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Waikato District Health Board

GP Liaison

March 2019

Welcome everybody to our June 2019 edition of GP Liaison.
We are here to make things easier for you. The team and I can help with your questions, ideas or concerns.
Let us know how we can improve your experience of Waikato DHB services. 

Dr Damian Tomic, Clinical Director Strategy, Funding and Primary Care, Waikato DHB. 
1. Commissioner and Deputy Commissioners
2. Primary Options (POAC) and Admission Avoidance
3. Acute COPD service
4. Frailty Admission Avoidance Service
5. Waikato Hospital To trial Emergency Q
6. Clinical Workstation Improvements (CWS) for GPs
  • Progress notes ( track your patient)
  • Access to mental health records
  • Click and view xray images directly from CWS 
7. GP Referral Issues and eReferral Developments
  • Talking with registrars
  • Dermatology changes
  • Orthopaedics
  • Radiology
  • BPAC advice Referrals
  • Orthotics
8. Community HealthPathways
9. Waikato Strength and Balance Service 
10. Venom Immunotherapy Service
11.Newborn Enrolment and Immunisation Improvement Service 
12.Waikato healthSystem plan, Te Korowai Waiora
13.System Level Measure Framework
14.Matamata Medical Centre: Rural Gp team of the year
15.GP Liaison Updates  
Waikato DHB now has a Commissioner and three Deputy Commissioners
Waikato DHB is going through a lot of change. The Board has been replaced by a Commissioner and Deputy Commissioners who will be working with senior DHB and PHO staff to support the provision of a high quality health service in the Waikato . 
Read about the Commissioners here
Primary options (POAC) and Admission Avoidance

Last year Waikato DHB reviewed the current Primary Options service. The review made several recommendations which has led to a revised Primary Options (POAC) programme from 1 July 2019.
You will be hearing from your PHO however I would like to make some general comments;
  • Waikato DHB is committed to funding a POAC programme that allows GPs to quickly and easily order diagnostics and access services to support you to manage your patients safely in the community.
  • A new clinically lead POAC monitoring and improvement group has been set up with DHB, PHO and GP membership. This group will also make recommendations to improve the POAC programme.
  • Each PHO now manages its own POAC programme.
  • Over the next 18 months Waikato DHB will be reviewing all services in our seven localities. This will include looking at our GP, urgent and emergency services and could also lead to POAC programme enhancements.    
Primary Options and Admission Avoidance Scheme July 2019
Acute COPD service
Waikato DHB is continuously working to improve the way it responds to your acute patients.
Over the next few months a new acute COPD service will be rolled out across the Waikato.
You can read about the new service below.  Information is also in the POAC manual.
From 1 July you will have a phone number to ring for all acute COPD patients who you would normally send up to ED. Please ring this number first as you may be given advice or your patient may be directed to to another location instead of ED to be seen.  
The eReferral mentioned in the document below will be ready in Mid July.
Read about the new COPD service here
Frailty Admission Avoidance Service

The acute Frailty Admission Avoidance Service is meant to support GPs and their vulnerable elderly patients by providing alternatives to Emergency Department referral.

Target patients are:
 “individuals with increased vulnerability resulting from ageing associated decline in reserve and function across multiple physiologic systems such that the ability to cope with every day or acute stressors is compromised”.
The service aims support GP’s to link patients into the most appropriate short-term community service:

  • Acute Home Based Support – in home
  • Respite  - in a rest home facility 
  • START – in own home but provides a rehab service 
Read how to refer your frail patient
Waikato Hospital To Trial Emergency Q
With Waikato Hospital’s Emergency Department (ED) on course to see 90,000 people this year (an increase of 20,000 people in just six years since 2011), its busiest days can see up to 300 people. As its hardest period of winter sets in, Waikato ED is embarking on a six month trial of New Zealand developed software platform, Emergency Q to help ease some pressure.
Read about Emergency Q here
Improvements to GP access to Clinical workstation
  1. Click here to see how you can track your patients progress while they are in hospital by looking at progress notes. 
  2. Click here to see which Community Services are also using progress notes.  
  3. Click here to read how mental health and addictions patient information has been improved for GPs. 
  4. Click here to see how you can view all public and private radiology images ( not just reports) easily through CWS. 
GP referral  issues and eReferral Developments
The GP liaison team have been working hard with services to improve the response to your referrals.

First of all please add the name of the registrar you speak to when referring a patient acutely if possible.
This is so that we know who to talk to if you do not receive the service you expect and need.
  1. Dermatology: Big changes are being made to the eReferral form in the middle of July to make it easier for your patients to get the help they need.Click here to understand what is changing.
  2. Orthopaedics: Many of you have been frustrated with how difficult it has become to have your patient seen by a specialist or accepted for surgery. Click here to read and understand what is going on.
  3. Ultrasound: Patients often have to wait an unacceptably long time for an ultrasound. Recently many patients were simply removed from the waiting list with no warning.Click here to read and understand what is happening and our plans to improve the service.
  4. BPAC advice referrals: Please ensure you use this system only when absolutely necessary. There is a lot of information in HealthPathways that can answer your question and if you need a more immediate answer around a particular patient consider ringing the specialty directly.
  5. Orthotics: The Orthotics eReferral will be in place June 27. Read all about it here.
  6. More eReferral changes are in the GP liaison's section at the end of this newsletter
Community HealthPathways
                                Read the latest updates on new pathways 
Waikato Strength and Balance Service
Work continues at pace to ensure all patients vulnerable to falls can access strength and balance classes either in group community settings or in their homes.
Both Pinnacle and Hauraki PHO have updated their patient dashboard or prompt to support this.
You will know already about the ability to refer to the strength and balance service using  eReferral. 
We are certain there are many patients still to be referred and as this has been proven to reduce the risk of falling and therefore serious harm please try to remember this service is in place.

Please take note the latest research does tell us that Vitamin D should be presecribed to residents of aged residential care, where deficiency can be assumed with no prior blood testing necessary. Our prescribing rates for ARC residents have dropped off recently so can I ask that you give this some attention.
Read our latest strength and balance report here
Read about the latest research on falls prevention here
Venom Immunotherapy Service
Waikato Hospital has begun venom immunotherapy. Although the initial treatment takes place in Waikato Hospital the maintenance treatment needs to occur in general practice. This is a monthly injection every five years.
Read more here.
Newborn Enrolment and Immunisation Improvement Service
This new DHB service is to support all of us in reaching our immunisation targets. Early newborn enrolment with general practice is essential in achieving the first three childhood immunisations on time. We are also targeting Maori infants.
The latest report contains some interesting data on newborn enrolments and highlights where improvements can be made.

Read the latest report here.
Waikato HealthSystem Plan, Te Korowai Waiora
The draft Waikato Health System Plan, Te Korowai Waiora, sets out a 10 year direction for the whole sector describing a future health system that will:
  • improve health outcomes, particularly for Māori
  • enable all people of the Waikato the opportunity to achieve their full health potential
The draft goals, actions and activities for the Waikato Health System Plan, Te Korowai Waiora, have been developed through an engagement process including consumers, community members, providers and other stakeholders. The draft Waikato Health System Plan was taken out for public consultation during April and May. A considerable number of people have taken the opportunity to provide feedback with most being largely supportive and affirming of the general direction. Having considered consultation feedback, an additional goal has been included to “Enhance the connectedness and sustainability of specialist care”.  This provides an explicit goal to strengthen hospital services as part of a joined up health system. 
As a next step, work has commenced to develop a work programme that will incorporate initiatives from the Waikato Health System Plan, clinical service planning and other work undertaken to focus on sustainability.
Have a look at the latest HSP here
System Level Measure Framework
The DHB and PHOs have been working together to finalise a SLM plan for the District starting 1 July 2019. We are hoping to finalise the activity for the plan this week, with a final signed version due to the Ministry by 21 June. Payments to PHOs for SLM activity is contingent on the Ministry agreeing to the activity put forward in the plan. 
Matamata Medical Centre Rural GP Team of the Year
Huge congratulations to the dedicated and committed team at Matamata Medical Centre.
Read more about this here.
General Practice Liaison Updates
Sending an email about a patient is sometimes unavoidable. However, we must take reasonable steps to ensure that patient information is kept secure when doing so. To help meet this obligation and to reduce the chance of a privacy breach, before sending an email about a patient consider the following:
  • Can the message be sent through a more secure way e.g. a portal?
  • Can the message be sent without disclosing identifiable information e.g. anonymising the details, if not relevant?
  • If the above isn’t possible, can you reduce the amount of identifiable health information included in the message? For example, cross referring to discharge summaries or the patient record.
  • If a large amount of patient information is involved or it is particularly sensitive, can you include that information in a password protected attachment instead?
  • Pause before you send e.g. double-check the email address is correct, double-check that the email address is not a shared or generic account, do not include an email chain by mistake and remove all unnecessary patient information.

Mark Taylor

Read Mark's update on Teledermatology for suspected skin cancer and iron infusions here.

Fiona Campbell

The new DVT Health Pathway is due to be published soon. A reminder that superficial thrombophlebitis can be approved indication to get a Primary Options Funded USS to exclude an underlying DVT. Arrange a scan if there are any of the following:
•             There is an involved segment of vein of 5 cm or more.
•             Either the great or the small saphenous vein is involved.
•             There is asymmetrical leg swelling.
D-dimer is not considered sensitive or specific enough to predict DVT in superficial venous thrombosis.
Work is nearing completion on the Transgender Pathway with an aim to improve consistency and experience for all patients from first presentation onwards. Please be aware that if you have a patient requesting referral for possible gender reassignment the preferred place to refer adults to is the Sexual Health Clinic and children to Eleanor Carmichael, Paediatrician at WDHB.
Any feedback on any of these pathways or other issues is always gratefully received.
Many thanks Fiona
For complete Maviret prescribing information look here

Angela Fairweather

Two new BPAC specialty templates are due this month.
They include a new Lung cancer eReferral with the ability for your patient to go straight to PET scanning if the triaging clinician thinks appropriate. This will allow faster treatment for patients with potentially curable disease to access PET scanning. The new health pathway with the clinical information supporting the eReferral is due for publishing very soon.
The other exciting eReferral speciality form due for release this month is the
Early Pregnancy Assessment clinic template. This is particularly exciting as it will mean that the e referral will be received DIRECTLY by the clinic, with all the relevant information and will improve safety of referral. Unlike the current faxed system there will be clear visibility of the referral as it is sent and received. The staffing for the Early Pregnancy assessment clinic has been improved in order to provide more continuity of care for the service and faster treatment for the patient.
Other e referral speciality forms under development include one for the Breast Care clinic. The Colonoscopy Direct access speciality form is under review, looking to see how useful it has been in getting patients to colonoscopy sooner and I please encourage all of us to continue to use this referral.
The Cognitive Impairment pathway and the Cellulitis pathway are other pieces of work nearing completion.
Thanks Angela


Sheril-Ann Wilson


My recent work has largely involved the Acute Care space . Hopefully those of you who attended the recent  GP Engagement Evening on Acute care (June 6th) found this helpful .
Some key points from Ian Martin the Clinical Director of ED
1. You should only need to make one phone call to the appropriate registrar- if they refuse or cannot be contacted or give unhelpful advice please document this with their name in the box labelled attention near the top of the BPAC ereferral form . This is the only way that ED can follow up with the registrar involved and Specialist staff are keen to educate their registrars in appropriate communication with colleagues.
2. If the registrar has given instructions such as they will see in ED or want ED to do specific tests please document this also in the attention box.
3. Please send your referrals to the specific acute specialty and not to Emergency Medicine as it will save your patients hours of waiting time and improve ED efficiency.
Please contact me if you have specific feedback re ED patient encounters.



Geraldine Tennent

I have continued to work with both Paediatrics and Mental Health, localising further HealthPathways.  In Paediatrics, the Bronchiolitis pathway is close to publishing - just in time for the winter onslaught.  We also have a Paediatric Gastroenteritis pathway near completion, which will assist you in using Primary Options to undertake rehydration in your practice. 

The mental health pathway working group has completed pathways for Youth Suicide Prevention and Deliberate Self Harm.  

I have this month met with some of the violence intervention allied health professionals, and we are beginning work localising the Family Violence HealthPathway.

Dr Geraldine Tennent
GP Liaison - Child Health
mobile: 021 0234 7173

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