Medical director update

This update provides you with the best information we have right now.

Kia ora, Firstly, I hope everyone is holding up in what continues to be a very busy time. General practice continues to step up to the mark providing frontline medical services to the patients we serve.

I want to use this update to highlight issues around back pocket scripts and pharmacy dispensing for COVID antivirals. We have been disappointed with the process around this and the unexpected announcement from Minister Verrall. The College hasn't taken a particular position for or against, as we accept that access to this medication is important. However, we have raised our concerns with Te Whatu Ora: Health New Zealand and the Ministry of Health around these proposals.

Patient safety is paramount, especially with medications that have potential serious side-effects, and drug to drug interactions. We haven't yet been convinced the system has uniform processes in place to ensure safe sharing of information, and also where responsibility lies for the dispensing of these medications when there are interactions between a pharmacist and GP. We have written a letter to Minister Verrall outlining our concerns and are yet to receive a response, although starting today (28 July), Paxlovid and Lagevrio (molnupiravir) are pharmacistonly medications, and community pharmacists who have undertaken a short online training course can dispense these medications to patients after a consultation.

Back pocket scripts 1. Think very carefully before prescribing and ensure you're complying with the Medical Council of New Zealand's standards on prescribing which includes: "Before prescribing any medicine for the first time to a patient, Council expects you to have an in-person consultation with the patient. If that is not possible because of exceptional circumstances, consider a video consultation with the patient ..."

2. Responsibility for the script lies very clearly with the prescriber.

3. Be aware the script is valid for three months.

4. Be confident the patient could make any adjustments to any co-prescribed medications including contraindicated medication (e.g., statins) 5. Be aware of safety issues if another medication is prescribed prior to the dispensing of the back pocket script e.g., Rivaroxaban for AF. 6. Given these concerns you must be sure that the potential benefits of issuing a 'back pocket prescription' outweigh the possible risks and record this clearly in the notes.

7. Remember you're not obliged to prescribe in circumstances where you're not comfortable with issuing a prescription.

Pharmacy dispensing 1. Any conversation with a pharmacist over pharmacy dispensing needs to be very well documented.

2. Information Sharing: Be aware if it is a simple request for a lab result, for example an eGFR, you have limited responsibility in just providing this information. If you consider that the result would make pharmacy dispensing unsafe, you have a responsibility to inform the pharmacist of your opinion.

3. Any discussion on the appropriateness or otherwise of the script being dispensed will potentially lead to a shared responsibility for that dispensing between the pharmacist and a general practitioner.

4. In the end these issues will be determined by the HDC if there was to be a complaint.

5. Ensure good documentation.

It is important that anyone who notes a side-effect or unintended interaction with the medications reports these to CARM who collate this information nationally. Reporting is very easily accessible online.

Please take the time to read the Medical Council statement on good prescribing and MPS statement on back pocket scripts.

Monkeypox The WHO recently announced monkeypox as a global emergency. There have been two cases in New Zealand up until this point.

Associate Professor Mark Thomas, Infectious Disease Specialist from Auckland University, has kindly written an opinion piece overviewing monkeypox. Several things stand out from it. The monkeypox virus is closely related to other pox viruses that have a long history of causing disease in humans, first identified in 1958, with the first human case in Congo in 1970.

Close contact is responsible for spread, incubation can be for 1-3 weeks, and diagnosis with PCR of the blister fluid. In Western countries, the spread has been predominantly between men who have sex with men (MSM), and there is now some international debate about if we are seeing the emergence of a new STD spread through close contact during sex, and the virus been present in ejaculate. It presently has a very low mortality rate with most cases, not all, being mild.

Mark's overview is well worth reading and was written two weeks ago. The number of cases worldwide has now risen to over 19,000.

As always, we continue to advocate on your behalf with ongoing contact with the Ministry of Health, Health New Zealand, politicians, and various sector groups including ACC, PHARMAC, immigration, MPS and the Medical Council.

We've have had a huge amount of feedback on a number of issues, including from members we spoke to over the weekend at the College conference, which Sam and I will raise with the appropriate officials.

Please keep your feedback coming through.

Kia kaha.