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Waikato District Health Board

GP Liaison

March 2019


Dr Damian Tomic, Clinical Director Strategy, Funding and Primary Care
Damian.Tomic@waikatodhb.health.nz
Primary Options Review

Last year Waikato DHB appointed an independent organisation to review the current Primary Options service. The review made several recommendations which we are now working on implementing. This Friday your PHO will be attending a next steps workshop here at the DHB.
We are committed to launching our new Primary Options Service 1 July 2019.

 
Read the letter sent to General practices on Primary Options
Read the full Primary options review document
Urgent and Emergency Care Review
We have also reviewed our urgent and emergency care arrangements across the Waikato District.

From my perspective early areas of focus need to be;
  • The working relationship between ED ,Urgent Care ( A and M clinic) and general practice
  • After-hours arrangements
  • The role of Urgent Care in providing care to patients who can be safely managed in the community with resource and support who would otherwise have gone to ED. 
The review makes recommendations by locality and next steps will also be discussed at our workshop on Friday.
Read the full Urgent and Emergency Care Review Here
Health System Plan and Care in the Community Plan
The intent of Healthy People Excellent Care is to shift the health system focus from specialist services to the community. Specialist services are vital and will continue to be funded to provide safe and high quality care, but we need a greater focus on preventing people becoming ill, intervening earlier when people do get ill, treating people in the community and for those with complex needs; helping them to recover, manage their illness and live independently in their communities.
 
The Health System Plan sets a direction and focus for the whole sector that will enable the strategic imperatives of the DHB’s strategy Healthy People Excellent Care to be achieved. This direction guides specific service and planning initiatives, priorities and decisions for investment and disinvestment.
 
The draft goals, actions and activities for the Health System Plan have been developed through an engagement process including consumers, community members, providers and other stakeholders. The process commenced with a focus on the Care in the Community Plan, where Māori, consumers and stakeholders gave us their broad perspectives and experiences with the health system as a whole, not confining their views to community services. People do not differentiate the system in the way people within the health system do (e.g. primary, secondary, rehabilitation etc) – they see health as a single system and want it to operate as one system.
 
Consultation on the Health System Plan will commence on 15 April for four weeks. There will be multiple opportunities for everyone to have a say – attend a meeting in of our local communities, send a note, complete a survey. Separate communications will come out with further details on this.
System Level Measure Framework
Development of the 2019/20 System Level Measure (SLM) Improvement Plan is well underway.  To ensure that perspectives from all relevant parts of the health system were captured a workshop with representatives from the Ministry, PHOs, Waikato DHB, Analysts, Planning and Funding, and Community Pharmacy was held in December 2018. At this workshop the SLM group was guided to identify activities and contributory measures for each of the six SLMs. Through feedback and input from all SLM partners the plan continues to develop, a final workshop will be held on the 3rd of April to agree as a collective on what activities will be our main focus for 2019/20.
 
The plan will have a strong commitment to Māori and Pacific health gain and eliminating health inequities. To ensure we make real progress towards this the group will focus on an achievable number of activities that can be done well and completed in 12 months in the knowledge that new measures and activities can be included in future SLM plans.
 
The 2019/20 year will see a new approach to the SLM group structure . Previously the development and implementation of the SLM plan was completed by six working groups. Based on growing experience it has become clear that areas of focus in each of the six SLM groups often interrelate or overlap. For this reason, the six groups have agreed that they will combine to create one large SLM group that meets quarterly for monitoring purposes while smaller working groups will be formed with a lead for each activity.
 
A final plan is to be agreed and submitted to the Ministry by 21st June.
Work to address GP referrals that are declined by Waikato DHB
Your GP liaison team continues to work on your behalf to address any concerns you have when your referrals are declined by Waikato DHB. This is can be extremely frustrating and upsetting for you and your patients.
Many of you do email the GP liaison team and myself on a regular basis and I would ask that you continue to do this.

At a system level we continue to work with all hospital services to bring greater transparency around the thresholds for referral acceptance for specialist assessment and surgical procedures. We are focused on Orthopaedics and Radiology currently.
We will make these thresholds available to you through our Community HealthPathways and eReferral tools.

Our Teledermatology service is a great example of things getting better and we have GP Dr Mark Taylor to thank for getting that in place.

All our email addresses are listed below;
Access a useful Teledermatology photography Guide here
Falls and Fragility Fractures 
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.

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
Hospice Waikato Project Echo: Education for GPs
We commenced our first Waikato Palliative Care ECHO Network in September 2018 with a focus in primary care. We are conducing a teleECHO Clinic for this Network once a month for 90 minutes starting at 7.30am and following the proscribed ECHO format. We have established the Specialist Hub team here at Hospice Waikato with myself or Dr Lara Hoskins facilitating, and are slowly increasing the number of GPs and other primary care providers joining as Spoke sites. Our focus for 2019 is to increase GP uptake of the Palliative Care ECHO and look at the feasibility of establishing a Waikato Palliative Care in Aged Care ECHO Network and a national Paediatric Palliative Care Network in collaboration with the StarShip Hospital Palliative Care Team.
 
We have Project ECHO information and some of our teleECHO Clinics recorded an available on our Website - https://www.hospicewaikato.org.nz/education-item/project-echo.
Hepatitis C Maviret Prescribing
It has never been a more exciting time in the treatment of Hepatitis C.
Please read the important new prescriber information contained in Fiona Campbell's Section at the end of the newsletter. 
Childhood Immunisation Rates are falling
There continues to be a downward trend for 8 month immunisation which is very worrying. If we cannot reverse this trend collectively we will see further outbreaks of preventable infectious diseases which always disproportionately affect our high need communities.

Look at the Waikato 8 month Immunisation rates in the blue button below. I am very keen to hear from GPs and practice nurses on what may help turn this around. 

Read the latest MOH Immunisation including information around influenza vaccine here.

 
Waikato 8 month Immunisation Rates
Community HealthPathways
Hopefully you are finding the new Community HealthPathways site useful and easy to access.
We are seeking expressions of interest from local GPs who would like to join a local Waikato HealthPathway group to further ensure that the tool meets your needs and that we are publishing pathways in the Waikato that you would see as a priority.
If you are interested in joining this group please could you email our GP liaison, Dr Angela Fairweather on angela.fairweather@waikatodhb.health.nz
Read the latest HealthPathways update here
Measles Outbreak Information
Read Here
General Practice Liaison Updates

Mark Taylor

Read Mark's update on Orthopaedic referrals, iron infusions and Bariatric surgery referrals here.

Mark.Taylor@waikatodhb.health.nz

Fiona Campbell


The Palpitations Pathway was published last month and contains within it the information for community use of adenosine in SVT. A reminder that funding is available through Primary Options for this enhanced service. It is currently being utilised by rural practices. If you are interested in having access to this please check out the Palpitations Pathway for more details alternatively contact me or your PHO.

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.

Women with Gestational diabetes require a follow up HbA1c at 3 months post-partum and annually thereafter. Please ensure you have a practice recall system in place for all these women. A Health Pathway is being developed for Diabetes and Pregnancy and will be published soon, there is a localised Map of Medicine Pathway which can be viewed on Health Pathways which contains all this information
 
Hepatitis C treatment  just got easier. Maviret is now funded as a treatment for all genotypes of hepatitis C, which is great news as it is a simpler regime and shorter course with a high cure rate.
There is no longer any need to do genotype testing as Maviret treats all genotypes. Not everyone needs a fibroscan before treatment (just those with a high AST to platelet ratio) and there is no Pharmac approval is not needed.  A new Health Pathway has been published detailing all the latest in Hepatitis C management.

Any feedback on any of these pathways or other issues is always gratefully received.

Fiona.Campbell@waikatodhb.health.nz
For complete Maviret prescribing information look here

Angela Fairweather


A new and exciting initiative from the Ministry of Health is the provision of more funding to increase equitable access to contraception .The new funding is to help those women of low income and those living in deprivation, to access both contraception counselling as well as provision of money for insertion and removal of LARCs (Long acting reversible contraceptives.). The funding will be available from the 1st of April 2019.  Mirena prescribing will remain available under special authority.
The targeted population is women aged 15 to 44 years:
.who live in quintile 5 areas; or
.hold a community services card; or
.are  at high risk of unplanned pregnancy and poor health and social outcomes.
 
The DHB will under this new model will be offering :
.funded training for interested GPs to gain skill in LARCS insertion and removal.
.free insertion and removal of funded LARCs for the target population
.a capped volume of very low cost contraception consultations (0 to $5 dollar co-payment)
This funding will be available to all of the Waikato, including Hamilton and we will be working closely with the PHOs in this project.
 
I have also been asked to advertise an upcoming GP workshop that will be run at the end of the RANZCOG conference in Hamilton on the 25th of May. The workshop will cover a variety of topics ranging from Transgender issues to Fertility and Pregnancy .If anyone has interest in this feel free to email me and I can provide more information as it comes to hand.

angela.fairweather@waikatodhb.health.nz
 
 
 
 

Sheril-Ann Wilson

 

I continue to be involved with ED/Primary care liaison. Please remember to specify the department that your acute referral is going too as this saves hours of patient wait time in the ED. It is a 2 way process and I would love to hear from you regarding any complaints/bouquets re the acute care space. 

I have been working with Mark Taylor to give GP perspective in the development of the new Primary Options programme commencing 1 July. 

We are having a GP Engagement Evening on June 6th regarding acute care and I would love some GP cases that illustrate the challenges around this interface. Please contact me if you would like to present a case. 

Sheril-Ann.Wilson@waikatodhb.health.nz

 

 

Geraldine Tennent

Mental Health Pathways
Although my primary role is working with Paediatrics, over the last few months I have also been working with Mental Health.  We have a group consisting of myself, Dr Andrew Darby (psychiatrist in primary care for Midlands Health Network), Dr Lyndy Matthews (psychiatrist in primary care for Hauraki PHO) and Dr Maree McCracken (GP Lead Mental Health for Midlands Health Network) working together on HealthPathways.  We have completed pathways for Depression in Adults and Suicide Prevention in Adults, still in the publishing process.  Next to be reviewed is Suicide Prevention in Youth.  As a group we would be very interested to hear which pathways would be most helpful to you, so we can prioritise our work accordingly.   Please take the time to feedback if you have any requests.
 
Paediatrics
I also continue to work with Paediatrics developing HealthPathways.  We are to add Pneumonia in Children, Croup and Pertussis to our list of Paediatric pathways over the coming months.  As above, feedback from General Practice on which pathways would be most helpful to you would be very welcome.   The paediatric department has requested that we include height and weight in referrals, and head circumference particularly if there is a neurodevelopmental concern.  Several measurements over time are very helpful, but even a one off measurement adds valuable detail to the referral.
 
I am aware that there is some confusion and difficulty with the referral process for developmental concerns, paediatric mental health, ADHD and related problems.  There are three separate services involved in these areas with some crossover which adds to the complexity.  I would like to work with the DHB to improve this process and provide clarity and ease of referral for General Practice, but feedback with specific examples would be very helpful in order to get this process started.  Please let me know if you have experienced difficulties in this area. 
 
Dr Geraldine Tennent
GP Liaison - Child Health
email: Geraldine.Tennent@waikatodhb.health.nz
mobile: 021 0234 7173
 

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