Forum Powerpoint_150622

Provider Forum 15 June 2022

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

Agenda Speaker

Session

Phil Back, General Manager, Network Services, PHO Update 7 to 7.15 PM WBOP PHO Dr Sam Lepine, Obstetrician and Gynaecologist, Gynaecology Service Update BOP DHB 7.15 to 7.35 PM Dorothy McKeown, Business Leader, Hospital Planned Care Services Update Services, Surgical Services, BOP DHB Angela Durham, Planned Care Services 7.35 to 7.45 PM Manager, BOP DHB Dr Scott Crawford, Nephrologist & General Physician, BOP DHB Dr Gavin McHaffie, Clinical Lead for Renal, Nephrologist & General Physician, BOP DHB

Renal Service and recent developments 7.45 to 8.05 PM

Michelle Meyer, Clinical Advisor, WBOP PHO

Cellulitis Review 8.05 to 8.15 PM

Dr Claire Isham, Clinical Director, WBOP PHO Dr James Peckett, Clinical Advisor, WBOP PHO

PHO Clinical Update 8.15 to 8.30 PM

PHO Update Phil Back

General Manager, Network Services Western Bay of Plenty Primary Health Organisation

Gynaecology Service Update Sam Lepine 15.06.2022

Service Update Department COVID Response Recovery

Michael JOHN – Clinical Director Penelope MAKEPEACE – Head of Department Chris THURNELL

Department

Bill McAULEY Aparna BASU Brad CHITTENDEN

Claire BRENMAN • 2020. Urogynaecology

Lynelle TAYLOR

New Hires

• 2022. Generalist

Katie CULLINEY • 2021. Education

Sarah YOUNG • Pending. Generalist

Capacity issues Unprecedented Challenge

Covid Perspective

Initially somewhat recoverable Staffing Crisis • Illness • Vaccine Mandate

17 Midwifes lost due to Mandate Whakatane closures

Maternity Perspective

BBC closures Complexity of Covid in labour

Gynaecology Clinics • 20/week. 7 patients per session • Decreased to Approx. 5/week

Gynaecology Theatres • Theatre • 8 Operating Theatres • 7/week. 300minutes per session • Decreased to Approx. 2/week • Minors vs. Majors

Days Waiting

Waiting List Procedure

337

(PRIORITY D) TLH + BS + UNILATERRAL OOPHERECTOMY O

287

(PRIORITY D) LAPAROSCOPY ENDOMETRIOSIS REMOVAL INS

286

LAPAROSCOPIC BSO - PALMER POINT ENTRY

279

(PRIORITY D) LAPAROSCOPIC OVARIAN CYSTECTOMY

248

(PRIORITY D) HYSTEROSCOPIC POLYPECTOMY

241

(PRIORITY D) LAPAROSCOPIC ADNEXL CYSTECTOMY

227

(PRIORITY D) TLH

220

(PRIORITY D) TLH + BS + EXC ENDO

203

(PRIORITY D) LAPAROSCOPIC EXCISION OF ENDO + MIREN

199

(PRIORITY D) OPERATIVE LAPAROSCOPY

191

(PRIORITY A) LAPAROSCOPIC EXCISION OF ENDOMETRIOSI

189

(PRIORITY D) TLH + B.S.

188

(PRIORITY D) DIAGNOSTIC LAPAROSCOPY +-TREATMENT OF

185

(PRIORITY D) OPERATIVE LAPAROSCOPY

182

(PRIORITY D) TLH + B.S.

181

(PRIOTRITY D) OPERATIVE LAPAROSCOPY + MIRENA EXCHA

Response • Phone Consults • Referral Grading • How to get your referral accepted • Central Triaging • Clinical Risk • Burnout

Response Community Gynaecology Clinic - GP Led

Response Additional Outreach Clinics • Katikati • Te Puke • Greerton

Response SMO directed acute gynaecology

Response Dedicated Caesarean Theatre

Response • Outpatient Hysteroscopy • Outsourcing • Grace Hospital • Southern Cross Hospital Rotorua

Response - Theatre • Streamlined Services • Integrated Pelvic Pain Service • Advanced Laparoscopy Service • BC/SL +/- MO • Combined Lists • Pre-screening of referrals • Regional MDM and preceptorship

Response Primary Care Integration Expression of Interest • Community Health Clinic • “Upskill Clinic” • Mirena Fitting • Cervical polypectomy • Pipelle Biopsy • Ring Pessary

Questions

sam.lepine@bopdhb.govt.nz lepinegynaecology@gmail.com

Planned Care Services Dorothy McKeown Business Leader, Hospital Services, Surgical Services

Angela Durham Planned Care Services Manager

What is Planned Care?

Planned Care services, traditionally known as ‘Electives,’ encompass medical and surgical care for people who don’t need to be treated right away. (Source: Ministry of Health)

Current Delays to Planned Care Services •

COVID-19

•

Impact on Workforce

•

Sustained High Acute Demand

•

Hospital Occupancy

•

Prioritisation – highest clinical need

•

Telehealth

•

Outsourcing

•

Communication with patients

•

Tauranga or Whakatāne Hospital

•

Health NZ and the Planned Care Taskforce

Number of Referrals Received

Total Referrals By Service (May 2022)

Woman Child & Family Services 17% (488 of 836 Accepted – 56%)

Medical Services 32% (932 of 1508 Accepted – 61%)

Surgical Services 51% (1827 of 2439 Accepted – 74%) (Orthopaedic referrals make up 19% of all referrals into the BOPDHB)

Referral Pathway • Urgent – for those patients that require urgent assessment and referral assessed within 24 hours and then triaged accordingly (including high suspicion cancer) • • •

Semi-Urgent Routine Advice Only

Referrals graded within 10 business days

Referral Pathway • Please include recent diagnostic investigations to support referrals • Please only include one presenting problem per referral For an updates on patients' status on wait list please call Patient Information Centre 0800 333 477 A second referral should only be sent where new clinical information is being provided

Cellulitis Programme Review of Activity and Programme updates March 2021 – March 2022 ØTotal Claims: 257

Cellulitis Programme Aim of programme review

Review uptake and utilisation of the programme following changes to the clinical management guideline

Purpose of Programme Ø To identify severity & appropriateness to manage treatment successfully in Primary Care Ø funding provision under the Acute Demand Service- for either Grade 2 or Grade 3 Ø Identified oral therapies therapeutically equivalent to the intravenous options –First line option Ø Eligibility: cellulitis Grade 2/3(some exclusions). No high needs criteria although identified as higher risk.

BPAC cellulitis : skin deep & spreading across NZ (2015)

Recap of Programme

Up to 2 f/up consultations

Up to 5 f/up consultations

Cellulitis_Pathway_Quick_Guide.pdf (wboppho.org.nz)

Changes Jan 2021 Update CNE Dr Kate Grimwade on new PO abx as first choice May 2021 Started seeing shift from IV to PO

Review Identified use by ethnicity, age, gender, Number, ACC Identified change/shift from IV to PO – has created the opportunity to offer more care to more people and increase the capacity of the programme

March 2021 – March 2022 Cellulitis Claiming Data Utilisation by Ethnicity: Māori 29 11%

Pacific 8 3%

Other 30 12%

Ø Underutilised by Maori/PI

NZ Euro 190 74%

Ethnicity

NZ Euro

Other

Māori

Pacific

March 2021 – March 2022 Cellulitis Claims Data Utilisation by Age Range: 160

Utilisation by Gender:

141 (55%)

Unknown, 2 (1%)

140 120 100 57 (22%)

80 60

Female, 123 (48%) 42 16%

40

14 (6%)

20

1 (0.3%)

1 (0.3%)

0

65+

45-64

25-44

15-24

5-14

0-4

Male, 132 (51%)

March 2021 – March 2022 Cellulitis Claims Data Claims by Grade: Grade 3, 52 (18%)

Claims by ACC/nonACC: ACC , 2 (1%)

Grade 2, 232 (82%)

Non ACC 255 (99%)

March 2021 – March 2022 Cellulitis Claims Data Type

PO

2020-2021

IV

Grade 2

150

55

Grade 3

29

22

Total 2122:

179

77

179

2021-2022 176

200 150

112 77

100 50 0 PO

Demonstrates significant shift from IV to PO

IV

Cellulitis Programme Recent Updates:

ØNew Halcyon claim form launched for Grade 2 & 3 Cellulitis claims (some exclusions)

ØInitial consultation now funded these grade 2 & 3 claims ØFollow up- F2F or Phone options available where appropriate ØWBOPPHO Portal – https://portal.wboppho.org.nz

Cellulitis Programme

Options/Ideas moving forward: 1. How do we support those who may have barriers to collection of medication?

2. Better quality data from DHB re presentations/grades 3. Patient redirect seen by regular GP/Practices

Cellulitis Programme Recap ØGuideline changed Jan 21– PO abx first line grade 2/3 ØSignificant shift from IV to PO demonstrated in data rv ØHighest uses >65yrs, equal male/female use, underutilised by Māori/PI ØMajority grade 2, Non-ACC ØFree initial consultation + 2-5 F/up consultations depending on grade ØFollow up F2F or Phone if appropriate

Cellulitis Programme Reminders: ØUse of free pharmacies ØDiscretionary funds for Rx fees for high needs pts prn ØFollow up can be In-Person or phone ØOne page ‘quick guide’ available on portal ØPortal for all info regarding project ØREMEMBER to claim Acknowledge:: Liz and Acute demand Team, IT team, Network services team

PHO Clinical Update Dr Claire Isham, Clinical Director, WBOP PHO Dr James Peckett, Clinical Advisor, WBOP PHO

ACC Monthly Primary Care Provider Updates Subscribe here: ACC COVID-19 update Of note in the most recent update, Audiologists can submit the ACC claim for occupational hearing loss.

Pharmac Medicine Notices: Supply issues, discontinuations and brand changes - Pharmac | New Zealand Government

Coroners (Doctors Fees) Regulation 2022 Regulations have been made to enable payments to doctors for the reports they provide coroners. IN force from 1 July 2022.

Fee model – hourly rate (4200+GST), capped at 4 hours.

See more info here: Coroners (Doctors Fees) Regulation 2022 - General Practice New Zealand by WBOP PHO Issuu

Palivizumab for RSV prevention in high risk children The Paediatric department are in the process of identifying eligible children and arranging a service for the administration of Palivizumab.

If you come across children who would be eligible (and have not been contacted by the Paediatric department already) please send a referral to the Paediatric department (via BPAC eReferral) Eligibility criteria are as follows: Initial application (palivizumab for RSV for the 2022/2023 RSV seasons, in the context of the COVID-19 pandemic) only from a paediatrician.

Approvals valid for 6 months for applications meeting the following criteria: Either: 1. Infant was born in the last 2 years and has severe lung, airway, neurological or neuromuscular disease that requires community ventilation; OR Both: 1. Infant was born in the last 12 months; and 2. Any of the following: 1. Patient was born at less than 28 weeks gestation; or 2. Both: 1. Patient was born at less than 32 weeks gestation; and 2. Either: 1. Patient has chronic lung disease; or 2. Patient is Māori or any Pacific ethnicity; or 3. Both: 1. Patient has haemodynamically significant heart disease; and 2. Any of the following: 1. Patient has unoperated simple congenital heart disease with significant left to right shunt (see note a); or 2. Patient has unoperated or surgically palliated complex congenital heart disease; or 3. Patient has severe pulmonary hypertension (see note b); or 4. Patient has moderate or severe LV failure (see note c)

Bowel Screening Programme update

As of Monday 8 June, 1348 FIT kits had been sent out, 172 had been returned, with 9 positives so far. The DHB team are now awaiting GP referrals after they have discussed the positive FIT with their patient.

Bowel Screening – Positive Fit claim via Halcyon. Service and claiming guide here If a fit test needs to be ordered contact the National Bowel Screening Programme – 0800 924432 Bowel screening | Time to Screen - National Screening Unit Recording of recent CME is here: https://youtu.be/Yq4D55oWe3c?t=178 New Halcyon Claims Bowel Screening – Positive Fit. Service and claiming guide here Mental Health Extended Consults. Updated service and claiming guide here Cellulitis. Updated service spec and claiming guide here All WBOP PHO Programme and Funding guides can be accessed via the PHO portal page https://portal.wboppho.org.nz/funded-clinical-programmes/

Laboratory Testing for Monkeypox Laboratory Testing for Monkeypox - June 2022 by WBOP PHO – Issuu

Canvassing interest for a second ACC GP MRI training in August An expression of interest email has been circulated, and will also be included in the next Practice News.

Please email nsadmin@wboppho.org.nz to register your interest.

Aim is to deliver the training in August (Tauranga and Whakatane based). Demand dependent.

Maximum of 30 can attend each session.

Covid Updates Pharmac COVID-19 antiviral Access Criteria Assessment tool Use the online tool to help identify who’s eligible for funded COVID-19 antiviral treatments.

Access Criteria Assessment Tool

Molnupiravir and Paxlovid available in the community Molnupiravir (brand name Lagevrio) and Paxlovid (nirmatrelvir with ritonavir) are available and funded with access criteria.

Always check the criteria before prescribing as updates may have been made.

Pharmac website – Covid-19 oral antivirals: Access Criteria

More information on how Paxlovid can be accessed and distributed to patients, and education material for healthcare professionals can be found on the Ministry of Health website.

Ministry of Health website: Information and guidance on use of Paxlovid

Covid Updates Second COVID-19 Booster Shortly the Medicines Act will be amended to enable voluntary booster doses for the Pfizer COVID-19 vaccine to be administered to the most vulnerable by all vaccinators without a prescription.

The Ministry of Health have indicated the following groups will be eligible but final details have not yet been released: • Older population • Residents of aged care facilities • People in disability care facilities aged 16 years and over • Severely immunocompromised people aged 16 years and over and who have received a three-dose primary course and first booster.

Updated PHO Covid Care in the Community Claiming Guide and Flowchart • Released this week to inform claiming activity https://portal.wboppho.org.nz/images/documents/Community_claiming-Flow_chart-May2022_(14.09.22)_(002).pdf • Includes some guidance for differentiating acute phase / new episode / long covid

at 9 June 2022

Source: Toi Te Ora

BOPDHB TAS Modelled Cases vs. Actual, Now Extended To Next Wave. at 9 June 2022

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

Thank you for joining us!