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WellInformed February 2018

Clinical Updates

Health Promotion

Long Term Conditions

Workforce Development

Nga Kupu o te Marama


From the Chief Executive, Ian Macara Primary and Community Care Strategy and Action Plan Thanks to all GPs, practice staff and key primary care providers and stakeholders who attended our recent locality meetings on the Primary and Community Care Strategy and Action Plan. We have greatly appreciated your discussion and input in response to the presentation by Dr Stephen Graham, WellSouth’s Clinical Director. We are encouraged by the general consensus that with a committed focus on our ‘total system’ working together more effectively, we can configure Southern healthcare delivery to better achieve what our communities and providers require into the future. WellSouth has a strong focus on the sustainability of general practice. The development of Healthcare Homes, Community Hubs and Locality Networks are opportunities to embed service models, based on increasing the strength of multi-disciplinary teams, to achieve this outcome. As Chris Fleming, SDHB CEO and Lisa Gestro, Executive Director Community, Planning and Strategy committed at our meetings: the Strategy’s preeminent focus is the Action Plan, which will be supported and resourced to ensure initiatives achieve the specified outcomes. This is an excellent signal in support of the partnership between SDHB and WellSouth as we strengthen healthcare integration the Southern District. After the next series of SDHB Commissioner led public meetings in late January and February, the Strategy and Action Plan will be finalised and implemented, with a start date of 1 July. 2018 is therefore going to be a challenging and rewarding year for WellSouth, let us all step up together!

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Contents From the Chief Executive 1 Clinical Updates Clinical Update by Dr Stephen Graham 3 Work Capacity Medical Certificates for Clients with Cancer 3

Long Term Conditions Free Comprehensive Health Checks and Intervention for the Pacific Island Community 4 Nutrition Courses 4

Ngā Kupu o te Mārama 5 Health Promotion Family Violence Talk Card 6 Draft Dunedin Local Food Charter - Opportunity for feedback 6 Green Prescription 7

Workforce Development 8 Notices Police Vetting 10 News Tips 10 Vacancy: GP, South Island Healthy Weight in Childhood Clinical Advisory Group 11 IT Helpdesk 11 Servants Health Centre - Nurse Open Night 12

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Clinical Updates Clinical Update by Dr Stephen Graham I am going to limit myself to two subjects for this issue because they are both important and in need of attention. Although this is short, if you wish there is plenty of reading on the primary and community strategy link. 1. The new Primary and Community Care Strategy. WellSouth and Southern DHB have just completed seven evening meetings in the region to inform the primary care workforce (and general practice in particular) about this. There will be an opportunity for general practices to become a Health Care Home. I would hate for a practice to miss out because they had either not heard about it or had not had the chance to investigate it. You can look at further information on the subject here. Please contact me or Paul Rowe if you wish to discuss with someone.

2. The bowel screening programme in our district is due to begin in early April. Southern is the first DHB in the South Island to provide bowel screening so this is an exciting health milestone. There will be an educational roadshow beginning in February. This is designed to address the many questions that providers will have on the subject. Our hope is to have someone from every practice attend this roadshow. As a backup plan, some individual practice visits are possible either by clinician or support teams. Please understand that if a large number of practices are not represented at the meetings, the logistics of visiting practices individually becomes very difficult, as we are a large geographical region. Here is a link with background information.

Dr Stephen Graham Medical Director, Wellsouth PHO

Community Exercise and Education for Long-Term Management of Diabetes and Multi-Morbidity University of Otago, School of Physiotherapy Research team: • Prof Leigh Hale, Principal Investigator, Research Physiotherapist, Dean of School of Physiotherapy • Prof Jim Mann, Consultant physician/endocrinologist • Prof Tim Stokes, Research General Practitioner • Dr Ram Mani, Research Physiotherapist • Dr Prasath Jayakaran, Health Researcher with a physiotherapy background • Dr Fiona Doolan-Noble, Research Nurse • Dr Trudy Sullivan, Health Economist • Andrew Gray, Biostatistician, • Chris Higgs , Clinical Physiotherapist The School of Physiotherapy have been running a Community Exercise Programme for people with Type II diabetes for many years now. We are excited to announce that we have recently secured a substantial Health Research Council grant to formally investigate the effectiveness (including costeffectiveness) of our Diabetes Community Exercise and Education Programme (DCEP) in a randomised control trial (RCT) that will run in both Dunedin and Invercargill over two years. We have now begun recruiting for participants with Type II diabetes to take part in the research. Those who are interested in taking part can be referred by their GP, or contact our administrator on or 03 479 4979, and they will then ask the volunteer for consent to contact the participant’s GP.

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All participants take part in an assessment (for which they will receive a supermarket voucher to compensate their time) that involves questionnaires about their health and wellbeing, as well as some physical tests, before being randomised into the DCEP programme or DESMOND. DESMOND is a wellestablished one-day self-care workshop for people with Type II diabetes run by WellSouth. Participants who are randomised into the DCEP group will attend twice-weekly community exercise classes that are followed by an education session (90 minutes in total). The exercise class is tailored to meet the participant’s specific health needs, and are safe, fun and friendly – no lycra or mirrors! All participants in both the DCEP and DESMOND groups, are assessed three more times over the duration of the study, and at each time will receive a $20 supermarket voucher in compensation. We are especially excited that we will be developing an implementation package from this research for any community in New Zealand (NZ) to enable the roll out DCEP in their community and make it truly accessible and helpful for those with health issues. Type II diabetes is an increasing problem in NZ, with almost 7% of adult New Zealanders, ie approximately 200,000 people diagnosed with Type II diabetes. We are truly appreciative to those who will take part in the study, as it paves the way for a greater understanding of what kinds of interventions work best for managing diabetes. For more information contact Bonnie Scarth, Project Manager phone 4797130


Long Term Conditions Free Comprehensive Health Checks and Intervention for the Pacific Island Community General Practitioners can refer patients for this service. Lou Oldham holds clinics at WellSouth’s Dunedin office on Mondays/Tuesdays 9am–2.30pm, or she is available for home visits.

The service includes chronic disease/long term conditions support and education, cervical smears, lifestyle planning and support, smoking cessation, general screening, family support including advocacy, and interagency liaison.

The vision for this service is to work alongside general practice teams to help in assisting Dunedin’s Pacific Island community.

Lou Oldham Pacific Island Community Nurse 021 405 232

Nutrition Courses In vs Out: Eating and Activity Guidelines in practice for Primary Care With the constant media hype on diet, it can be pretty tough knowing what is current evidence based practice in nutrition and physical activity, and even tougher giving practical advice to patients about changes they can make to improve their nutritional wellbeing. This three hour course explores how to implement practical changes to improve the typical New Zealand diet towards the recommendations of the Eating and Activity Guidelines for Adult New Zealanders (2015). It sets these changes in the context of Action Plans similar to those used in DESMOND and Walking Away courses delivered by WellSouth.

Food first before supplements – managing malnutrition on older people in the community As many as half of our old elderly are at risk of malnutrition or have malnutrition. Unplanned weight loss of 5% or more from a usual adult weight over a 3-6 month period is an indicator of malnutrition risk. If unmanaged the loss of muscle mass from poor nutrition increases the risk of falls and fractures, plus poor wound healing and increased infection risk. All these will reduce quality of life and can result in hospitalisation and move older people into long term care. This three hour course discusses the risk factors for malnutrition, the signs

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and symptoms to look for. It also helps you identify who you should be monitoring, when you should be running a screening questionnaire, and how often you should follow up at risk or malnourished patients. The course also covers the “food first” activities required before oral nutritional supplements can be offered on special authority. Managing malnutrition in older people is made more complicated by their long term conditions such as CVD or diabetes, so “changing the message” is highlighted in the course.


Nga Kupu o te Marama Words of the Month Manawapā – Anxiety Mahi-ā-rōpū – Group work Haumanu Korkikori – Physiotherapy

WellSouth is including Māori Words of the Month that are related to relevant health topics covered in WellInformed

Health Promotion Breast Feeding Pharmacies Accredited Breastfeeding Friendly Pharmacies have been added to Pharmacy profiles on the WellSouth Website! Pharmacists are often the most accessible medical expert for breastfeeding women. They are frequently asked for breastfeeding related advice due to their highly visible role in the community. The Health Promotion Team developed the Breastfeeding Friendly Pharmacy project, to assist more pharmacies to be supportive environments for breastfeeding in the community. A Breastfeeding Friendly Pharmacy has: • Adopted and implemented workplace policies to ensure staff protect, promote and support breastfeeding • Put signage on display encouraging women and whānau to tell pharmacy staff they are pregnant or breastfeeding • Staff who complete breastfeeding professional development • Promoted community breastfeeding services Go to the WellSouth website, chose “find a pharmacy” click on their profile, and in the “about” section it will state if the Pharmacy is Breastfeeding Friendly.

If you have an interest in becoming a Breastfeeding Friendly Accredited Pharmacy email us or call 03 477 1163

New Smokefree Environments – Invercargill CBD and Central Otago Invercargill City Council (ICC) have unanimously passed a Smokefree Areas policy which covers the central business district (CBD). Public areas within the CBD Smokefree including footpaths and pocket parks will be Smokefree. The policy aims to de-normalise smoking especially in places where children are present and reduce the visibility of smoking. E-cigarettes and vaping are included and the policy will be reviewed in a year.

Central Otago District Council is moving towards Smokefree public outdoor areas. Council owned parks and reserves, tracks and walkways, sportsgrounds and playgrounds will be Smokefree. Within 10 metres of public pedestrian entrances to Council owned buildings (including libraries and swimming pools) and bus stops will become Smokefree. On publicly owned land areas set up for café or dining purposes will also be included.

Both the Invercargill Youth Council and Smokefree Murihiku supported the policy. WellSouth is a member of Smokefree Murihiku who is working alongside ICC to develop signage and promote the policy throughout the CBD.

Central Otago Wakatipu Smokefree Coalition has been advocating 10 years for these changes and is now supporting council with implementation.

For more information about Smokefree Murihiku contact Bridget Rodgers, or call 03 214 6436

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For more information or to join the coalition contact Jo O’Connor, or call 027 210 4716


n Green Prescriptio

y r o t S s ’ a n i T Fit for Life Green Prescription improves the health and wellbeing of adults through free support around physical activity levels and nutrition habits. Everyone has a ‘light bulb moment’, a moment that stops them in their tracks and opens their eyes to what could be. For Tina, that was an afternoon at the park with her family, and she was struggling to keep up with her great niece. It clicked for her that she soon would be a Nana for her own grandson; what sort of Nana did she want to be? For Tina, this started a conversation in her head about where she was with her health and fitness and how much she valued being able to be ‘Nana fit’. This moment started Tina on her journey to not just be ‘Nana fit’ but ‘Tina fit for life’. Tina had led a fit and healthy life up until what she now recognises as her ‘top of the cliff’ moment. She was a frontline Police officer and unfortunately sustained a career-ending injury in the line of duty. This sparked the start of a downward spiral in both her physical and mental health. She was hurt emotionally with the feelings of failure due to not being able to continue with her work which she loved. This also took a massive toll on her self-esteem and confidence. Tina can see now that she turned to food as her form of comfort, “wrapping myself physically to protect myself emotionally”. It took her a few years to recognise that she was not happy with how she was; despite having a supportive and loving husband, she was still struggling to love herself. This is when she knew the time was right for her. So, she sought out support to make the changes she needed to make to be a better version of herself. That is when she walked through the Green Prescription doors to talk to our team and got the support she needed to find activity that she would enjoy and set herself some goals. When Tina came to Green Prescription she had somewhat of an idea of what to expect as she had been on the programme previously in a different area. However, she did not engage fully and didn’t feel a connection with the programme but this time it was different. Tina felt from the get-go that this was the right time for her to take this on, as not only had she sought help with her activity, she had also started looking at her whole health too. She described it as “you’ve got to have a stable table; the more support (legs) you have on your table, the better off you’ll be. For me, that is what made the difference, knowing I had the support in all areas so if one dropped off the others would keep me going.” Tina felt that the Green Prescription team showed a genuine interest in her and that she was valued as an individual throughout her time on the programme. Tina started with small changes, including more active transport, regular walks with her dog, and got her bike serviced. A game changer for her was the Aqua Fitness classes; she loved the atmosphere in the pool and that she could connect with other like-minded people on the same journey as her. Tina also took more notice of what she was putting into her body, making better food choices and questioning herself as to if she really did need to eat something. Even with having to undergo spinal surgery, she has not let anything get in her way. “You have to stop focusing on the ‘can’t’ and shift that focus to what you can do and what works for you.” With this positive attitude she has come through the whole experience better and stronger than ever, finding her body can do much more than she would have thought possible. Tina has worked through the ups and downs and come out the other side with a smile on her face. She puts it all down to a few simple points; 1) accept change, the good/bad and new, 2) find your why, find the enjoyment in things and hold onto that because only you can make those changes, 3) count the little wins; set small achievable goals and celebrate them. 4) find and use the support that is available to YOU, the more you have the easier things will be. Tina knew the time was right for her and kept positive throughout her journey that she proudly says she is still on. She is not done yet but feels that she is well on her way to the person she wants to be for life. Tina is an inspiring woman who is proof that if you trust the process and do what works for you, you can achieve your goals. As she says “the only thing it will cost you is effort!”

If you would like to make exercise a part of your life, ask your doctor or nurse for a referral to Green Prescription or self-refer to the programme online at:

Workforce Development Education January - February 2018 Dunedin 13 February CPR Level 2 6pm – 8pm 16 February SDHB PDRP Drop in Sessions TBC 17 February In vs. Out: Eating and Activity Guidelines in practice for Primary Care 9am – 12pm 17 February Food first before supplements – managing malnutrition on older people in the community 1pm - 4pm 19 February National Bowel Screening Training 7am – 8:30am 19 February National Bowel Screening Training 12pm – 1:30pm 19 February National Bowel Programme Training 6pm – 7.30pm 21 February Practice Nurse Professional Forum 5:30pm – 8:30pm 23 February Otago Exercise Programme for Home Based Exercise Providers 9am - 12pm and 1pm - 4pm 28 February Training for Community Strength & Balance Exercise Group Providers 10am – 3.30pm 14 March New Beginnings – Update on Maternity Services, Support, Wellness 6:30pm – 8:30pm 20 March CLIC Training 8:00am – 12:30pm

Otago 20 February Practice Nurse Professional Forum Balclutha 5:30pm – 8:30pm 21 February CLIC Training Balclutha 8:00am – 12:00pm 22 February Practice Nurse Professional Forum Oamaru 5:30pm – 8:30pm 23 February National Bowel Screening Training Balclutha 7am – 8:30am 26 February National Bowel Screening Training Palmerston 7am – 8:30am 26 February National Bowel Screening Training Ranfurly 12pm – 1:30pm 26 February National Bowel Screening Training Oamaru 7am – 8:30am

Central Otago 20 February 20 February 21 February 21 February 21 February 21 February 21 March 21 March

National Bowel Screening Training National Bowel Screening Training National Bowel Screening Training National Bowel Screening Training National Bowel Screening Training National Bowel Screening Training Practice Nurse Professional Forum Practice Nurse Professional Forum

Roxburgh Alexandra Queenstown Wanaka Queenstown Queenstown Queenstown Cromwell

12pm – 1.30pm 6pm – 7.30pm 7am – 8.30am 12pm – 1.30pm 5:30pm – 7pm 7pm – 8:30pm 12pm – 2:30pm 5:30pm - 8:30pm

National Bowel Screening Training National Bowel Screening Training National Bowel Screening Training National Bowel Screening Training

Gore Tuatapere Lumsden Te Anau

12pm – 1:30pm 12:30pm – 1:30pm 12pm – 1:30pm 6pm – 7:30am

Southland 23 February 27 February 28 February 28 February

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Invercargill 15 February 15 February 15 February 27 February 28 February 01 March 07 March 15 March 19 March 20 March

CLIC Training SDHB Baby Friendly Essentials and Challenges Workshop SDHB Unstable Patient Workshop National Bowel Screening Training National Bowel Screening Training Practice Nurse Professional Forum Fragility Fractures and Falls Risk Assessment in Primary Care New Beginnings – Update on Maternity Services, Support, Wellness Cultural Competency & Working with Interpreters Drug Interactions Invercargill Meeting room and via Vidyo

12:30pm – 5:00pm 8:30am - 4pm 8:30am - 4pm 6pm – 7:30pm 7am – 8:30am 5:30pm – 8:30pm 9am – 4:30pm 6:30pm – 8:30pm 8:30am – 12:30pm 6:30pm – 8:30pm

NB: There will be two additional training sessions for the National Bowel Screening Programme on Monday 5 March and Wednesday 7th March from 7pm – 8.30pm via Vidyo conference link. Please ensure you have tested your software on your computer before the day. People in Invercargill can attend our Clyde Street office for either session and participate via our big screens.

Southland GP Educational Weekend – Borland Lodge 26 and 27 May The Southland Faculty and WellSouth are hosting an educational weekend for Southland GPs at Borland Lodge, Blackmount on the 26-27 May 2018. Speakers include Professor Tim Stokes, Dr Julie Mador, Dr Emma-Kate Lacey and Dr Konrad Richter. To see the agenda, click here. A flyer will be faxed to you shortly. Registrations are open now at

Upcoming Training Opportunities • Do not miss the update on Maternity Services and Supporting Wellness in Before, During and After pregnancy. • Practice Nurse Professional Forum • CLIC Education Sessions • Cultural Competency and Working with Interpreters

Did You Know? You can now register for training on the WellSouth website without using a login or password. Just click on the people icon then click on Workforce Development picture and then on “Find professional development link”.

Please note that these dates can change, so please check For times, dates, registration details and upcoming training

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Notices Police Vetting Vulnerable Children’s Act 2014 From 1 July 2015: new core workers must be safety checked before they start work From 1 July 2016: new non-core workers must be safety checked before they start work By 1 July 2018: existing children’s core workers (ie those currently employed or engaged as a contractor) must have been safety checked By 1 July 2019: all existing non-core workers must have been safety checked.

Definitions Child – a person who is under the age of 14 years Young Person – a person who is aged between 14-17 years Children’s Workers –people providing a regulated service and whose work may involve regular or overnight contact with children, taking place without a parent or guardian present. Core Workers – a children’s worker whose work requires or allows them to be the only children’s worker present, or has the primary responsibility for or authority over, children (section 23 of the VCA) Non-Core Workers – those who are not registered medical professionals, eg courtesy van drivers, receptionists, office workers, foster carers Although there is a national rollout period, WellSouth would like all practices to start completing the new police vetting as per the Vulnerable Children’s Act 2014 before these dates and preferably this year. Please send police vetting forms via email, fax or post to Lizzie Ross. Tel: 03 477 1163 Fax: 03 477 1168 Post: WellSouth, PO Box 218, Dunedin 9054

For further information about the Vulnerable Children’s Act and police vetting, please see:

News Tips If you have any news items or are starting a new initiative that you would like to see in WellInformed, please email or call on 03 477 1163.

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Vacancy: GP, South Island Healthy Weight in Childhood Clinical Advisory Group We are looking for a GP with an interest or experience in childhood healthy weight management to join the South Island Healthy Weight in Childhood Clinical Advisory Group (SICAG). The role of this group is to oversee the implementation of the South Island Childhood Healthy Weight Strategic Plan and provide support, advice and direction to South Island DHBs. The group is made up of representatives from across the health sector – primary care, secondary and specialist care, as well as members with paediatric, consumer and MÄ ori health perspectives. This is an opportunity to help shape the development and delivery of child health services across the South Island. Meetings are held every second month via videoconference. The membership term is three years with the option to extend. Self-employed members of the group are reimbursed for their time. Applications close end of business 26 February 2018. More information about the South Island Healthy Weight in Childhood Clinical Advisory Group.

For more information about the role, contact: Child Health Service Level Alliance Facilitator Jane Haughey Email: jane.haughey@siapo. Phone: 03 378 6914 or 027 512 6122

IT Helpdesk Where possible, all IT jobs must be logged through the WellSouth portal. Doing so automatically logs your query on our ticketing system and supplies you a ticket number to query us on. WellSouth portal: Accessible from your PMS or directly Email: Ticketing system: - allows you to check on the progress of your ticket and send replies to any queries. Free phone: 0800 935 575, option 1 Please include as much information as possible about the issue/request, including any screenshots and attachments that may assist with the job. Remember to remove/cover/blur any patient identifiable data when corresponding with us.

NOTE: Please do not email IT staff directly as then your job will not be tracked on our ticketing system.

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Wellinformed feb 2018 final  
Wellinformed feb 2018 final