medicine expert along with Sarah Watson, an Army Intelligence veteran, Assistant Director at DVA and qualified yoga instructor.
If you’re interested in more information or to watch previous webinars, please go to Veterans’ Health Hub: Resources & Support for Clinicians.
- For registrars considering an ADF training pathway, what opportunities exist to develop their skills in military and veteran health – and what excites you most about the next generation of GPs working in this space?
Registrars undertaking the Australian Defence Force training pathway will naturally get lots of amazing experiences and training in military and veterans’ health.
For registrars who are part of the more usual training pathways, there are opportunities to see veterans anywhere in Australia and support available to do so. In addition to the above, Veterans’ and Families’ Hubs around the country can support social connection, employment and more. From July 1st there will also be a Veteran and Family Wellbeing Agency that veterans can be connected to. This will help GPs to concentrate their part in care.
Dr Anna Colwell is Deputy Chief Health Officer at the Department of Veterans Affairs and a Canberra GP.
