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WellInformedJune 2019
Clinical Update by Dr Stephen GrahamClinical Updates
Dear Primary Care Workforce,
General Practice can feel like it is under siege. This is the case more in some areas than others. I want to put some good news out there by underlining some progress that has occurred in General Practice in Otago and Southland in the last year. Some of this is through the Primary and Community Strategy and some is independent of that (they would hopefully have occurred anyway). I apologise if I’ve left something off.
1. Health Care Home. A number of practices are successfully beginning implementation of the programme and more are preparing for it. The feedback is that this is simplifying management of acute and chronic care for the Health Care Home practices. That is, it is easing the burden of day-to-day management of patients in General Practice. Expect the number of practices involved to increase.
2. Primary Options in Acute Care (POAC). The following services are funded in primary care to allow care to be provided in General Practice without the cost barrier.
• Intravenous Antibiotics for cellulitis
• Iron Infusions
• Pipelle biopsy
• Jadelle for nurses (early stages)
• Intravenous fluids for appropriate patients
• Urinary catheterisation
3. Ambulance diversion for mild/moderate COPD exacerbations. A more comprehensive programme around COPD management is in design between the respiratory department and primary care.
4. National Bowel Screening Programme rollout. Most of the credit goes to the gastroenterology department and their bowel screening team as well as the MOH but General Practice can share in the glow with this. Few interventions offer (and deliver) the same reduction in morbidity and mortality that this programme does.
Hopefully we can look forward to additional assistance with mental health care in General Practice also in the near future.
I welcome communications.
Thanks
Dr Stephen Graham
Medical Director WellSouth PHO
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Contents
Clinical Updates 1
Message from the Chief Executive 3
Joanne Dowling-Smith, Nurse Practitioner 3
GP impressed with new triage system 3
Workforce Development 4Southland GP CME Educational Weekend Stewart Island 4Upcoming Education and Training Opportunities 6
Updates on Southern HealthPathways 7
Bowel screening video resources for patients 8
Health Promotion 9Whakaaro of the week 9Celebrate Men’s Health Week this 10 – 16 June 9Matariki – our Māori New Year 9‘Move Your Butt’ to beat bowel cancer 10
Green Prescriptions 10
One-on-one pregnancy and parenting education sessions 10
IT Helpdesk 11
SAVE THE DATE - Invitation to attend a health systems design wāãnanga on behalf of the Māãori Expert Advisory Group, NZ Health & Disability System Review 12
I Stopped Smoking And Proved Everyone Wrong 14
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Message from the Chief ExecutiveThank you to those general practitioners that attended the recent CME event on Stewart Island. It was my first visit to this stunning part of New Zealand and I was glad to lend a hand (first time I have been a barman!). The feedback from those that attended has been great and the analysis of the evaluation forms proved the efforts by staff here ensured GPs benefited from the opportunity to meet their fellow GPs and hospital specialists and learn from each other. We will be holding the event again and the debate on venue for next year continues. Keen to hear where GPs would like to go.
Stephen Graham and I visited a number of general practices in the WellSouth network on 25 May 2019, finding out from staff in the practices what this organisation does well, so we can keep doing it to support them and importantly the actions we do that we frustrate or hinder practices supporting their patients. I very much appreciated the time and honestly from practices. These conversations are essential for me as I learn more about WellSouth and its history and also important as we head into Strategy Planning for next year.
I look forward to the budget – the first Well Being Budget. We will ensure that we communicate the implications and opportunities for us in the next WellInformed.
Andrew Swanson-Dobbs, CEO
GP impressed with new triage systemThe Gore Medical Centre is reorganising the way patients who need to see a doctor urgently can receive help.The new system is called GP Triage, which is a process that allows a doctor to sort people according to the urgency of their need.
Joanne Dowling-Smith, Nurse PractitionerI became a Nurse Practitioner (NP) on 14th of February this year. It comes at the end of a long journey of post graduate study and nurse practitioner internship. Of course it is not the end, along with a new title comes new learning opportunities and challenges. I am currently employed at Cromwell Medical Centre and am very grateful for the support I have received from all my colleagues, there is no way I would have made it without them.
I was a RN prescriber for a year before becoming a nurse practitioner and for me this was a valuable step and has helped me ease into the role of NP. I am enjoying seeing a wider variety of patients and having the autonomy to provide treatment, order investigations or referral to other services.
***
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Workforce DevelopmentSouthland GP CME Educational Weekend Stewart Island
WellSouth PHO with the support of the Southland Faculty of General Practice have just completed another successful “Southland GP CME Education weekend”, this time on beautiful Stewart Island from 3 to 5 May 2019. This is a third CME weekend in the scenic South in recent years for Southland. Previous weekends have been held in Te Anau and at Borland Lodge, both in Fiordland.
43 new and frequent flyer GP delegates and partners either flew or ferried across Foveaux Strait on Friday 3 May where they were wined, dined, educated and entertained locally. Topics ranged from Travel Medicine to Stroke Thrombosis. As the Mihi rang out through the conference centre and delegates were welcomed with a hongi, the cultural competency education began. This year’s cultural focus was on continuous Māori education and Islamic learning for general practice staff and patients with 2 CME points on offer.
Our expert presenters in their fields included local GPs Dr Robert Bester, Dr Wali Kamali and Dr David Hamilton, Dr Hamish Wilson from Otago Dept. of General Practice and Dr Mohammed Hafetz and Dr Chris Johnson from Southland Hospital and Dr Sue Crengle and Peter Ellison from Māori Health. 11 CME points were on offer along with a wealth of information and education. Opportunities for Q&A after the presentation and the ability to network with presenters throughout the weekend was welcomed by all. Our many thanks to our wonderful presenters without you it wouldn’t be possible.
Our wonderful delegates and their partners this year were predominantly from Southland and rural Otago but we were very happy to also welcome some from Dunedin, Christchurch and Wellington. This year there was more opportunities and time for networking and some key relationships and longstanding friendships were made. Support has continued to grow on an annual basis for this boutique education weekend and WellSouth is delighted to continue hosting them.
Stewart Island turned out to be a uniquely beautiful venue for a conference. Most took the opportunity on Saturday afternoon to explore the environment, with walks, running groups (who went further and faster than planned) souvenir shopping or boat trips to Ulva Island to see bird life. Unfortunately, a planned kiwi watching trip was cancelled by the only rain of the visit on Saturday night. Apparently Kiwi’s like us are shy of the rain. But for those who stayed longer on the Island, I believe the Kiwis were not shy on Sunday night.
Saturday morning greeted us with the sunrise of a life time and photo’s to match. As the sunrise changed from fire engine red to brilliant orange to golden yellow, preparations were being made to host the first full days event. Our fabulous speakers showered our delegates with education, data and thought provoking case based scenarios. Throughout the weekend the Mexican or Stewart Island wave kept developing and as teams volleyed for extra points with moves which would put John Travolta to shame, those sought after prizes became attainable. Our special thanks to Mobile Health and EBOS for sponsoring the prizes and congratulations to Kevin Tyree, Tania Phillips, Sam Strachan, Mohammad Hafetz and Patrick O’Mera who not only reign as the 2019 Quiz champions they also took home those fabulous prizes.
Friday and Saturday night saw our stars of Open Mic shine again. Who knew we had such talent tucked away. From life stories to sing alongs, our GP talent was on display. Before the final presentation of Saturday evening Dr David Hamilton and
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Dr James McMillian-Armstrong had a wee surprise for our delegates. An emergency CPR scenario. As James clutched his chest and fell to the floor with symptoms emulating a heart attack and acting worthy of an Oscar, “Is there a doctor in the house” rang out. As Bill Grove administered CPR and David Hamilton walked everyone through the procedure, with onlookers providing some helpful and not so helpful advice, you’ll be pleased to know James is well and the scenario was a success. As for the rest of this fun filled weekend, as the old Stewart Island saying goes, what happens on the island stays on the island.
As the sun set and our lovely MC Scott Arrol brought this successful conference to a close, the organising committee got to discussing what 2020 would look like based on your invaluable feedback and ideas. The next location will be decided with consultation from Southland GPs. Just to put everybody’s minds at ease, we think the Auckland Islands and the Antarctic are too remote!
What our delegates said:“Awesome weekend they just keep on getting better”“More of the same, great fun, keep it local”“Range of presenters, opportunity to network & seek support from our colleagues”“Presenters, venue, networking with GP’s, the PHO staff – all great”“Networking, collegiality, location, entertainment, ethnic recognition fantastic”
WellSouth and the Southland Faculty would like to also thank the organising committee Dr Bill Grove (Riverton), Dr David Hamilton (Fiordland) and Dr Stephen Graham, Cheryl Moeke Workforce Development Advisor and Helen Ramsay Relationship Services Practice Network Manager all of Wellsouth PHO.
Special thanks to the staff of WellSouth who worked tirelessly behind the scenes, Andrew Swanson-Dobbs CEO, Paul Rowe Practice Network Director, Kate Lewis and Angela Ryley Relationship Services Practice Network Managers. To our sponsors, The Southland Faculty of FRNZCGP, The Otago Faculty of FRNZCGP, Southlink Health, the Southland Medical Education Trust our special thanks for enabling this event to happen. Our thanks to our prize sponsors EBOS and Mobile Health. Our special thanks to Habit Food who provided us with 5 star food fit for royalty.
And finally to all the delegates who attended – our special thanks to you, you made the weekend the success that it was. We hope to see you again in 2020.
Co-authors: Stephen Graham, Medical Director and Cheryl Moeke, Workforce Development Advisor
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Workforce Development
Upcoming Education and Training Opportunities
GP and NursesMore Care Planning Session dates will be available throughout 2019. We’ll let you know when they are scheduled.
GP (Please note the start time differences in Southland)23 Jul “Equity in the Office” Dr Sue Crengle, (start time 7:00pm) Invercargill
26 Aug “The ABCs of oncology- alphabet soup and newer cancer treatments Invercargill
in New Zealand” (start time 7:00pm)
Nurses27 - 28 Sep Nursing Conference Queenstown
Reserve the dates – Programme and registrations details soon
NEW Triage dates for Reception/Call Handler Reception/Call Handlers (Practice Managers Welcome)20 Jun Telephone Triage Training for Receptionists/Call Handlers Invercargill
24 Jun Telephone Triage Training for Receptionists/Call Handlers Dunedin
25 Jun Telephone Triage Training for Receptionists/Call Handlers Dunedin
HealthCare/Primary Care Assistance11 Nov HealthCare Study Day Invercargill
CALD - Culturally and Linguistically Diversity Training Wednesday, 12 June 2019 Time: 8:30am - 5:00pm
Register by emailing:[email protected]
People Managing People – Don’t miss out 25 people per courseConflict Management Training for General Practice Staff
Practice Managers - you told us 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. FreeSpiritNZ (http://www.freespiritnz.com/) was established in 2000. 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 Conflict Management Training (9:00am – 5:00pm) Dunedin
13 Aug Conflict Management Training (9:00am – 5:00pm) Invercargill
14 Aug Conflict Management Training (9:00am – 5:00pm) Cromwell
To find out more info on the events and to register go tohttp://training.wellsouth.org.nz/upcoming-events/
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Updates on Southern HealthPathways
SOUTHERN COMMUNITY HEALTHPATHWAYS APRIL 2019
New Clinical Editor appointedAs advised last month, Dr Aisha Paulose has joined the HealthPathways team as a Clinical Editor based in Southland. Aisha was born and raised in London and graduated from UCL Medical School in 2004. She qualified as a GP with MRCGP in 2009. Aisha had an active role in education with the UK RCGP from 2010 and attained a PGCE.
In 2015 she emigrated to New Zealand with her husband and attained FRNZCGP In 2016.
Aisha now works as a GP in Winton, and has continued her love and passion for education and learning, leading the Otago/Southland GPEP programme as well as other roles for the RNZCGP, MCNZ, WellSouth PHN and various clinical working boards.
When not working, Aisha enjoys rural living in her house on a hill, mountain tramping, oil painting, crystals and aromatherapy.
A total of 609 pages are now live.
Pathway ReviewsThe review programme of work is moving forward with the review of 4 pathways completed in April bringing the total number of pathways reviewed to 61.
So what HealthPathways have you been looking at?
The 10 most frequently viewed pathways for the month of April:
The 10 most frequently visited pathways not yet localised for the month of April (page views in brackets):
1. Measles (1) 1. Acute Spinal Pain in Adults (9)
2. Cognitive Impairment (4) 2. Mild Traumatic Brain Injury –Concussion (16)
3. Contraceptive Options 3. Chronic Pain Medications (21)
4. Hip and Knee Joint Replacement (6) 4. Depression in Children and Youth (26)
5. Newly Diagnosed Type 2 Diabetes 5. Mental Capacity (28)
6. Advance Care Planning (ACP) 6. Chronic Pain (34)
7. Benign Prostatic Hypertrophy 7. Acute Ankle Injuries (51)
8. IV Iron Infusion (2) 8. Adult Weight Management (53)
9. Describing Injuries 9. Child and Adolescent E-Therapy for Depression and Anxiety (59)
10. Notifiable Diseases 10. Frailty in Older Adults (105)
*Figure in brackets denotes previous month Analysing this information helps us to identify localisation priorities.
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Southern HealthPathways had 30,858 page views in April 2019 with an average page view per session of 4.46. Of the 1,626 users who viewed pages on HealthPathways, 830 (45%) of these were new users to the site. The number of sessions per user was 4.26.
What to look out for• A new look HealthPathways Home Page being launched
June/July• HealthPathways Mobile App being launched July• System news being updated regularly on the HealthPathways Home Page• Southern HealthInfo anticipated launch June/July
If you would like a visit to your General Practice from the HealthPathways Team then please contact us and will organise this with you.
If you do have any queries then please contact either Bridget-Mary McGown, E: [email protected] PH: 0274331711 or Jolene Jones, E: [email protected] PH: (03) 214 7243.
Don’t forget that you can also contact us by hitting the send feedback button on any HealthPathways page.
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HealthPathways Page Views
17-18 18-19
Bowel screening video resources for patients There are excellent and informative video resources available for clinicians to share with patients who are undertaking the Southern DHB’s National Bowel Screening Programme, which is for those aged 60-74 years who are eligible for publicly-funded health care.
1. In the first instance, there is an animated video demonstrating the correct way to take the faecal immunochemical test: www.youtube.com/watch?v=k62Odxjm7yo
2. For those patients who receive a positive test result and require a colonoscopy, there are videos that illustrate the procedure and processes. Having a colonoscopy at Dunedin Hospital: www.youtube.com/watch?v=_FfZ0JTLaMA Having a colonoscopy at Southland Hospital: www.youtube.com/watch?v=qlo2NBh6bJg
Of those people who receive a positive test result, the latest statistics indicate about 70% will have non-cancerous polyps and approximately 7% will have cancer.
It is positive to note that since the screening programme began, data shows that symptomatic patients are not having to wait longer to receive a colonoscopy, and there has been no change in the percentage of symptomatic referrals being accepted.
In the Southern district, 95% of colonoscopies are performed within 45 working days of a positive test result – above the national average.
This is especially pleasing given that the district has the highest participation rates in the country, with 70.6% of eligible residents taking part.
***
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Health Promotion
***Matariki – our Māori New YearMatariki is nearly upon us, and is a special and significant time of celebration here in Aotearoa – this year the Matariki period is 25 June to 3 July.
Matariki, the Māori name for a cluster of stars visible in our night sky during a certain time of year, signals the start of the Māori New Year. Matariki has nine visible stars: Matariki, Tupuārangi, Waipuna-ā-Rangi, Waitī, Tupuānuku, Ururangi, Waitā, Pōhutukawa and Hiwa-i-te-Rangi.
The Māori view of the world holds that each star has an important significance related to our environment and our wellbeing. Tūpuna (ancestors) would look to Matariki (either it’s appearance or disappearance) for guidance with harvesting, preserving crops for winter, and to predict the upcoming season – clear and bright stars promised winter warmth and abundance while hazy stars warned of winter bleakness. Matariki is a time to celebrate new life, to remember those who’ve passed and to plan for the future. And it’s a time to spend with whānau and friends – to enjoy kai (food), waiata (song), tākaro (games) and haka. To find out more about Matariki check out the following website links:
https://www.twoa.ac.nz/Pages/Te-Iwa-o-Matariki?sc_lang=en#Resources
https://mch.govt.nz/nz-identity-heritage/matariki
https://www.kiwifamilies.co.nz/articles/matariki-maori-new-year/
Whakaaro of the week
Celebrate Men’s Health Week this 10 – 16 JuneAs Men’s Health Week 2019 is about to begin, it is a great time to consider your own health and wellbeing, or to encourage all the men in your life to consider theirs. It’s time to start open conversations and kick the old ‘She’ll be right’ attitude to the curb!!
Make a start by checking out the Men’s Health Week website https://menshealthweek.co.nz/ to take the What’s Your Score? health survey, and while you’re there you’ll find some great information and links. For a quick summary of important ‘Men’s Stuff’ to get you or your beloved thinking, take a look at this great Men’s Health Trust NZ resource:
Te Reo Māori - http://menshealthnz.org.nz/wp-content/uploads/2017/02/Signs-and-symptoms-Te-Reo-web.pdf
English - http://menshealthnz.org.nz/wp-content/uploads/2017/06/Signs-Symptoms-Brochure-web-2017.pdf
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‘Move Your Butt’ to beat bowel cancerJune is bowel cancer awareness month and all New Zealanders – young and old, fit and unfit – are encouraged to move their butts and take part in Bowel Cancer New Zealand’s ‘Move Your Butt’ campaign. You don’t have to run a marathon, simply challenge yourself to be more physically active and exercise more than you usually do.It is recommended that to help reduce the risk of cancer, we should aim to be physically active every day, in any way, for 30 minutes or more. So get out there and ‘Move Your Butt’ this June – not only will you feel great, connect with others and reduce your cancer risk, you will also be helping to raise bowel cancer awareness.Check out the Bowel Cancer New Zealand website for great information and get involved with Move Your Butt - https://bowelcancernz.org.nz/move-your-butt/.
Green Prescriptions
To refer or not to refer…The Green Prescription programme has been proven to be an effective and inexpensive way to increase a patient’s physical activity levels.
A Green Prescription is a health professional’s written advice to a patient to be physically active, as part of that patient’s health management.
Determining whether a patient would benefit from a Green Prescription is not a difficult process. The Ministry of Health has created a helpful health flow chart that practitioners can use to help them make the decision, and also help guide them through the referral process.
The flow chart also reminds practitioners of the importance of stabilising any of their patient’s pre-existing conditions before referring them to the Green Prescription service.
Take a look at the flow chart to determine whether your patient is suitable for the Green Prescription programme.
To refer to Green PrescriptionSport Otago (03) 474 6350
Sport Southland (03) 211 2253
One-on-one pregnancy and parenting education sessions Starting a family is an exciting time, but there are lots of questions too!
Plunket’s pregnancy and parenting education (PPE) courses, supported by Southern DHB, are a helpful place to start.
PPE – or antenatal or childbirth classes – provide first time parents and their support people with valuable information and support at an important time.
For those who cannot attend the regular PPE session, one-on-one classes may be available.
These sessions can be requested in cases where language, mental or physical health or location make attending group classes challenging.
Every course is facilitated by a qualified facilitator, and each facilitator follows the Ministry of Health recommended service specifications for Pregnancy and Parenting Education.
Topics covered include maternity services in New Zealand, healthy pregnancy, pregnancy care, labour and birth, postnatal care breastfeeding, safe sleep and early stages of parenting.
More information is available at https://www.plunketppe.org.nz/
***
IT HelpDesk
What services does our Helpdesk look after?
Its important to use these options so we can track your tickets and monitor the timeline to resolution 0800 Option: 0800 935 575Email: [email protected] Expected Service LevelsNormal Same Day response | 3 day resolutionUrgent Same Day response | 1 day resolutionCritical 1 hour response | 4 hour resolution Service Level GuideNormal I can still work but need this looked intoUrgent I can still work but need this soonCritical I can't work and I'm freaking out
Options for Help
Phone: Stephen Murphy IT Manager - 0272457361
Not Resolved lets Escalate
For IT Services excluding Health Cloud ReporterPhone: Stephen Murphy IT Manager - 0272457361 For Health Cloud Reporter EscalationsPhone: Chris Mitchell - IS Manager - 0212256445
Not Satisfied?
Phone: Kyle FordeChief Information OfficerTXT Keyword: ITHELP and issue to 0275500033
Mediation Required
Phone: 0800 935 575
Updated: 07/11/2018
HealthONEHealth Cloud ReporterPatient DashboardWeb Portal (Claiming) ERMSWellSouth Medtech EvolutionHealth Cloud Internet Services*
*Applicable to Health Cloud customers only for Internet, Connected Health and Firewall
Email: [email protected]
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SAVE THE DATE - Invitation to attend a health systems design wāãnanga on behalf of the Māãori Expert Advisory Group, NZ Health & Disability System ReviewE ngā manawa ora, e ngā rau awa o te motu nei, e ngā ringa tōhau nui, he mihi maioha tēnei ki a koutou katoa.
The Māori Expert Advisory Group, of the NZ Health & Disability System Review, invites you to attend one of four health systems design wānanga in May-June 2019. These wānanga are your opportunity to help shape what the future New Zealand health and disability system might look like. In particular, we are seeking your whakāro about the current issues impacting on Māori and the health system, plus your ideas and inspiration about a future system that is designed to prioritise Māori health equity, outcomes and aspirations. In short, what are the system level changes that we can make to drive improved Māori wellbeing? We are keen to see the benefits realised within the next 5-10 years.
The wānanga dates and locations are as follows:• 24 May 2019, Kaikohe
• 4 June 2019, Rotorua
• 18 June 2019, Dunedin
• 25 June 2019, Wellington
Final details of the wānanga venue will be sent to you shortly.
If you would like to attend, please click the link: https://sharonshea.wufoo.com/forms/health-disability-systems-review/ and complete the online RSVP form.
If you have any queries about the wānanga, please email Lawna Kani at [email protected] or cell: 022 6977469.
If you are unable to attend a wānanga, you can complete this online survey https://systemreview.health.govt.nz/overview/contribute-to-the-review/.
You may also wish to submit your whakāro via this email: [email protected].
The system review team are completing multiple engagements between now and March 2020 (when the final report is due). There will also be follow-up Māori specific engagements after these wānanga.
Contact [email protected] for details about planned upcoming engagements with the sector.
The opportunity to re-shape New Zealand’s future health system doesn’t come along very often. We hope you can join us to make a difference.
Nei rā anō āku kupu pōhiri kia koutou, nau mai haere mai Nāku iti nei Sharon Shea, Chair, Māori Expert Advisory Group (MEAG)
Health & Disability Systems Review
Cell: +64 021 482199
https://systemreview.health.govt.nz/
Nga Kupu o te Marama
Māruaroa – JuneMurihiku – Southland
Rakiura – Stewart IslandTe Wharawhara – Ulva Island
Ringaringa – to waveAta tū, whitinga o te rā - Sunrise
Whakaaro – IdeaTe Wiki Hauora Tāne – Men’s Health Week
Waka tūroro – Ambulance
WellSouth is including Māori Words of the Month that are related to relevant health topics covered in WellInformed
Words of the Month
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I Stopped Smoking And Proved Everyone Wrong
Stewart Whittingham - ManapouriWhen everyone told me I would never stop smoking, I set out on a mission to prove them all wrong. And I succeeded.
