PM Meeting Minutes 16th March

Western Bay of Plenty PHO Practice Manager’s Meeting Minutes MEETING INFORMATION Date and Time

Wednesday 16th March, 12.30pm – 2pm

Venue

Zoom

In Attendance: Adele Hedges, Aryana Grootjans Camilla Wilkin, Courtney Takawe, Courtney Takawe, Deb Livingstone, Delice McShane, Emma Morton, Fiona Mears, Gareth Hudson, Glenn Dunkerley, Jan Farquhar, Karen Woodhouse, Karilyn Lowe, Kerri Fabish, Leigh Kennedy. Lorraine Anderson, Pam van der Nest, Robynne Klatt, Rowena Cook, Ruakapua Bristowe, Sarah-Lee Lacy, Stephanie Birkbeck, Trevor Deane, Wendy Dillon, Wendy Sharplin

PHO Staff in Attendance: Lindsey Webber – CEO Phil Back - General Manager, Practice Services Network Services Team: Emma Skellern, Donna Hardie, Laura Penny, Nick Page Bharat Mahajan - IPMHAS Program Manager Jenny Falconer – IPHMA Coordinator James Peckett – Clinical Advisor Michelle Meyer – Clinical Advisor Trish Anderson – Sarah Johnson – CPRT Lead

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Welcome and Karakia PHO CEO Updates Practice Spotlight: The Doctors Phoenix - Jabba Phone app & Voice Bridge boxes Integrated Primary Mental Health & Addiction Service – Bharat Mahajan & Jenny Falconer Mental Health Service: Proposed changes in referral process and funding allocation – Naomi Malcolm Network Support & Acute Demand Service - Liz Knowles Equity in Health Conference, Key Learnings - Laura, Kiri, Michaela Network Services Team Updates: • Foundation Standards Updates • Format of meetings 2022 • Service Guide Re-Print 9. CPRT Update – Sarah Johnson & Trish Anderson 10. Covid Clinical Management – James Peckett 11. AOB: Updated Maternity Schedule (Te Puke MC) 12. Karakia & Close of Meeting

Meeting Opened with Karakia – Whakataka Te Hau To listen to an audio clip to support pronunciation of this karakia, see here (audio clip no. 2 ‘Traditional Karakia’): https://www.otago.ac.nz/maori/world/te-reo-maori/karakia-prayers/

Welcome – Phil Back Thanks for taking the time to join us today. It’s not ideal to be having this online again but we appreciate everyone joining us. We look forward to a near future when we can all meet in person again.

PHO CEO Updates – Lindsey Webber Tautoko sentiments from Phil – we’re all feeling a bit ‘zoomed out’, missing the hustle and bustle of meeting together with our network properly, to be together and share kai.

PHO have a few staff down with illness currently so we are running at a bit of deficit, however we are managing ok by redeploying staff where needed to provide continuity of support.

I want to acknowledge the stress and extra workload on our network at the moment and the impact that caring for covid patients is having on BAU.

We are monitoring closely and advocating on behalf that MOH will not penalise practices if BAU activity drops over the next while. Particularly in relation to SLM funding – we’ll be advocating for a reprieve as was done last year. The reality is you can’t do everything. You have to be able to prioritise, so you may have BAU work that you have to delay in order to effectively get through this Covid surge.

Shout out to CPRT team – they are keen to continue to support practices where they can. Reach out if you can if you do not have the ability to manage your own covid patients. We’re urgently working on a tool to give you better visibility of your covid patients who may be higher risk.

WBOP PHO has just gone through a re-structure. We have set up a new Population Health and Innovation Team, consolidated a lot of our services we provide support for. We now refer to GPL team as Network Service Team. If anyone wants to see the new structure, we’d be happy to share that information.

Practice Spotlight: The Doctors Phoenix - Courtney Takawe Jabba Phone app Works on a cloud phone system (Spark etc) – this is a ‘soft phone’ you can download on phone/laptop and can access all practice calls from home – so anyone isolating can continue to support with phone calls from home. You can also transfer calls, dial practice extensions. Courtney will circulate more details to NS Team who will share with the network.

Voice Bridge Boxes We faced a problem, struggled hearing people through masks & Perspex. This is a box that amplifies the patient & receptionist voices and helps you hear each other clearly. It has improved communication and getting a message across first time round. Helps exposure incidences as well, as often if patients couldn’t hear they were coming round to speak to the staff closer. If you are interested and would like to know more about it, feel free to contact Courtney. More information will be shared from NS Team as well.

Integrated Primary Mental Health & Addiction Service – Bharat Mahajan & Jenny Falconer Jenny is the new programme coordinator and support for IMPHA. Just commenced new role, working with PHO since August 2020 in another role.

IMPHA rollout is going well, have successfully recruited 7 health coaches and 6 HIPS. Many practices are up and running. We aim to continue rollout in the next stages to more practices including: Katikati, Gat Pa, Some Green Cross Practices and The Drs Phoenix.

Next Training session will be held 4th May – some PMs will be aware as communication was shared just before Christmas. If all goes well those above should have HIPS and HC by end of May. Those already up and running – Halcyon is used for all clinical documentation – this copies back into PMS. Halcyon has been live since December and is running smoothly.

We are working with DHB on Launch Strategy to socialise the programme, opting for a ‘soft launch’ as a phased rollout rather than spread it too widely before it’s activated for all practices. Full launch will take place end of 2022 when available in most/all practices.

Mental Health Service – Phil Back on behalf on Naomi Malcolm Referral and Funding allocation in CPO MH has been a pain point for many resulting in frustration for refers and inequities for our population. To address these issues there will be a redesigned Referral form; simplified with two options for referral into our service

1. Social worker 2. Mental health support (this option for Individual counselling and group workshops ) The Kessler will not be mandatory, and the referral form has been significantly simplified. There is provision for the referrer to advise which support they feel would most benefit their patient and give background information as necessary. The MH team will contact the patient to complete the Kessler, assess their needs and make a treatment plan i.e., Referral to group workshops, Individual Counselling sessions etc.

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The fee paid ($34.50) to practices for referral into service will cease once new referral form is live in best practice.

Extended consults will be claimed under Halcyon (there will be a link on the Best Practice form to this for GPs) there will be allocations of these to practices.

Funding for POC will not be allocated out to practices these will be managed by the MH team and allocated according to clinical presentation.

Please be aware there has been no extra funding for the programme so discretion is still required before referral to ensure the service is not suddenly overwhelmed.

The use of your HIPS and Health coaches is recommended in first instance as well as other options for funding (WINZ, ACC etc) these will be explored by the MH team too. 

People in crisis who require urgent support need to be referred to the Crisis Team, as we will still be processing referral routinely and as we change systems there may be some delays as we find our footing.

Referrers will receive advice re: the outcome of the MH teams’ initial assessment and treatment plan.

Final reports will continue to be processed as is for now.

We are aiming to go live with this new system in April – we will confirm with the network once it’s live.

Network Support & Acute Demand Service - Liz Knowles Liz started new role of Network Support and Acute Demand Team Lead in January. Coral Rahi is filling Liz’s previous role as programme facilitator. The team is working hard to move programmes away from archaic systems, bringing them into the modern day and integrating programmes into Halcyon where possible.

Acute Demand Cellulitis programme being tested in Halcyon and you will receive an update on when it will be going live. Should be very soon. Mental Health extended consults also moving into Halcyon very shortly.

Acute Demand Radiology referrals coming through for positive covid patients - advice at the moment is to continue to treat the patient but they cannot have radiology procedure done in the community until they are system free.

For X-Rays the patient must be sent to hospital. DVT Ultrasound – treat patient as though DVT is present, then when result is back, refer through.

Skin Surgery Covid has brought us to look at how we notify GP of outcomes for Skin Surgery (and mental health) – currently sent by ‘snail mail’. Looking into a new way of notification either by email directly to a general practice ‘results’ email address, or via the PHO Portal. We’ll touch base with practices to see what the best solutions are for them.

Audit of Services – Lindsey Recently the PHO underwent an audit of services. The Primary Options contract was audited and with change in clinical practice, there is now opportunity to broaden the suite of services which are on offer under this.

We will consult with practices on which other services they would like to see covered in this programme.

There seems to be significant variation across the country around what service are available under this.

Equity in Health Conference, Key Learnings - Kiri, Michaela Shared gems from the Equity in Health Conference November 2021.

The conference confirmed we’re on the right track as a PHO. Now we need to do the mahi to make sure we stay on track, as equity in an ongoing piece of work. See slides for full details.

Network Services Team Updates: Foundation Standards Updates - Emma Slides show summary of all recent Foundation Standards updates, these can also be viewed online. New Standards can be downloaded for free – 1 download per user.

• https://www.rnzcgp.org.nz/Quality/Foundation/Foundation_2022/Quality/Foundation_2022/Foundation _Standard_introduction_.aspx?hkey=2c5db860-8261-4f74-ad8e-23a94e3ff9cb

Network Services Team will work in conjunction with practices to support achievement of Foundation Standards.

PHO Infection Control Template for Practices will be updated to reflect the new changes. Any other PHO Template updates that need updated will also be done (e.g. Clinical Governance Templates) There is a new requirement for Child Protection Training for all staff. The PHO will look into provider options for this to see if we can help facilitate training options.

Cornerstone – confirmation of an extension of 12 months for practices due.

Format of meetings 2022 Based on PM feedback meetings for 2022 will be a mixture of online and face-to-face, will be held every 5 weeks and will be 1.5hrs max. Learning sessions and educational events will be separated out from general meetings.

Service Guide Re-Print A reprint was done in December 2021. This will be the last physical copy distributed. Any future updates will be shared electronically and updated on this PHO Portal page: http://portal.wboppho.org.nz/funded-clinical-programmes/

CPRT Update – James Peckett & Trish Anderson Referral Form – there is a new form to use for practices requiring Tunstall Care over the weekend (Handover Note) to make sure Tunstall get all the info they need. This can be sent by email. CPRT are working on a BPAC referral option for this.

Pts with Covid who to go ED - over the weekend, the discharge will be sent directly to Tunstall, CC’ing in Enrolled Practice. Tunstall will carry on care over the weekend for these patients, and then will handover to practice on Monday.

Thalamus Reporting Provides a summary and breakdown of all covid patients per practice – pulls info from NCTS and CCCM into one place – pulls clinical information as well to offer possible high acuity criteria - includes info on Diabetes, COPD etc. This will also provide maps showing hot points to enable pre-planning at PHO level so we can offer support where needed. More information will come shortly. Hopefully up and running next week. Will welcome feedback on improvements once it goes live.

Q – What % of Covid Patients are currently High Acuity?

A – There is no easy answer on this one currently. Risk Stratification being talked about at national level.

National support coming in around these tools and planning. This added level of Risk Strat might lend us to have a better view of this Question.

Q – Which report will these be added to in Thalamus?

A – Very early stages but it’s likely it will be a new report rather than adding onto an existing one. As soon as we know more, we’ll let you know.

Covid Clinical Management – James Peckett Medication - Antiviral called Remdesivir needs to be given in hospital, don’t think we’ll be using it within primary care in the community. If it’s relevant to primary care we’ll update on it but watch this space.

Peak - Based on the numbers we’re seeing we may be over our peak but with colder weather coming we may see another peak. Trends are only as good as the data we have access to, and we know that not all positive results are being reported online so it’s hard to know.

Long Covid - similar to Chronic Fatigue following other viral infections – it is important for patients to manage energy levels, and really important to have a support system around you, to support physical and mental wellness.

Dealing with Aggressive Patients and Complaints Trevor - We’re seeing a lot more aggression and name-calling from patients towards our staff. People seem to be getting more and more angry about perceived injustices towards them. Disability commission have a

disclaimer on their site saying they’re overwhelmed with complaints and don’t even have a timeline for getting back to people.

Camilla - Yes we’re also seeing complaints taking up a lot of our time. Lodge a 105 call on police website if the person is treating your staff badly and causing upset. We have had some really disgusting awful emails.

PHO - Training Opportunity?

PHO would like to offer training for frontline staff training for managing aggressive behavior, and building staff resilience. PHO will look into options for this, and will liaise with the network for opinions on whether there is value in this.

Trevor – To be honest our staff have been on loads of similar training and they know what to do, but it doesn’t make it any better when they’re having to deal with it day in and out.

Lindsey – This is a recognized issue going right across the system - the health & safety reports from DHB showed the same thing, increase in angry verbal assaults on staff have gone up through every department.

Patients are scared they’re not receiving the same level of care due to mask wearing – there is a public perception of lack of care, which seems to fuel aggressive encounters.

Phil – Have dealt with a few complaints from patients who were upset when billed for virtual consultations in place of face-to-face, but this is the reality of our current healthcare system.

AOB:

Hands Up Database Database for staff developed by the Ministry, kept to MOH and DHB previously. We began pushing as to why PHO could not have access. Initially it was used for staff who had capacity to work in a vaccination space.

We are advocating for primary care having access to this list of available staff.

3 in BOP now have access – Phil on behalf on WBOP PHO, and representatives from EBPHA and NMO. We can go in on behalf of practices to identify suitable staff vacancies which could support available roles.

This network has not been vetted – just another source of potential recruitment. Can be people to mobilise quite quickly on a temporary basis. We will share info on this via the Practice News.

Karakia & Close of Meeting Thanks everyone for joining the meeting – please don’t hesitate to contact us with any queries.

Date of Next Meeting: 20th April 2022