Getting frustrated with funding issues?

Are you getting frustrated with funding issues or annoyed with the continuing rhetoric of services being devolved to general practice yet with little money to follow? If this is the case then the upcoming Northland Faculty RNZCGP symposium, on the 17th of October, is for you! This is an opportunity for you to question your funders (i.e. DHB and PHO) on the burning issues. Of course the symposium is not all about letting off steam but is also an opportunity to mix with colleagues from around Northland as well as an opportunity to have some CME (5 points).

For the full programme click here and to register click here.

Four weeks until the Annual Waitangi Symposium...

There are only four weeks to go until the annual Waitangi Symposium on Saturday October the 17th. This year the focus is on the future of general practice in Northland. GPs and practice nurses attending the symposium have the opportunity to question the CEOs of the DHB and PHOs on the future of general practice in Northland. In a separate panel discussion the question of funding for after hours, in particular of rural general practice, will be debated. The remainder of the symposium consists of a series of practice changing updates from invited GPs and Specialists.

The programme outline is:

Topic Speakers
Panel discussion and debate: What is the vision of NDHB and the PHOs for Primary Care? Nick Chamberlain - CEO NDHB, Rose Lightfoot - CEO Te Tai Tokerau PHO, Mary Carthew - Acting CEO Manaia PHO
Panel discussion: Rural SLAT and after-hours Rose Lightfoot - CEO Te Tai Tokerau PHO, Invited Rural GPs
‘Ten tips to take away for tomorrow’ - Practice changing research from 2015 Kyle Eggleton - GP & Senior Lecturer
Vasectomies Quality Control Alex McLeod - GP Registrar
Recognition, monitoring and management of CKD3 at Dargaville Medical Centre Steve Thrupp - GP Registrar
New Wine for Old Wineskins Walaa Saweirs - Renal Physician
The Disorders of Personality in General Practice Joseph Foote - Psychiatry Registrar
Hips 0–100 Lyndon Bradley - Orthopaedic Surgeon
Managing your media profile Andrew Stacey - Urgent Care Physician and MPS Adviser
‘Sex it up’ Peter Chapman-Smith - Appearance Medicine Doctor

Register today by clicking this link. Cost is only $60.

Waitangi Symposium 2015

There is just over a month to go until the RNZCGP Faculty annual Waitangi Symposium on the 17th of October. The symposium this year is a mix of quick fire updates from both specialists and GP registrars as well as a political session debating the future of general practice and after hours in Northland. In the political session attendees are invited to pose anonymous questions (that Board members will ask) to the CEOs of the DHB and PHOs. Check out the full programme on this link and register today.

Northland Rural Support Trust

Most dairy farmers are busy with spring calving while the serious impact of the drop in dairy payout is sinking in. If you are checking in with how some of your farming patients are dealing with this it might be helpful to know that the Northland Rural Support Trust is a local service that helps farmers with financial advice and assistance, farming management decisions, facilitation with banks, work and income and Fonterra. They have facilitators that visit farmers under stress and support them through difficult times. They can be contacted via their website or by phoning 0800787254. These details will be posted on our resources page for future reference.

Registrations open for Waitangi Symposium

Registrations are now open for the 2015 Waitangi Symposium. This is to be held on the 17th October. The theme of the conference is "the future of general practice in Northland". The morning session consists of two panel sessions. In the first panel session the future of general practice is debated and in the second panel session rural SLAT issues and after hours in general are debated. The afternoon consists of presentations from the future of general practice - local Northland general practice registrars, as well as invited speakers who will give some brief clinical updates. The programme is to be found on this link. The cost of the symposium is only $60. Practice nurses are welcome.

Waitangi Symposium

The annual symposium for GPs and Practice Nurses is being held this year on the 17th of October at the Waitangi Copthorn Hotel. A detailed programme will soon be available. This year the symposium will tackle political issues. Featured discussions include rural after-hours provisions as well as the role of the DHB and PHOs in general practice. The symposium will also have brief clinical updates on a range of topics including personality disorders, foot conditions, renal disease, impotence and managing social media.

Northland Long Term Conditions Clinical Governance Group

Northland Faculty Board member Mark Lankshear sits on the Northland Long Term Conditions Clinical Governance Group his report from its latest meeting is below:

Dear all,

I attended the Northland Long Term Conditions Clinical Governance Group on 5th May 2015 as a GP representative.

This was an interesting and at times quite lively meeting chaired by Aniva Lawrence. We were a little low on numbers but did achieve a quorum. We heard updates from a number of work streams, specifically the respiratory, CVD, ACP, gout and dementia work.

One piece of good news is that the spirometry equipment guidance for Northland has now been approved and training is being undertaken for practice nurses – we were told 60 nurses have now been through this approved training and that the guidance re equipment and training will be circulated shortly to practices. The cost / finances and access issues have yet to be worked out.

The CVD rehab and dementia pathways are both going to go through a co-design process which will be beginning soon with Lyn Rostern newly appointed to take a lead on these – probably in Kaikohe to start with. The respiratory rehab programme still seems stalled and there was some frustration expressed around this and Lyn will be looking at any commonalities that could be useful here.

The gout project has had a redesign to try to ensure wide access and equity – we were told that all of Northland's pharmacists have signed up for this and although there will be two pilot sites initially it's hoped this scheme will be available Northland wide in the near future.

A number of other issues came up for discussion including the ongoing structure of rehab services in general. One of the work streams reported their concern that the MoH had issued a statement that they wanted to see rehab programmes based in primary care and with a generic flavour. The workstream felt this had risks of lack of expertise and focus and were going to write to the minister expressing this.

This has been a common discussion theme within the group and I (and some others) expressed the view that, although the key to successful rehabilitation is clearly good partnership working between patient, primary and secondary services, that these services should be based in the community and be patient rather than disease focussed. My feeling is that the key task is engagement (which is a primary care strength) and ensuring people with chronic diseases are ultimately well connected to primary care is essential to their long term management and well being. I think this is a key issue for this group which will continue to be a subject of debate.

As ever any feedback is very welcome and will be taken back to the groups next meeting which will be in early June.

Two weeks to go...

There are two weeks to go until the Russell Conference. Over 75 people have registered so far...make sure that you don't miss out on the biggest GP event in Northland for 2015 by registering on the website. The Northland Faculty RNZCGP AGM will also be held at the conference. On the agenda are:

  • Discussion on political activity of the Faculty
  • Current clinical issues in Northland
  • Discussion on proposed mentoring scheme for new Fellows
  • Member engagement

Final week for Early Bird Registration

This is the last week for early bird registration for the annual Russell Conference. Register now before prices increase!

One of the speakers at the conference is Felicity Goodyear-Smith. Felicity is Professor of General Practice at the University of Auckland and has published numerous studies. Her particular area of research interest is in identifying anxiety and depression in a general practice setting. She has been instrumental in designing an electronic screening tool (eChat) to screen for mental health and addiction issues within general practice. Felicity will deliver two talks. The first will address some of the presenting features of, and risk factors for, depression and anxiety in adolescents, how to identify and a step-wise approach towards management. Her second talk is on social contagion. Social contagion is a mass sociogenic illness involving a condition that spreads within a social group, but does not seem to have a common organic cause. This talk presents a number of reported cases dating from the Middle Ages to the present, with a fascinating example that occurred in Auckland in 1973.

Obituary of Peter Milsom

The Northland Faculty would like to pay tribute to Mr Peter Milsom. The faculty was indeed lucky enough to have Peter speak at the Russell conference in 2014. It was a touching, personal presentation of his journey through medicine in Northland paralleled by the creation of an arboretum legacy at his home in Pakaraka with his wife, Gerry. Both journeys are marked by energy, commitment, long hours, a supportive family and a sense of permanence that only few get to create in a lifetime, short or long.

Peter's career is well known in Northland, developing obstetric skills and furthering his surgical skills at the Bay of Islands Hospital while he was a general practitioner. Peter's time in general practice not only benefited the people of Moerewa, Kawakawa and surrounding districts, but his rapport, humor, availability and understanding of general practice was also of benefit to Northland General Practitioners when relating to him as a surgeon and eventually the clinical director for Northland DHB surgical services.

In 2014 the Royal Australasian College of Surgeons awarded Peter the Outstanding Service to the Community Award. Despite such extraordinary achievements and dedication that leaves one wondering about their own sense of purpose, Peter was a fairly humble man who lived in the community he served, enjoyed music and a good story.

"I am not old but believe I will not get much older" Peter passed away peacefully on the 25th February 2014. His life was celebrated by the wider community at Otiria Marae and family and friends at his Pakaraka garden.

He will be missed by his Northland General Practice colleagues

Northland Long Term Conditions Governance Group report

Northland Faculty Board member Mark Lankshear sits on the Northland Long Term Conditions Governance Group. His report from its latest meeting is below.

"I attended the Northland DHB Long Term Conditions Group last night as a GP rep.

This group oversees DHB work streams to improve care of people with LTCs.

At last night’s meeting there were a number of things of note.

There is a plan for integrated education sessions with primary and secondary workers around diabetes care and initiating insulin that are hoped to happen in July / August.

Although there is some frustration about slow progress, there are ongoing efforts to improve delivery and access to both Cardiac and Respiratory rehab – the funding group have asked for these to go through a “co-design” process before approving further funding. Although challenging there are efforts being made to take this forward, with a suggestion to use Kaikohe as a possible area to try out the co-design process and with efforts to link this with the Neighbourhood Health Care Home initiatives.

Also regarding respiratory conditions there is ongoing work to try to improve access to spirometry. There has been progress with some nurses receiving training in Christchurch and work will be ongoing to look at issues around local workforce training and accreditation before proposals can be taken forward to try to ensure locally available equipment and testing – I will be advocating hard for this to be available in primary care.

The gout pilot is almost ready to be rolled out and pharmacists are being actively recruited – funding seems largely in place and we are at the stage of final reviews of the protocols for medication packs prior to training for pharmacists / GPs and ensuring local arrangements are in place where community pharmacists have expressed willingness / ability to participate.

There is very early work being done around dementia pathways and looking at roles for ‘navigators’ to assist people through services – the thought being they would probably take a wide role in supporting access for people with a range of LTCs rather than focus solely on dementia.

We also reviewed the LTC element of the DHBs annual plan which is almost complete.

As ever if anyone has any opinions / questions / feedback for the group I would be happy to convey this / try to answer questions."

Reminder of Early Bird Registration - Russell Conference

The 2015 Russell Conference is shaping up. Its theme is the urgent and contagious. All attendees who register before the closing date for early bid registration will be in the draw for a bottle of wine. Please click here to register

This year the Faculty has invited Year 5 and 6 medical students based in Northland to present interesting cases that they have been involved with during their GP attachments. The students will do a poster presentation and GPs will be invited to select a winning poster (with a $250 prize attached).

Our highlighted presenter this week is Brandon Wong. Brandon is known to most of us as a highly approachable physician based at Whangarei Hospital. His talk is titled All puffed out and nowhere to go. Brandon will present a number of different cases, that he sees referred to him from general practice, illustrating the myriad of causes of shortness of breath.

Early Bird Registration at Russell Conference

Four weeks to go until early bird registration ends for the annual Northland Faculty RNZCGP conference Medical Clap in Russell: The urgent and contagious. Register now!

A guest speaker is John Kennelly. John is a senior lecturer in the Department of General Practice and Primary Health Care at the University of Auckland and a GP for a Pacific Health Trust. One of John's interests is the management of soft tissue infections. His talk is titled 'Mr T' needs you. The challenge of reducing soft tissue infections in our community

New Zealand has the highest incidence of Staphylococcus aureus disease among developed countries with the highest rates in Maori and PI people. Most disease is due to methicillin-susceptible S. aureus (MSSA). There has been a steady and significant increase in S. aureus infections over the past few years predominantly due to a rise in non-invasive community-associated MSSA. The result of this large pool of soft tissue skin infections (STSI) is the unacceptable rate of osteomyelitis and septic arthritis in Maori and PI children. The presentation will discuss a GP approach to this public health disaster. The presentation is in two parts: 1. a recent case from his practice in West Auckland ('Mr T') demonstrates the difficulty of early recognition of dangerous STSI complications and a useful clinical prediction rule 2. a brief description of a proposed general practice/public health approach to controlling the spread of S aureus in our community.

Meeting of the Northland Clinical Governance Forum

Northland Clinical Governance Forum

The Northland Clinical Governance Forum is a collective of NDHB, PHO and Faculty representatives that provide clinical governance on issues impacting on integration and the primary-secondary interface. Three Faculty Board members sit on the Clinical Governance Forum - Geoff Cunningham, Mark Lankshear and Kyle Eggleton. The second meeting of the Clinical Governance Forum was held on the 25th February and a summary of the meeting is presented below. What is important to note is that many of the issues raised by GPs and discussed on the Faculty website were discussed at the Clinical Governance Forum and helped to guide the Board members in representing the views of GPs. The Board would like to encourage GPs to continue to express their views on issues by posting concerns on the website. This ongoing dialogue will result in the voice of GPs being heard at a higher decision making level.

Clinical Pathways

Northland DHB has agreed to implement the Canterbury Health Pathways in Northland. These are a collection of primary care pathways that have been designed by GPs in Canterbury. Ultimately the pathways will be available directly within GPs PMS e.g. MedTech or MyPractice. One of the issues that the Faculty reps raised was the importance of Northland GPs being involved in the 'Northlandisation' of the pathways. A way that this could be achieved was if each peer group was given a pathway to review and ensure that it was relevant to Northland and practical. This could be achieved if each peer group nominated one person to attend a brief meeting discussing the implementation and review of pathways and then chose a pathway to take back to their peer group. Please let the Board know what your thoughts are on this idea by following this link.

Followup of results

We all hate the words "GPs to chase...". The NDHB has drafted a policy on expectations relating to followup of results. This goes a long way to addressing many of the issues that we as GPs have with transfer of care documents. A summary of the policy is as follows:

  • It is not appropriate for GPs to followup hospital histology results.
  • Responsibility for following up a test lies with the person who ordered it.
  • GPs can not be asked to follow up a test results unless there are clear instructions on what to do with an abnormal result.
  • If results are not forwarded to a GP then responsibility for locating the test results lie with the ordering clinician.
  • The language used in transfer of care documents must be appropriate e.g. not to ask GPs to chase

Overall the Faculty Board endorses the draft policy. However the Faculty reps did raise the ongoing issue of inaccuracy of the NDHB GP databases with results and letters often going to the wrong GP or practice. We have been reassured that NDHB is aware if the issue and that there are some long term plans to improve things.