WellInformed August 2019
Clinical Updates Clinical Update by Dr Stephen Graham Dear Primary Care Workforce, We live in interesting times. We are hearing that many of our general practices feel under pressure. This pressure can come from: • Difficulty recruiting and retaining appropriate workforce • Business pressures related to funding practice services under a largely population based funding system • Increasing expectation of services from patients and medical systems. With this in mind, I’ve chosen this month to bullet point several ongoing issues from my perspective inside WellSouth: 1. Health Care Home. This part of the primary and community strategy continues to roll out in practices across the region. This change is allowing practices to manage their workloads through triaging and provide some more space in their practices to service their patients more easily and conveniently. This is ease and convenience both for providers and for patients. This is the most obvious way we have of strengthening General Practice. 2. In our rural areas it has generally (not universally) become standard for Nurse Practitioners and Prime nurses to shoulder the afterhours provision. This has allowed the onerous afterhours burden to be taken off just GPs and shared with these other vital parts of the rural General Practice team. In this way, through necessity, rural General Practice is modelling how nurses can do more as part of the General Practice Team. 3. I have the following fear. General Practice is no longer perceived to function at a high enough level to maintain its preeminent place in the health system. Other services can do parts of what has been traditional general practice. Primary Health Care becomes more fragmented. How can we prevent fragmentation of primary care? I think that General Practice needs to be in the space of strengthening itself (I’m talking about all varieties of extended general practice) in order to maintain its pivotal place. Strengthening itself may come from doing more or it may come from helping the whole system. 4. A CVD risk assessment is close to coming out into WellSouth General Practices through the health portal. It may have arrived by the time you read this. WellSouth and others have been involved in developing an algorithm to implement the MOH guidelines. The CVD algorithm will likely work very well but is also likely to come with some form of disclaimer in the first instance. This is because the work to develop this has not received the level of assistance around test cases from MOH that it might have.
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
1
5. ACC are involved in a current consultation process with representatives of General Practice. The ACC component for standard general practice has not increased significantly for some time. In contrast, in rural practice (with the rural contract) and in A+M clinics (with A+M contract) there is a much higher level of ACC funding. It allows more resource to enter rural General Practice (or A+M) from ACC. Perhaps we should try to get more ACC funding for our region? 6. Health Pathways. We want a transparent and reproducible assessment for access to secondary care. We want some assurance that more urgent cases get seen more urgently than less urgent cases. We want some support if we point out real errors in the system. We want to be able to advocate for better resourcing once all of this has been achieved. (Actually I do think this is where Health Pathways are leading us). 7. Self-purchased FIT screening tests. Although I have not heard a lot of noise in our region on this subject, at a national level it is prominent. This is a national statement on the subject. https://www.nsu.govt.nz/health-professionals/national-bowel-screening-programme/use-self-purchasedbowel-screening-kits. I remain of the opinion that the bowel screening programme is the best good news story in health. 8. Mental Health funding. The Government have put aside very significant funding for new mental health roles in primary care. We aren’t sure exactly how these will roll out, but they will almost certainly be practice based positions for mental health support at practice level. WellSouth will be helping practices with some new services in this area soon. 9. We have a number of distinguished GPs who have recently been recognized by the College. Congratulations to Phil White, Tim Medlicott, Jill McIlraith, Susie Meyer and Ali Gaston. https:// rnzcgp.org.nz/RNZCGP/Im_a_member/Recipients_of_2019_College_Awards.aspx?utm_ source=RNZCGPNewsletters&utm_medium=RNZCGPNewsletters&utm_campaign=RNZCGPNewsletters I welcome feedback. Thanks Dr Stephen Graham Medical Director WellSouth PHO stephen.graham@wellsouth.org.nz
Inspirtional Stories from Southern Stop Smoking Service My Children Won't Remember Me As A Smoker! Switching From Smoking To Vaping Was Easy
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
2
Contents Clinical Updates 1 Inspirtional Stories from Southern Stop Smoking Service
2
Message from the Chief Executive 4 News for the Southern District Health Board
4
Workforce Development 5 PHARMAC seminars: clinical pharmacology for nurses - Friday 6 September 2019 6 Updates on Southern HealthPathways 7 Bowel screening Update 8 Alliance South Update from the Alliance Leadership Team Chair - July 2019
9
Health Promotion 10 Staff Profile: Sarah Williamson Outreach Nurse
11
Green Prescriptions 11
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
3
*
Message from the Chief Executive Thank you to those that have agreed to attend the upcoming workshops - Transforming the Health System. One workshop in Dunedin and the other in Invercargill later this month. These are important workshops that will help guide the development of new models of care for the health system in this region. Thanks also to those practices that have responded to the data sharing request recently received from the SDHB. As stated in the last newsletter we will not be sharing any data until we have a data sharing agreement in place with the SDHB that agreement has been shared with practices to give them confidence in any arrangements. The Ministry of Health is working with us and the SDHB to ensure we get this agreement right and the process will certainly involve us seeking a Privacy Impact Assessment to ensure all aspects of the agreement and the data sharing are legal, correct and appropriate. Andrew Swanson-Dobbs, CEO asd@wellsouth.org.nz
News for the Southern District Health Board Lakes District Hospital welcomes CT scanner Diagnostic services at Lakes District Hospital are enhanced with a state-of-the-art CT scanner, now installed and operational.
Passport trial opens the door to better hospital discharges A ‘Hospital Passport’ for Southland Hospital medical ward patients is being trialled to help improve discharge communication with patients, and increase the number of before midday discharges.
Valuing Patients’ Time The Valuing Patients’ Time programme of work at Southern DHB started at the end of 2018 and is looking at how improvements can be made to the patient experience through our hospitals and beyond. It follows that if we value our patients’ time, we value our staff time by providing more time to care for our patients. Read the latest newsletter here.
New Website We are proud to introduce Southern Health, a new all-in-one website for services in the Southern district. With this new website comes a new logo – available for those providing care in the Southern district to present themselves as part of this wider health system.
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
4
Workforce Development Upcoming Education and Training Opportunities GP 26 Aug 16 Sep 08 Oct
"The ABCs of oncology- alphabet soup and newer cancer treatments in New Zealand” (start time 7pm) Recognition and management of common genital dermatoses Otago Faculty RNZCGP CME “Privacy and Cybersecurity” (rsvp to CME RMIP cme.rmip@otago.ac.nz)
Invercargill
Nursing Conference - Registrations Now Open
Queenstown
Invercargill Dunedin
Nurses 27 - 28 Sep
Practice Managers 20 Aug Practice Managers Forum Balclutha 30 Oct Practice Managers Meeting Oamaru 30 Oct Practice Managers Meeting Dunedin 31 Oct Practice Managers Meeting Central 31 Oct Practice Managers Meeting Invercargill
Conflict Management Training 13 Aug 14 Aug 28 Aug
Conflict Management Training (9:00am – 5:00pm) Invercargill Conflict Management Training (9:00am – 5:00pm) Cromwell Conflict Management Training (9:00am – 5:00pm) Dunedin Book now as this course will not be repeated!!! Limit 25 people per course – see our website for more detail (open to general practice staff only)
Ask the Haematologist 17 Sep Takitimu Room, Ascot Park Hotel (6:00pm) RSVP deborah.tomlin@leukaemia.org.nz no later than Thursday 12 September
Invercargill
Implementation of Shared Care Plans from a clinician’s perspective Presented by Rosie Laing, it is not a repeat of previous sessions. Presenter Rose Laing is a part time GP, part time GP liaison and Clinical Lead of Collaborative Care under the Canterbury Clinical Network. She has previously been a Regional Director of training for RNZCGP and post graduate education coordinator. 16 Jul Implementation of Shared Care Plans from a clinician’s perspective Invercargill 23 Jul Implementation of Shared Care Plans from a clinician’s perspective Dunedin 6 Aug Implementation of Shared Care Plans from a clinician’s perspective Cromwell
If you do not want to receive this flyer by email and would prefer still to receive it by fax email Cheryl Moeke, Workforce Development Advisor or cheryl.moeke@wellsouth.org.nz or ph 03 260 7739.
To find out more info on the events and to register go to http://training.wellsouth.org.nz/upcoming-events/
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
5
Workforce Development
PHARMAC seminars: clinical pharmacology for nurses - Friday 6 September 2019 Location: Hunter Centre Annex, University of Otago, 71 Frederick St, Dunedin. This seminar will be presented by Dr Elissa McDonald and Dr Felix Ram. They will discuss clinical pharmacology as it applies to primary care and common misconceptions about medicines in New Zealand. Other topics will include: asthma management, hypertension - current management options and diabetes, an evidence-based approach. Feedback from this seminar includes:
“Excellent presenters and a great update on the latest guidelines for asthma, CVD and diabetes pharmacological management”. “A really informative day and enjoyed the interactive approach to learning and discussions”. “Thank you for a valuable day - a very helpful seminar which will improve my practice”. For more information and link to registration website: https://www.pharmac.govt.nz/seminars/clinical-pharmacology-for-nurses-4/
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
6
Updates on Southern HealthPathways SOUTHERN COMMUNITY HEALTHPATHWAYS June 2019 HealthPathways now Mobile Friendly: The HealthPathways mobile friendly version went live on the 9th July 2019 along with a refresh of our standard site. For users with older browsers or devices, a “classic� HealthPathways site is running parallel to the mobile-friendly version, to ensure everyone can still access local clinical guidance, regardless of their technology. Clinical content is identical on the mobile-friendly and classic versions of Southern HealthPathways sites.
New domain name The mobile-friendly version of Southern HealthPathways has a new domain name. Your existing bookmarks and links to the site will continue to work, but you will be redirected to the following: Community HealthPathways: https://southern.communityhealthpathways.org
Access to the new site Your normal login details or access method will continue to work, but you may need to log in again with your usual username and password due to the change in domain names. If you are using an older web browser or device (computer, tablet, or mobile phone), you might be redirected to the classic site. A total of 622 pages are now live.
Pathway Reviews The review programme of work is moving forward with 80 Pathways now reviewed.
So what HealthPathways have you been looking at? The 10 most frequently viewed pathways for the month of June were: 1. Medical (1) 2. Abnormal Uterine Bleeding (3) 3. IV Iron Infusion (2) 4. Surgical (10) 5. UTI in Adults (6) 6. Bowel Screening- Family History (4) 7. Tonsillitis (8) 8. Zoledronic Acid Infusion (18) 9. Headaches in Adults (5) 10. National Bowel Screening Programme (NBSP) (21) *Figure in brackets denotes previous month
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
7
Southern HealthPathways had 30,888 page views in June 2019 with an average page view per session of 4.56. Of the 1,737 users who viewed pages on HealthPathways, 919 (52.9%) of these were new users to the site. The number of sessions per user was 4.56.
What to look out for Southern HealthInfo anticipated launch August. Want to know more visit: https://southern. healthpathways.org.nz/index.htm If you would like a visit to your General Practice from the HealthPathways Team then please contact us and we will organise this with you. If you do have any queries then please contact either: Bridget-Mary McGown, E: Bridget.McGown@southerndhb.govt.nz PH: 0274331711 or Jolene Jones, E: Jolene.Jones@southerndhb.govt.nz PH: (03) 214 7243. Don’t forget that you can also contact us by hitting the send feedback button on any HealthPathways page.
*** Bowel screening Update New bowel screening resources for Māori The Southern DHB’s National Bowel Screening Programme has a new Māori champion in Invercargill resident, Mooney Ngatuere. He has shared his experiences on video after receiving a bowel screening test result and having a colonoscopy. The video also features representatives of the kaupapa Māori support services available throughout the Southern district for other Māori who find themselves in Mooney’s position. The programme has also created new printed resources in Te Reo Māori – please contact Emma.Bell@southerndhb.govt.nz if you would like some.
Reaching diverse communities The Programme team is encouraging GPs to mention the National Bowel Screening Programme to patients within the eligible age range of 60-74 – especially those from diverse communities. The team is working with the Dunedin Multi-Ethnic Council and WellSouth to reach smaller populations. Middle Eastern communities are a particular focus at present, and it is pleasing to note that the former refugee community has high participation rates so far. In addition, the team is working with Servants Health Centre to identify their eligible patients who have not taken part, and proactively working together to remove barriers to their patients’ participation.
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
8
Alliance South Update from the Alliance Leadership Team Chair July 2019 Kia ora colleagues You may recall that in last month’s WellInformed newsletter I talked about our plans to evaluate the implementation of the Primary and Community Care Strategy (PCCS). As mentioned then, an online health provider experience survey is running during August and September as part of the evaluation. Further detail about the survey is outlined below. WellSouth and the Southern DHB are involved in a collaborative project with the University of Otago to investigate perceptions of integrated care and staff experiences in general practices and rural hospitals, one year into the implementation of the PCCS. This strategy was intended to deliver safe, high quality, team-based care closer to patients’ home with improved integration between primary and community care and specialist services. It is one of the most significant changes to the Southern Health System, and involves the implementation of Health Care Home, health hubs and locality networks providing services in the community rather than in hospitals. Although a positive impact of this strategy on patient-centred care is vital, it is important that these system changes do not negatively impact the working lives of general practice and rural hospital staff, including doctors, nurse practitioners, registered nurses, allied health professionals and administrators. For instance, we want to know how staff perceive the effectiveness of care coordination within their health centre and with external providers, how they work as a team, and whether their workload is manageable despite role and system-level changes. This initial investigation is part of the wider evaluation of the effectiveness of the PCCS in the Southern region. The survey results will allow us to identify initial strengths of this new strategy and areas of improvement. We hope that any areas of improvement can be addressed for years 2 & 3 to make the impacts of changes on people’s working lives more manageable in future. We are asking practice managers to pass to the study team the e-mail contacts of the GPs, nurses and administration staff at their practice. We will then email people to ask them to take part in the 15 minute online survey, which goes live on the 19 August. So please look out for it and take the time to complete the survey, so your views are included. To find out more about this project, please contact Wendy Findlay, Stuart Barson or myself. Ngā mihi nui Dr Carol Atmore carol.atmore@southerndhb.govt.nz
Regional stories from the South Island Alliance that have regional primary and/or community relevance • • • •
Health Connect South break-glass survey – tell us your thoughts RSPI will make more digital connections across the South Island Trauma South 2019 - the South Island trauma conference New award recognises clinical contribution to digital health
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
9
Health Promotion Celebrating World Breastfeeding Week – “Empower Parents, Enable Breastfeeding” World Breastfeeding Week is celebrated in the first week of August each year. Empower Parents, Enable Breastfeeding’, the 2019 theme aims to empower, enable and support parents and whānau, so breastfeeding can be a successful and positive experience. Empowering really just means supporting parents to manage their circumstances. The WHO recommends exclusively breastfeeding baby for the first six months, so we all have a role in recognising and removing obstacles that breastfeeding women and their whanau often face. It is also important to ensure supportive environments for all mums, parents and whānau, whether they are breastfeeding or not. Check out what is happening in your area and how you can get involved:
SOUTHLAND: Big Latch On Invercargill Big Latch On Winton Big Latch On Te Anau Big Latch On Gore
Fri 2 Aug, 9.30am Sat 3 Aug, 10.00am Fri 2 Aug, 10.00am Sat 3 Aug, 10.00am
Invercargill Public Library Winton Plunket Rooms Lakeside Presbyterian Church Gore Parent Centre
Thurs 1 Aug, 10.30am Fri 2 Aug, 10.30am Fri 2 Aug, 12:00pm Fri 2 Aug, 10:30am Tues 6 Aug, 11.00am Wed 7 Aug, 10:30am Tues 13 Aug, 10.30am
The Hang Out Queenstown Plunket St Johns Frankton Edgewater Queenstown Plunket Alex Baptist Church Playcentre
CENTRAL LAKES: Mums4Mums Cromwell Morning Tea Empowering Parents Playgroup Lakes District Baby Friendly Hospital shared lunch Celebrating Parents Wanaka Morning Tea Mums4Mums Queenstown Morning Tea Mums4Mums Alexandra Morning Tea Ranfurly Playgroup Morning Tea
COASTAL OTAGO: Big Latch On Oamaru Fri 2 Aug, 9.45am Oamaru Plunket Rooms Big Latch On Dunedin Fri 2 Aug, 10:00am Meridian Mall Ground Floor La Leche League Dunedin Afternoon Tea Sat 3 Aug, 2:00pm Croque-o-dile Café Botanic Gardens 4th Trimester: Supporting Postnatal Wellbeing seminar Mon 5 Aug, 10a:00m Dunedin Public Library For further information on events happening in your region – see the Big Latch On website, facebook or email health.promotion@ wellsouth.org.nz
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
10
Staff Profile: Sarah Williamson Outreach Nurse Sarah has been part of WellSouth since September 2018 when she joined us as an Outreach Nurse. She hails from the UK but has lived and worked in NZ since 2007, currently based out in Long Beach, Dunedin, where she lives with her daughter Freya. Her working history as an RN includes 10+ years of emergency nursing and more recently managing a team of nurses working for an HCSS provider across Southland and Otago. As part of the Outreach team she works with practices in the North Otago, Dunedin, Central Otago and South Otago regions to ensure that our high needs populations has equitable access to healthcare. This includes working with Māori, Pacifica and quintile 5 patients to ensure that they are able to access the funded screening they are eligible for (CVDRAs, Cervical Screening and Annual Diabetes reviews). Sarah visits people in their homes and workplaces which many of the patients she interacts with find to be an awesome option. Sadly, people fail to prioritise themselves, so making time to go to a medical centre when they are ‘well’ is rarely top of many priority lists. She is able to work outside of normal working hours (evenings and weekends) which ensures the service is flexible to meet our patient’s needs. A large part of Sarah’s job is education. She carries with her portable lipid and HbA1C machines so has immediate access to results which means any abnormalities are discussed then and there. Referrals are easy to do via ERMS - there are eligibility criteria and Sarah can provide you with these if you are not sure – feel free to drop her a line on 0212217282 or sarah.williamson@wellsouth.org.nz
Green Prescriptions Research shows that a Green Prescription (GRx) is an inexpensive way of increasing activity for sedentary people. GRx patient support advisors use the stages of change to identify the patient’s level of motivation to make positive activity and nutrition changes in their lifestyle. GRx patient support advisors work with patients to move from precontemplation through to maintenance. To identify whether a patient is ready to change their behaviour, take a look at the model here.
To refer to Green Prescription Sport Otago (03) 474 6350 Sport Southland (03) 211 2253 ERMS – ALLIED HEALTH – GREEN PRESCRIPTION
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
11