June 5 PHO Provider Forum Slides

Provider Forum

June 5, 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

Wendy Dillon, General Manager of Network Services, WBOP PHO

Session Welcome & Karakia Tīmatanga

PHO Board & CEO Update

Renee Wilton, Suicide Prevention Postvention Coordinator, Hauora a Toi Te Whatu ora

Fiona Whitworth, Medical Advisory, Health & Disability Commission (HDC)

Suicide Postvention in WBOP

Hints & Tips to Avoid a Health & Disability Commission (HDC) Complaint

Brighid McPherson, National Bowel Screening Clinical Nurse

Specialist, Hauora a Toi Te Whatu Ora

Dave McGouran, National Bowel Screening Clinical Director, Hauora

a Toi Te Whatu Ora

National Bowel Screening Programme Two Years On Network Services Team, WBOP PHO

Update: New Provider

Onboarding Resources

Clinical Advisory Team, WBOP PHO

PHO Clinical Updates

Closing & Karakia

PHO Update

Wendy Dillon General Manager of Network Services

Western Bay of Plenty Primary Health Organisation

Suicide Postvention

•

Definition

WBOPPHO Clinical Forum

5 June 2024

• Who is

involved?

• What is the process?

• Resources

What is Suicide Postvention?

Definition

Any intervention that is activated in response to a suspected suicide... with The overarching purpose being to prevent any further loss of life.

Multiple Agencies

• Police

• Coronial Services

Who’s Involved?

• Victim Support

• Hauora a Toi BOP

• Other Government Agencies

• Suicide Bereavement Support Services

• Other community health & social service organisations

Police

• Attend initial incident

• Contain area and conduct a scene examination

• Take initial witness statements

• Complete a Pol47 and send through to the National Initial Investigation Office (NIIO)

Coronial Services

• NIIO based on Pol47 information will then send basic demographic details through to the Clinical Data Service (CDS) at CASA (Clinical Advisory Service Aotearoa)

• Appoint the SSID (Suspected Self Inflicted Death) to the appropriate Coroner’s Office.

• A Coronial Case manager will then be appointed to liaise with the deceased significant others during the process of investigation.

Victim Support

• May be present at the initial Police response.

• MOU between Police and Victim Support (VS)

• Will make phone contact with those referred within 24-48hrs.

• Provide practical support with coronial process and other issues i.e. financial assistance/entitlements.

• Link into other agencies as need requires.

Hauora a Toi

BOP

Suicide Prevention Postvention Cooordinator

• Receives NIIO SSID Coronial Notifications.

• Conducts health background search.

• Liaises with Victim Support.

• Notifies GP Practice.

• Liaises with other health and social service agencies as appropriate.

• Organises and leads Interagency Postvention Meetings as indicated by case.

Legal aspects to information sharing

• The sharing of personal information as part of suicide postvention activity is allowed under Rules 10 and 11 of the Health Information Privacy Code (1994; HIPC). These rules state that sensitive health information can be shared if:

• “The disclosure of the information is one of the purposes in connection with which the information was obtained.” OR

• “The disclosure of the information is necessary to prevent or lessen a serious threat to public health or safety or the life or health of an individual.”

Suicide

Bereavement

Services Tauranga Grief Support

Services

Provides unlimited FREE suicide bereavement support: www.griefsupport.org.nz • Individual or family/group counselling

Peer support • Community support groups

WAVES programme • Workplace Support Aoake Te Ra: www.aoaketera.org.nz

.Nationwide FREE service under CASA

Provides brief individual sessions (x610) via face to face, virtual or phone.

Family/Whānau counselling.

Kaupapa Māori Services

Maketu, Pukehina, Paengaroa, Pongakawa, Te Puke

• Maketu Health & Social Services: 07 533 2551

• Poutiri Trust: 07 573 0091 (covers most of WBOP also)

Welcome Bay, Pāpamoa, Mt Maunganui, Central Tauranga

• Whaioranga Trust (Welcome Bay): 07 544 9981

• Ngati Ranginui Inc: 0800 494 6262. They also have a Trauma Counselling Service

• Ngai Te Rangi: (07) 575 3765

• Te Manu Toroa : 07 571 2026

• Te Puna Hauora: 07 571 8024

Bethlehem,Te Puna, Katikati, Omokoroa, Makakana Island

Ngati Kahu Hauora: 07 576 0160

Pirirakau Hauora: 07 552 4573

Rūnanga o Ngāi Tamawhariua (Katikati): 07 549 0760

Ngati Kahu Hauora (Makakana Isand): 07 578 7862

Hints and Tips How to minimize the risk of a complaint to HDC

Dr Fiona Whitworth GP Medical Advisor to HDC

Aims

 Look at the scale of the issue

 Establish what typically leads to complaints

 What we can do to minimize the risk

Figures and charts from HDC Pūrongo ā-Tau Annual Report 2023: https://www.hdc.org.nz/media/wzpdch0g/hdc-annual-report2023.pdf

Where are the risks?

Where are the risks?

Where are the risks?

Good clinical notes

 Can I step into your shoes to take over care?

 Structure: SOAP follow up and safety-netting

 Can I tell what your working and differential diagnosis is?

 Document each patient contact and after every clinical discussion (corridor consult)

 Remember the patient can see all emails and messages to be polite!

 Add to your notes after the fact, just make it obvious

 Nabla copilot? (webinar and podcasts)

How much should I write?

What inferences can be drawn from these records?

Refs: https://www.rnzcgp.org.nz/gpdocs/New-website/Advocacy/06.2015-Delayed-diagnosis-of-cancer-Policy-brief-1.pdf

https://www.hdc.org.nz/media/sq5fxdro/delayed-diagnosis-of-cancer-in-primary-care_april-2015.pdf

13 GP complaint investigations completed 2023

Last 5 minutes - risks and tips

 Pain history

 Possible malignancy – risk factors? weight loss? Assessment (abdo/DRE in CRC), haemorrhoids and persistent symptoms…

 Critical referrals – time frames, tracking, pt autonomy, private option, updating if Sx change – set tasks

 Persisting Sx despite ‘negative’ results – CXR/skeletal mets

 Safety netting – do and document

 Try to have good rapport with patients

2 min Q and A

Bay of Plenty District Health Board

NBSP Primary care education

Two years on

Dr David McGouran – Gastroenterologist – Clinical Lead for Bowel Screening

• Bowel cancer in New Zealand

• Why it’s suitable for screening

• Results so far

• Participation

• Who shouldn’t be screened

• Pre malignant disease detected on the program

Bowel cancer in New Zealand

3000 New Zealanders diagnosed every year

More than 1200 die from bowel cancer

Why does bowel cancer screening reduce cancer deaths?

Potentially Years of asymptomatic, pre malignant disease

Cancer

stage at diagnosis

90% chance of survival with early diagnosis

10% chance of survival with late diagnosis

Stage 1 cancer

• NBSP – 40%

• Symptomatic – 11%

Early Detection Saves Lives

Requires Participation

NBSP April 2024

NBSP April 2024

NBSP April 2024

7/100 will have cancer

April 2024

Nationwide Bay of Plenty

NBSP April 2024

Nationwide Bay of Plenty

https://tewhatuora.shinyapps.io/nphs-nbsp/

Reasons for reduced participation in Maori

• Living rurally Less phone coverage

• More migration compared with other parts of NZ Leads to kits being sent to the wrong properties

• Bowels and bowel functions is a culturally sensitive issue

• Deprivation known to be linked with reduced access to healthcare

Improving participation

Maori Pacific

Deprivation groups 9 and 10

National Call Centre call participants 3 times if kit not returned

Cases then referred to local outreach team

4010 potential participants referred Called, Messaged, Texted, Visited 607 kits returned

(Of those who didn’t want to participate, roughly 50% agreed to a 2 year recall)

54 Face to face events

Community events – May – Katikati wellness week visiting 3 different venues

• Gp practices

• Hauora

• Community picnic

Projects

• Mail drop in low participation areas

Presentations

• 3 year rolling Rota of presentations

• Gp practices

• Community organizations

• Hauora

• Large private employers

Improving Participation through General Practice

Raising Awareness

• Can be opportunistic

Dispelling misconceptions

• The test itself

• Who should be screened

• The result

+ve FITS

• Referring through the correct one of the three pathways

• Liaising with the DHB in complex cases

Knowing who shouldn’t be screened

Which people within the screening age shouldn't be enrolled in BCS?

7% cancer

Benign

polyps

Summary

Bowel screening is effective at reducing cancer deaths

The BOP has comparable participation rates to the rest of NZ but we do face our own challenges

We are hopeful that participation rates will improve over time

We thank you very much for your involvement

Thank you

• BOP NBSP 24/7 helpline: 0800 531 288

• BOP NBSP email: bowelscreening@bopdhb.govt.nz

• BOP NBSP Clinical Lead: Dr David McGouran

• BOP NBSP CNS: Brighid McPherson

• BOP NBSP Kaihautū Navigator: Chrissy Paul

• BOP NBSP PM: TBA

• BOP NBSP Admin: Sandy Marshall

Q Why don’t we except commercially bought KITS we can’t guarantee the efficacy of those tests

Q What is the participation per practice?

We supply quarterly reports on participation but has a 6 month lag

Q Why do MOH only give $60 per referral Beyond our control

Q. What are our referral to colonoscopy timeframes

2-4 weeks, our fastest time was 2 weeks from posting the test to having the colonoscopy.

Onboarding Project Updates

• Onboarding Document and New Provider Form available in our Portal

• Onboarding meeting for new staff

PHO Clinical Updates

WBoP PHO Clinical Advisory Team

General PHO Updates

PHO Portal has been Reorganised

Funding/Programme Updates

Changes in Covid-19 Funding

• Agreements held with Primary Care providers for the provision of free COVID-19 clinical assessment consultations for the public will end on 30 June 2024.

• COVID-19 antiviral medicines remain free and available for people with a higher risk of severe illness from COVID-19.

• The service delivery model for the supply and dispensing of antivirals by community pharmacies from 1 July 2024 has not been confirmed. We [Te Whatu Ora] will engage with key community pharmacy sector representatives in early June to discuss these changes.

• Free COVID-19 vaccinations including funded administration of the COVID-19 vaccine will remain available to those who meet Pharmac’s eligibility criteria from 1 July 2024 until further notice. Vaccination service providers will be contacted [by Te Whatu Ora] in June to discuss the terms and conditions of their Service Agreements from 1 July 2024 onwards.

• Free rapid antigen tests (RATs) from the Health NZ Central Supply will continue to be available for healthcare providers to access until 30 September 2024. Healthcare provider access to personal protective equipment (PPE) from the Health NZ Central Supply will end on 30 June 2024 and providers will need to purchase PPE products from the private market.

• Free RATs will also remain available to the public via Health NZ’s Distribution Provider Channel until 30 September 2024.

New DAR Example Template

• Found on the Portal’s Guide to Programmes & Funding, under D

• DAR-_template_example__Final_May_24.pdf (wboppho.org.nz)

Secondary Care Updates

How to access Te Whatu Ora Midwives

for those without an LMC

• 0800BOPMUM, Option 1

Self-referral for pregnant people to get an LMC to get an appointment with a TWO midwife

• Referral via BPAC form

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