Primary Care Update Information for general practices, PHOs and DHBs Update Four: August 2020 Māuri ora ki a koutou This is the fourth primary care update for general practice and primary health organisations (PHOs). Thank you for all the work you are doing to keep the primary health care system operating and our communities safe. You can find previous primary care updates on the Ministry of Health website.
COVID-19 response and the move to Alert Level 2 & 3 midday Wednesday 12 August 2020 ______________________________________________________________________________________________
Key messages for Primary Care Our response to the COVID-19 pandemic is rapidly evolving. As at 14 August 2020, the advice is as follows. All patients presenting with symptoms must be tested. Get a test if you have symptoms •
We encourage anyone in Auckland with symptoms consistent with COVID-19 to be tested, whether or not they meet the Higher Index of Suspicion.
•
If you live outside of Auckland and you have symptoms, call your doctor or Healthline to find out if you need to get a test for COVID-19. If you’re offered a test, take it.
•
The assessment and test for COVID-19 is free. We will support anyone who has COVID-19 and their family, and look after their health and wellbeing.
•
If you do not have symptoms, you do not need a test, UNLESS you’ve been advised by health officials, for example if you’re a close contact a confirmed case, or if you work at the border.
•
The tests are free and should be easy to access for everyone.
•
It’s also important to remember the basic public health measures which keep communities protected: staying home if you’re sick, frequent hand-washing, and good sneeze and cough etiquette.
We encourage you to keep checking the Ministry of Health and COVID-19 websites for new information. 1
Information can be sourced from https://www.health.govt.nz/our-work/diseases-andconditions/covid-19-novel-coronavirus and https://covid19.govt.nz/ Medicine supply - update for general practice •
Pharmacies all over New Zealand are starting to report stockpiling behaviour with regard to medicines
•
Medicine supply chains are secure, and pharmacies will remain open throughout all alert levels so there is no need to stockpile
•
We are asking prescribers to prescribe normally and be mindful of the significant negative impacts of enabling stockpiling behaviour through their prescribing.
•
Despite there being no significant medicine shortages in New Zealand, stockpiling will put a major strain on supply chains. Unlike supermarkets, who are able to re-stock from New Zealand manufacturers, medicines are mostly sourced from overseas suppliers and the ability to re-stock quickly is very limited.
•
We need to ensure that every New Zealander will continue to have access to the medicines they need and that vulnerable communities don’t miss out.
•
If stockpiling behaviour continues PHARMAC will need to seriously consider re-instating monthly dispensing, this is not ideal as it can also have negative consequences for adherence and means people who are in isolation will potentially have to visit pharmacies more often.
•
We encourage you to keep checking the Ministry of Health and COVID-19 websites for new information.
Information can be sourced from https://www.health.govt.nz/our-work/diseases-andconditions/covid-19-novel-coronavirus and https://covid19.govt.nz/ Key messages to provide the Public Get a test if you have symptoms •
We encourage anyone in Auckland with symptoms consistent with COVID-19 to be tested, whether or not they meet the Higher Index of Suspicion.
•
If you live outside of Auckland and you have symptoms, call your doctor or Healthline to find out if you need to get a test for COVID-19. If you’re offered a test, take it.
•
The assessment and test for COVID-19 is free. We will support anyone who has COVID-19 and their family, and look after their health and wellbeing.
•
If you do not have symptoms, you do not need a test, UNLESS you’ve been advised by health officials, for example if you’re a close contact a confirmed case, or if you work at the border.
•
The tests are free and should be easy to access for everyone.
•
It’s also important to remember the basic public health measures which keep communities protected: staying home if you’re sick, frequent hand-washing, and good sneeze and cough etiquette.
2
Medicine supply There is no need to stock-pile on medicines. Community pharmacies stay open to the public through all COVID-19 levels and will be available in your communities to support you with your medicine supply and information needs. If you don’t need your prescription straight away, arrange for the prescription to be sent through to the pharmacy of your choice and then make contact with that pharmacy to arrange a convenient time to pick up your medicine or have it delivered. This will ensure the pharmacy team can be available to spend time with you and minimises numbers in pharmacies at any one time to support physical distancing. As you would in your local supermarket, please be kind to those people in your local pharmacy they are there to support you. We encourage you to keep checking the Ministry of Health and COVID-19 websites for new information. Information can be sourced from https://www.health.govt.nz/our-work/diseases-andconditions/covid-19-novel-coronavirus and https://covid19.govt.nz/
Whakamaua – Māori Health Action Plan 2020-2025 Launched ______________________________________________________________________________________________
Kei ngā pou tokomanawa e tū ai te whare nei o Te Manatū Hauora Tēnā koutou katoa, I am excited to inform you that Whakamaua: Māori Health Action Plan 2020-2025 has now been released. It is live on our website here. As you know, this plan sets out a pathway towards achieving pae ora, healthy futures for all Māori. It will give effect to He Korowai Oranga: Māori Health Strategy by setting out a suite of actions that will help us achieve better health outcomes for all Māori. We know the health and disability system is failing Māori - significant health and wellbeing inequities have been created as a result. The response to COVID-19 has reinforced these issues and reinforced the importance of taking collective action to achieve Māori wellbeing, acknowledging the important role Māori communities must play. The good news is that Whakamaua provides clear direction on how we can work together to address these issues. The successful implementation of Whakamaua will require collective effort across the Ministry and the wider sector. Your continued leadership to champion Māori health and equity will be crucial to achieving this. As such, the Māori Health Directorate and I look forward to working with you. In addition to Whakamaua, we have published Whatua: Engagement for the development of Whakamaua: Māori Health Action Plan 2020-2025. This report recognises the myriad of voices heard during our engagement process in 2019 and provides a broad overview of the key issues and opportunities in Māori health and wellbeing. While it has been used to shape the direction of Whakamaua, it can also be used as a source of insights to inform the development of other strategies, plans, and initiatives.
3
Thank you for contributing to a better future for our people. I am committed to working with you to ensure we attain pae ora. Ko te pae tawhiti, whāia kia tata, ko te pae tata, whakamaua kia tīna. Let us seek out the distant horizons, while cherishing those achievements at hand. Nāhaku me aku mihi aroha, John Whaanga Deputy Director-General | Māori Health Directorate
Introducing Dr Don Matheson, Deputy Director-General Public Health and Primary Care Transformation ______________________________________________________________________________________________
Don Matheson joined the Ministry of Health on 27 July 2020. Don's role will focus on leading a strong national public health service, key to strengthening our response to COVID-19 and wider public health issues. It will also support further development of primary care so that it can play a stronger role in the system, as highlighted in the Health and Disability System Review. Don’s career focus is on health systems. He encountered the architect of the Alma Ata Declaration on Primary Health Care while still a medical student and has spent his time since exploring how health systems best deliver health equity in the spirit of social justice. Don’s most recent role has been working with the health sector in North Brisbane. He helped establish a ‘neutral space’ where different parts of the health and social sector worked together to tackle health challenges in the region. Central to this approach has been the respectful relationship built with patients and carers as partners in health reform efforts. Previously Don worked as an independent health systems consultant, and over a nine year period undertook evaluations of national and district health systems in the Asia Pacific region. He holds visiting professorships at Griffith University and Queensland University of Technology. From 2000 to 2008 he was the New Zealand government’s leading policy advisor on public health and international health, managed the development of the New Zealand Health Strategy, and co-led the health sector’s approach to addressing health inequalities. At the regional level, he served as WPRO’s regional adviser on non-communicable diseases. At the global level, he represented the NZ Minister of Health on the WHO Executive Board and provided policy advice to World Health Reports on health care financing (2010), primary health care (2008), and to the Commission on the Social Determinants of Health (2008). His early medical career was spent as a district medical officer on the Zimbabwe Mozambique border. Returning to Aotearoa NZ in the mid-1980s, Don became a general practitioner, and worked firstly with unions and Iater alongside mana whenua to establish community and iwi controlled health services in Newtown, Wellington and in the East Coast’s Ngāti Porou rohe. He is a specialist public health physician and has previously held positions in New Zealand as Director of Public Health, National Director of Training for the Australasian Faculty of Public Health Medicine and Director of the Public Health Association. 4
WEBINAR: Primary Care Research findings during COVID-19 - including a focus on the use of telehealth ______________________________________________________________________________________________
This Health Care Home Collaborative webinar was delivered in collaboration with Victoria University of Wellington & Health Navigator Charitable Trust. Panelists: • Dr Janine Bycroft: Executive Director, Health Navigator Charitable Trust • Dr Fiona Imlach: Senior Research Fellow, Health Services Research Centre, Victoria University of Wellington • Merle Samuels: Consumer Representative, Health Care Home Collaborative / Māori Cultural Advisor, Health Navigator Charitable Trust • Gary Sutcliffe: Consumer Representative, Health Care Home Collaborative / Health Navigator Charitable Trust Chaired by Bridget Allan: CEO, Te Awakairangi Health Network / Co-design Champion, Health Care Home Collaborative The panel shared the results of: • • •
Victoria University research on the use of Telehealth during the COVID-19 lockdown; Health Care Home consumer focus groups relating to access to general practice during COVID-19; and broader consumer focus and how we can better connect with patients and deliver services that are most impactful for them.
Here is the link to the recording of this webinar https://youtu.be/gHiksGBROQ4 with some highlights below. Victoria University’s research findings included lessons for future of telehealth from the patient perspective: • • • • • •
most but not all patients liked telehealth options patients are able to judge whether they need or want to be seen in person and when telehealth is appropriate patients are often willing to try telehealth (both phone and video) but some may need proactive support to become familiar and comfortable with it most people have a fair idea of what is value for money Successful telehealth requires mutual trust between the patient and provider depending on the person, health issue and circumstances, telehealth might not be as good as an in person visit or it might be better, it - can be a more convenient, time efficient, no-travel, infection-safe, person-centred approach to health service delivery; or - may not appropriate for all people or all issues.
Although a much smaller sample size and different method, the HCH Collaborative research findings are similar to Victoria University’s and include suggested improvements for general practice, these are: • • • •
implementation of phone consultation and virtual consultation extending business hours to one (or more) late evening and/or partnering with other afterhour care providers in the region continuing with the COVID-19 precautions support with referral services.
5
Patient stories presented by our two consumer representatives provided both positive and negative interactions and it is clear that a number felt overwhelmed during lockdown with much uncertainty. For further information regarding this research please contact collaborative@hch.org.nz (Source: National Health Care Home Collaborative, 6 August 2020)
National Primary Care Patient Experience Survey ______________________________________________________________________________________________
We reported in our June 2020 update that the New Zealand primary care patient experience survey due to go out in May 2020 was delayed by the COVID-19 pandemic. This survey is now confirmed to be sent to patients on 24 August 2020. The survey underwent redevelopment at the end of 2019 to ensure that it was able to collect information that is most relevant to patients, practices and PHOs. Improving participation, particularly for Māori and Pacific people, is a focus for the survey. The Health Quality and Safety Commission (HQSC) recently published a report on responses to the general practice module and where future improvements could be made. Between 22 June 2020 and 29 July 2020, a COVID-19 focussed primary care patient experience survey was sent out. This survey was designed to understand patients’ experiences of primary care during the COVID-19 pandemic, particularly at alert level 3. The aim of the survey was to find out what worked well in primary care for this period, and what didn’t. Also, to understand who was able to access health care during this period, and who faced barriers to access. Results from the COVID-19 survey will be available over the coming weeks. If you would like further information, please email Catherine.Gerard@hqsc.govt.nz or Avril.Macfarlane@hqsc.govt.nz
Improving Measles Immunity in under 30-year olds ______________________________________________________________________________________________
It is vital we continue to prioritise core public health functions like immunisation. A large number of people did not have their measles, mumps and rubella (MMR) immunisations as children, leaving communities vulnerable to a measles outbreak in the future. To address this, a year-long Measles Immunisation Campaign was officially launched on 31 July 2020. The DHB-led campaign targets 15-30-year olds who missed their MMR vaccine. The campaign has a particular focus on increasing immunisations for Māori and Pacific peoples. DHBs are planning and developing innovative outreach approaches to deliver the free MMR vaccinations. Activities build on successes of this season’s influenza vaccination initiatives and COVID-19 testing centres. These saw people getting health services in pop-up clinics at marae and other community hubs. Campaigns will begin rolling out soon, with peaks of activity varying depending on the region. Along with our normal supply, an additional 350,000 doses of MMR have been purchased for the campaign. We have done a detailed assessment of the requirements and a plan is in place for managing and distributing the stock.
6
We anticipate general practices will see an increase in demand for MMR as regional campaigns progress. People may also ask for their immunisation records. GPs should contact their PHO if they have questions about getting information from their Patient Management System (PMS). Please take every opportunity to offer MMR vaccinations to this group of adolescents and young adults, particularly MÄ ori and Pacific peoples. Please also make sure all MMR administered through the campaign is recorded onto the National Immunisation Register (NIR). Thank you for supporting the campaign and for continuing to recall children whose scheduled immunisations are overdue.
The FluTracking programme ______________________________________________________________________________________________
FluTracking is an online initiative that lets you help us track flu and COVID-19 symptoms across Aotearoa New Zealand. Each week participants receive a link to a short survey (it takes less than 30 seconds to complete) asking whether they have had fever, cough or other related symptoms in the last week. It has over 90,000 registered participants and currently receives about 60,000 completed surveys each week. This information allows us to map flu and COVID-19 symptoms across the country. This helps us prioritise where surveillance efforts are needed. FluTracking could be particularly valuable in helping us detect a return of COVID-19. We encourage people to register online at www.flutracking.net and invite colleagues, friends, family and whânau to participate.
Quota Refugees ______________________________________________________________________________________________
Quota Refugee programme on hold The quota refugee (QR) arrivals were put on hold due to the COVID-19 response. Immigration New Zealand is working with agencies and international partners, including the United Nations Refugee Agency (UNHCR) and the International Organization for Migration (IOM), to develop advice to Government on requirements for resuming the Programme. We do not know when the intake of new refugees will resume. It will be important to ensure international travel routes are available for safe refugee movements. Appropriate health measures and controls will need to be in place, so resettlement can then resume in a manner that is safe for QRs and our communities. Ongoing health services for Quota Refugees From 1 July 2020, the annual refugee quota set by the Government increased from 1,000 to 1,5001. However, due to the impact of COVID-19 globally, it is unlikely this number increase this year. To ensure we continue to meet the health needs of our QRs, Immigration New Zealand, as the responsible agency, is partnering with the Ministry of Health to develop a new health model.
1
Quota refugees are referred for resettlement to New Zealand by the United Nations High Commissioner for Refugees. Asylum seekers are not included in the refugee quota and are not considered under the Refugee Quota Increase Programme or the Quota Refugee Health Services Model.
7
The model will provide a continuum of health support and services for QRs through all stages of resettlement in Aotearoa New Zealand. The new service at the Mangere Refugee Resettlement Centre (MRRC) and how it will work with current and new resettlement regions is currently being developed. We are working to ensure the new model is well integrated including from offshore to the MRRC and to the resettlement regions. One of our immediate priorities has been to ensure we have a service provider in place at the MRRC for when the Programme resumes. An announcement on this will be made over the coming weeks. We will also work with the resettlement regions (both new and current) to ensure that this continuum of services continues.
Change to cognitive impairment screening tool – from MoCA to Mini-ACE ______________________________________________________________________________________________
The Mini-Addenbrooke’s Cognitive Examination (Mini-ACE) is now the recommended cognitive impairment screening test on HealthPathways, replacing the Montreal Cognitive Assessment (MoCA©). This is due to changes in access to the MoCA. From 1 September 2020, anyone who conducts cognitive impairment screening should use the Mini-ACE, unless they are willing to pay for training and certification through the MoCA Institute. The Mini-ACE test and accompanying guidance will be available on HealthPathways from 1 September 2020. Online training is available on DHB and Ministry of Health learning platforms from 1 August 2020. Mini-ACE is a brief cognitive impairment screening test. It’s free, easy to use and takes around five minutes to complete. For more information, including where to find the tools, guidance book and online training, visit: www.nzdementia.org/mini-ace
Sign up for the Health Workforce Directorate newsletter ______________________________________________________________________________________________
The Health Workforce Directorate sends a regular newsletter with updates on their work programme and news from across the sector. If you would like to sign-up to receive the newsletter, got to https://www.health.govt.nz/ourwork/health-workforce/subscribe-health-workforce-sector-updates
Further information ______________________________________________________________________________________________
We welcome your feedback on the information you would find useful from us. Please email Rachael.Bayliss@health.govt.nz with your suggestions or to be added to the email distribution list. Thank you for your support and hard work to provide people with greater access to primary care, particularly during the response to COVID-19. Ngā mihi nui ki a koutou katoa 8