Tēnā koutou katoa

 

Welcome to February! Hot and warm for us, we take a moment to think of our family, friends and colleagues who are doing it tough in the upper North Island. Viruses are getting upgrades, with mpox replacing the primates in Monkey Pox and the greek alphabet overtaken by mythological sea monsters for the new Covid variant. And we have a new PM and Minister of Health to boot. So the year is getting off to a memorable start.

 

Key points today:

  • Update on Covid-19 Primary Care funding changes

  • GPSI Skin programme update

  • ACC Concussion Pathway – Medtech Practices ONLY

  • New Standing Order for Lidocaine

  • Mpox Vaccination Reminder

  • Cancer Nurse Coordinators for the Southern Region

  • Workforce Capacity and Pay Survey

  • ACC GPMRI Referral Training

  • Registered Nurse Prescribing in Community Health Q+A Session Recording

  • Covid Vaccine for immunocompromised infants (6 months to 4 years) – announcement expected next week

  • Comirnaty (3mcg) 6 months to 4 years Immunisation Advisory Centre Webinar

  • WellSouth Clinical Quality Committee meeting

  • Primary Care Clinical Digest – January 27, 2023

  • Covid numbers

 

 

What’s new

Covid-19 primary care funding changes

I have reattached the Covid-19 funding changes for primary care (Guidance for Primary Care Funding for COVID-19, FAQs - Primary Care Funding Framework) sent last Friday, in case you missed it. Thanks to those of you who have got back to me with questions and comments about these changes.  I was at a GPNZ Primary Care Clinical Leaders meeting with Te Whatu Ora Covid team last night and can provide some updates on these queries.

The Te Whatu Ora Covid team have a communication plan for both us providers and the public, which will start on 8 February. This will include social media, the Unite against Covid19 website, and promotional materials for pharmacies and practices to print off and use on our websites. The changes are planned for 13 February, and on that day, the patient portal information on the Unite against Covid19 website (where people register their positive RAT test) will reflect the changes in what people can expect. There is a media stand-up planned for 14 February.

The Te Whatu Ora team are working with the claiming portal vendors and anticipate that changes will be made by 13 February to enable the smooth roll-out of these changes.

The question of whether general practices are expected to monitor their inboxes for positive Covid cases and contact Covid positive patients on the weekends in Te Whatu Ora’s new settings was raised. There was a clear consensus from Primary Care Clinical Leaders at the meeting that this expectation was no longer appropriate. The RNZCGP is currently updating their standards on Covid care and will reflect this. Te Whatu Ora acknowledged that the changes in settings will place more onus on people with Covid to make contact with services, and will monitor the impact of these changes on equitable outcomes for priority patient groups.  

Red and green stream approaches were also briefly discussed, and the RNZCGP plans to soon circulate updated advice about infection prevention and control measures in primary care settings.

As I mentioned on Friday, I contacted the Te Whatu Ora Covid team seeking clarity about the expanded eligibility criteria for priority populations to receive a funded proactive initial assessment and this was discussed last night as well. The message back was that yes, all Māori and Pacific peope are eligible for a funded proactive initial assessment. The Te Whatu Ora team couldn’t yet give a definition for who will be considered remote and rural people (who are also eligible for a funded proactive initial assessment) and hope to be able to clarify this next week. The same answer applied to what conditions met the disabled people criteria. As there is an expectation being set by Te Whatu Ora that funding claims may be audited going forward, it is important to have clarity on these criteria. There is a webinar for providers next Wednesday evening 7.00 – 7.45 pm 9 February, details yet to come. The Te Whatu Ora team hope to be able to clarify these points then. It would be worth someone from your practice or pharmacy attending if you can make it. We will circulate the webinar details as soon as we get them.

 

GPSI Skin Programme Update

We are providing this update to let you know that we have now moved into the next phase of our skin lesion referral programme changes.

This means that ERMS referrals into the programme are no longer able to be sent or received.

The new referral is now active in the WellSouth portal and being used by practices to submit their referrals (with the exception of some Invercargill practices).

For Invercargill practices without the portal, we are working with several GPSI providers who hope to be able to provide a service in Invercargill soon. We will be progressing this with them during February and March and will update you as soon as we have news.

In the meantime, Invercargill referrals can be sent to Southland Hospital surgical.

For all other non-Invercargill practices, please refer in the portal and if secondary referral is indicated following clinical triage this will be redirected by WellSouth. The referral processes are embedded in the links below:

GPSI Skin Referral Process Flowchart

Skin Cancer Type – Triage Criteria

Skin Lesion Referral Portal Screenshots Guide


For GPSI providers with active ERMS referrals – (patients with procedures still pending), please ensure these are completed and claimed before the old claiming portal closes at the end of February.

If you have any questions about these changes, please contact your practice relationship manager, or (after 20 February)  Katrina Braxton at Katrina.braxton@wellsouth.org.nz

 

ACC Concussion Pathway – Medtech Practices ONLY

In May 2022, ACC launched the concussion pilot designed for General Practitioners. Initially, the pilot was only available to two PHO’s. ACC contacted WellSouth in December 2022 for our practices who utilise MedTech as a PMS to be included in the pilot. The pilot aims to improve outcomes for patients with a concussion, by supporting AND FUNDING General Practitioners to manage concussion patients in primary care. This will see PHOs working with ACC to trial a new standardised concussion management pathway.  

The aim is to consistently support patients to get the right care at the right time and help them recover faster from their injury. The pathway provides GPs with a standardised concussion assessment tool (the “BIST” designed in partnership with Auckland University of Technology), appropriate education and learning. By using this pathway, GPs will be able to quickly assess patients with concussion, identify those who they can manage within primary care and identify those who need referral on to other services.

Education for patients and their whānau is also included in English and Te Reo. This seeks to optimise the one-on-one GP consultation time. The education will ensure that patients and whānau understand how to manage their injury at home, as well as standardising education on concussion management nationwide.  

ACC provides additional funding including the co-payment for a subsequent appointment (up to 30 minutes) if required to complete the BIST assessment. ACC will also fund further follow-up appointments where necessary.

Feedback from the pilot has been positive, with GPs saying that it is quick and easy to use and provides a clear process for managing concussion. The pathway has been helpful when facilitating conversations with patients to normalise symptoms or identify what is abnormal. 

Participating GP’s are required to complete an online training session, which takes approximately 45minutes, on how to use the BIST assessment tool. The training is available online from both BPAC and Goodfellow and is CME point registered.

Please note: the training and assessment tool are currently only available to GP’s who use Medtech32 or Medtech Evolution in General Practice.

WellSouth will host regular peer feedback sessions led by our Clinical Lead Dr Richard Macharg. WellSouth is also working with ACC Concussion Service providers in our region to ensure seamless access to the service for those patients that require further support and assistance. 

If you are interested in participating, please register by emailing concussion@wellsouth.org.nz

 

New Standing order for Lidocaine

A reminder that WellSouth has a number of Standing Orders available for practices to download and utilise within their own practice.

This week a new standing order for lidocaine has been added to the list.
All Standing orders can be found on the WellSouth website Current Standing Orders and on the Southern HealthPathways under Standing Orders.

 

Mpox Vaccination Reminder

There are dedicated clinics in Dunedin on a Tuesday and Wednesday evening (Sexual Health Clinic, Dunedin Hospital) and in Queenstown a Monday afternoon clinic (Queenstown Medical Centre). 
A clinic in Invercargill should be open mid-February (at the Sexual Health Clinic, Southland Hospital).  

Anyone who wishes to attend a consultation at these clinics to discuss their risk of Mpox may ring Healthline on 0800 116 672.  People can complete an initial assessment at https://www.burnettfoundation.org.nz or by ringing the new dedicated mpox Healthline on
0800 116 672 between 8am and 8pm. If a consumer asks you about how they can access the mpox consultation, please ask them to visit the Burnett Foundation website to use the assessment tool which will tell them what to do next. If they cannot access the website, they can ring Healthline on 0800 116 672.

 

Clinical guidelines 

Medical practitioners may initially supply the vaccine to groups who are eligible for pre-exposure prophylaxis (PrEP), including:  

  • Close physical contacts of people infected with mpox, such as sexual partners and people who live in the same household.   

  • Gay, bisexual and other men who have sex with men (GBMSM) who have multiple sexual partners, and trans, and non-binary people and cisgender women who are in intimate relationships with these eligible men.  

  • Those recommended to have the vaccine by medical specialists – we recommend only medical practitioners with additional training through IMAC prescribe the vaccine. If you are a doctor and are unsure, please phone your local sexual health, public health, infectious diseases specialist or IMAC for advice depending on the situation. 

 

This vaccine can also be prescribed for physical contacts of people infected with mpox after they have been exposed to mpox. If this is within four days after first exposure to mpox it will provide the highest chance of avoiding the disease, but it can be given up to 14 days after exposure.
If people think they have been exposed to mpox they should call Healthline on 0800 116 672 

If a patient of yours might be suitable to be prescribed a vaccine due to recent exposure to confirmed mpox please phone your local public health unit who are managing active cases. 

If you have any questions or queries, please email immunisation@health.govt.nz. 

 

Cancer Nurse Coordinators for the Southern Region

A quick introduction to the Cancer Nurse Coordinators –

The Cancer Nurse Coordinators of the Southern region are focused on providing equitable care for patients with higher needs who have a confirmed or high suspicion of cancer. Our team consists of clinical nurse specialists who work at the front of pathway and provide care coordination.

Rachel Miller covers equity and works in an advisory role.

Sara Morton covers Dunedin and the surrounding locations of Palmerston and Oamaru - 027 256 3242.

Rachel Oxley covers Invercargill and the surrounding areas Bluff, Stewart Island, Mataura and Winton - 027 256 3243.

Tara Cheung covers rural areas - 027 688 3322.

For patients who may struggle to navigate the system please do not hesitate to contact us as we would love to provide support. 

The best way to refer is through email cancernursecoordinator@southerndhb.govt.nz or the contact numbers listed above.

 

 

 

 

Opportunities to be involved

 

Workforce Capacity and Pay Survey

GPNZ have put together a short survey that will help inform their advocacy and priorities in relation to workforce capacity and pay, particularly nurses’ pay.

Please take some time to complete the survey linked below before the 10 February 2023.

Survey link: https://www.surveymonkey.com/r/8DKS2J6

 

Upcoming training and webinars

 

ACC GPMRI Referral Training

General practitioners in Southern are now able to make direct referrals for MRI scans for patients with knee, lumbar (LSpine) or neck (C-Spine) injuries. The new GP-referred MRI (GPMRI) service supports trained GPs and doctors including GP registrars and locums, to refer patients for MRI scans. Already in place in Auckland, Canterbury and elsewhere in New Zealand, the service supports better patient care and outcomes, improves the quality of referrals to secondary, and reduces wait times for FSAs. WellSouth is funded by ACC to deliver and manage the programme, with Habit Health providing training.

Referrals, funding, and criteria

Referrals will be via the WellSouth Portal and payments on completion of the package of care is $129 + GST for eligible patients meeting clinical criteria

Qualification and Training

Vocationally registered general practitioners, GP registrars and doctors working in general practice who complete the 3-hour training session will be eligible to make MRI referrals. We are delivering 4 further in-person training sessions across the district in February and March.

Dates and locations:

  • Dunedin – Wednesday 15th February, 6pm-9pm

  • Invercargill - Thursday 23rd February, 6pm-9pm

  • Cromwell – Thursday 9th March, 6pm-9pm

  • Dunedin – Thursday 30th March, 6pm-9pm

(Refreshments provided from 5.30pm. Training begins promptly at 6pm, so please arrive early.)

Training includes:

  • Clinical Guidelines – further detail

  • Assessments - demonstration

  • Referrals – process of referring via WellSouth Portal

  • Claiming – quality control and auditing via the WellSouth portal

 

Registration is required and is available via the WellSouth Workforce Development page

https://training.wellsouth.nz/events/643-acc-gpmri-referral-training/

Please contact GPMRI@WellSouth.org.nz with any queries regarding the training or referral process 

 

Registered Nurse Prescribing in Community Health Q+A Session Recording

WellSouth held a Q+A session on the 23 January 2023 about the Registered Nurse Prescribing in Community Health (RNPCH) programme, for those who we unable to attend the recording is now available online: https://youtu.be/kfyWE9eV92s

The RNCPH programme is the first of its kind in the South Island and one of seven across the country. The fully funded programme is delivered online to increase equity of access and flexibility for participants.

Find out more about the programme on the WellSouth website – Nurse Prescriber Training

Applications for the next cohort close on Monday 24 April 2023, and the cohort will start the programme on 2 May 2023. 

If you have any questions please contact programme co-ordinator Ellen Clearwater.

 

 

Covid Vaccine for immunocompromised infants (6 months to 4 years) – announcement expected next week

We understand there’ll be an announcement in the coming days to confirm the start of this programme next week.

You’re likely to receive calls and queries from patients so even if you are not delivering the vaccine you will want to be familiar with eligibility criteria.

Providers in Southern offering the Infant dose will be listed on the Book my Vaccine web site https://bookmyvaccine.covid19.health.nz/  and the Te Whatu Ora Southern web site. https://www.southernhealth.nz/COVID19/clinics. Bookings can be made via https://bookmyvaccine.covid19.health.nz/  

 

Please also note the IMAC webinar this evening – info below and it’s being recorded – will provide more details.

Below is the information already made available on the Ministry of Health web site:  https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-vaccines/children-and-covid-19-vaccine


 

Comirnaty (3mcg) 6 months to 4 years
Immunisation Advisory Centre Webinar

We recognise this is late notice on the webinar but it will be recorded and it is recommended that all health providers view the video if you are unable to attend

When: Thursday 2 February 5.30 – 6.30pm

The webinar will be held on Zoom, you must register to attend – click here to register

The Immunisation Advisory Centre are providing a webinar that is designed to cover everything you need to know about Comirnaty for high risk 6 month - 4 year olds.
The session will be recorded so you can watch it later if you are unable to attend. 


Key topics:
•    Safety and effectiveness  
•    Eligibility
•    Vaccinator requirements
•    Vaccine, storage, preparation and administration
•    Reducing risk of errors
•    Co-administration with other vaccines
•    Questions 

Speakers:

  • Dr Emma Best 

  • Sally Schnauer

 

Other general information


WellSouth Clinical Quality Committee meeting

We had our first WellSouth Clinical Quality Committee meeting for the year today. We welcomed Jo Sanford (practice manager rep from Tuatapere Medical Centre), Teresa Manahi (nursing rep from Te Kaika), Angela Riley (nursing rep from Junction Health) and Natasha Sharp (GP rep from Kurow) to the committee. Thanks team for putting  yourselves forward. They join Daniel Pettigrew (GP rep from Dunedin North Medical Centre), Danielle Millar (pharmacy rep from Gladstone Pharmacy, Invercargill), Anu Shinnamon (Health pathways editor rep lately of Wanaka), Erolia Rooney (community rep from Dunedin), Rachel Greenwood (GP rep from Murihiku Medical Services, Invercargill), Gaylene Hastie (Nurse Practitioner rep from Queenstown Medical Centre) and myself on the committee, along with our WellSouth team of Ruth Zeinert, Andy Shute, Alex Ryde, Katrina Braxton and Jodie Black.

 

We focused on the Long Term Conditions programme refresh WellSouth is undertaking currently, our osteoporosis support services and the upcoming change to the Cervical Screening programme to primary HPV screening.

 

We are still seeking a second Community Pharmacy rep, so if you are interested, please email me on carol.atmore@wellsouth.org.nz

 

Primary Care Clinical Digest – January 27, 2023

This issue covers:

  • Transition to Biosimilar Adalimumab (Amgevita): Alcohol Wipes now available
  • Pharmac Update: Primary Care Prescribers for the week ending January 20, 2023

The email is attached if you would like to read through any of the updates above.

 

 

A message - a Dunedin Orthopaedic GPSI has moved

Please be advised, Dr Alan Walker – Pitt Street Medical GPSI has moved to the Gardens Medical Centre.  Please send all Orthopaedic GPSI ERMS referral to the Gardens Medical Centre from now onwards.  If any problems, please feel free to contact Pitt St on 034741348.  Thank you in advance.

 

 

Covid-19 updates

Southern Numbers

So we are certainly over our third wave, as the figures below show. Covid related hospitalisations are right down, and we had one Covid related death in the last week. Thus far, 295 people in Otago and Southland have died related to Covid-19 since the beginning of 2022, with 94% being European, 4% being Māori and 1% being Pacific.

 

 

And that is all I’m going to say about Covid this week!

 

So I am away for a wee break and will be back, bright eyed and bushy tailed, on 27 February. If you spot someone who looks like me in a caravan or a boat around the Southern lakes, give them a wave.

 

Ngā mihi nui

Carol