Provider Forum
July 17, 2024
Whakataka te Hau Karakia Tīmatanga (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
Speaker Session
Lindsey Webber, CEO, WBOP PHO
Dr. Massimo Giola, Clinical Lead, Sexual Health Service
Infectious Disease & Sexual Health Physician
Mat Delaney, Area Operations Manager – Western Bay of Plenty & Central
East District, Hato Hone St John
Fraser Watson, Specialist Clinical Lead (ECP), Hato Hone St John
Wendy Dillon, General Manager of Network Services, WBOP PHO
Claire Isham, Clinical Director, WBOP PHO
Clinical Advisory Team, WBOP PHO
PHO Update
Lindsey Webber CEO
Western Bay of Plenty Primary Health Organisation
Workforce Development
What do you see are the top primary care health workforce issues here in the Western Bay of Plenty?
https://forms.office.com/r/fsfMbcFZUa
WBOP Primary Care Health Workforce consultation
• The initial consultation will run for at least 2 months to inform the WBOP PHO's first workforce strategy and annual action plan
• A network workforce survey will be issued
• We will also establish a mechanism for ongoing dialogue
• Please contact the WBOP PHO's Network Workforce Development Lead, Emma Skellern at emmas@wboppho.org,nz if you have a workforce issue you would like to discuss
• You can also share your thoughts at any time via this form https://forms.office.com/r/fsfMbcFZUa
The Sexual Health Services in BOP
Who we are, what we do
Plus updated epidemiology of STIs in Aotearoa
Massimo Giola, FRACP, FAChSHM
Infectious disease & Sexual health physician, Sexologist
Clinical lead of the Sexual health services in Tauranga, Whakatane, and Rotorua
Our contacts
• We are on BPAC for eReferrals - our preferred way for you to refer to us
• Our phone is 0800 267 256
• Email Clinic2@bopdhb.govt.nz
• We are now located in Greerton at Te Pa Harakeke building – 1378 Cameron Road (next door to the Greerton Countdown – opposite the racecourse)
• Open 5 days/week – no walk-ins, appointments strongly recommended
• We will do our best to see on the same day people who are symptomatic.
Who we are
• Two SMOs in Tauranga collectively working for one FTE – myself Mon to Wed, my Colleague Dr Anne Thu and Fri
• A full-time PGY2 – when the Hospital is not short staffed, and they can spare one
• CNM Ross, Nurse Prescriber Helen, and CNS Anne and Belinda in Tauranga – 2 FTEs in total
• One SMO in Whakatane (Julia E.) – one day/week (Wed)
• One Nurse Prescriber (Julia DS) in Whakatane (Wed to Fri)
• One dedicated Receptionist and Scheduler (Trish) for both locations.
How we work
• On average, we see 300 women and 150 men/month in Tauranga, 45 women and 20 men/month in Whakatane
• We work closely as a Team – we have internal procedures about who needs to see a Doctor (eg all syphilis cases, PrEP scripts, complex genital dermatology cases, gender identity clinic, sexual dysfunction cases…)
• The Nursing Team can manage autonomously almost all STI cases (apart from syphilis) either as Nurse Prescribers or under Standing Orders
• We are completely paperless and use MedTech 32 as our EPMS
• All our STI tests are coded – you cannot see the results
• However, we always reply to your referrals and we request tests under NHI (with patient’s consent) when we feel other care providers might need to see the results too.
What we do - STIs
• Our core business are STIs: chlamydia, gonorrhoea, syphilis, genital herpes, genital warts, mpox…
• We offer prevention, diagnosis, and treatment of all STIs to everyone, free of charge, regardless of their eligibility/immigration status
• Medico-legal certificates for Immigration NZ (typically, for syphilis) are not provided through the public system and must be referred in private
• We do not have dedicated resources to do notifications or contact tracing/partner notification on behalf of other providers – it is the responsibility of the diagnosing clinician.
What we do –
HIV testing and prevention
• We offer HIV PEP follow-ups for STI and HIV/BBVs testing down the line (4 weeks after starting PEP and 3 months after the episode)
• All prescribers are now allowed to obtain the ESA and prescribe the whole 28-day course of PEP
• We do not store “PEP starter packs” – ED do
• We offer HIV PrEP visits, tests, and F/Us – preferably for those who are not otherwise eligible (WHV, international students, etc.) or who face other barriers in accessing GPs (Maori/Pacific people, unemployed, CSC…)
• People who are eligible and can afford seeing a GP should not be referred to us for PrEP – just do it.
What we do – other genital infections
• We accept referrals for recurrent BV and/or recurrent thrush
• We manage single episodes of BV, thrush, UTIs, scabies if diagnosed during an assessment for ?STI
• Pubic lice are essentially extinct.
What we do – genital dermatology
• Apart from the above-mentioned skin infections, we are happy to see genital dermatitis/dermatoses like balanoposthitis, vulvovaginitis, ?lichen, etc.
• We do not do skin excisions or drainage of abscesses
• We do not have a dermoscope and are not trained in dermoscopy => do not send us pigmented genital lesions where melanoma could be in the differential
• We do not have cryoguns anymore – would use the same liquid nitrogen spray you probably have – so don’t refer just for “freezing of warts”.
What we do – sexual dysfunction
• Historically we have only seen female sexual dysfunctions – particularly vulvodynia/dyspareunia
• I have started seeing male sexual dysfunctions as well – ED, PE, etc.
• Referrals for male sexual dysfunction initial assessments and management planning are welcome in public until I have capacity
• We are not set up in public for intracavernosal injection initiation, training, and follow-up – but I have recently taken over the Sexology practice at Venturo for that.
What we do – contraception
• We do general contraception and LARCs - only if eligible for the NZ public system
• Not for bleeding control, ?endometriosis, or as part of menopause hormonal therapy => refer to Gynae instead
• Preferably for priority groups: <25yo, Maori/Pacific people, unemployed/CSC…
What we do – gender medicine
• Since 2015, we are the only public provider of gender affirming hormonal therapy (GAHT) in BOP
• We work closely with Gender Dynamix who support people through their journey from the mental health and social perspective
• All referrals for gender identity concerns to be sent to Gender Dynamix please – we will then work with them when people are ready for GAHT.
STIs in AoNZ - epidemiology update
Gonorrhoea National Rates By Sex
National gonorrhoea rates by prioritised ethnicity
National gonorrhoea rates by age group
Estimated national gonorrhoea rates by sexual behaviour
National chlamydia rates by sex, 2014 - 2023Q2
National chlamydia rates by prioritised ethnicity, 2014 - 2023 Q2
National chlamydia rates by age group, 2014 - 2023 Q2
Infectious syphilis cases in New Zealand
Infectious syphilis notifications by ethnicity
Rates of infectious syphilis by sexual behaviour
Syphilis cases among WSM 2018-2023Q2
Syphilis cases among women aged 15-44, pregnant women and congenital syphilis cases, 2018-2023Q2
Cases of congenital syphilis by ethnicity, 2017-2023Q3
*One additional CS case reported in 2023 Q3 to date, bringing 2023 total to three cases
Missed opportunities for congenital syphilis prevention, 2017-2023Q3
Some good news - PREP has been effective against HIV
Extended Care Paramedics in primary care
What is an ECP?
ECPs are specialist paramedics with post graduate qualifications
ECP - Extended care paramedic
APC - Annual practising certificate
BHSc - Bachelor of Health Science
PG Dip - Post graduate diploma
TKM/PC Te Kaunihera Manapou Paramedic Council
CPG - Clinical Practice Guideline
HP - Health Pathways
EAS - Emergency Ambulance Service
ATP - Authority to Practice
Extended Care Paramedic
• Operational paramedic + specialist scope
• Community management
• Registered health professional + APC
• BHSc Paramedicine + PG Dip
• TKM/PC determining specialist paramedic registration
• Prescribing in scope, lag in regulatory framework
• Underpinned by SO = CPGs +/- HP +/- practice SO
• EAS framework: ATP, governance, audit, internship
Scope
• Broad scope
• High degree of autonomy
• Comfortable with all acuity
• Triage, assessment, management
• Acute undifferentiated caseload
ECP scope is broad.
Role is adaptable to community need
• Comfortable leading resuscitation
• Phone triage
• Clinic based face-to-face consultations
• Community response (planned and unplanned)
• Exact role adapted to community needs
• Mostly autonomous
• Integrated with other clinicians
Work-flow
ECPs are versatile and integrate well with the wider primary care team
SO - Standing orders
CPG - Clinical practice guidelines
ACC - Accident Compensation Corporation
• Top cover on-site or via phone consult
• Medicines = administer + supply via SO/CPGs or
• Prescribing workarounds
• Image and lab request pathway variability
• ACC being considered
• Versatile, hands-on
• Collaborative and collegial
• Algorithmic approach
• Escalate, consult and refer appropriately
Assessment of acute undifferentiated caseload
Capabilities
Medical model, ROS
12-lead ECG interpretation
ECP practice is broad, capabilities differ between practice settings
ROS - review of systems
POCT - point of care testing
POCUS - point of care ultrasound
LA - local anaesthetic
SPC - suprapubic catheter
PEG - percutaneous endoscopic gastrostomy
NG - nasogastric
PR - per rectum
Otoscopy, urinalysis, ketones, POCT, +/- POCUS
Wound care, LA, closure with sutures, staples
Incision and drainage of abscesses
Placement/replacement of in-dwelling catheters
Replacement of SPC, PEG, NG
Bowel Care, PR, enema, manual disimpaction
Palliative care, symptom management, drivers
Children, older persons
Extended Community & Primary Care (EPCC) Programme Updates
PHO Clinical Updates
WBOP PHO Clinical Advisory Team
Funding & Programme Updates
Update on Pre-Call/Recall Activity
Immunisation Funding Available
• Māori/Pasifika Age 55-64 Influenza Vaccination
• Funded Influvac Tetra vaccination for Māori/Pasifika age 55-64 patients until September 30
• Overdue Immunisation Consult
• Funded conversation with a parent or caregiver of a tamaiti/child in a high priority group that has missed their immunisation milestone.
• The usual recall process must have been completed before this service is to be utilised.
• Second or Third Trimester Immunisation Visit
• This funding is for a second or third trimester visit for hapū māmā where the Best Start Kōwae Programme funding criteria is not met. As part of this funded appointment, the clinician will introduce and discuss immunisations for hapū māmā and her baby/pēpē.
• All programme guides available on the Portal’s Guide to Programmes and Funding
Diabetes Dashboard
New Resource: Diabetes e-Referral Options Flowchart
Reminder: Acute Demand Programme Eligibility
• Limited resource where the intention is to avoid hospital admission
• Radiology imaging for those aged <15 years old is outside of the scope of WBOP PHO’s Acute Demand Programme.
• Imaging for those under 15 years require a BPAC referral into Te Whatu Ora’s radiology department.
COVID-19 Updates Effective 1 Aug 2024
1. The COVID-19 Clinical Care Module (CCCM): Will be switched off
Please continue to report COVID-19 cases via HealthLink as COVID remains a notifiable disease and this test result will automatically flow through to the Notifiable Disease Management System.
2. GP’s will no longer receive notifications of self-reported RAT results. The text message that a person receives when they self-report a positive RAT result has been updated and they are taken through a questionnaire to assess if they are eligible for antiviral medicines. If they are unwell or if it appears they’re eligible they are recommended to contact their healthcare provider or a participating community pharmacy.
Secondary Care Updates: Day Infusions
Pathways
Reminder: The hospital Day Infusions team will sort out the prescriptions and charting as well as provide any medication through the hospital pharmacy system for patients referred to their service.
Revised TWO Recommendations for Breast Screening
• Full recommendations can be found on the Portal’s Guide to Programmes and Funding under Breast & Cervical Screening Support Service: July2024_TWO_Breast_Screening_Recommendations.pdf (wboppho.org.nz)
Highlights
• Frequency of surveillance screening for those >70 yrs and 10yrs+ following breast cancer diagnosis
• No need for screening for those post bilateral total mastectomy
• Diagnostic process for those current to breast clinic with new symptoms
Kia tau
Karakia Whakamutunga (closing)
Kia tau
Kia tātou katoa
Te āio, te aroha me te marutau
Tīhei Mauri
Ora
May peace, love and safety
Be upon us all
Let there be life
Our next Provider Forum is on September 4. It will be a service expo with lots of great community services in attendance!
See you then!
For any queries in the meantime, please email NSAdmin@wboppho.org.nz