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WellInformed July 2019
Message from the Chief Executive Early this week information was sent to all practices informing them of a request for data that has come to us from the Southern DHB for health service planning. We have taken this request very seriously and want to assure you that while we agree with the intention of good service planning based on real and accurate data, that we will not be sharing any data that we hold on your behalf until we have gone through a very rigorous process. To ensure we get it right as a sector we have requested support and guidance from the Ministry of Health to help guide us and ensure we get it right. As you can see by the process we have put in place we have informed you of the request, detailed the information requested of us and will only release once we gain your permission to share it. Again we take our role of stewardship of what data we retain very serious. By now you will be aware of the investments in the area of mental health that were included in the governments recent “Wellness” budget. I am really excited to see the level of investment that has been provisioned for primary care and particularly the large investment targeted toward supporting general practice to provide interventions for their patients. Key to this investment is an expectation that health funders co-design the solutions in each region. I am keen to hear from practices that have an interest in working with us in the consultation with funders on what the solutions look like. Email if you are keen. The WellSouth Board and senior leadership team had a recent strategic planning session and reaffirmed our commitment to the health care home program of work and the very real need to design and build general practice that is ‘fit for the future’ for the southern region. With the new investments coming into the area of mental health it is no surprise this area has been elevated as a key priority to invest time and effort. We are also going to put a more energy into key enablers such as our digital strategy, health pathways and virtual health solutions Andrew Swanson-Dobbs, CEO asd@wellsouth.org.nz
Winter Symposium Invercargill 11 July 2019 A major review of the NZ Health and Disability System was launched last year, described by Health Minister David Clark as a “once in a generation opportunity to improve equity and outcomes for New Zealanders”. Can it make a difference? Panellist Professor Peter Crampton is a member of the Expert Review Panel on this, with an interim report expected soon…. Information on the panellists Start: 5:30pm Venue: Learning and Research Centre, Southland Hospital
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
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Contents
Message from the Chief Executive 1 Winter Symposium Invercargill 11 July 2019 1 Workforce Development 3 Alliance South Update from the Alliance Leadership Team Chair - June 2019
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Updates on Southern HealthPathways 7 I Stopped Smoking And Bought An Audi
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National Bowel Screening Programme updates 10 Certificate of Advanced Dermatoscopy 10 Diabetes Community Exercise Programme (DCEP) 10 Viv Williams: Shared Care Plan Coordinator 11 Green Prescriptions 11 Health Promotion 12 WellSouth Reflection 13
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
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Workforce Development Upcoming Education and Training Opportunities GP (Please note the start time differences in Southland) 23 Jul 26 Aug 08 Oct
“Equity in the Office” Dr Sue Crengle, (start time 7:00pm) “The ABCs of oncology- alphabet soup and newer cancer treatments in New Zealand” (start time 7pm) Otago Faculty RNZCGP CME “Privacy and Cybersecurity” (rsvp to CME RMIP cme.rmip@otago.ac.nz)
Invercargill Invercargill Dunedin
Nurses 27 - 28 Sep Nursing Conference Rydges Lakeland Resort, 38-54 Lake Esplanade, Queenstown Accommodation: You are responsible for booking and paying for your own accommodation. Rydges has accommodation available, the St Moritz or Crown Plaza are within walking distance. Start time: 10:00am Friday 27th September 2019 Finish time: Approximately 3:35pm Saturday 28th September 2019 Theme: Power in the Profession Registrations open 8 July 2019
HealthCare/Primary Care Assistance 11 Nov HealthCare Study Day Invercargill
CALD - Culturally and Linguistically Diversity Training 12 Jun
Culturally and Linguistically Diversity Training (time: 8:30am - 5:00pm) Register by emailing:Tiger.Scott@southerndhb.govt.nz
People Managing People – Don’t miss out 25 people per course Conflict Management Training for General Practice Staff Practice Managers you told us via live survey at last year’s Balclutha forum your top training requirement was conflict management/ resolution. We took that on board and WellSouth is delighted to be working with FreeSpiritNZ to offer you just that. Facilitator Kim Chateris-Wright is a well known and highly respected specialist in personal and professional development consulting, coaching, training and facilitation. Her primary emphasis is personal, team and leadership development. Don’t miss out on this one time opportunity! Outcomes: To maximise individual strength, confidence and competence. Learn how to manage conflict and have conversations that matter in order to ensure positive and empowering professional working relationships. If your role requires you to manage or lead people you need to attend. Limited to 25 people per course. This training is valued at $150 per person. Your individual registration cost is $50 per person and WellSouth will pay for you the remaining balance of $100 per person. 31 July 13 Aug 14 Aug
Conflict Management Training Conflict Management Training Conflict Management Training
(9:00am – 5:00pm) (9:00am – 5:00pm) (9:00am – 5:00pm)
Dunedin Invercargill Cromwell
If you have any queries about current or upcoming training or want to suggest some training topics 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
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Accessing Podcasts on WellSouth Website Did you know you can now see Otago Faculty podcasts regardless of the region you work in. Visit: https://wellsouth.nz/ Select ‘GPCME podcasts’ from the drop down box.
Already a Registered Member: If you are already a registered member (since December 2017) type in your email address and password, click on the picture of ‘Right Way’ under ‘GPCME Podcasts’ and chose your podcast to watch. If your email address and password don’t work then you will need to reregister (see below). Lost Password - click on “I’ve lost my password” directly underneath the log in button.
Not a Registered Member or need to ReRegister: Click on the ‘Register Now’ link on the WellSouth Login page (above). 1. Complete the ‘Register as Care Provider’ form and select ‘Submit’. This registers you for access to WellSouth website. (An email will be sent to WellSouth to verify your registration details). 2. Once you have registered please send an email to Cheryl: - cheryl.moeke@wellsouth.org.nz with your full name, practice name and your professional registration number. 3. Once your details have been verified (please note this is not instantaneous and is a manual process) your account will be activated. 4. You will receive a confirmation activation email from Cheryl. You can now access the Podcasts!
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
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Home administration of subcutaneous Azacitadine chemotherapy Indication: for palliative treatment of intermediate-2 or high risk myelodysplastic syndrome (MDS), chronic myelomonocytic leukaemia (CMML) or MDS-associated acute myeloid leukaemia (AML). Drug data intention is to be given 7 days in a row every 28 days until relapse or intolerance. Unable to be given 7 days in a row due to instability and short expiry in most centres, where there is no ability to compound chemotherapy onsite. Therefore it is given with a 2 -3 day break in the middle. Patient population: Currently 1 patient who lives rurally but the potential for more at any time. A detailed patient education protocol has been formulated with the intention of allowing them to self-administer as per the schedule below. Schedule for “at home� administration. Day 1
Tuesday
Day 1 dose administered onsite at Day unit
Day 2
Wednesday
Day 2 dose administered onsite at day unit & patient given Day 3 dose to take home
Day 3
Thursday
Day 3 dose patient to self-administer
Day 4
Friday
Day 4 dose administered onsite at day unit & patient given Day 5 dose to take home
Day 5
Saturday
Day 5 dose patient to self-administer
Day 6
Sunday
Break/no treatment
Day 7
Monday
Break/no treatment
Day 8
Tuesday
Day 8 dose administered onsite at day unit & patient given Day 9 dose to take home
Day 9
Wednesday
Day 9 dose patient to self-administer
All patients are instructed to contact the Oncology/Haematology Acute Assessment service 24 hours a day if there are any issues with administration at home and will be assessed by chemotherapy certified nurses on alternate days when treatment is given in the day unit. We anticipate no need to contact the GP service during the treatment period regarding this process. If there are concerns relating to treatment which are brought to your attention that you are concerned about, myself, the Oncology day unit or the lead haematologist can be contacted. Further information can be found at https://www.eviq.org.au/haematology-andbmt/leukaemias/myelodysplastic-disorders/1173-myelodysplastic-syndrome-azacitidine
Julie Smith Haematology Clinical Nurse Specialist Southland Hospital 0274839489
Alliance South Update from the Alliance Leadership Team Chair June 2019 Hello colleagues You may have seen in the newspaper recently that Alliance South (i.e. WellSouth and Southern DHB) along with the University of Otago, Otago Polytechnic and Southern Institute of Technology received the Health Research Delivery Award at the recent Health Research South Excellence Awards. Health Research South has awarded us funding for a project over the next three years to:
• support the evaluation of the implementation of Southern Primary and Community Care Strategy (PCCS) and • build evaluation capacity within the Southern Health System. This is great news, as successful implementation of the PCCS is critical to the future viability of the Southern Health System, including the success of the new Dunedin Hospital when it is built. So what’s the plan? Identified service provider leads and academic leads will partner to monitor how key elements of the PCCS and the strategy overall are implemented. The key elements for focus are health care homes, community health hubs, locality networks, client led integrated care (CLIC) and care planning, and our rapid response services for older people. Health Research South’s Health Research Delivery Award will fund the following for three years: • A Strategy Evaluation and Oversight lead role, with responsibility for coordination of the various project parts and to lead the overall evaluation • A postdoctoral research fellow role to undertake many of the day to day tasks required for the evaluation in partnership with the wider team members and • A research fellow role to specifically focus on the impact of the PCCS’s implementation from a Māori perspective. These roles will work closely with WellSouth, SDHB and health providers to further develop people’s evaluation skills. Biostatistical support is also funded. Regular feedback of evaluation findings to WellSouth, SDHB and providers during the project will allow us to improve processes as we go. Annual health provider experience surveys will be part of the evaluation, to capture the impact of changes on people’s day to day working lives. The first of these electronic surveys will come your way around August/September this year, 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
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Updates on Southern HealthPathways SOUTHERN COMMUNITY HEALTHPATHWAYS May 2019 HEALTHPATHWAYS MOBILE FRIENDLY FROM 9 JULY: From 9 July 2019, HealthPathways will become mobile-friendly. The site uses responsive design, meaning all pages shift and adjust the content depending on the device you are using (desktop computer, laptop, tablet, or mobile). Rather than creating separate desktop and mobile sites, we've created a single site that works no matter how you access it. For users with older browsers or devices, a “classic� HealthPathways site will run 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 614 pages are now live.
Pathway Reviews The review programme of work is moving forward with the review of 11 pathways completed in May bringing the total number of pathways reviewed to 72.
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
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So what HealthPathways have you been looking at? The 10 most frequently viewed pathways for the month of May:
The 10 most frequently visited pathways not yet localised for the month of May (page views in brackets):
1. Antenatal- First Consult 2. Antenatal Screening 3. Responding to Drug Seekers 4. IV Iron Infusion (8) 5. Measles (1) 6. Atrial Fibrillation (AF) 7. Sexual Health 8. Requests for Termination of Pregnancy 9. Hip & knee joint replacement (4) 10. Long Term Contraception and Sterilisation *Figure in brackets denotes previous month
1. ADHD in Children and Youth (16) 2. Frailty in Older Adults (46) 3. Knee Injuries (48) 4. Anxiety in Adults (57) 5. Diverticular Disease (60) 6. Acute Ankle Injuries (74) 7. Bow legs (81) 8. Medical Care Guidance (98) 9. Mental Capacity (100) 10. Osteoarthritis (108) Analysing this information helps us to identify localisation priorities.
Southern HealthPathways had 37,172 page views in May 2019 with an average page view per session of 4.55. Of the 1,873 users who viewed pages on HealthPathways, 1055 (48.4%) of these were new users to the site. The number of sessions per user was 4.36.
HealthPathways Page Views 40,000 30,000 20,000 10,000
What to look out for
Southern HealthInfo anticipated launch July.
17-18
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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.
I Stopped Smoking And Bought An Audi Kurt Scriven - Oamaru I’d been smoking 20-30 cigarettes a day for 48 years; a habit I started in my teens and never tried to stop. Everyone smoked in those days, it was normal, and it just became ingrained in my lifestyle.
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
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Nga Kupu o te Marama Words of the Month Toru, Takurua, Hōngongoi, Hūrae – second lunar month of the Māori year, approximately equivalent to July Makariri – winter, cold Te Whare Wānanga o Otāgo – University of Otago Rongoā Kākāriki – Green Prescription Wai māori – fresh water Wai tai – sea water Manaaki – show respect, generosity and care for others Oranga - health
WellSouth is including Māori Words of the Month that are related to relevant health topics covered in WellInformed
*** National Bowel Screening Programme updates Ordering bloods from patients with positive FITs Although there is no expectation on the part of the GP/RN to take bloods on the day of consultation, in certain circumstances having recent renal bloods is essential prior to arranging the most appropriate investigation. These circumstances include a patient who has multiple co-morbidities, or someone who is more appropriate for CT colonography.
Pasifika champion joins the programme The Southern DHB’s National Bowel Screening Programme now has a Pasifika champion in Southland Presbyterian pastor, Reverend Tau Ben-Unu. Pasifika participation sits below the national 60% target in the Southern district, at 56.2% according to Ministry of Health data to the end of March 2019 – although it is significantly higher than the national figure of 42% Pasifika participation. Rev. Ben Unu has shared his story on video, from his positive test to getting a bowel cancer diagnosis, and subsequently undergoing treatment. Watch the video and read more on the new Southern Health website.
Certificate of Advanced Dermatoscopy
The Early Bird rate for the July Symposium has been extended to the 7th July 2019. http://www.skincancersymposiums.com/
Diabetes Community Exercise Programme (DCEP) Since January 2018 WellSouth in partnership with the University of Otago, School of Physiotherapy have been running a randomised controlled trial studying the effectiveness of a Diabetes Community Exercise Programme (DCEP). The final round of DCEP commences in Invercargill on the 16 July 2019 and we would be grateful if general practices in the Southland region could bring the trial to the attention of patients with Type II Diabetes (35yrs +). Referral to the study can occur using the Electronic Request Management System (ERMS) referral system or by phoning 0800 687 489 if the practice does not use ERMS. Further Information about the study can be found at https://www.otago.ac.nz/dcep/index.html. If you have any comments or questions please contact: dcep.physio@otago.ac.nz. We appreciate your support with this exciting research.
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
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Viv Williams: Shared Care Plan Coordinator Viv was born and bred in Australia, where she trained to be a registered nurse at Flinders University, in Adelaide, South Australia. After graduation Viv did a year of a post grad programme, then moved to Perth to pursue a career in Intensive Care Nursing. Being based at Royal Perth Hospital Viv enjoyed a number of years working in this very dynamic, modern and progressive environment. After her mother was diagnosed with advanced stage multiple myeloma, Viv decided to change her career choice. The care her mother received from the palliative care nurses was exceptional and prompted her to pursue a career in this new direction. After numerous oncology courses and experience on the ward Viv began work with a company called “Silver Chain”. Silver Chain is a district nursing palliative care service. There she enjoyed many years visiting palliative patients in their own homes offering symptom control and palliative care education to the patient and their loved ones. Viv then had two “perfect” children, ha ha and moved to Christchurch, New Zealand while they were still young. When ready to return to full time work Viv moved sideways supporting an educating post -op cardiothoracic patients once discharged home. A brush with cancer herself led Viv to the Cancer Society to seek support and information. During this visit she learnt of a position which was vacant and was invited to apply. Commencing work as the cancer information nurse two weeks later. This varied role included answering cancer related questions on the 0800-line, meeting with patients face to face during any stage of their cancer experience, formal education sessions to health professionals and community groups and editing the Cancer Society booklets. After six years in this role Viv remained with the Cancer Society, applied, and was successful in securing the role as Information and Supportive Care Manager for Canterbury/West Coast Division. This opened a world of budgets, strategic planning and staff management. With her children studying at Otago University, a love for this vibrant city and the newly advertised “Shared Care Plan Coordinator” position…….all her ducks were in a row! As the Shared Care Plan Coordinator, Viv sits under the umbrella of the long-term conditions team. In this role she essentially supports GP practices to educate how to complete care plans with the patients, uploading of these electronically and ensuring an annual follow-up of the patients progress is maintained. These care plans are acute plans, Personal care plans and advance care plans. Viv will be travelling to practices throughout Southland, Central and Otago. Her role also involves providing education sessions on care planning and one to one education on specific plans and any problems which practices may be having around this. Viv is also becoming involved in a number of working groups to promote the advance care plan and will soon be delivering ACP training workshops across our Southland and Otago regions.
Green Prescriptions GPs prescribing exercise and other non-clinical activities is on the rise. It’s not just our hearts and lungs that benefit from physical activity and movement. Exercise reduces the risk of a wide range of physical conditions, including one of New Zealand's leading causes of health loss, obesity-driven Type 2 diabetes. The Healthy Food Guide and The Otago Daily Times have shown their support and encouragement for health professionals to prescribe Green Prescription to address lifestyle change before prescribing medication. To refer to Green Prescription: Sport Otago 03 474 6350 Sport Southland 03 211 2253 ERMS – ALLIED HEALTH – GREEN PRESCRIPTION
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Health Promotion
Whakaaro of the week
Confused about Vaping and E-Cigarettes? Sort out the facts from the myths by visiting the new Ministry of Health-Health Promotion Agency website ‘Vaping Facts’ - https:// vapingfacts.health.nz/ for all the info you need to know about: • Key vaping facts • Smoking Vs Vaping • Vaping to quit smoking Vaping Facts is designed to make it easy and simple to access on a mobile phone and features include a Cost Calculator, quiz, videos and a vaping Position Statement of 5 key points: 1. The best thing to do for your health is to be smokefree and vape free 2. Vaping is not for children and young people 3. Vaping can help some people quit smoking 4. Vaping is not harmless but is much less harmful than smoking 5. Vaping is not for people who do not smoke
Choose FREE water on the go! Did you know that on average, each of us in New Zealand uses 168 plastic bottles per year! With just 1/3 being recycled. We are collectively throwing away 526 million water bottles every year. Along with helping our environment, choosing free tap water will keep us well hydrated and benefit our wallets too. Participating businesses nationwide are embracing the #ReFillution and YOU can too! Simply look out for places displaying the RefillNZ sticker in their window – showing they are a Refill station and you’re welcome to come on in - and fill up your bottle with water for free! For more information and refill places in Otago & Southland check out this website - https://refillnz.org.nz/where-to-refill/.
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WellSouth Reflection On 15 May 2019 the Oamaru Heart Foundation held an education day for patients within the community diagnosed with various heart conditions. This is one of many heart health education days that have also taken place in Balclutha and Cromwell. As a primary health network, health consumer education is a corner stone of what WellSouth provides. This meant that as a student I was able to attend with my preceptor, long term conditions nurse, Sue Walker. The event was also attended by the heart failure specialist nurse and cardiac nurse specialist from the DHB, a pharmacist from WellSouth, a Heart Foundation Dietician and a volunteer exercise specialist. The combination of primary, secondary and tertiary care health professionals, was both an effective and inspiring approach to holistic patient care. For someone learning about the health-care profession it was reassuring to see that there is a common goal among organisations to promote patient independence, allowing for a better quality of life. The interactive presentations covered by the speakers included topics from diet, exercise, wellbeing, medication information, to insight around the diagnosed heart conditions that were in the room. All presenters, in their own way enabling the patients to take control of their conditions in their own homes. Furthermore, creating a community among the survivors to reinforce nobody is alone in their health journey. I believe one of the most influential parts of the day was the last session. During this time, the clients were divided into small groups who had commonalities in their illnesses. Within these groups, which were led by one of the health professionals, clients were encouraged to set at least one goal. This goal was guided by the days new learnings and varying personal incentives which had been established. Each target was individualised to suit the lifestyle of the client. As well as lining up with their level of motivation and current health status. The importance of having these conversions in a group setting was visible by the amount of idea’s the clients could bounce off each other. Sharing their enablers and disablers opened doors for new approaches to goals that may have already been attempted. Each person within my group was able to write down a new goal by the end of the session. These were made sustainable by uncovering a circle of support. This varied for each client but was often composed of friends, whÄ nau and their close health care team. This reinforced for me that patients circle of care can be so broad. As a result, it is important to have a united front from primary through to tertiary health care providers. During my time at WellSouth I have had the opportunity to see an overview of the many different teams within the network. It has been an eye-opening experience to see how all the underlying pieces of the puzzle, fit together to provide a succinct care plan for each individual. I think looking at each role and how a registered nurse interlinks with each profession was an advantage for me. This is because I was purposefully conscious of the amount of communication needed to fuse all of the specialised knowledge together. The inter-professional cooperation between each of the teams showed me how important it is to recognise each professions scope of practice. Being able to acknowledge this ensures high quality care for the client. I would like to thank everyone who helped to make my experience in primary care so positive. I have truly enjoyed my time at WellSouth. Jess Faulks (Otago Polytechnic Student Nurse)
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
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