Tēnā koutou katoa

Welcome to this week’s update. Apart from the elections – dont’ forget to vote - the big news this week is that WellSouth’s Primary Health Care Nurses Conference, Toward Positive Change in Primary Health Care,  is starting on Friday in Dunedin. Kate Norris, our Professional Nurse Advisor Leader, and the organising committee have put together a great series of speakers and workshops, and it should be an excellent Conference – many thanks to the hard work of all involved.

 

Thanks to all the hard work the Clinical teams in Queenstown Lakes have been shouldering during the Cryptosporidium outbreak. The funded surveillance testing continues for people with symptoms of gastro who have been in Queenstown since 18 August. We will advise you as soon as this changes.

 

And a big shout out to our practices for your efforts in the childhood immunisation space. Three quarters of our 79 practices, have over 95% of enrolled 8 month olds up to date for their immunisatons.  Of the remaining quarter of practices, eight are sitting between 90-95% up to date, and 11 were under 90%. It is a constant effort to keep on top of this work, and thank you for all your work to protect our tamariki.

 

And watch out for the lab strikes 17-20 October.

 

Key points today:

  • Toitū Takata – LTC Programme

  • Measles Update

  • Prescription Coding

  • Consent from ARC residents for oral antivirals

  • Primary Care Colleague Referral Pathways

  • Using Health Connect South to review patient admissions/discharges

  • Labour Day logistics update

  • Crisis Respite Service Dunedin

  • New National Clinical Network Expressions of Interest

  • Vaccine administration webinar – tomorrow!

  • Advance Care Planning – Invercargill

  • Breast Care – HealthPathways CME sessions

  • AIR Webinar for Southern General Practices – recording

  • 6th Annual Southland GP Weekend Education conference

  • Otago Community Hospice Education

  • Maternal Immunisations webinar recording

  • GPNZ September monthly activity report

  • MenACWY vaccine offered by pharmacies

  • Additional COVID-19 boosters for late 2023

  • COVID-19 Resources

 

 

What’s new

 

Toitū Takata – LTC Programme

We are looking forward to presenting Toitū Takata at the Primary Health Care Nurses Conference this Friday.

After the conference WellSouth is holding a series of Nurse Champion Workshops around the region for more detailed information on the support that Toitū Takata can provide.  The workshops will focus on supporting nurses to improving health outcomes for those living with long term conditions, dates have been scheduled across the region in October and November and further dates have been added to keep up with demand. Please register here.

Webinars will be offered in November and December to provide information on Toitū Takata to other practice staff including Practice Managers.

The Toitū Takata webpage is being up dated regularly, please check here for the updated Frequently Asked Questions.

  

Measles Update

MMR clarification for health care providers

As you know, the MMR vaccine is given as part of the National Immunisation Schedule at ages 12 months and 15 months. Two doses are recommended and funded for non-immune children and adults.  

Immunity to measles, mumps and rubella is assumed after two documented doses of MMR, unless revaccination is required post-immunosuppression or in occupational high-risk situations where serology has been undertaken.   

Immunity to measles is also assumed in people who lived in New Zealand prior to 1969. Other people who lived in countries with limited circulating measles* prior to 1969 may not be immune to measles if not previously immunised with a measles-containing vaccine. Therefore, they can be considered for funded MMR vaccination, particularly in the case of a community outbreak. Those born prior to 1969 do not need to be recalled for MMR vaccination but may benefit from a clinical discussion about their risk. 

MMR vaccine information has recently been updated in the Immunisation Handbook to not preclude people born before 1969.  
  
*Countries with limited circulating measles prior to 1969 include remote island nations. 

If measles is suspected: (images courtesy of DermNet https://dermnetnz.org/topics/measles-images)

 


  • Please notify the Medical Officer of Health  as soon as you suspect measles – do not wait for a laboratory confirmation.

  • Arrange nasopharyngeal or oropharyngeal sampling, using viral swab, for measles PCR. Include clinical details and symptom onset. Contact local laboratory if further information on testing is required.

  • Isolate patient immediately and maintain IPC measures.

  • Check HealthPathways for further up-to-date measles assessment and management information.

 

Additional advice:

  • Please encourage primary care staff to check their immune status for measles. If there is measles exposure on-site, immunisation records may be requested.

  • As measles is increasing globally, please consider measles in those presenting with symptoms who have recently travelled overseas to countries with active outbreaks.

  • Children under one year travelling to countries with active measles outbreaks can be offered MMR vaccine from aged 4 months on prescription. Refer to the immunisations handbook or contact IMAC for further detail.

  

Prescription Coding A3 vs A4

Community pharmacies have noted that occasionally prescriptions are coming from some general practices for enrolled patients which have been coded as ‘A3’ – an unenrolled adult without a community services card - instead of ‘A4’, an adult enrolled at the PHO the practice is part of.   This means the patient would have to pay $15 per item instead of it being free. While the ‘A3’ vs ‘A4’ code on a prescription makes no difference at the general practice, it is a big issue at the community pharmacy end.

In most cases there is a previous history for the patient who has always been A4.   Although the community pharmacist can change this, it requires a phone call to the general practice, which wastes people’s time.

Anecdotally in a lot of cases, although not all, it seems to be a doctor who is new to the practice, so it may be an issue in the set up of the new doctor. Either way, please be on the look out for this as it's great if we all make each others’ life easier!

 

Consent from ARC residents for oral antivirals

An Aged Residential Care facility has raised with me that they were concerned about Paxlovid being prescribed for residents when there appeared to be no consent from the resident, or their EPOA’s consent. In some instances, medications were being appropriately withheld, but the consequences of being without these medications had significant impact on the person’s wellbeing (eg some pain or psychoactive meds), as well as some people having significant side effects with the Paxlovid medication.

We would all agree that informed consent is one of the tenants of how we provide good quality care. Options available include

  1. documenting in the person’s clinical notes at a routine visit, whether or not they want Paxlovid if they contract Covid, and issuing a prescription at the time that they contract Covid;

  2. providing an advance prescription for Paxlovid (funded whether a prescription given or not, but  at different rates), or

  3. discussing it with the person or their EPOA if applicable, when the person contracts Covid (funded, whether virtual or in-person).

  

Primary Care Colleague Referral Pathways

The Primary Care Colleague Referral Pathways are now fully up and running so please use and consider this when discussing referral options with our patients. The Health Pathways page provides the framework and governance along with the available procedures and services. Not every service has an option yet but if you open the drop down it will list practices currently accepting referrals. The referral can then be sent using ERMS, directly to the practice or provider (you can search either for the practice, the service or navigate to the General Practice tab).

If you as a provider or a practice have interest and capacity to accept referrals from colleagues and other practices, you can sign up directly using the links at the bottom of the HP page.

 

Using Health Connect South to review patient admissions/discharges

One of the good things that Health Connect South does, is provide data around admissions and discharges from hospital and can be accessed from the main HCS page. On discussion with a practice recently, they weren’t sure of the details of this, so here is a update on the ‘how-to’. The attached document explains how to access this. As a practical example of how this could be used, some practices are using their Tōku Oranga (Access and Choice) team to make contact with their vulnerable patients proactively, on notification of discharge to review their care needs and coordinate follow up or review. If any practices are keen to share their approaches and innovations around how they use the data, we would be happy to share ideas with others.

 

Labour Day logistics update

There will be no deliveries (Vaccine/consumables) on Monday the 23rd, and Tuesday the 24th of October due to the Labour Day public holiday. If your scheduled delivery day is either Monday or Tuesday, please ensure that you have sufficient stock of vaccine to get you through this period. If you have any questions, please email romilly.smith@southerndhb.govt.nz  or phone (03) 476 9915.

 

Crisis Respite Service Dunedin

Pact have a 5 bedroom Crisis Respite service available to those in need of support. The house is situated on North Road, Dunedin, and provides a homelike environment for those in crisis needing time away to rest and recuperate in a safe place. The service has supportive staff onsite 24 hours a day, 7 days a week, with clinical oversight. The referral process can be explained by the Clinical Lead, Kerry Cross RN MN, and can be completed by other staff in the practice with GP oversight. Brochures are available upon request, and visitors (including potential clients,) are welcome to view the property to ensure the environment is right for them.

For further information or guidance on the referral process, please contact Kerry Cross 027 216 7128 or email Kerry.cross@pactgroup.co.nz

  

 

Opportunities to be involved

 

New National Clinical Network Expressions of Interest

Expressions of interest (EOIs) for the co-leadership of the next tranche of National Clinical Networks have been released. I would really encourage you to consider whether you have the interest and time to be involved in these funded roles. We need strong primary care voices in these roles to change the system – I am reminded of Einstein’s definition of madness,  doing things the same way and expecting a different outcome.

The EOIs are for the co-leads of five new networks: radiology, radiation oncology, ophthalmology, infection services and critical care.

Applications for the roles will be sought from a broad range of clinical professions - including nursing and allied health - from both hospital and specialists' groups and primary care.

Applications are particularly welcomed from Māori, Pacific people, disabled people, and the LGBTQI+ communities. The EOIs for these roles will be open until 18th October and can be found here. 

The networks will influence how we prioritise and drive system change by developing national standards and models of care and they support the third system shift set out in Te Pae Tata. Everyone will have equitable access to high-quality emergency and specialist care when they need it, wherever they live.   

Find more information on the National Clinical Network page here and email any questions you might have to NationalClinicalNetworks@health.govt.nz. 

 

 

Upcoming training and webinars

 

Vaccine administration webinar – tomorrow!

Thursday 12 October, 6pm (1 hour)

Join IMAC Programme Manager Jane Morphet and IMAC Medical Advisor Joan Ingram to discuss practical issues relating to vaccine administration.

This webinar will look at a range of issues, including a review of best practice, latest research, use of paracetamol, needle length selection, a reminder on Bexsero spacing, MMR eligibility, and a review of resources, as well as immunisation updates and learnings.

Please register for the vaccine administration webinar here.

 

Advance Care Planning – Invercargill

Thursday 19 October, 8.15am (Free one-day course)

Are you passionate about advance care planning (ACP)?

We are looking for health professionals who want to:
• help grow the use of ACP
• learn how to translate an individual’s wishes into written documentation for ACP
• gain experience in supporting patients with ACP Course pre-requisite: ACP e-learning needs to be completed before attending the workshop. https://acp.elearning.ac.nz 

You will be notified if your application has or hasn't been successful for this course.

Register here.

  

Breast Care – HealthPathways CME sessions

Tuesday 24 October, 7 pm

Online via Zoom

Join Alice Febery (General Surgeon Southland) and other members of the Te Whatu Ora Southern Breast Care Service for a CME session.

Breast symptoms are a common presentation in primary care. Learn more about Breast Care, Healthpathways updates and new processes with Pacific Radiology moving offsite.

This free session is open to all primary care clinicians and will contain both clinical and process updates.

Register here.

  

AIR Webinar for Southern General Practices – recording

If you were unable join us to learn more about the Aotearoa Immunisation Register (AIR) going live in November and what to expect, you can view the recording and linked presentation below.
Loren Shand Programme Lead for the National Immunisation Programme and the AIR Engagement team presented the update.

The webinar video (and transcript) are now available here.

A copy of the webinar agenda and relevant contact and information links can also be accessed via the video or here.

 

6th Annual Southland GP Weekend Education conference 
4 - 5 November 2023

Distinction Hotel, Te Anau

Register here.

The Annual Southland GP Education conference is back for the 6th year, hosted by the RNZCGP’s Southland Faculty in Te Anau.

We have a fantastic line up of speakers across the two days.

9 CME points, and practitioners from Southland will be offered a 50% discount.

For the full schedule of events and speakers click here.

If you require assistance, please contact workforce@wellsouth.org.nz.

 

Otago Community Hospice Education

Otago Community Hospice provides a wide range of education - much of which is now available online. 

Their standard programmes are:

  • Palliative Care for Care Assistants - delivered by zoom - 4 x 2hrs 

  • Fundamentals of Palliative Care - delivered online + a 6 hr face-to-face workshop (Dunedin, North Otago or Central Otago)

  • Syringe Driver Training workshop - mainly for ARC (Otago-wide)

For further information, check out the programme calendar on their website, or email education@otagohospice.co.nz. 

  

Maternal Immunisations webinar recording

View the recording of IMAC’s latest webinar on maternal immunisations, which covers latest research, improving coverage and supporting positive conversations.
The webinar also covers the incidence of disease, as well as reviewing current guidance and updating you on range of resources that are available to promote and support maternal vaccination uptake.
View the webinar recording here.

 

Other general information

 

GPNZ September monthly activity report

Attached is the GPNZ monthly activity report for September, please read the report to stay informed on their work.

September Monthly Report

 

Meningococcal MenACWY vaccine offered by pharmacies

Effective immediately, there will no longer be a requirement for pharmacies to provide evidence of identified demand when they approach their District to request access to adding the MenACWY (MenQuadfi) vaccine to the portfolio of vaccines offered in their pharmacy. 

This change aligns access to MenQuadfi with the other funded vaccines currently available for community pharmacies to order via the CIR Inventory Portal. Pharmacies should continue to only order sufficient stock to meet demand to support vaccinations for the close living eligible cohort as per Pharmac eligibility criteria.

Te Whatu Ora is continuing to support pharmacies to widen the number of vaccines they can offer their community to ensure consumers are able to access vaccines they are eligible for. By increasing community access to meningococcal vaccines, it is envisaged pharmacies will be able to provide these vaccines to young people who are moving into close living facilities (boarding schools or halls of residence).

If you have any questions, comments or would like support to onboard for any of the available vaccines please reach out to immunisation@health.govt.nz.

 

Covid-19 updates

And I had promised for no more Covid updates…. Sorry team.

 

Additional COVID-19 boosters for late 2023

A new IMAC factsheet with clinical guidance on additional COVID-19 boosters for late 2023 is now available. Click here to view the factsheet

For people who are up to date with COVID-19 boosters, those who are most likely to benefit from another dose in late 2023 include:

•    Anyone aged 75 and older
•    Māori and Pacific people aged 65 and older
•    People aged 16 and older who are severely immunocompromised
•    People aged 30 to 74 with significant complex health needs that increase the risk of frailty (e.g., those living in residential care and those with long term medical conditions)

For further clinical advice, please call 0800 IMMUNE (0800 466 863) or email 0800immune@auckland.ac.nz

 

COVID-19 Resources

IMAC’s dedicated COVID-19 website is now closed. COVID-19 vaccination information is now integrated with our routine immunisation programmes and you can find all of the latest guidance, documents and resources on our immune.org.nz website. 

Click here to visit IMAC’s updated COVID-19 Programme page where you will find links to vaccines, factsheets, our new Aotearoa NZ COVID-19 Vaccinator course, and more.

 I would like to end today’s update by acknowledging the passing of Dr Tom Mulholland. He will have touched many of our lives in different ways, as a colleague, as a speaker, as an author, as a friend. I have known Tom since Med School and have laughed and wagged class and worked with him in some of his hairbrained schemes over the years. Always giving and loving and living full steam ahead. Rest in peace Tom, we will miss you.

 

It is also a time to reflect that we as health professionals are not immune from the stresses and pressures that send people to dark places. Please, if you are struggling, talk to someone you trust. And if one of your mates or colleagues seems to be not themselves, please ask them if they are really ok.

 

Ngā mihi nui

Carol