PHO Forum PowerPoint May 1 2024

Provider Forum

May 1, 2024

Whakataka te Hau Karakia Tīmatanga (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

Lindsey Webber, CEO, WBOP PHO

Symon Roberton, Body in Motion

Scott Crawford, Nephrologist & General Physician, Renal Department, BOPDHB, Te Whatu Ora

Helen Eddington, Renal Consultant, Renal Department, BOPDHB, Te Whatu Ora

Luke Bradford, Medical Director, The Royal New Zealand College of General Practitioners (RNZCGP)

CEO & Board Update

ACC Integrated Care Pathway

Renal Team Innovations & Programmes

RNZCGP Updates

Dr. Joe Bourne, Chief Medical Officer, Ministry of Health MoH Update & Q&A Session

Clinical Advisory Team, WBOP PHO

PHO Clinical Updates

Closing & Karakia Whakamutunga

PHO Update

Lindsey Webber CEO

Western Bay of Plenty Primary Health Organisation

ACC Integrated Care Pathway for Musculoskeletal Conditions

Contract live since 4th March 2024

Who is ICP MSK for?

● ACC covered MSK Injury

● Moderate to high injury and noninjury complexity

● Clients requiring more integrated, specialised and coordinated treatment

● Bundle based funding aiming at delivery of value-based healthcare

What is ICP MSK?

Key Features

1. Fully funded pre and post operative physiotherapy management

2. Orthopaedic assessments pre and post operatively to guide the rehabilitation pathway.

3. Vocational Support for those who require support to return to work.

4. Other rehabilitation services: Psychology, Pain management assessment, Dietary support and Cultural supports.

ICP Goal

● Safe and sustainable Return to Work or

● Return to Independence.

Clients will also be supported to progress towards meaningful goals for them.

Accepted ICP

MSK Diagnosis

List

Knee –Ligament/ Tendon

Reconstruction , ORIF, Joint Replacement

Accepted ICP MSK Diagnosis List

Fracture involving the tibial condyle (or tibial end of the knee)

Fracture involving the femoral condyle (or femoral end of the knee)

Anterior Cruciate Ligament Rupture with/ without meniscal tear

Posterior Cruciate Ligament Rupture

Medial and/ or Lateral Ligament Rupture

Post-Traumatic Osteoarthritis

Patellar Tendon rupture

Traumatic Patellar dislocation

Knee -

Arthroscopy and Debridement

Fracture of the patella

Medial and/ or Lateral Meniscal tear or other internal derangement

Osteochondral fracture

Fracture clavicle

Fracture humerus (or humeral end of shoulder)

AC Joint dislocation

Fracture glenoid (or scapular end of shoulder)

Shoulder

Glenohumeral joint dislocation

Post-Traumatic Osteoarthritis

Rotator cuff full thickness tear (rupture)

+/- Biceps tendon high grade tear

+/- traumatic Labral tear

Lumbar disc prolapse, or extrusion, with radiculopathy

Lower back

Lumbar fracture

Other Previous fracture mentioned above managed with ACC funded surgery, and now requires removal of metalware

Eligibility Criteria

● MSK Injury at approved body site

● <12 months since DOI

● Client must reside in NZ

● Client must reside or work where supplier provides services

● Not with Accredited Employer – unless has opted out for nonwork related injury.

How to Refer

ICP Supplier Directory

www.acc.co.nz/for-providers/provider-contracts-and-servigrated-care-pathways/icpmsk-supplier-directory

● Send client for initial Physiotherapy assessment to BIM clinic

● BIM Physio will assess suitability for ICP and complete referral to ICP if appropriate

● GP to identify on referral clearly ‘for consideration for ICP’

● GP will receive notification of ICP Triage Acceptance or Decline

GP Forum

Renal Service Innovations and Programmes

Te Whatu Ora Hauroa o Toi - Bay of Plenty

Dr. Helen Eddington

Dr. Scott Crawford

Update on Service

One Day Renal Transplant Workup (ODRTW)

Advanced Kidney Care

Renal Targets

National & Regional Clinical Networks

Renal

Update on Service

Rapid Growth

Focus on increasing allied health

Nursing - Increasing leadership roles

Equity across WBOP & EBOP

Constraints

Risks

Renal Service - Innovations

Update on Service

One Day Renal Transplant Workup (ODRTW)

44 yr old Maori Female

Type 1 Diabetic

Pre-Dialysis - CKD 4

Legally Blind, reliant on Mother, lives 1 hour away

New baby, Breastfeeding

Key Problem - Inequity

Current Renal transplant workup Process

Significant time (months/years)

Multiple visits in multiple sites

Financial cost to patient and Whanau

Prioritization in a busy hospital with competing demands

Baseline Data / Current Situation

Aim of this Innovation - Patient Centred - Equity Focused

'ONE DAY RENAL TRANSPLANT WORKUP

A Pathway

A majority of investigations required

A single day

A central point of scheduling/coordination

Improve access - Reduce Inequity

Reducing time to transplant listing.

Reducing hidden 'costs' + Burdens

Improving access / Reduce inequity.

Promote Toi Ora, optimum health + wellbeing for Māori

Recognise strength and expertise of mātauranga Māori

Increased early manaaki (support) wrapped around patients and whānau

(From Left) - Nephrologist Dr. Scott Crawford, Te Pare o Toi Health Navigator Marie Tata, Medical Schedular Lead Amanda Chapman, Renal Scheduler Paula Sidwell

Key Changes Implemented

Communication

On the Day

Assistance With

Parking

Transport - Taxi/Shuttle

Food

Clinic Appointment

Transplant Education

Suitability

Suitability for workup

Transplant survival score

Testing required

Referrals to Scheduler

Checklist complete

Referrals submitted (sticker applied)

Organization

Communication

Target existing appointment

Target Stress ECHO

With Patient (Email, Post Text + Phone call)

With Referrer (Email)

Place

Key Changes Implemented

47 F, Māori

Education Transplant Tauwhero Social Worker Contact

SINGLE DAY

Accomodation

Place to Rest

2.5 Months

1

within 180 days of starting dialysis

within 6 months from listing

Outcomes so far

Nationally endorsed as the standard model of care in other centres

Western Bay of Plenty

Quickest referral to listing: 86 days (Māori, 20-year-old male)

Eastern Bay of Plenty

Quickest referral to listing: 132 days (diabetic patient needing more workup)

Recently transplanted patient:

369 days from referral to listing

Patient Feedback

Collected by Marie Tata, Health Navigator Te Pare o Toi

Great and easy to navigate (Māori, 20-year-old male)

Transplanted within 180 days of starting dialysis - important KPI

Appointments well planned

One day makes it so much better

No hanging around waiting

Can only every attend appointments if mums available - much easier Good communication from the hospital

Lessons Learnt

Importance of ...

Project endorsement

Translating care model

Create Equity Statement

Shared goals + values focused on patient, whānau and equity

...'try something once, prove it’s possible’

...'shop floor desire to innovate’

Early Tauwhiro / Social Worker support

Auditable Data

Renal Service - Innovations and Programs

Advanced Kidney Care (AKC)

• Nurse practitioner – Terry Jennings

• Database of information to allow for easy review

• Track our performance over time.

• Improve access to modality of choice

• Improve access to transplantation

• Improve numbers of patients starting dialysis with definitive access

• Improve anaemia management

Who ?

Focus on education & planning eGFR < 20 Rapidly Progressive Failing transplant

Renal Service - Innovations and Programs

Renal Targets

Renal Service - Innovations and Programs

Renal Targets

Renal Service - Innovations and Programs

Regional Clinical Network

• Renal clinical and capital services plan:

 Put patient and whanau at the centre of healthcare

 Hospitals and districts working together to provide seamless care for every patient

 Bring treatment closer to home

 Remove barriers to accessing healthcare

 Data and digital solutions to support innovation, development and clinical decision making

• Renal Regional leadership Group:

 Vascular access

 BOP infrastructure

Renal Service - Innovations and Programs

National Clinical Network

- Members on main group: 2 co-chairs, MDT represented in group.

- Working groups feed into the main group: currently identifying work plan

 Data, Quality and Performance

 Digital infrastructure

 CKD

 Consumer and Whānau voice

 Models of care Dialysis

- Transplantation will have its own national group

RNZCGP Update May 2024

DR LUKE BRADFORD MEDICAL

DIRECTOR

Your Work Counts

417 diary studies

Over 230 practices

56% Time is clinical contact ie 22.5hrs per wk per FTE

31% non contact clinical

Remainder teaching, training, CME, governance and management (likely insufficient)

Remarkable consistency across, gender, experience, rural/urban, 10thsetc

What Next?

ACTIONS

1 week repeat study from 5th June

Validated data on what a FTE GP role involves

Cross check work data with practice demographics

Practice based audits into patient utilization data

SO WHAT

Using the data with TWO In the TAG regarding capitation review

Present findings to Health Minister

Present recommendations for GP:patient ratios

Recommendations for number of GPs needed in NZ

GPEP

17 BOP GPEP1s as part of largest national

intake

Approx 300 applications for next year (drop)

Increased focus on GPEP 2 /3 following feedback re structure, support etc

Proposal being formulated on 3 year contract and program

25th-28th July

Wellington

50th Anniversary of the College

Gala Dinner

Broadening of content following feedback

More clinical and practical- abstracts sought

Highest ever number of abstracts

Graduation

Chance to socialize, network, be enthused

Keynotes are exciting and varied

ADHD

Data clearly showing gap between expected prevalence and diagnosis and prescription rate

Clear social impacts re education, employment, relationships, corrections

Massive inequity in access

Adult ADHD a particular concern

Parliamentary hui 2nd May

College advocating that 1. The SA renewal criteria be removed 2. The diagnosis and management of ADHD gazette be broadened to include Specialist GPs

This would be a Specific Interest model eg skin cancer, travel, menopause, not a 15 minute capitated model

Specific Interest Groups

Imminently looking for our first 5 pilots

A Chapter like model allowing CME sharing, peer support and ultimately recognition of Specific Interest

Does not risk Generalism, nil micro credentialling

Examples ADHD, dive medicine, menopause medicine, aged residential care medicine

Opportunity to create and deliver CME, become an advisory source for policy etc

Current Advocacy/Work Streams

TWO Capitation Advisory TAG clinical representative

Working with Pharmac/TWO/Goodfellow re CGMs and insulin pump introductions

National MSK pathway primary care lead

ACC re recognition of Specialism/potential GP contract/guidelines

National Workforce Survey development

Transfer of care policy development with TWO/MH should see less “GP to chase” and inbox cc’ing

Guideline input to POCT, Gestational Diabetes, Melanoma, LARCs, Kahu Taurima, Oranga Tamariki, Work placed disease, rare disorders, infectious diseases etc…….

Updates from MoH & Q&A with Dr. Joe Bourne

Chief Medical Officer, Ministry of Health

No Ingarangi ahau, ara, no London

Ko Lansdale Pikes taku maunga

Ko Thames taku awa

Na Tapuika ahau i pōwhiri mai ki konei

Kai te mahi ahau ki Te Puke

Tauranga e noho ana ahau

He rata-ā-whānau ahau

Ko Joe Bourne taku ingoa

Regular Meetings

Minister and associate ministers of health – weekly

Te Whatu Ora CMOs – weekly

Cross agency clinical chiefs

Primary care clinical leaders

Primary and community care policy steering group

Health and Disability Commissioner

National Quality Forum (NQF)

Optimisation of medicines steering group

Key Relationships

Primary care sector – RNZCGP, GPNZ, GenPro

Te Whatu Ora – Clinical, commissioning, HSS, P&C

Responsible authorities – MCNZ

Crown entities – Te Aka Whai Ora, Pharmac, Te Tāhū Hauora, HDC

Joe Bourne Chief Medical Officer

This Month

• GPS

• Te Whatu Ora Plan

• Physician associate regulation

• HNZ workforce plan

• Ministry restructure

Coming up

• Puberty blocker EB and next steps paper

• Healthpathways conference

• Third medical school

Celebrations/Challenges

• First clinical leadership meeting

• Engaging R&M SLT

• Longer term funding for mesh credentialling

• Round 2 Tier 1&2 credentialing interviews May

Portfolios

Primary care policy work programme

Health workforce

Surgical mesh

Puberty blockers

Immunisation

Optimisation of medication

Skills/Interests

Clinical leadership

Primary care/general practice

Digital enablement

Social prescribing

Improvement methodology

Evidence based medicine

Film

Football includes commentating on matches

Podcasts

Music

PHO Clinical Updates

WBoP

PHO Clinical Advisory Team

Funding/Programme Updates

• Immunisation Funding

• Childhood immunisation

• Inflenza vaccination for Māori/Pacific 55-64yrs

• Immunisations Updates:

• Gen2040 Best Start Kōwae & Second Trimester Funded Programme can be used for the third trimester as well

• Update on Skin Lesion Service

• Sometimes a biopsy will be requested

Secondary Care Updates

• IUD Insertions at Clinic 2

• Age and Criteria limitations on referrals

• Change in Process for Giant Cell Arteritis

• A new process is in place for patients with suspected Giant Cell Arteritis in the BOP.

• The Fast Track Giant Cell Arteritis eReferral form has been discontinued. Please use the generic rheumatology form instead.

Diabetes Updates

• New BPAC Diabetic Referral Forms have gone live as of April

• Dates for Diabetes CNE/CME Zoom are:

• Diabetes Part 1: Fundamentals: Thursday May 23rd, 6pm –8pm

• Diabetes Part 2: Medication Management: Thursday May 30th, 6pm – 8pm

• Prescribing for T2DM: Thursday June 13th, 6pm – 8pm

• Insulin Initiation for T2DM: Thursday June 20th, 6pm – 8pm

• Register by contacting Niki Pucci, Diabetes Nurse Educator, at niki.pucci@wboppho.org.nz

General PHO Updates

• Please send Clinical Leads contact details to clairei@wboppho.org.nz

• We are working with the Consult 365 team to feedback queries to their team from the network.

• If you have anything you wish to share please email NSAdmin@wboppho.org.nz with the NHI and a brief summary of your feedback

• National Bowel Screening Programme- May is National Bowel Screening Primary Care Promotion month

• Whānau Voice survey continues through month of May

• Link to complete: buff.ly/49gSurb

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