Forum Powerpoint_031121

Provider Forum 3 November 2021

Agenda PHO Update. Lindsey Webber, CEO, WBOP PHO Reflecting on 2021. Dr Luke Bradford, Chief Medical Officer, BOP DHB PHO Clinical Update. Dr Claire Isham, Clinical Director, WBOP PHO

Integrated Primary Mental Health & Addictions Service update.

Bharat Mahajan, Program Manager – IPHMAS, WBOP PHO Bay of Plenty DHB Mental Health Clinical Service Plan. Emma Joyce, Nurse Lead & Dr Marcel Hediger, Consultant Psychiatrist, BOP DHB System Level Measures and beyond. Phil Back, General Manager, Practice Services, WBOP PHO

Whakataka te Hau Karakia Timatanga (opening) Whakataka te hau ki te uru Whakataka te hau ki te tonga Kia mākinakina ki uta Kia mātaratara ki tai E hī ake ana te atakura He tio, he huka, he hau hū Tīhei mauri ora!

Cease the winds from the west Cease the winds from the south Let the breeze blow over the land Let the breeze blow over the ocean Let the red-tipped dawn come with a sharpened air A touch of frost, a promise of a glorious day

PHO Update Lindsey Webber CEO, Western Bay of Plenty Primary Health Organisation

Reflecting on 2021 Dr Luke Bradford, Chief Medical Officer, BOP DHB

WBOPPHO FORUM RD 3 NOV 2021

We are now opening this up to all SMOs and GPs in BOP to increase usefulness. The more doctors on board, the better it will work.

We would love you to join. Simply text our GP Liaison Dr Chris Tofield on 0221501058 and he can text you an invitation link. Any questions, feel free to contact Chris as well.

CELO: INCREASING USE BY GPS/SMOS • Download app • Change your department to General Practice in Settings • Run under the GP/SMO Platform

• Text Chris Tofield on 0221501058 who will send you an activation code

PREFERRED CONTACT METHOD • 14.5% DNA rate for Maori to OP 6% general • All through letters • Will soon be prompted to check preferred method of contact on referrals via BPAC • At first manual, are working on auto populate system

900

100

800

90

700

80 70

Cases

600

60

500

50 400

40

300

30

200

20

100

10

-

Hospital Admissions & Beds

BOPDHB COVID-19 @ 90% Eligible (12 yr + Vaccinated)

1 2 3 4 5 6 7 8

1 2 3 4

1

2

3

4

5

6

7

8

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Cases (Left axis)

A potential view, 90% 12+ vaccinated, Bay of Plenty DHB Week # 1 2 3 4 5 6 7 8 9 Cases (Left axis) 15 31 56 80 96 116 139 173 208 Admissions 1 2 3 6 7 8 10 14 Beds occupied 0 1 2 3 4 5 6 9 ICU occ 0 0 0 1 1 1 2 Admit % 3% 3% 4% 6% 6% 6% 6% 7%

10 249 17 11 2 7%

11 349 20 13 3 6%

Admissions

12 410 22 15 3 5%

Response Phase: Contact Tracing High demand Overloaded COVID-19 Testing Pop up community testing centres stood up to ensure ease of access 7 days COVID-19 +ve Cases Care in Community 90%+ of cases will be cared for in community Planned Care Decision To Reduce / Stop based on IPC Risk & Capacity BAU

13 656 23 16 4 4%

Beds occupied

14 820 38 22 4 5%

15 779 66 37 5 8%

16 740 62 46 7 8%

ICU occ

17 703 59 43 10 8%

18 668 56 41 13 8%

19 535 53 39 13 10%

5

Parameters used ALOS (non-ICU) = 5 days ALOS in ICU = 14 days, 10% of hosps Volumes based on HSU population of DHB Age 12+ vaccinated to 85-90% Peak is around 4 weeks in length Surge is over a 3-4 month period Daily maximums can be 3x the average Monitoring patients at home = 10 day course Planning principles Plan for managing peaks Regional spread of load - when differential impact able to spread load Hospital capacity key limiter Maintain capacity for non-covid medical and surgical emergencies Primary care is able to manage and monitor unwell covid patients at home at least as well as MIQ facilities have done to date

20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 410 328 295 266 239 215 194 174 173 156 140 126 113 102 80 43 23 19 17 15 14 14 14 14 14 13 11 10 9 8 34 24 15 13 11 10 10 10 10 10 10 9 8 7 6 12 11 10 7 5 4 3 3 3 3 3 3 3 3 2 10% 7% 6% 6% 6% 6% 7% 8% 8% 9% 9% 9% 9% 9% 10%

Winter peak & living with COVID

35 36 37 72 80 96 6 5 6 5 4 4 2 2 2 8% 6% 6%

38 80 7 4 1 8%

39 40 41 64 80 96 6 5 6 4 4 4 1 1 1 9% 6% 6%

42 80 7 4 1 8%

43 44 45 64 80 96 6 5 6 4 4 4 1 1 1 9% 6% 6%

Restart based on IPC risk & capacity Long COVID & delayed care Impacts

46 80 7 4 1 8%

A potential view, 80% 12+ vaccinated, Bay of Plenty DHB Numbers from scenarios in Summary sheet, estimates between An initial surge upon introduction, eventual control and steady state endemic covid thereafter week

A potential view, 80% 12+ vaccinated, Bay of Plenty DHB 1,400

200

Peak

1,200

160

Cases per week

1,000

140 120

800

100

Surge 600

80 60

Steady state

400

40 200

Hospital admissions/beds

180

20

-

0 1

3

5

7

9

11

13

15

Cases per week Hospital admissions/beds

17

19

21

23

25

27

29

31

33

35

37

39

41

43

45

Week Cases (Left axis)

Admissions

beds occupied

ICU occ

Assumptions

[For Scenarios see Summary page]

Steady state

Describes the longer term case and hospital load. Assume 85-90% vaccination rate, tight public health controls - Scenario 2 Expect a initial surge as the virus outruns the public health efforts to hit the unvaccinated otherwise immune-naive population. Uses Scenario 5 - Looser controls, 90% vaccination Allow for up to double the caseload within the surge for a week or two - 2x the Scenario 5 cases, 3x the hospitalisations

Surge Peak

1 2 3 4 5 6 7 8

1 2 3 4 5

Parameters used ALOS (non-ICU) = 5 days ALOS in ICU = 14 days, 10% of hosps Volumes based on HSU population of DHB Age 12+ vaccinated to 85-90% Peak is around 4 weeks in length Surge is over a 3-4 month period Daily maximums can be 3x the average Monitoring patients at home = 10 day course Planning principles Plan for managing peaks Regional spread of load - when differential impact able to spread load Hospital capacity key limiter Maintain capacity for non-covid medical and surgical emergencies Primary care is able to manage and monitor unwell covid patients at home at least as well as MIQ facilities have done to date

Estimates

Daily cases Daily admissions Daily ED attends Daily ED attends w covid Daily child cases Primary care monitored /day Primary care consults / day Avg occupied beds Max occupied Average ICU Max ICU Infectious per 1000 pop

Steady Surge (3-4 Peak (4state months) 6 weeks) Notes 25 85 170 Estimated deaths over year: 125 2.0 6 18 5 15 45 Presenting with covid symptoms 0.3 1 3 Just happen to have covid, presenting for other things - ie not necessarily w symptoms 5 23 69 Ages 0-14, included in the above; very few hospitalisations 27 111 221 For any one day the number being monitored across the DHB 17 58 173 For direct covid care - resp symptoms, diagnosis etc - excludes eg long covid 12 46 53 36 82 82 4 17 25 12 32 32 1 3 5 Chance of a person being infectious at any point in time

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

31 32 33 34 35 36 37 38 39 40 41 42 43

Cases (LeftAdmissions axis) beds occupied bed nights ICU occ 80 0 0 0 0 173 6 2 14 0 208 14 7 50 0 249 17 11 78 2 289 20 13 93 4 347 25 16 115 5 417 31 20 140 6 592 37 24 168 7 948 42 28 196 9 1,185 67 39 272 10 1,126 117 66 460 13 1,069 111 82 571 21 1,016 106 78 543 29 965 100 74 515 32 772 95 70 490 30 592 76 61 429 29 474 42 42 295 26 427 33 27 188 21 384 30 23 159 14 346 27 20 143 10 311 24 18 129 9 280 24 17 122 8 252 25 18 125 7 249 25 18 127 7 224 25 18 127 7 202 23 17 121 7 182 21 16 109 7 163 19 14 98 7 147 17 13 88 6 173 15 11 79 5

156 173 208 173 138 173 208 173 138 173 208 173 138

14 13 14 17 14 11 14 17 14 11 14 17 14

10 10 10 11 11 9 9 11 11 9 9 11 11

73 67 67 78 78 64 64 78 78 64 64 78 78

5 4 4 4 4 4 4 4 4 4 4 4 4

Context: COVID-19 Primary Care Clinical Model •

The clinical expertise and skillsets in the primary care sector can be leveraged and supported to manage the evolving COVID-19 pandemic. This is especially the case as the pandemic becomes endemic and part of everyday life.

•

The pressures on the northern region requiring a more sustainable model of COVID-19 management has informed the development of a COVID-19 Primary Care Clinical Model that is fit for purpose and still adaptable to the evolving situation.

•

The proposed COVID-19 Primary Care Clinical Model leverages existing expertise, infrastructure, connections and trusted engagements in primary care that can be built on at pace and easily scaled up when required.

•

Primary care, particularly general practice currently support over 4.8 million enrolled individuals/whānau. It therefore makes sense to leverage existing patient-clinician connections with general practice, for those who are already engaged or willing to engage with general practice.

•

An equitable approach should be applied to all whānau and individuals that require clinical management and support in the community. Regions need to work in partnership with Māori and Pasifika providers along with iwi/hapū and community to ensure that their needs and aspirations are placed at the centre of service delivery.

•

The COVID-19 Primary Care Clinical Model allows for regions to adapt, tailor and flex the model to meet local needs, and address local workforce capacity constraints.

•

The COVID-19 Primary Care Clinical Model takes into consideration the clinical and social requirements of the whole household / whānau ‘bubble’. The clinical risk profile of a ‘bubble’ is determined by the most vulnerable/at-risk member of the bubble.

•

The focus of the COVID-19 Primary Care Clinical Model remains on safe, quality and effective clinical care.

•

The community care, welfare, home and community, mental health and disability support needs of the household/whānau are organised alongside the COVID-19 Primary Care Clinical Model. This organising function is currently being explored in the Auckland region and South Island in the form of a coordination ‘hub’ for health and social supports.

•

Compliance and security requirements for management of cases in the community are deliberately kept separate from the COVID-19 Primary Care Clinical Model to protect the integrity of the therapeutic relationship. The delivery of these aspects are being considered separately to this work.

•

The COVID-19 Primary Care Clinical Model has been informed by overseas models such as the RPA Virtual Hospital in NSW Australia and Ontario Canada, and local models (NRHCC, CDHB, SDHB) across New Zealand.

13 DRAFT – NOT PUBLIC POLICY – October 2021

Benefits of a ‘mix / hybrid’ shared care model The COVID-19 Primary Care Clinical Model takes a shared care approach across primary care (general practice), telehealth services, secondary care, Māori and Pacific healthcare services and other allied health workforces.

The benefits of a shared care approach include: •

The ‘burden’ on the health workforce is shared and mobilised across the health system. This includes supporting the stretched general practice workforce who are also delivering testing and vaccinations, on-top of everyday clinical care.

•

There is flex and resilience in the system to manage surge and future outbreaks.

•

Clinical expertise and capacity in the primary care sector is utilised to keep people well in their homes (where appropriate to do so) and reduce demand on secondary care resources (eg. hospitals). The model focuses on reserving specialist resources in primary and secondary care to manage complex conditions and cases.

•

An integrated model of care that has the flexibility to be tailored and adapted to local contexts and needs (including rural community needs) as the pandemic evolves.

•

Existing infrastructure, clinical capacity and capability in telehealth services can be leveraged quickly to support primary care. A base level of telehealth support is available to general practice to manage low risk in the community. Additional support is available for those with medium risk, and follow-up care.

•

More intensive clinical management and wrap around support capacity is made available for those with more complex conditions, medium risk (includes consideration of social support requirements), and moderate symptoms that can deteriorate quickly.

Clinical pathways have been developed to support the COVID-19 Primary Care Clinical Model

DRAFT – NOT PUBLIC POLICY –October 2021

14

Currently • Pathway being finalised • Work on Social Support • Surveying practices • Practice Packs • Patient Packs • Interfaces with hospital/OOH/Palliative/Social Support/Virtual Round/Public Health

DRAFT V2 – NOT PUBLIC POLICY – 17 October 2021

15

DRAFT V2 – NOT PUBLIC POLICY – 17 October 2021

16

Adapted from West Metro Victoria, Australia, by Dr John E, Dr Christine M and then by Ministry of Health Oct 2021

COVID-19 Primary Care Clinical Model (The model refers to sections in green. Other sections are being developed in parallel and sit outside this scope) Clinical Care Of people with COVID-19

Identification of People with COVID-19 Notification

• Primaryand community

• • •

Notification of positive test Register, inform, assign, investigate case, create location, link case Provision of isolation and infection control guidelines Contact tracing questionnaire Assess suitability of isolation at home / in community settings Notify registered general practice / PHO, or assign primary care clinical provider if not enrolled

Hospital Provider / Function TBC • Arrange welfare, accommodation and transport • Social and welfare needs assessment • Social and welfare care coordination with Community SIQ coordinator

Escalation / De-Escalation

Initial Virtual Consultation • •

•

• •

Model of Care Level 1: Regular virtual/telehealth health check monitoring, referral for other health and social supports

Low

Clinical assessment risk factors and severity of symptoms identified Risk stratification and clinical assessment to determine care level Assess whether non COVID-19 health care is being addressed, and social supports are being activated Liaise with public health, Community SIQ as needed.

Notify community pharmacist if known

Medium

Workforce: Hybrid model integrating with individual/whānau regular or alternative general practice provider with urgent care support, telehealth services, service navigator and kaiāwhina support Model of Care Level 2: Regular more frequent virtual/telehealth health check monitoring and consultation as required, supported by multi disciplinary clinical team with shared care approach. (In person care may be required for non-covid urgent care needs).

Workforce: Whānau centric MDT includes general practice, telehealth services clinical team, urgent care, secondary care specialists and nurses, pharmacists, physiotherapists and paramedics (to be regionally determined), service navigator and kaiāwhina support Model of Care: Acute care in hospital setting, or palliative care

High

Workforce: Secondary care teams, service navigator and kaiāwhina support

COVID-19 HealthPathways Telehealth services for COVID-19 enquiries and after-hours clinical advice Data capture and integrated IT systems Welfare and social support, accommodation and transport Shared governance and oversight to support continuous improvement

DRAFT – NOT PUBLIC POLICY – October 2021

Emergency ambulance transfer

• •

Review Plan

Discharge and Clearance

Follow-up check

Primary Care / General Practice

Public Health TBC

Symptoms

Test setting

Risk Stratification

Assessment

Clinical Service Release

Public Health Release

General Practice / Primary Care / Telehealth Services

COVID Care Cases + Contacts PROPOSED CENTRAL HUB: Manaaki social and cultural care, COVID-19 specialist care, hospital in the home, palliative care

CURRENT: MIQ BCMS and NCTS

PROPOSED PROTOTYPE: Community COVID Care Provider/s Immediate model uses BCMS and NCTS

Information pack +/- oximeter, phone

Clinical Monitoring, Social support +/- Public Health Monitoring

+

DEVELOPMENT: Community COVID Care Primary Care General Practice Requires development of PMS integrated & centrally connected IT

Testing

Information pack +/- oximeter, phone

Clinical Monitoring, Social support +/- Public Health Monitoring

Testing

PC Practice

PC Practice

PC Practice

Low volume

Surge

Surge + BAU

MIQ facilities (hotels)

In home / In community

In home / In community

Key Components of Model (DRAFT) Central Coordination • Referral in, through and out • 7 days a week • Triage public health risk • Inform their GP they have COVID • Match with a virtual monitoring provider (usual provider as a default?)

• Clinical triage 24/7 • Compliance • Contacts?

• Are they becoming a case/ testing?

Routine care (virtual) • Provided by own GP where possible • Or if no GP then by their virtual monitoring provider? * Note: process map for MIQ outreach model currently in development

COVID-19 Monitoring (virtual) • Assess personal health risk – who fits this against public health risk?

• For medium + risk cases or all?

• General practice (?groups initially then all) • ‘Specialist’ model for some whanau: Maori and Pacific providers • Including mental health e.g. HIP? • After hours, weekends, public holidays?

• Palliative care Manaaki/welfare • Psychosocial assessment and support • Could be same provider as above or different Home supports Community health services, HCSS

Red Stream Centres • For urgent face to face • Including urgent non-COVID related for COVID/respiratory symptom patients

Hospital

Hospital in the Home • Early Supported Discharge • Intermediate care?

• DHB provided, likely to differ slightly between districts

Adapted for the New Zealand Context from Determining Risk for rpavirtual Community COVID-19 Positive patients V 3.1

COVID-19 Clinical Risk & Management Algorithm Clinical Monitoring Needs for Isolating and Quarantine Period VAX STATUS

Unvaccinated or Partially Vaccinated

Fully Vaccinated

AGE M &PI <60 years Others < 70 years

M &PI >60 years Others > 70 years

M & PI ≥ 50 years Others ≥ 60 years

M & PI <50 years Others < 60 years

M & PI < 40 years Others < 50 years

M & PI ≥ 40 years Others ≥ 50 years

MEDICAL RISK & SOCIAL NEEDS No Significant Medical History

High Risk Medical History Or Social Needs Factors

Very High Risk Medical History

SYMPTOMS

High Risk Medical History Or Social Needs Factors

No Significant Medical History

Asymptomatic or Mild symptoms

Very High Risk Medical History

Moderate Symptoms

RISK LOW

MEDIUM

HIGH

MEDIUM

HIGH

OXIMETER

VERY HIGH

COVID-19 Clinical Risk & Management Algorithm

MEDICAL RISK & SOCIAL NEEDS High risk medical history (all ages) • • • • • • • • • • •

Chronic lung disease Cardiovascular disease Active cancer Immunosuppression Chronic kidney disease Diabetes (Type 1 &2) Liver Disease Significant frailty or disability Major mental illness Pregnant < 20 weeks Obese BMI > 30

Very high risk medical history (all ages)

High social needs

• Dialysis patient • Home oxygen requirement or known severe lung disease • Transplant patient • Active haematological malignancy.

• Currently receiving chemotherapy or severely immunocompromised • Pregnancy> 20weeks

Complex social circumstances e.g.: • Access to phone/video consult • language barriers, • large households, absence of a suitable caregiver, • socially isolated, • geographical location and transport factors that impact speed of access to higher levels of care

Model of Care The model of care level is determined by the risk of the most vulnerable/at-risk person within a ‘bubble’ and the intensity of symptoms A detailed assessment tool sits underneath this framework and will be available through the COVID-19 Community HealthPathways

Low Risk

Medium to High Risk

SYMPTOMS mild

Level 1

mod

mild

Level 2

DRAFT – NOT PUBLIC POLICY – October 2021

mod

severe

Hospital

COVID-19 Clinical Risk & Management Algorithm

Clinical Monitoring Protocols RISK Advice/ information pack Oximeter Smart Phone or tablet +/- culturally appropriate face to face care Monitoring

6-week follow up

LOW*

MEDIUM

HIGH

VERY HIGH

ADMISSION

Digital

Pack

Pack

Pack

n/a

no

yes

yes

yes

n/a

No (not low risk if no phone)

no

yes

yes

n/a

no

If required

If required

If required

HealthPathway Alternate day monitoring

HealthPathway Daily monitoring

HealthPathway Daily monitoring

HealthPathway Twice daily monitoring

n/a

immunise

immunise

immunise

Symptom check & immunise

Clinical Model of Care – Level 1 • Providers

General practice, telehealth services, Māori and Pasifika clinical providers, community pharmacy • Workforce (may include): Clinical workforce for monitoring and management: Nurses, nurse practitioners, GPs, telehealth services clinical team, clinical support through Māori and Pasifika providers, community pharmacists, physiotherapists, counsellors

Non-clinical workforce for support: HIPS & Health Coaches, Māori and Pacific providers, translation services, community support workers, kaiāwhina, cultural support workers, service navigators • Decision-making framework: Triage and escalation pathway, testing and results for consults • Training / Guidance: COVID-19 Community HealthPathways, clinical webinars, 0800 COVID-19 Positive Line for cases, Clinician to Clinician helpline • IT: Integration with shared care record between NCTS, public health, primary care (PMS), telehealth and secondary care providers • Equipment: Patient access to cell phone with data or landline (video capability if available), testing kits, PPE

DRAFT – NOT PUBLIC POLICY – October 2021

Clinical Model of Care – Level 2 • Providers Whānau at the centre of a general practice virtual multidisciplinary team providing shared care approach for daily virtual/telehealth monitoring and supportive management of COVID, co-morbidities and chronic care.

Virtual team ‘hub model’ for the coordination of health services to be regionally determined across primary, community and secondary care • Workforce (may include): Clinical workforce for monitoring and managing care: GPs and Urgent Care doctors, nurse practitioners, nurses, clinical support through Māori and Pasifika providers, community pharmacists, secondary care clinicians and nursing, telehealth services clinical team, paramedics, physiotherapists, counsellors Non-clinical workforce for support: HIPS & Health Coaches, Māori and Pasifika providers, translation services, community support workers, kaiāwhina support, cultural support workers, service navigators • Decision-making framework: Triage and escalation pathway, testing and results for contacts • Training / Guidance: COVID-19 Community HealthPathways, clinical webinars, 0800 COVID-19 Positive Line for cases, Clinician to Clinician helpline • IT: Integration with shared care record between NCTS, public health, primary care (PMS), telehealth and secondary care providers

• Equipment: Pulse Oximeters, thermometers, cell phone with data or landline (video capability if available), testing kits, DRAFT – NOT PUBLIC POLICY – October 2021

PHO Clinical Updates

Topics 1 End of Life Choice Act – goes live 7 November 2 Bowel Screening Programme – postponed to March 2022 3 GP Led MRI Service 4 Upcoming Halcyon form release 5 Updates from the PHO Mental Health team 6 Gynae Threshold Change 7 A reminder re. the hospital covid clinic 8 PHO Training

End of Life Choice Act. From 7th Nov….

• Referral process • Overview • Practice policy • Preparing staff • Getting support

End of Life Choice Act. From 7th Nov….

How to refer?

• All information will be available from 7th Nov on the MoH website • Referral numbers/email • Printable patient handouts

• Refer by contacting the Assisted Dying Service Secretariat • Phone number and email to be advised

• Local AD provider list will not be made available

Process

Practice Policy

Learning Module

Resource

Resource

Resource

Does your practice need support?

Contact your General Practice Liaison representative to enquire about an in-practice education session

Bowel screening in the Bay of Plenty • The Bay of Plenty National Bowel Screening Team (NBSP) completed the first stage of its readiness assessment via a virtual meeting with the Ministry of Health review team on 1 September.

• Due to delays from Covid restrictions, and other operational issues, the launch of bowel screening in the Bay of Plenty has been deferred until 22 March 2022.

• The Ministry has emphasised the importance of delivering timely colonoscopy procedures for both symptomatic patients and screening participants, before bowel screening is launched and the DHB are actively working on achieving this.

GP Led MRI Service •

Training running 4 Nov in Tauranga and 9 Nov in Whakatane.

•

Further training will run in early

2022 for additional GPs who would like to participate, with priority attendance given to any practices

who do not have a representative at the November trainings.

Upcoming New Halcyon forms LARC and Cellulitis Planned for release in December

Update from the PHO Mental Health team Recent referrals received for high risk individuals.

A reminder that PHO services are for mild to moderate mental health issues.

When a patient presents with a Kessler score over 35 (indicative of severe distress and illness) referral to secondary mental health services for support is recommended.

Semi urgent referrals can be made through Best Practice but be aware Best Practice referrals are opened only during office hours.

If your client is requiring Urgent support, please contact the Crisis team on 0800 800 508 Referrals can be emailed to the Crisis Team on mhcrisis@bopdhb.govt.nz This email address is monitored 24/7.

Gynae Threshold Change As of Monday 18/10/21, the threshold for gynaecology referrals changed to decline grade 3 referrals.

Please see this page on Bay Navigator for more information.

You can access gynaecology guidelines via Midland HealthPathways.

Username: midlanduser Password: midlandpassword

Hospital covid clinic Available for high risk patients and sedation

PHO Training COPD Management for Nurses Friday 19 November 2021, 8.30 – 1.00pm

Event flyer and programme will be circulated shortly.

While this training and programme is designed to be nurse led, interested GPs can also participate.

Insulin Initiation in Primary Care Fri 11 November 2021, 8.30 – 4.00pm.

Please note – you must have completed a Diabetes Fundamentals course prior to attending this session.

RSVP to jennyf@wboppho.org.nz

Integrated Primary Mental Health & Addiction (IPMHA) Service update Bharat Mahajan, Program Manager - IPMHA, WBOP PHO

IPMHA • Primary health organisations (PHOs) and general practice teams are often the first point of contact for many people experiencing mental health and/or addiction issues.

• A new model of integrated primary mental health and addiction services (IPMHA) is being implemented across New Zealand by the Ministry of Health. This model of care is part of a suite of services being developed to expand access to, and choice of, Primary Mental Health and Addiction support.

• The aim of these new services is to: • Increase access and equity of access • Increase choice in addressing people’s holistic concerns • Reduce wait times for mental health and addictions support • Improve population health and equity outcomes • This service is for anyone who is enrolled in the practice whose thoughts, feelings or actions are impacting on their health and wellbeing. There are no barriers to accessing this support, no referral criteria, no wait time, no cost to the patient and services are designed to ‘flex’ to meet the identified population health needs.

IPMHA • There are ‘key components’ of the service which will look similar across New Zealand. All services will be accessed via the general practice with priority given to Māori and Pacific peoples, youth and those people living in rural and remote locations. Some services may choose to use a locally relevant name for their service; however, in all cases new staff will join the practice team and become integrated within the practice. The key components of the service include: • Health Improvement Practitioner (HIP) - an experienced and registered mental health clinician who will provide assessment and brief intervention therapy as needed • Health Coach (HC) – a trained support, peer or cultural worker who will support the individual to manage their health through a range of personalised interventions/Support Worker (SW) who will provide access to cultural and social supports within the local community.

• A confident and competent general practice team. Effective links and coordination between primary and secondary services. The HIP and HC work as a part of the practice team to provide brief intervention focused on strengthening self-management strategies.

Their notes are written directly into the practice-based PMS and ‘warm handovers’ ensure that the practice team members can make an introduction when the need arises and are kept updated with patient information. Additionally, the HIP also supports the practice team through psychoeducation, consultation and identifying patient pathways to increase access to behavioural support.

Key Features of HIP and Health Coach roles: • Actively seek work rather than waiting for “referrals” • See on average 8-10 people per day • Write clear and concise notes within the practice management system that comply with established standards • Be able to demonstrate skills, knowledge and attitudes that ensures culturally safe practice • Use agreed outcome measurement tools and session rating scales each time they see a person • Review performance reports with their professional leaders and colleagues to develop their own practice/assess fidelity to the model and further develop services (PHO is responsible for meeting this criteria) • Receive regular supervision and ongoing professional development (PHO is responsible for meeting this criteria)

General Practice Team: • Will integrate HIP into Practice team • Will make available appropriate facility resources (including room) as appropriate • Will provide HIP with full access to Practice PMS for recording of encounters and outcomes • Will accommodate HIP bookings into PMS appointments palette • Enable and support Orientation (supported by PHO) • Support ongoing training needs, peer supervision and clinical supervision (provided by the PHO) • Data collection for MOH reporting (shared responsibility of the General Practice and PHO) • Enable warm handover process

Integrated Primary Mental Health & Addiction Model Patient/ Whānau

Feedback pathway

GP

HIP

Practice Nurse

No further support required

Referral to Kaiārahi/Health coach/ CSW

Whānau/ family engagement

Session 1: Introduction Duke/SDQ Identify problem Risk assessment Practice Commitment END

Session 2: Introduction Duke/SDQ Identify problem Risk assessment Practice Commitment END

Intervention fACT CBT Mindfulness Self Management

Intervention fACT CBT Mindfulness Self Management

Referral to NGO s + Other community services

Cultural support practices e.g Marae, te reo, kapa haka

CSW/ parenting support/ WINZ/ HNZ/ Women s Refuge/ Peer support/ Employment support

Dedicated youth support

Referral to Primary Care MH & A Support

Referral to Secondary MH & AS

Referral to Oranga Tamariki

Support triage process

Support notification process

Questions?

Bharat Mahajan Program Manager - Integrated Primary Mental Health and Addictions Service

P: (07) 571 7160 | M: 0211992096 | E: bharatm@wboppho.org.nz

Bay of Plenty DHB Mental Health Clinical Service Plan Emma Joyce, Nurse Lead, BOP DHB Dr Marcel Hediger, Consultant Psychiatrist, BOP DHB

System Level Measures and beyond Phil Back General Manager - Practice Services WBOP PHO

Primary Care Focus - current year Acute Hospital Bed Days - Cellulitis in EBOP - COPD in EBOP - NZ CVD Clinical Guidelines (2018) Amenable Mortality - Maximising breast and cervical screen coverage - Focus on pre-diabetic patients - Seasonal Flu campaigns, particularly for Māori 65+ - Pilot Te Ahunga Whānau Community Nurse/Kaiawhina

Youth Health - Mapping of Youth Mental Health Services - Strengthen School Health Services

Ambulatory Sensitive Hospital Admissions - Use of Risk Stratification to reduce ED attendances - Increased referrals for asthma patients to Healthy Homes - Equity in access to Oral Health services for our BOP children

Patient Experience of Care - Enhanced cultural awareness across Practice network - Enhance Shared Care Plans for patients with Long Term Conditions - Increased uptake of Advanced Care Plans - Increased Patient Portal uptake - Improve Māori participation rates in PES by recording email address Babies Living in Smoke Free Homes - Stop Smoking incentive programmes for pregnant women - Key health professionals supported to provide brief advice to pregnant women, particularly LMC and secondary care personnel.

Beyond System Level Measures 1 July 2022 – Health System Indicators adopted 6 areas of Government Priority - Improving child wellbeing - Improving mental wellbeing - Improving wellbeing through prevention - Strong and equitable public health system - Better primary health care - Financial sustainable health system 2 High-level indicators for each priority 2 key descriptors of each indicator to reflect system performance

High-level indicators influenced by Primary Care Improving child wellbeing: - Immunisation rates for children at 24 months - Ambulatory sensitive hospitalisations for children (0-4) Improving mental wellbeing: - Under 25s able to access specialist MH services within 3 weeks - Access to primary mental health and addiction services Improving wellbeing through prevention: - Ambulatory sensitive hospitalisations for adults (45-64) - Participation in bowel screening programme

Strong and equitable public health system: - Acute hospital bed day rate - Access to planned care Better primary health care: - People report they can get primary care when they need it - People report being involved in the decisions about their care and treatment Financially sustainable health system: - Annual surplus/deficit at financial year end - Variance between planned budget and year end actuals NB:

We are still to receive any advice in respect to retention of current SLM funding. This is being pursued via PSAAP.

Kia tau Karakia whakamutunga (closing) Kia tau kia tātou katoa Te āio, te aroha me te marutau Tīhei Mauri Ora

May peace, love and safety Be upon us all Let there be life

Sixth 2021 PHO Provider Forum

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