Provider Forum Presentation 21 June 2023

Provider Forum

21st June 2023

Whakataka te Hau

Karakia Timatanga (opening)

Whakataka te hau ki te uru

Whakataka te hau ki te tonga

Kia mākinakina ki uta

Kia mātaratara ki tai

E hī ake ana te atakura

He tio, he huka, he hau hū

Tīhei mauri ora!

Cease the winds from the west

Cease the winds from the south

Let the breeze blow over the land

Let the breeze blow over the ocean

Let the red-tipped dawn come with a sharpened air

A touch of frost, a promise of a glorious day

PHO Update

Lindsey Webber CEO

Western Bay of Plenty Primary Health Organisation

 July 1st funding uplift

 RN Pay Disparities Update

 WBOP Locality Development

– What’s New?

COMMUNITY PHARMACY SERVICES

LEANNE HALL AND ASHLEIGH DICK

OVERVIEW

MINOR AILMENTS

FREE PRESCRIPTIONS

FUNDED PHARMACY SERVICES

UNFUNDED PHARMACY SERVICES

NEW CONTROLLED DRUG REGULATIONS

ELIGIBILIY FOR MINOR AILMENT SERVICE (MAS)

MUST BE ELIGIBLE FOR PUBLICLY FUNDED HEALTH SERVICES AND ONE OF THE FOLLOWING:

CHILDREN UNDER 14 YEARS OF AGE

WHĀNAU MEMBERS (ANY AGE) OF A CHILD UNDER 14 YEARS OF AGE, WITH THE SAME SYMPTOMS

M

ĀORI AND PACIFIC PEOPLE

COMMUNITY SERVICE CARD (CSC) HOLDERS

CONDITIONS INCLUDED

• ACUTE DIARRHOEA, AND DEHYDRATION

EYE INFECTIONS AND INFLAMMATION

PAIN AND FEVER

SCABIES

HEADLICE

ECZEMA/DERMATITIS • MINOR SKIN INFECTIONS

MAS TREATMENTS AVAILABLE

• ADVICE, REFERRAL

• MEDICINES – GENERAL SALE, PHARMACY-ONLY, PHARMACIST-ONLY

• Eg sodium cromoglycate eyedrops, loperamide, metal head lice combs, hydrogen peroxide cream, clotrimazole 1%, Pedialyte,

• Not oral antibiotics or ibuprofen tablets, internal thrush treatments

FREE PRESCRIPTIONS

• From 1st July

• Only the ‘4’ code i.e. not specialists or dentists

• All prescriptions coded A4 and J4, which previously had a $5 govt co-payment, are now tax free in every pharmacy.

• This does NOT include prescriptions from a specialist or dentist, which are coded A3 or J3, nor does it include prescriptions from a specialist or dentist, where the patient has a community services card (coded J1 & A1)

FUNDED SERVICES

• Rapid response sore throat treatment

• Kiri Ora ( Te Puke and EBOP)

• ECP <25 yrs

• NRT

• Sharps disposal

• Complex LTC

• MAS

• CPAMS

NON FUNDED SERVICES

• Oral contraception,

• UTI 18-65 yrs

• Thrush

• ECP for >25 yrs

• Sildenafil 35-70 years

• Insomnia

CONTROLLED DRUG RX CHANGES

• Since 1st June, funded 90 days supply of dexamfetamine and methylphenidate on a bar-coded Rx –monthly dispensing, no exemptions

• No requirement to send original Rx to pharmacy if NZePS

• Maximum quantity is 30 days for non bar-coded Rxs

• Opioids that are Class B controlled drugs maximum 30 days supply, dispensed at 10 day intervals unless specified differently:

• fentanyl

• methadone hydrochloride

• morphine hydrochloride

• morphine sulphate

• oxycodone hydrochloride

• pethidine hydrochloride

THANK YOU

WE HOPE YOU HAVE LEARNT SOMETHING NEW THIS EVENING

System Pressure Planned Care (POAC)

Phil Back , GM Network Services WBOP PHO

Dr Claire Isham, Clinical Director WBOP PHO

POAC Update

 Winter Pressures significantly impacting 8 Public Hospitals nationally

 Tauranga Hospital is the only one within the Te Manawa Taki (Midlands) Region identified

 Set of local initiatives that will enable a greater response within Primary and Community

 Rapid turnaround of initiatives and implementation with go live 19 June 2023

 Enhance current service environment (Acute Demand) – not create new expectations

 Enable clinically-led responses where capacity exists and clinically indicated

 Prelude to broader, more comprehensive national rollout of POAC later this year.

 Initial phase runs through to 30 September 2023

POAC service components:

 Existing Acute Demand service components offered to casual patients

 Extending access to community radiology within 2nd Ave (avoiding ED referrals)

 Post-discharge / Post exacerbation GP follow-up consults

 Adult Pneumonia diagnosis GP follow-up

 Consider Point of Care Testing (Troponin) for 2nd Ave and rural Practices

 Other considerations include: Pneumococcal vax for at-risk pts and Chest Pain (ECG & f/u)

 Delivered at no cost to the patient.

 Target population is Māori, Pacific, and Community Service Card holders

Afterhours Session

Phil Back , GM Network Services WBOP PHO Representative on behalf of Providers Inc.

Afterhours Update

 Staywell Afterhours Service Review Report received and endorsed by Afterhours Committee and Providers Inc.

 Strong emphasis on removing Opt-offs and reducing shift length for weekends and public holidays.

 Consideration of inclusion of Nurse Practitioners within AH roster.

 Identification of preferred provider of virtual GP consults to enhance General Practice and Afterhours.

 Communication to Practice Owners via Practice Managers on 10 June provided an update on the above.

 These are initial steps to ensuring a sustainable afterhours service. More to be done.

 Active participation of stakeholders is essential to take forward further review and enhancement.

 Following presentation is from our preferred virtual service provider.

Practice Plus

Jess White – P+ General Manager

Dr Emma Calvert – P+ Clinical Director

Telehealth Practice Partner – Practice Overflow

• Telehealth service established Feb 2022

• Extension to general practice capability, by augmenting general practice care with video and telephone consultations

• If partnered General practices are lacking capacity, they have a trusted partner to refer patients through

• Alternative to long Urgent Care/After Hour/ED waits

• No enrollments, No Clawback

• Patients book (themselves or with assistance) through an online portal to be seen by a Clinician

• Clinicians will assess and manage the patient (if appropriate) through telehealth

Direct Patients to P+ for Same Day Demand

• “Our next available in person appointment is xxx, otherwise would you like a phone or video consult today? We partner with Practice Plus, who can complete your appointment over phone or video.

• Go to our Medical Centre website, you will see a Practice Plus logo. Click the link and it will take you through a simple online booking page, where you can select a time that works for you.”

This sounds like a viral illness, that will most likely resolve by itself. If you become more unwell over the weekend, you can go to Practice Plus, it will connect you with a Clinician who can help

Service Provision

• NHI, NES sync to determine patient demographics and Enrolled Practice

• Prior to consult, Clinicians will review GP/Hospital Notes and prescribing history

• National Prescribing data, Labs through Pathlab

• Review patients for variety presentations

• Request Labs/Referrals BOP BPAC electronically

• Prescribe, send to local Pharmacy - NZePS

Connection with Enrolled GP

• All Consultation Notes sent to Enrolled GP

• Investigations have Enrolled GP cc’d but P+ will action results

• Provide feedback to Enrolled Practice if concerns

www.practiceplus.nz

Engages patients and manages online payments and provides patients with a virtual consultation room and patient SMS reminders ensuring both patients and providers have a seamless experience.

Patients with an existing Myindici account can log in with their credentials without needing to register

PATIENT DEMOGRAPHICS

>20% Māori

40% Quintile 4 / 5

25% CSC

Over 500 Consultations patients over 70

Appointment Resolution

90% ‘Resolved’

3% Urgent Review (ED)

3% Semi-Urgent GP Review

PATIENT EXPERIENCE

• For my neighbour I access practice plus for him. He is a 50 year old maori male who lives rurally and who was in a lot of pain . He didn’t want to go to the doctor, as not could he afford it. I accessed practice plus for him through mahi . He was so appreciative, was seen straight away and got the advice he was needing”.

• The doctor answered all my questions and was super helpful with advice and explaining how the body works and processes a viral infection. Would recommend her highly!

• “I have had personal and kaupapa whanau experience with utilising Practise Plus and it was awesome. This service has brought relief to whanau in more ways than one, including whanau referrals to specialists prioritised and seen in 2 days, & financial relief. Would absolutely love to see this continued.”

Te Kete Hauora Rangitane - Dannevirke

Clinician Governance and Quality

• Workforce

• Mostly GPs, but can include Urgent Care Doctors, Emergency Docs, Full Scope NPs

• Workforce based all over the motu

• Policies, Audits and Data sharing

• Repeat Rx, CD and investigations policy

• Audit on starting and cycle

• Clear data reporting and transparent review of clinical management

• Comparing clinician rates/trends in; Antibiotic prescribing, CD prescribing, Investigations

• Other In-person Clinical Work

• Clinicians work part-time and have regular In-Person GP work they complete and are encouraged/supported to maintain this

QUESTIONS?

PHO Clinical Updates

Claire Isham – Clinical Director

Western Bay of Plenty Primary Health Organisation

Karo CVDRA Issue

HPV Primary Screening

Key Dates

• On track for GO-LIVE 26 July 2023

• NCSP Clinical Guidelines 2023 available online now for use from 26 July 2023

• Order HPV test kits from Pathlab from early July 2023

• Training and educational resources available from mid-June 2023*

• Public campaign and resources for participants released late June 2023

• Primary Care have access to NCSP-Register by December 2023

HPV Primary Screening Training, information and feedback

• E-learning modules via Te Whatu Ora online learning – starting from next week

• Educational video ‘Overview of HPV Primary Screening’

• https://www.nsu.govt.nz/health -professionals/national-cervical-screening-programme/hpvprimary-screening/hpv-primary

• Subscribe to the Sector update Newsletter by emailing HPVScreen@health.govt.nz

• Health Professionals pages on the NSU website contain FAQs: here

• View the Bay of Plenty HPV Primary Screening update by emailing Cervical.Screening@bopdhb.govt.nz for a link to the presentation

• Email any questions and feedback to HPVScreen@health.govt.nz

Clinic -2 Moving

Cilazapril Discontinuation

https://pharmac.govt.nz/medicine-funding-and-supply/medicine-notices/cilazapril/

Amendment to Prescribing and Dispensing: Methylphenidate & D examfetamine

 From 1 June 2023 methylphenidate and dexamfetamine will be funded for up to three months on a prescription, when prescribed electronically.

 To make funded supply consistent with recent legislative changes to the prescribing and dispensing of these medicines, which are Class B controlled drugs.

This decision means that:

 The number of times people need to visit a prescriber for funded repeat prescriptions for these medicines will be reduced from every month to every three months if they are prescribed via the New Zealand ePrescription Service (NZePS). The amount that can be prescribed on a paper prescription will stay as one month.

 People taking methylphenidate and dexamfetamine will pay a prescription co-payment every three months instead of every month when these medicines are prescribed via the NZePS.

Decision to amend the Pharmaceutical Schedule Rules on prescribing and dispensing of methylphenidate and dexamfetamine -

Pharmac | New Zealand Government

Upcoming Reclassification

of: Fentanyl, Tramadol, Zopiclone and Zolpidem

On 1 July 2023:

• fentanyl will be up-scheduled to a Class B1 controlled drug (from Class B3)

• zopiclone will be scheduled as a Class C5 controlled drug

• zolpidem will be scheduled as a Class C5 controlled drug.

On 1 October 2023:

• tramadol will be scheduled as a Class C2 controlled drug.

LARC Updates

Updated Process to align with National Guidance

Online Training Modules – (no longer GoodFellow):

 National Contraception Training Services (NCTS):

• Contraceptive Counselling course; AND

• Intrauterine Contraception (IUC) and/or

• Contraceptive Implant theory courses. https://www.familyplanning.org.nz/courses

Requirements for Cultural Competency Prerequisite.

Maintaining Competency:

 Average 10 per year (each procedure type)

 Practice holds all evidence at their end, PHO may audit as appropriate

 Providers (approved for funding via Halcyon) will be asked to confirm current competency every 2 years

Updated Resources – PHO Portal:

• Guide Page (in draft)

• NEW Practitioner LARC Guidance & Application Form_WBOP PHO

• EXPERIENCED Practitioner LARC Registration Form_WBOP PHO

• Appendix 1 - LARC Checklist

• Appendix 2 - LARC LogBook

New Zealand Female Pelvic Mesh Service

for Women with Health Problems Relating to Pelvic Surgical Mesh

• Holistic care and support for women with health problems relating to pelvic surgical mesh is now available through a new nationwide service.

• Designed in partnership with mesh-injured consumers, Māori and Pacific health representatives and medical professionals, and in collaboration with ACC.

Referral Pathways:

1. Healthlink – Referred Services: “NZ Female Pelvic Mesh Service (Northern Hub)”

2. e -Referral - Key words for search: Pel, Pelvic, Mesh

Any feedback on eReferral please contact Nestor Tio: eReferrals@healthshare.co.nz

More information and Resources available on: https://www.tewhatuora.govt.nz/keeping-well/the-new-zealand-female-pelvic-mesh-service/.

Rangiora Health Hub - Reminder

 A free, walk-in immunisation centre including childhood immunisations

 Located in the Fraser Cover Shopping Centre, Fraser Street, Tauranga

 Open 9:30 am-5:00 pm, Monday to Saturday.

Rangiora is a walk -in Health Hub. No appointment is needed.

This may be of particular help for General Practices to direct patients to when they are at capacity or for requests from casual/unenrolled patients.

Rangiora Health Hub provides Vaccinations including:

• COVID 19 & Boosters

• FLU jab

• Childhood Immunization

Other services include:

• Dietitian Service

• Te Piripoho Service (Hapū māmā and pēpi)

• Before School Checks

• Healthy Lifestyle Service (Nutritionist and Health Lifestyles Coach)

• Access to a Pharmacist on Tuesdays and Wednesdays

• Disability Support Awhi Mai, Awhi Atu

• Cervical Screening