WellInformed September 2019
Clinical Updates Clinical Update by Dr Stephen Graham Dear Primary Care Workforce, 1. Thanks to all of those (around 40 practices) who replied to the recent questionnaire regarding colonoscopies in Southern region. These responses have allowed us to have better informed feedback to the DHB on the subject. Based on the feedback we are looking at a more in-depth survey of our primary care experience of the whole of primary/ secondary interactions. 2. You will all no doubt be aware of the new Pharmac funding for Hepatitis C treatments. Margaret Fraser from the Gastroenterology Department has supplied this information for primary care on the subject. She will soon be providing education sessions and will be outreaching to General Practice as well. The key to treating Hepatitis C (in the absence of a formal screening programme) is to identify the patients at General Practice level. You need to be aware that Southern Community Labs do not fund screening for Hepatitis C. So the indication for testing needs to be for symptomatic patients or patients with risk factors for Hep C. Can I suggest you specify “symptomatic/risk factors” for Hepatitis C for these tests. Thanks to Margaret for these thoughts to aid identifying Hepatitis C patients.
Finding / Identifying People with Undiagnosed Hepatitis C There is estimated 25,000 New Zealanders undiagnosed infected with Hepatitis C. To find these people without universal testing will be challenging as frequently people with Hep C will have liver functions within the normal range. Maybe the range of LFT’s needs to be re-examined: men with an ALT >30 U/L and females ALT > 20 U/L could be considered.
I suggest testing by symptoms: • Patients complaining of lethargy • Patients with a previous raised LFT result or had jaundice • Patients with Porphyria Cutanea Tarda: blisters on the back
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
of hand and sun exposed skin • Patients with haemochromatosis / elevated iron studies results • Patients with a history of depression • Patients with abnormal TSH • Joint pain / arthralgia’s • Unusual symptoms that defy diagnosis
Testing on Risk Factors: • Patients with multiple life time sexual partners? • Blood transfusion before 2002? • Surgery / medical intervention / dental surgery / cosmetic procedure in a 3rd world country? • Had a tattoo or body piercing or cosmetic procedure in unlicensed premises? • Mother or house hold member have hep C? • Lived or received health care in SE Asia, the Indian subcontinent, Middle East, Eastern Europe? • Been in prison? • Injected drugs including steroids or intranasal drugs In the last 12 months 40% of the patients referred to the Liver Transplant Unit for assessment with a hepatoma had their liver cancer diagnosed before their hep C diagnosis, this is not a good look. Let’s find the people before they develop cirrhosis. Hepatitis C treatment is easy with GP prescribing for patients with no cirrhosis. All it takes is an 8 week course of Maviret, 3 tablets taken all together with food once daily with minimal side effects and 99% cure rate. Check your local hep C pathways. 3. Through recent locumming in Southland I was surprised by the difficulty of referring to ACC GPSI. ACC have become aware of this and are opening up applications for ACC GPSI, this is their communication.
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General Practitioner with Special Interest (GPSI) Request for Applications
How do I apply? For more information on the service and how to apply, please visit the GETS website, or alternatively email Anthony.Pettett@ acc.co.nz.
Kia Ora, ACC has recently posted a tender on Government Electronic Tender Service (GETS) requesting for applications under the GPSI contract. Due to demand for the GPSI service in specific areas, we’re currently looking at onboarding suitably qualified practitioners in: • Northland • Hawkes Bay • Central Otago • Southland Please note applications for this tender close 3pm Wednesday 18th September.
What qualifications are required to be a provider of ACC’s GPSI service? Medical Practitioners who hold vocational registration in General Practice and have completed a relevant postgraduate tertiary level qualification, in any of the following recognised scopes of medicine: • Musculoskeletal • Occupational • Sports Medicine • Orthopaedic
Paul Abernethy, Strategic Partner, ACC Tel 03 3351565 / Mobile 021 2424296 ACC / Strategic Partnerships & Perf 2060 / BNZ Centre Level 2 Private Bag 4966, Christchurch, 8024 / Christchurch 8140 / New Zealand / www.acc.co.nz
Best wishes for Spring. I welcome feedback. Thanks Dr Stephen Graham Medical Director WellSouth PHO stephen.graham@wellsouth.org.nz
Inspirtional Stories from Southern Stop Smoking Service http://www.kaitahu.maori.nz/inspirational-stories/smoke-free-one-year-on
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Contents Clinical Updates 1 Inspirtional Stories from Southern Stop Smoking Service
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Message from the Chief Executive 4 News for the Southern District Health Board
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Workforce Development 5 Bowel screening Update 6 Spirometry Service 6 Congratulations to the recipients of the RNZCGP 2019 College Awards
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Updates on Southern HealthPathways 7 SDHB Community Continence Service 8 Alliance South Update from the Alliance Leadership Team Chair - August 2019
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WellSouth officially opens new Alexandra office space
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Health Care Homes Tranche 2 kicks off
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Health Promotion 12 Will you be a winner in the inaugural New Zealand Primary Healthcare Awards?
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Green Prescriptions 13
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Message from the Chief Executive Thank you for the feedback to our recent survey seeking your experiences regarding access to colonoscopies. WellSouth as a PHO covering 82 general practices working constructively with the Southern DHB, are keen to ensure the voice of primary care is part of the resolution of any issues and hearing your opinions is necessary. Your feedback was consolidated and feedback on this issue. The DHB has sought a meeting with us and we will keep you up-dated. One clear message we received was that this is only one area of concern for you and that you would like us to do a more detailed survey that seeks to understand access across other departments. We have even heard from hospital departments keen to understand how their department is perceived. We are working on that survey. Just making a plug for the WellSouth Clinical Quality Committee. This committee is made up of representatives from our general practices and if you have issues, concerns or questions on any programs we run, we use this committee as a sounding board. Dr Keith Abbott is the chair so make contact with him if you have an issue you want to consider for the agenda. Andrew Swanson-Dobbs, CEO asd@wellsouth.org.nz
News from the Southern District Health Board Prototype brings ‘immunisation calculator’ one step closer to helping migrant children catch up on vaccination schedule The creators of a new immunisation catch-up calculator are celebrating an important project milestone. A prototype for the online tool has now been completed and a clinical audit has begun. The tool has the potential to bring immigrant children in line with the New Zealand vaccination schedule, and reduce the associated administration workload for health care staff. https://www.southernhealth.nz/publications/prototype-brings-immunisation-calculator-one-step-closerhelping-migrant-children
Nau mai, haere mai, welcome to Southern Health! www.southernhealth.nz The new Southern Health website is up and running. Developed in partnership with Community Health Council, its aim is to make it easier for people to understand our health system, and find the health services they need. More than 500 health providers have provided information to help make finding care even more accessible. Enjoy exploring the new website.
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Workforce Development Upcoming Education and Training Opportunities GP 16 Sep 08 Oct
Recognition and management of common genital dermatoses Otago Faculty RNZCGP CME “Privacy and Cybersecurity” (RSVP to CME RMIP cme.rmip@otago.ac.nz)
Invercargill Dunedin
Ask the Haematologist 17 Sep Takitimu Room, Ascot Park Hotel (6:00pm) • Chronic Myeloid Leukaemia and related blood tests and diagnosis • Acute Myeloid Leukaemia and related blood tests and diagnosis • Lymphoma – types and treatment • Causes of anaemia - investigations and management RSVP deborah.tomlin@leukaemia.org.nz no later than Thursday 12 September
Invercargill
Nurses 27 - 28 Sep Nursing Conference Queenstown 6 Sep Clinical pharmacology for nurses Dunedin 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. For more information and link to registration website: https://www.pharmac.govt.nz/seminars/clinical-pharmacology-for-nurses-4/
Conflict Management Training 3 sessions held – Dunedin, Invercargill and Cromwell – 98% of attendees rated the training ‘excellent and above’, and rated Kim “Awesome”. There are over 60 practice staff that are much more confident with managing conflict or difficult situations. It was great to have our Dunstan colleagues attend (Cromwell session) and the opportunity to get to know you better. We are pleased you found the training so valuable.
Did you miss out on: Implementation of Shared Care Plans from a clinician’s perspective watch the Cromwell recording on our website (NB: low quality sound). Once you log in or register in, click on “Other Podcasts for General Practice”.
To find out more info on the events and to register go to http://training.wellsouth.org.nz/upcoming-events/
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Bowel screening Update Advice regarding commercial bowel testing kits The National Screening Unit is sharing advice for GPs to clarify and manage the expectations of patients regarding the use of commercially available testing kits. Read more here: www.nsu.govt.nz/health-professionals/national-bowel-screening-programme/use-self-purchased-bowelscreening-kits
Māori lead the way in bowel screening participation Māori participation in the Southern DHB’s National Bowel Screening Programme has equalled or exceeded overall participation every month since the programme began in April 2018. Read more here: https://www.southernhealth.nz/publications/maori-lead-way-bowel-screening-participation
Pilot programme shares bowel health message with pupils Pupils at Invercargill’s New River Primary School are learning about the digestive system, bowel health and the importance of healthy eating habits, in partnership with the Southern DHB’s National Bowel Screening Programme. Read more here: www.southernhealth.nz/publications/primary-school-children-learn-and-share-bowel-health-message
Spirometry Service Our Long Term Conditions Nurse Sue Walker in Dunedin is now offering a Spirometry Service with reversibility testing and interpretation report back to the GP for review, for any patients who would benefit from having a Spirometry. This service is free and can either be done as a ‘spirometry clinic’ at your Practice or at WellSouth in Dunedin. Please refer using the ERMS system choosing Respiratory then Spirometry Otago. Feel free to discuss further with Sue, Mobile 021 705 663 or email sue.walker@wellsouth.org. nz.
*** Congratulations to the recipients of the 2019 RNZCGP College Awards that were presented on Saturday 27 July at the annual Conference for General Practice in Dunedin. WellSouth Primary Health Network Hauora Matua Ki Te Tonga
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Updates on Southern HealthPathways SOUTHERN COMMUNITY HEALTHPATHWAYS July 2019 Total Live Pages 628
Total Reviews Completed 157
Southern HealthPathways had 332,648 page views in July 2019 with an average page view per session of 4.22. Of the 2,302 users who viewed pages on HealthPathways, 1,776 of these were new users to the site. The number of sessions per user was 3.42. To keep up to date with pathway activity check out our home page- Southern HealthPathways.
Request for Expressions of Interest to be part of HealthPathway workgroups: We are keen to hear from interested General Practice staff and community providers who would like to be involved in work groups in the following areas: • • • •
Oral Health Urology Breast Carpal Tunnel
If you would like to know more or are interested then please contact Bridget-Mary, Bridget.McGown@southerndhb.govt.nz.
Hazardous Substances Injury (including suspected Lead Poisoning) - Hazardous Substances Injury Changes have recently been made to Health Pathways to make it easier to notify Hazardous Substances Injury (including suspected Lead Poisoning). Similar to Notifiable Disease reporting, there is now a Hazardous Substance (including Lead) Reporting page. This is found via the ‘Public Health’ tab on the front page. It is a legal requirement in NZ for all Medical Practitioners to notify a patient suffering from an injury caused by a Hazardous Substance to the Medical Officer of Health. Aside from Lead poisoning, there have been very few notifications into National Hazardous Substances reporting in the Southern District to date. At present, Primary Care clinicians can lodge a report from Med Tech using the Best Practice HSDIRT tool electronically, using the Hazardous Substances Injury ERMS form or printing, completing and faxing a HSDIRT form.
Hernia in Adults - Hernia in Adults A working group consisting of Primary Care and Southland and Dunedin surgeons, have met over recent months resulting in an agreed pathway for managing and referring hernias. By following the pathway we hope that unnecessary ultrasounds will be reduced and unnecessary referrals received allowing more appointments to be available for those who need them and therefore improve overall efficiency within the system.
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Continence Clinic Attendance It has recently been brought to our attention that there is poor attendance to outpatient continence clinics. To support our colleagues we would like to encourage all referrers to please ensure that the continence pathways have been reviewed prior to referral and ensure the patient is aware of the importance of attending their specialist appointment. • • • •
Continence Advisory Request page Urinary Incontinence in Women Urge Incontinence Pelvic Organ Prolapse
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: Bridget-Mary McGown, E: Bridget.McGown@southerndhb.govt.nz PH: 0274331711 Don’t forget that you can also contact us by hitting the send feedback button on any HealthPathways page.
SDHB Community Continence Service For some time now the SDHB Community Continence service has been under significant pressure with increased demands for service. As a service we are looking very closely at what should be provided by this speciality continence service and what we require from referrers in terms of robust referrals to ensure the patients receive appropriate along with timely care prior to referral. This is in line with Ministry of Health Service Specifications. In order to facilitate early treatment, we encourage the use of Southern Health Pathways to guide early initial continence work in primary care.
Southern Localised Health Pathways https://southern.communityhealthpathways.org/ • Community Continence Service • Constipation in children • Enuresis in children • Urinary Incontinence in women • Benign Prostatic Hypertrophy • Recurrent UTIs in Women Further valuable reading available online - IMPACT Paediatric Bowel Care Pathway Australia. In order to accept a referral please ensure the following information provided and refer to the Southern Localised Health Pathways. Dipstick urine or MSU if appropriate Medical & surgical history
Current medications Examination results
Please note patients are required to have a minimum of a 3 month history of ongoing continence problems that is not responsive to other treatments for the continence problem (Ministry of Health Service Specifications) prior to referral to the service. Angela Koopman Charge Nurse Manager Community Nursing Southern District Health Board
WellSouth
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Alliance South Update from the Alliance Leadership Team Chair August 2019 Kia ora colleagues Mental health services are a hot topic currently. We are all eagerly awaiting more information from the Ministry of Health about how the promised extra funding for primary mental health services across the district will be allocated. Indications are that funding will be expected to be planned for and provided by groups of people working together to best meet the needs of local communities. Alliance South is well placed to be involved in such a collaborative approach. We have recently strengthened the connection between the work of the Alliance and the Mental Health Network within the district. The Alliance Leadership Team is looking forward to working with the Mental Health Network in these next phases of improving mental health services for our communities. You may recall that I have been mentioning the on-line health provider experience survey, as part of evaluating the implementation of the Primary and Community Care Strategy (PCCS). The survey is being run over September. The survey is 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. The changes heralded by the strategy are some of the most significant changes to the Southern Health System, and involve the implementation of Health Care Home, health hubs and locality networks, providing services in the community rather than in urban hospitals. 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. 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 email contacts of the GPs, nurses and administration staff at their practice. We will then email you to ask you to take part in the 15 minute online survey, which goes live on the 26 August 2019. 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 Helen Owen, the post-doctoral research fellow involved in the project, helen.owen@otago.ac.nz or myself.
NgÄ mihi nui Dr Carol Atmore carol.atmore@southerndhb.govt.nz
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How have the changes affected my working life?
How well do WE coordinate! care and work as a team? © SDHB 2018
How have health system changes affected YOU, your patients and your practice? Have your say in our survey! • The Southern Primary and Community Care Strategy & Action Plan (PCCS) was intended to deliver safe, high quality team-based care to patients closer to home, through improved integration of specialist services into primary and community care. • One year into the new strategy, we would like to know how you perceive care integration processes, your workload and your work environment. • Our findings will help inform the implementation of the strategy in years 2 & 3. • In particular, our findings will allow us to identify strengths of the new strategy and help us get back on track if there are areas that need improving. • For more information, please email: Dr Helen Owen Department of Preventive & Social Medicine helen.owen@otago.ac.nz
WellSouth officially opens new Alexandra office space WellSouth new Alexandra offices offer more space and better facilities to help support primary care providers and the Central Otago community. The new premises boasts three clinic rooms, a meeting room and two offices, plus additional space for visiting staff and clinicians, as well as new Vidyo video-conferencing facilities to support telehealth clinics and consultations.
“The team put a great deal of thought into creating this space to better support our own staff, healthcare providers and the people of Central Otago, which is important as the population in the area continues to grow and we seek to continue to improve how we support general practices and other health care services, ” says WellSouth CEO Andrew Swanson-Dobbs. In addition to staff based at the Alexandra office, WellSouth dieticians, brief intervention services staff, health promotion team and others will use the space when delivering services in the area.
*** Health Care Homes Tranche 2 kicks off WellSouth PHO and Southern DHB hosted a great workshop welcoming 6 new practices into the programme. HealthCentral in Alexandra, MHC in Dunedin, Clutha Health First in Balclutha and North End Health Centre in Oamaru, Invercargill Medical Centre and Te Kaika Caversham are the second HCH tranche. Thanks to Dr Richard Macharg of Queenstown Medical Centre and Paulien Lejinse of Broadway Medical Centre who presented on their experiences of the HCH programme, discussing how they are implementing change, the benefits so far, as well as some bumps experienced along the way.
“You’ve got to be fully committed,” said Richard, who noted that GP triage has been a particular success for the resort town practice. “You cannot pick and choose the changes you want to make. Just go for it.” Paulien says the HCH programme improves patient care and the work environment for staff: “Change is hard, we’re a creating an
environment that is fit for change and working to support staff through process."
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Health Promotion Don’t Know? Don’t Drink – Be a Pre-testie Bestie! September is Fetal Alcohol Spectrum Disorder (FASD) Month. 9 September is FASD Awareness Day. Two out of every five babies born in New Zealand each year are a result of an unplanned pregnancy (24,000 births). Approximately half of women drink alcohol in early pregnancy before they know they are pregnant, inadvertently exposing their developing baby to risk. FASD is estimated to affect up to 3,000 babies every year, presenting many challenges for families and communities dealing with the long-term effects. Check out the Don’t Know? Don’t Drink and Pre-testie Bestie campaigns. Further information and resources are available at https://www.alcohol.org.nz/digital-toolkit-dont-know-dont-drink.
Explore your way to wellbeing – Whāia te ara hauora, whitiora While we should nurture our mental wellbeing each day, Mental Health Awareness Week (MHAW) is a great time to consider how and why we need to value our own mental wellbeing and that of our loved ones. With MHAW 2019 being celebrated nationwide during September 23rd – 29th, using the theme Explore your way to wellbeing – Whāia te ara hauora, whitiora, we encourage everyone across Aotearoa to explore their way to wellbeing. Discover the things that make you feel good and do more of them! When you uplift your personal wellbeing, you uplift the wellbeing of your whānau, communities and Aotearoa as a whole. Get involved!! Keep an eye out for local events happening across the Southern region on WellSouth Community.
Brainwave Trust are presenting in Dunedin…. In a nice synergy with FASD Awareness Day and MHAW week celebrations Brainwave Trust are coming to Dunedin. The FREE sessions are supported by local speakers and showcase the importance of the early years and shed light on teenage brain development. • The Early Years presentation - Monday September 9th (midday) • The Adolescent Brain – Tuesday September 24th (evening) For event details keep an eye on Facebook, contact WellSouth or Public Health South.
Celebrating Smokefree success at Rob Roy Dairy Rob Roy Dairy is going tobacco-free on 10th September 2019. Smokefree Otago has organised fun activities for the day! Visit the store from 12pm to 2pm and win some exciting prizes!
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*** Will you be a winner in the inaugural New Zealand Primary Healthcare Awards? The Health Media Ltd and the Pharmacy Guild of New Zealand are thrilled to announce the launch of the New Zealand Primary Healthcare Awards | He Tohu Mauri Ora. Community pharmacists, industry suppliers, GPs, nurses and practice managers now all have the chance to show New Zealand who’s who in primary healthcare. The NZ Primary Healthcare Awards – to be celebrated in Feb 2020 – will support and reward innovation, collaboration and superlative outcomes in the primary healthcare sector. They are a natural extension of the 28-year-old New Zealand Pharmacy Awards. We encourage you to find out more and consider entering the awards. Visit: nzphawards.co.nz.
Green Prescriptions Part of Sport Otago and Sport Southland’s Green Prescription Area Managers (GRAM) role is to visit primary and secondary care in the region. This is to ensure there is constant communication between all of those involved in the care of patients suitable for any of the health programmes that Sport Otago and Sport Southland offer. Aurora Health Centre in Dunedin is an example of such a primary care provider, and they’re one of Otago’s champion referring practices. Intrigued by their outcomes, we investigated why there is such demand and what the practice perspective is on the programme. Read the results here.
To refer to Green Prescription Sport Otago (03) 474 6350 Sport Southland (03) 211 2253 ERMS – ALLIED HEALTH – GREEN PRESCRIPTION
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Otago Medical School Te Kura Hauora o Ōtākou
Teaching Skills for Clinicians
Tuesday 12 November • Teaching and facilitating learning
To register
Wednesday 13 November • Assessment of learning • Educational research and scholarship
11-14 November 2019
Thursday 14 November • Educational leadership
• Preparation course for Membership of the Academy of Medical Educators (London).
REGISTRATION Doctors and dentists: 4 days (5 modules) $500 1 day $120
https://bit.ly/2DPJ0bZ
Held at University of Otago, Christchurch
• A practical, facilitated course guiding participants through the five domains necessary for AoME membership. • Open to any health professional or University staff member.
WN-HSC-HM0088 1018
Monday 11 November • Designing and planning learning
Other health practitioners: 4 days (5 modules) $300 1 day $75 Contact: joy.rudland@otago.ac.nz