Tēnā koutou katoa

 

Jeepers, its December already, where has the year gone? A lot has happened in the last fortnight too – a new government, new plans for smoking related legislation, for Te Aka Whai Ora, and ongoing uncertainty while the new landscape unfolds. GPNZ has sent briefings to the Incoming Ministers from a primary care perspective that are worth a look - viewable at https://gpnz.org.nz/publications/election-2023-briefings-for-the-incoming-ministers/

 

I also want to acknowledge our small number of our colleagues in general practices and community pharmacies that were targetted as part of the anti-vax attacks in the media late last week – this is a distressing situation for you to be in, we are standing with you, kia kaha.

  

Key points today:

What’s new

  • Clinical Programme Updates – changes to funding criteria

  • Palliative Care Review Update

  • Toitū Takata – LTC Programme Update

  • Pae Ora Healthy Future – Primary Care Leadership Course

  • Rural General Practice Workforce Survey

  • ACC GP Referred MRI – New contract includes Nurse Practitioners

  • Southern Primary Health Care Research Network (SPCRN) newsletter

  • Aotearoa Immunisation Register (AIR) Cutover

  • Book My Vaccine (BMV) Provider Alerts

  • Immunisation Systems Support

Opportunities to be involved

  • Feedback requested: New Te Whatu Ora Southern Transfer of Care

Upcoming training and webinars

  • Skin Cancer Symposiums Introduction to Dermatoscopy 2024

Other general information

  • Reminder: Closing of 0800 VIRUS 19 line

  • Reminder: Awanui Labs Strike Action

  • GPNZ Primary Care Clinical Digest – December 1, 2023

Covid-19 Updates

  • Reminder: Closing of 0800 VIRUS 19 line

  • Closure of Dunedin Immunisation Centre

 

 

What’s new

 

Clinical Programmes Updates – changes to funding criteria

Long-acting reversible contraception (LARC) extended eligibility

We are very pleased to advise that the current LARC programme for IUD and Jadelle insertion and removal has had an extension to the age eligibility criteria with women now eligible up to age 52 (must not have had their 52nd birthday). This will provide reliable contraception for women aged 45 until the average age of menopause.  This change is effective immediately. See programme information sheet for full details of this programme. Thanks to those within our General Practice community who have advocated for this inequity to be addressed – you know who you are!

 

Former refugee subsidy extended

For practices who have former refugees (quota refugees) enrolled with them there will soon be a change to the amount paid for a first consult. This is currently $100 and is increasing to $160. We are very aware of how challenging these consults are and the time that they take, and we know this increase will be a welcome change. There is no change to the rate paid for subsequent visits, however patients on the programme will be eligible for 3 years instead of the current 2 years.

Once the changes are live, we will be in touch with practices to share more detail, including updating of service codes.

We are very pleased to advise that any claims made for initial appointments only since 1 July 2023 will be back paid at the increased rate, and we will contact practice managers to advise when and how this back payment will be applied.

There will be some patients who are in between 2 and 3 years since initial enrolment with you. For now please continue as you are with those patients and we will advise on individual cases if they will be re-enrolled on the programme as this will depend on how long until they reach they reach the 3 year point. 

 

IV Antibiotics still available for pyelonephritis and sepsis but not cellulitis

We recently hosted an online webinar presented by Professor James Ussher, Clinical Microbiologist on the treatment of Cellulitis. See recording here if you missed it: YouTube. It was a very interesting presentation with new research presented and is well worth a look.

The strong message from this presentation was that IV antibiotics are not indicated for the treatment of cellulitis in the community, with high does oral antibiotics & Probenecid as effective. This is now the standard of care for recommended treatment.

With this advice, WellSouth will be moving away from funding IV antibiotics for Cellulitis treatment in the coming weeks. The Southern Health Pathway is also being updated to reflect the recommendations (the update may be a week or so away yet so keep checking back).

In the last year, WellSouth received 224 claims for IV antibiotic treatment of cellulitis. This does not include the follow up doses.  There were an additional 25 claims for IV antibiotics for Pyelonephritis and 119 claims for ‘other’. In over 30 of these cases clinical notes indicate that cellulitis was still the presenting concern.

We will continue to fund IV antibiotics for Pyelonephritis, and sepsis. If there are other situations where you use the iv antibiotics claim for non-cellulitis situations, please let me or Katrina Braxton katrina.braxton@wellsouth.org.nz know. We want to ensure we capture all the clinically relevant situations where general practice teams would be administering iv antibiotics so let us know.

The savings from reorienting the programme in line with recommended best practice will be redirected to other POAC services included in our current contract.

While the WellSouth portal updates will take some time to come into effect, we ask you to move to oral antibiotics for cellulitis treatment in all cases going forward.

 

IV iron infusion

As you know, we have an IV iron programme available in the WellSouth portal. We are seeing very high utilisation of this programme, well above the funding we receive from Te Whatu Ora for the service.

In the 5 months since 1 July this year, there have been over 600 claims. If claiming were to continue at this rate, we may need to consider restricting access to the programme similar to the criteria we use for IV Zoledronate.  So it’s a good opportunity to double check that iv iron is the best tool in the tool kit for the person in front of you. Also, if there are any observations you have about the programme that would help us understand its usage more, Katrina and I would be interested in your perspective – again, either email me or Katrina at katrina.braxton@wellsouth.org.nz.  Many thanks.

 

Palliative Care Review Update

We are making progress with the review of our palliative care funding, having spoken to a number of practices, ARC providers, and the two Southern hospices. While it is clear that there are systemic issues with funding for palliative care beyond WellSouth’s ability to respond, and certainly we have reached no conclusions, there is general agreement that the greatest difficulty for patients and their families lies in getting timely medication prescribing and GP advice at the end of life. Over the next few weeks, we will continue to talk with practices. In the New Year, we will reach a draft conclusion, check this with interested parties, and then notify practices of any changes to the funding criteria. 

If you would like to contribute to the review, in any way, we very much would welcome it. Please contact stuart.barson@wellsouth.org.nz.

 

Toitū Takata – LTC Programme Update

We are excited to be able to start trialling Toitū Takata in a few practices early next month with it being available for all practices to use from 30 January 2024.

Toitū Takata will support practices to improve outcomes for those who experience the greatest health inequity in New Zealand; including those on low incomes (Community Service Card holders and/or living in Quintile 5 areas), holders of High Use Health Cards, Māori, Pacific and former refugee communities as well as those with severe & enduring mental illness and addiction.

Toitū Takata funding focuses on long term conditions which create the greatest health burden for these groups; diabetes, respiratory and cardiovascular disease, stroke and gout.
 The programme funding will also cover investment, evaluation, development, and research to ensure the effectiveness of the programme, and funding into advance care planning.

Based on the eligibility criteria there are currently 28,000 people within the Southern Region that meet the criteria for Toitū Takata. Unfortunately, it is not possible to fund this number of people within existing national funding therefore WellSouth have revenue for 6500 funded places on the programme.
WellSouth is building a Thalamus dashboard to help practices identify those patients who will most benefit from Toitū Takata.

 

Pae Ora Healthy Future – Primary Care Leadership Course

At WellSouth, we are putting equity at the heart of a lot of our work with primary health care.

This year, we worked with the University of Otago Business School to deliver the inaugural 'Pae Ora Healthy Futures - Primary Care Leadership Course'. Targeted at emerging leaders from Māori and Pacific providers, general practice teams, community pharmacists and other community health providers, the one-year course aims to develop effective leadership skills with a particular focus on equity and Māori health and gaining the tools to make change in the community.

Image caption: Pictured at Ōtākou Marae for one of the leadership/equity wānanga are some of the course participants listening to co-facilitator Professor Jo Baxter, Dean of the Dunedin School of Medicine.

Participant feedback was very positive of the experience:

“I have thought of leadership in a very different way now and feel more confident in my own abilities.”

 

“Incredible insightful facilitators. Their ability to direct group discussions but also allow space to respond to the needs or direction of the group was great.”

“Re Equity in Māori health, I learned more than I knew previously and a large part of what I learned is around how much I have still to learn!”

“The whole course rejuvenated my work life energies with time to consider how to best prioritise and focus them towards effective goals.”

“The whakawhanaungatanga amongst our group was one of the highlights.”

“This is a genuinely game changing course.”

So thanks to those who participated, and to their management teams who allowed you to. We are currently reviewing the programme and its usefulness to see if we continue to invest in this going forward.

 

Rural General Practice Workforce Survey

Hauora Taiwhenua – Rural General Practice Network has recently released its Rural General Practice Workforce Survey. About two thirds of all the rural practices in the country participated, and the findings make interesting reading about the state of the rural workforce and what services practices  are and aren’t providing. The report is available here: Rural General Practice I Rural GP | Rural Primary Care | Rural GP Network (htrhn.org.nz)

 

ACC GP Referred MRI – New contract includes Nurse Practitioners

We are pleased to announce that the ACC GP Referred MRI programme that has been successful in providing better, faster and more convenient access for patients to appropriate higher-level imaging for knee, lumbar spine and neck injuries is continuing. Moreover, we are pleased to be able to say that the programme has been extended to allow referrals by trained Nurse Practitioners as well as GPs. This change has been brought about in part by advocacy from some of our nurse practitioners, so again, thanks, you know who you are!

WellSouth is committed to bringing NPs on board as soon as possible and is looking to plan further training for referrers accordingly.

Please could all Nurse Practitioners who wish to pursue training contact Dr Richard Macharg (richard.macharg@wellsouth.org.nz), the Clinical Lead for the programme, directly with an expression of interest.

Future training, open to both GPs and NPs can then be planned as efficiently as possible for the new year.

 

Southern Primary Health Care Research Network (SPCRN) newsletter

Issue 2 of the 2023 Southern Primary Health Care Research Network (SPCRN) newsletter was released last week.  Read the latest issue here.

This newsletter will share updates of our research project, and if you have a research idea and want to collaborate with SPCRN, please feel free to get in touch at spcrn.info@otago.ac.nz. 

This newsletter will be published several times a year and will include important updates about Primary Care research and evaluation projects happening in our region! 

If you would like to subscribe to the newsletter please click the following link and add your email address https://redcap.otago.ac.nz/surveys/?s=KM3JFF4L3JFY7P7M

 

Aotearoa Immunisation Register (AIR) Cutover

The AIR cutover was completed last weekend and went live at 0900 Monday 4 December. The CIR portal is only to be used for stock management and all vaccinations must be entered into the provider's PMS which will communicate to AIR. Please refer to linked AIR Covid payment guide for further information, if you have a current Covid Vaccination extended contract (expires June 2024) with Wellsouth the method of payment will not change. By all accounts, the transition has gone smoothly but if you have any concerns or questions, please contact AIR support via help@imms.min.health.nz, or by phone on 0800 855 066.

 

Book My Vaccine (BMV) Provider Alerts

Below is a summary of the changes that will be made to Book My Vaccine (BMV) on Wednesday 6 December 2023.

Action Required to Offer Flu Vaccination Appointments in 2024:

If you wish to continue offering appointments for flu vaccinations after 31 December 2023, you must extend your site closing date and your flu vaccine expiry date. To change your vaccine expiry date and closing date, see this useful guide when logged into the BMV admin system.

For those who do not extend their closing date and expiry date, all vaccine supplies containing flu will be expired on BMV on 31 December 2023. No flu appointments will be available for consumers to book at your site after this date.

Manage Your Site Access: a new ‘Manage Access’ tab is now available on your BMV admin system dashboard. This new tab will allow you to request access to additional sites as well as remove any site access you no longer require. This tab will display all the sites that you currently have access to, and the type of access you have for each site. 

To request new site access and remove existing site access follow these useful guides when logged into the BMV admin system:

 

Immunisation Systems Support

How-to Guides: All procedures can now be found in the help centre section of the BMV admin system.

Drop-in Support: If you have questions and would like technical support, please join a drop-in Teams session. The team is available between 1pm and 1.45pm each weekday.

Email and Phone Support: The team is available to answer questions and provide support. Please email help@imms.min.health.nz or call 0800 223 987. These channels are currently monitored:

  • 8am - 5pm, Monday to Friday (from 9.30am on Wednesdays)

  • 9am - 2pm, Saturday


If you are contacting via email (recommended), please provide a detailed description of the issue, your full name and your mobile number so we can contact you with a resolution. For critical service outages outside of these hours please call 0800 223 987.

 

 

Opportunities to be involved

 

Feedback requested: New Te Whatu Ora Southern Transfer of Care

Te Whatu Ora Southern are seeking feedback on their new transfer of care document, a replacement for the discharge summary.

Message from Te Whatu Ora Southern:

“Given the significant changes to systems and processes that we are likely to see in the next few years as a result of both the transition to more regional and national approaches within Te Whatu Ora and the move to the new Dunedin Hospital, the approach we have taken is one of refinement rather than reinvention.

The key aims with this new template are to:

  • Improve usability of the form for staff

  • Improve communication of key information to patients and their whānau, GPs, and other community providers where applicable

Linked below you will find:

We welcome feedback from WellSouth/Southern GPs, NPs, other members of the practice team and Community Pharmacists on the new template. We will take on board all comments that we receive but can’t guarantee that all feedback will be reflected in the final template. Please note that the template is also still subject to ongoing internal consultation.”

Please provide feedback directly to Sarah Sharfe at Sarah.Sharfe@southerndhb.govt.nz by Friday, 15 December.

 

 

Upcoming training and webinars

 

Skin Cancer Symposiums Introduction to Dermatoscopy 2024

Skin Cancer Symposiums provide fully accredited, very practical teaching on early skin cancer detection. The courses are designed for primary healthcare providers.

They are holding courses: Introduction to Dermatoscopy and Certificate of Skin Cancer Management on 16th - 17th March 2024 at Whenua Pepuke, North Shore Hospital, Auckland.

They have courses at varying levels that are aimed at equipping all healthcare providers with a systematic and practical approach to assessing skin lesions that are suspicious for malignancy.

Their team is very passionate about the early detection of skin cancers, and best practice. Many GPs in New Zealand lack confidence in assessing skin cancers, which is something they are committed to changing.

For further information please click here.

 

 

Other general information

 

Reminder: Awanui Labs Strike Action

Awanui Labs have received a notice from APEX of intended withdrawal of some services by its members between Tuesday 5 December and Sunday 24 December 2023.

While there is not a full withdrawal of labour, there are some areas impacted.

Please click here for the impact of withdrawal of labour in your region.

 

GPNZ Primary Care Clinical Digest – December 1, 2023

In this issue:

  1. Te Whatu Ora Response to Release of Misinformation

  2. Supply of Methylphenidate – Concerta

  3. Goodfellow Continuing Professional Development

  4. Ruruku – Latest News and Updates from Te Whatu Ora and Te Aka Whai Ora November 29 2023

  5. Invitation: Building the Future of Health Virtual Hui December 7 2023

  6. My Health Records Consumer Channel

  7. Supply Issue Update Olanzapine Depot Injection 

  8. Pharmac Tender Notification November 2023 

  9. Top Weekend Viewing


Read the full digest here.

 

 

Covid-19 updates

 

Southern Numbers

The epicurve for Covid related deaths in our district below shows that 5th wave of Covid is definitely out and about in our district:

 

 

Reminder: Closing of 0800 VIRUS 19 line

The WellSouth call centre has been offering advice on Covid-19 testing and where testing is available, via the phone line 0800 VIRUS-19 (0800 847 8719).

The 0800 VIRUS-19 line will close at 4.30pm, Thursday 7 December.

The following voicemail will play if the phone line is called:

Welcome to the Southern Covid-19 hotline. This number is no longer active. You can either visit www.healthpoint.co.nz for information on RAT collection sites and testing or press 1 to be transferred to Healthline.

A friendly reminder to please update your Healthpoint and any other platform that advertises this number. 

 

Closure of Dunedin Immunisation Centre

The Dunedin Immunisation Centre is closing permanently on 22nd December. So if you were directing your patients there for Covid vaccinations, check in with Health Point  for community pharmacies near you who provide this service  -  go here:  https://www.healthpoint.co.nz/covid-19-vaccination/. 

 

 

Well, less than three weeks til Christmas and I expect that things are starting to ramp up at work and at home. And I look forward to providing the last update for the year in a fortnight.

And remember to carve out a bit of time for yourselves in amongst the busy-ness of the coming weeks.

 

Ngā mihi nui

Carol

 

Dr Carol Atmore FRNZCGP PhD MSc(PubHealth) MBChB

Clinical Director|Kaiwhakahaere Haumanu

WellSouth Primary Health Network