Update No. 35 - February 24 2022

Tēnā koutou katoa

Welcome to another week of change! So we moved to Phase ‘2.8’ as dubbed by Susan Jack on Tuesday, with RAT testing at the testing centres, ahead of Phase 3 being announced to start tomorrow. Hopefully things will be a bit more streamlined going forward, as most of the changes have come into place now. So here is the latest news.

The National Picture 

The table below comes from an interesting blog from the University of Otago, see the link below. It compares excess mortality rates for several countries. Makes me glad to be living in the Land of the Long White Cloud.

Dr Jennifer Summers, Professor Michael Baker, Professor Nick Wilson* Mortality declines in Aotearoa NZ during the first two years of the Covid-19 pandemic, Public Health Expert, blog at https://blogs.otago.ac.nz/pubhealthexpert/mortality-declines-in-aotearoa-nz-during-the-first-two-years-of-the-covid-19-pandemic/

This table below came from the MOH webinar tonight, and (despite its poor quality, aroha mai!) shows that nationally, Omicron Covid infection is affecting Pacific communities the hardest, with highest absolute numbers for Pacific people (green) compared to Māori (pink), Asian (light blue) and European/other (purple).

Data Craft, the makers of Thalamus, have produced a very nice, open access, set of interactive dashboards about Covid in NZ. The figure below is an example. View the whole lot at datacraft.nz/covid

The Southern picture

Our outbreak in Otago/Southland is currently largely centred on the student population in Dunedin, thanks to ‘O-micron Week’. As the graphs and figures below show, our outbreak currently is in a tight age range, and (in contrast to the national picture) most of our cases are in NZ European. We anticipate that over coming days and weeks, that this will expand into the wider and older communities, as was the progression in Australia. We have a rocky six to 10 weeks ahead of us.

Current cases as of 11.59pm 23 February 2022  

* We do not have TA information for RAT-positive cases 

Managing COVID-19 Care in the Community 

Move to Phase 3

The government’s move to Phase 3 of the Omicron response signals a number of changes for testing, case investigation, management of Covid positive patients, criteria for testing and isolation rules. This includes shifting to testing of most people who are symptomatic with RAT tests and focus of PCR testing on priority populations. PCR tests are no longer required to confirm a positive RAT test. From reading the RATs specific operation guidance for GPS Phase 3 attachment, it looks like there is not any indication for PCRs in general practice now, but there may be some guidance to clarify this coming on this in the next few days.

The following documents and information immediately below provide you with some highlights and we will provide additional information as we get more detail.

Operational changes to respond to Omicron 23 February

Phase 3 of operational changes to respond to Omicron 23 February

The focus of Phase 3 is very much towards Self Management. Most people will be fine without active input from the practice.  You in general practice can ‘pull’ your patient into active management through completing a Covid initial assessment. If you look at a patient’s record and decide that they don’t need an initial assessment, you could put a whiteboard note in to this effect, or give them an acuity level 1 without doing an initial assessment. This would let us in the WellSouth Coordination Centre know that you have had a look and think self management is fine for that person.

The MOH’s self-service text message went out to about 80% of people who were Covid positive across the country yesterday, so that figure is improving. We are still texting people who are unenrolled with a general practice, to let them know they are positive and giving information about self isolation, self management, and what to do if they become unwell. Once we are confident that everyone is getting the MOH text we will stop this. 

About half of people had replied to it and completed the online assessment form. The clinical information they provide comes back into the NCTS system (sorry for all the acronyms) and we will be able to view  that information at the WellSouth Coordination Centre. So when that information starts to flow, (we are working on how we can see it easily – not a unique problem for us!) we will work out a process for how we use that information to best effect. For example, if you have noted that the person is for self-management without an initial assessment, and we receive their self assessment clinical information that identifies that they are pretty sick, or that they are pregnant, for example, we our coordinator could contact you to suggest you may want to do an initial assessment.

In the clinician network, we are aiming to provide an initial assessment for unenrolled people who are Māori, Pacifika, over 50, under 5, and who are between 12-50 years old and unvaccinated or partially (1 sot) vaccinated (in that order). For the weekends, we will aim to provide an initial assessment for all people according to these priorities. If numbers get very high, you may find on Monday morning that some of your patients in these groups may not have been contacted, and it will be up to your clinical judgement about whether you contact them.

Thanks for your ongoing commitment to providing care for your patients for all their health needs, including Covid-19 infections.

Tuesday’s WellSouth Webinar  -  Slides and Recording

Thanks to everyone  who joined us on Tuesday evening for the CCitC webinar, and to the line-up of presenters who took the time to share their insights: Dr Carol Atmore,  Dr Susan Jack, Gaylene Hastie, Nancy Todd, Sarah Martin, Trinity Mennell,  Peter Whalley, and Michelle Derrett. My slides are attached and here is the link to the webinar recording. We will provide the Q and A feedback next week. We will also include Trinity Mennell’s map of the MSD services next week.

WellSouth and Omicron Phase 2 Covid care pathways Webinar-20220222_190256-Meeting Recording.mp4

Director-General of Health webinar – 6.30pm – Thursday 24 February

Following the announcement by the Prime Minister about the national shift to Phase Three of the Omicron response, the Director-General of Health held a Webinar at 6:30pm on Thursday 24 February to outline the changes.

The link to the livestream recording is below – it was working at time of sending of this message, but I can’t guarantee it hasn’t be shifted somewhere else on the interweb since. Recommended browsers are Google Chrome, Firefox, Safari.  Please note this link will not work on Internet Explorer or Microsoft Edge.

https://livestream.com/accounts/26834806/events/10191610

CCCM/BCMS update

CCCM processes continue to improve, and while it may feel like slow progress, things are getting better. Patients are now auto allocated to a facility based on their postcode, and from today patients are now allocated to a General Practice “room” based on their NES record. This means delays in CCCM records are reduced, especially if using your PMS to access CCCM.

While the auto-allocation to General Practice room is good news, it does create slightly more work for the next 10 days. As cases have been allocated to your practice abbreviation, practices will have to search for both this abbreviation and for the name of your General Practice. This will not be required once patients allocated to the three-letter abbreviation are discharged.

This will only affect practices that use the web version of CCCM.

Few things to remember:

• Please continue to create Tasks for pulse oximeters for patients who require them

• Acuity 1 = self-management, acuity 3 = follow up required (clinician determines when), and acuity 6 = daily follow up.

• If a patient needs followed up during the weekend (only those patients who are acuity 3 or 6), you need to flag the patient with the yellow flag so this is picked up by the Clinician Network.

There continue to be updates coming into CCCM/BCMS. Tomorrow, we are told that all patients with CCCM records will be set to ‘self management’ as a default. I’m not quite sure what that will look like, so let’s wait and see.  Also, apparently, the vaccination information will not be mandatory fields to be able to progress, which will be a very good upgrade. Also, we should expect from tomorrow that the date of Day 0 will be able to be updated in CCCM, to match the first day of symptoms, or the date of a positive test if asymptomatic. And its 10 days isolation from then.

BCMS/CCCM demonstration video

The Covid Care in the Community team has put together a short video to help practice teams to use BCMS/CCCM

CCCM Training 22022022.mp4

Ministry of Health reply to GPNZ call for funding and COVID Care in the Community Funding Changes

Please find attached, Ministry of Health response to GPNZ call for COVID-19 funding for general practice in response to the Omicron outbreak.

Following an update from the MoH regarding funding, changes are going LIVE tonight for the COVID Care in the Community Programme. An updated programme information sheet can be found on our website: https://wellsouth.nz/assets/COVID-19-Care-in-the-Community-Programme-Pack-FINAL.pdf

The following Service Codes will not be used once the change goes live. With the sign off for February claims where the claim has been used on one of the below service codes it will be paid so they are still relevant.

For the below Service Codes, the notes have been updated as follows:

We have had a few questions where practices have treated someone presumptively as Covid, given the clinical context, before the positive PCR came back, due to delay. We are confirming that consultations undertaken in the gap will be claimable, if the PCR turned out to be positive. Going forward from here, RAT testing will provide quick confirmation of a patient as Covid Positive, and PCR confirmation is NO longer required in Phase 3.

Covid-19 testing update

The table below outlines daily testing numbers since the beginning of the month. The drop off in PCR testing by community providers reflects the change to predominantly RAT testing in the community testing centres on Tuesday, with high levels continuing in general practice. We don’t currently have reporting on the number of positive RATs yet.

RATS being distributed directly to General Practice

Below is a Message from the COVID-19 Health Supply Chain (see also attached RATS Specific Operational Guidance Phase 3).  

Please note we have also been advised late today by Southern DHB that in addition to the $45 current payment to the GP for a RAT Test, there is expected to be a separate payment of $75 (thus totalling $120) to the GP for the consultation / service component associated with the patient visit. We understand this will be announced imminently I am told. This is a temporary payment to help transition people from PRC to RAT testing.

“Kia ora,

As you may be aware, the Prime Minister stated yesterday that rapid antigen tests (RATs) will be available from general practices from today, 24 February 2022.

To prepare general practices and urgent care we have confirmed a push order of self-test RATs to go out to all relevant providers around the country. This will be delivered via urgent courier services. Auckland based providers will start receiving deliveries today, with those outside of Auckland receiving their orders from Friday with the majority being received early next week.

Each provider will receive at least 245 tests in total (35 x test packs of 7). As this is a relatively small quantity, general practices and urgent care will need to place RAT orders via the Ministry of Health PPE Portal based on the likely needs of your local communities and order on an ongoing basis as required. Although there are still significant global supply constraints, we have secured the delivery of enough RATs to help New Zealand through a widespread Omicron outbreak in the coming months. 

If you have any questions, please contact covid.healthsupplychain@health.govt.nz.

Noho ora mai,

COVID-19 Health Supply Chain

COVID-19 Health System Response, Ministry of Health  l www.moh.govt.nz”

Reporting positive RAT test results

Positive RAT results can now be reported through My Covid Record. For people to report their result, they should log in to their My Covid Record account: https://mycovidrecord.health.nz/  Or call 0800 222 478 and press option 3.

COVID-19 Testing and Assessment Form Update

When completing a Covid-19 ‘Full Assessment’, or ‘Car or Dedicated Room’ in the claiming portal, the HIS criteria is no longer a requirement.

Covid-19 vaccinations update

Currently 63% (up from 56% 10 days ago – more fantastic work everyone!) of enrolled patients aged 18+ who are eligible, have had their Covid vaccine booster. It is concerning that the figure for Māori is still sitting lower at 44% (up from 38% 10 days ago – again, great progress). This figure is also lower for Pasifika people, at 48%. Everyone is under huge pressure at the moment, and we appreciate the efforts that community pharmacies and general practices are putting in to improve these rates. My son finally got his booster yesterday so I am a happy mother!  Similarly  50% of children (up from 46%   10 days ago) of eligible children have had their first vaccinaton, but this figure is sitting at 34% (31%) for Māori tamariki, and 43% for Pasifika children.  We need to work together to address these gap in rates for Māori and Pasifka compared to the whole population.

General Practice Survey feedback.

Thanks to all the practices who are answering our weekly survey of how practices are faring through this round of the pandemic. We have had over 85% of practices responding for the last 3 weeks. Your feedback is really helpful to us at WellSouth, and I hope it is of interest to you to see how your colleagues are getting on generally too.

So, another long update – I hope there are things in here of interest. All the information is a bit overwhelming at times, so I hope the pictures and graphs lighten the load! As famously said, We are at the end of the beginning, not the beginning of the end. Hold on to your hats!

“He aroha whakatō, he aroha puta mai” If kindness is shown, then kindness you shall receive.

RATs Specific Operational Guidance

WellSouth Webinar

Letter GPNZ