GP Liaison Newsletter

Issue 11 - March 2017

My week in focus

I thought it would be interesting for you to hear about the work I do during a typical week in my role as CD Primary and Integrated Care apart from the many emails I receive directly from you when a patient of yours hasn’t received the service you expect from the hospital. I also spend time supporting our five GP liaisons of course who are doing great work. Last week was busy as always, here are last week's highlights:



Usually my day as a GP, I work at South City Health and thoroughly enjoy the clinical work within a great general practice team. However last Monday I visited Paeroa Medical centre and Hauraki PHO head office to talk about SmartHealth and opportunities for GPs and their patients. Great discussion occurred leading to several GPs getting clinician accounts and nurses having a broader understanding of the opportunities. If you would like me to visit your practice to have a discussion please let me know.


Sheril-Ann Wilson and I put the finishing touches to the new Acute GP referral process and memo you should have all received by now. Please see Sheril-Ann’s section for the detail. Thanks also to Sheril-Ann for helping to pull this off! A development I am very excited and if a little nervous at the same time….


Meeting with respiratory department and managers discussing a model to support COPD patients in the community and for primary and secondary care to work together better to manage exacerbations. Generally a lot of what I do is supporting our Strategy and Funding department in making the right funding decisions for Primary care. You will hear more about the COPD initiative soon. I also met with a PHO from Midcentral to share ideas in the GP liaison space.


Discussion around the proposed Waikato Medical School followed by a useful discussion with the hospital in how primary and secondary care can work together better when managing serious/sentinel events. We are now developing a new process ensuring that primary and secondary care work together when these issues arise and share each other’s learnings. In the evening I met with the Magic Waikato/BOP netball team to further discuss our partnership around population health messages and SmartHealth.


Progressed a new pathway which will provide IV adenosine to practices who want to manage SVT patients in the community to reduce the need to refer to ED. I also did some work on a new community falls prevention initiative which all PHOs have been heavily involved in to help reduce falls and their adverse consequences.




We continue to enrol patients and clinicians into SmartHealth, the virtual out of hours service continues to grow and is well received by patients. Please let me know if you would like a practice visit to find out how you can sign up yourselves and your patients to start enjoying the professional and patient benefits.


Your Electronic Referrals to Waikato DHB
Changes to letters received by GP referrers and patients

Waikato DHB is making some changes to BPAC at the the triaging clinicians’ end that are being driven by the National Patient Flow Project – due to a small delay, these changes are now due to Go Live on Tuesday 4th April 2017.

The main change that you may see in Primary Care is to some of the letters that are sent back to referrers and patients.

Some of the language has been amended to align with the new decline reasons that are reported to the Ministry of Health.

Additionally, if a referral has been for advice only (and not for an FSA) and advice is being provided, any correspondence will simply acknowledge the request for advice and provide the advice. There will be no mention of referrals being declined. Many of you have asked for this to happen so it is gratifying this has occurred


Electronic Clinic letters to GPs - Golive!

Following on from our successful electronic discharge summary launch we have now started sending clinic letters electronically to GPs. We are working slowly through all our hospital departments and by Mid April all clinic letters should be sent to GPs electronically, straight to your inbox which is great news. I want to thank our IS teams and our hospital departments for all the hard work on this. Please let me know if you have any questions.

New acute GP referral process

April 3rd sees the launch of our new acute GP referral process into Waikato hospital removing the need for obligatory registrar phone calls. Please can I ask that you use the specialty referral guidelines properly and only send appropriate patients up to hospital. You must name the specialty on the ED ereferral form (please see memo in Sheril-Anns section for more detail). I need to prove to secondary care that primary care can do this well.

The GP liaison team and I are trying to put in place the changes that general practice are telling us are important. The changes we can make to support our general practices and their patients; it’s a privilege to work on your behalf so please keep the suggestions coming in.

Dr Damian Tomic, Clinical Director Primary & Integrated Care

B4 School Checks

Drop in Performance

A clinical pathway with tools and resources is in the final stages of development which will support general practice in managing children (and their families) who are identified at the B4SC as being > 98th centile for BMI (New raising Healthy kids/growth National Health Target). Simon Shingler our GP Liaison for Child Health talks more about this in his section. This work will be published on Map of Medicine. Unfortunately Waikato district is not doing as many B4 School Checks as previously…and we now rank 17th in the country.


Early childhood immunisation

In spite of all your hard work, national targets and groups that talk about immunisations across our district we have not yet met 95% coverage at 8 months (91% now) and insufficient coverage at 6 months means this target unlikely to be met next quarter. Achieving national immunisation targets is essential in keeping our child population healthy and well.

I am interested in hearing your views on how our outreach immunisation teams, communities and our general practice teams could work together differently in order to achieve 95% coverage. I will take your views, along with your views around the B4 School Check to the Waikato Child Health network which I Chair - 

Updates from GP Liaisons

Fiona Campbell

GPs will soon be able to access echocardiograms directly for Heart Failure investigation. This is being implemented following a successful pilot study last year. The process will follow best practice management of heart failure as per the published Map of Medicine pathways. Provided the inclusion and exclusion criteria are fulfilled then the patient will be referred directly for an echo. Interpretation of the results and an advice letter will then follow from cardiology. This is to be supported by an ereferral template which is in development. Further communication around this will follow when we have a go live date!

A new map for Sleep services is ready to be published and an ereferral template to support this is also in the final stages of development.

Angela Fairweather

The colonoscopy ereferral template is up and running on BPAC, which is very exciting. Its purpose is to allow direct access for our more high risk patients, to a colonoscopy and avoid the need for a first specialist assessment. If your patient does not meet the criteria for direct access, you may still refer them for consideration of a specialist assessment. Some of you may already have used the template and I am hoping that you have found it useful. I welcome any feedback you may have, as we are always looking for improvements. There will be some monitoring of the referrals, to make sure the template is correctly highlighting those patients most in need of fast service.

The lung cancer ereferral template will be available for use from the 13th of April and will help to provide all relevant information to speed the referral process. This form is already in use regionally (in Taranaki and in the Bay of Plenty).

Sheril-Ann Wilson

Based on feedback from our GPs and discussions within Waikato DHB the GP/A and M acute referral process to Waikato Hospital will be changing from April 3rd in an attempt to make things more streamlined and time efficient for our patients, GPs, Specialty registrars and ED staff. We are hoping to also reduce the amount of frustration that is currently occurring.

Simon Shingler

With bronchiolitis season on our doorstep it was timely for us to review the existing published map of medicine guidelines re: bronchiolitis.

Waikato hospital along with several other sites across Australasia including Tauranga, Rotorua & Hawkes Bay are working in collobaration with the PREDICT network (Paeds Research in Emergency Departments International Collaboration) on a study having its focus on management of bronchiolitis.

The essential take home message is:
“When managing infants < 12 months of age with a clinical diagnosis of bronchiolitis, there is no evidence for the use of chest x-rays, salbutamol, steroids, antibiotics or adrenaline.”

Please take this opportunity to look at the map if in doubt about threshold for referral.

On the respiratory theme, we are also looking to ensure that the map of medicine asthma guidelines for acute and chronic management reflect current best evidence.

With regards to the map of medicine concerning childhood obesity, feedback has indicated that some GPs are unaware that BMI is applicable to children. Although the same formula as adults, the reference ranges are age and sex dependent. To make it easier to determine BMI and subsequent management, we are working with BPAC and practice management systems to make it easier, quicker and to ensure we are utilising the WHO growth charts for our patients-on which are current map guidance is based.

Finally, we are in the early stages of developing a local map of medicine guideline to address paediatric allergy and in the coming months we will be working with Pathlab, paediatricians and dieticians principally to provide support to GPs in this rapidly evolving complex area of paediatric medicine

Mark Taylor

On 6 April, we are putting together a WPGMI meeting on anaemia, iron deficiency and direct access to colonoscopy. As all these conditions will be having significant changes to GP’s access to investigations and management (all for the better – we feel you will really like these), we wanted to make sure that GP’s know about these really exciting changes and how to access them.
This will be an evening of case studies and questions and answers. Although we will have a General Physician and a Gastroenterologist present, we are not expecting them to give a presentation as such. However, they will be present as a resource for us to use. So please, if you have some interesting, challenging or downright frustrating cases that involve anaemia, iron deficiency, bowel cancer screening or investigation – please let me know, as these are exactly the type of clinical scenarios that we want to discuss. The floor is yours to use as you want and we are hoping for some good robust discussion to try and improve the service that the DHB is giving to both our patients and our primary care workforce.
All cases emailed to
We look forward to seeing as many of you on the night, as possible.

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