Update 7th April
Notes from CEO group 7 April
Update from Andrew Slater, Healthline
- Continued to see week on week reduction in time to speak to clinician. Ave wait yesterday was 2 minutes
- Onboarded additional 200 staff
- Still seeing massive call volumes – 16,000 contacts in one day last weekend, usual 10500.
- Cyclical – quieter Monday / Tuesday
- Concern in the reduction and acuity in non-Coved related work – running at twice the rate of calling 111 and three times the rate of referring to general practice
- Acuity is pregnancy, stroke, cardiac arrest and co-morbidities
- Message to government – if you are unwell go to the place you would normally seek care
- Last 3 days significantly more referrals to general practice. Might be due to case definition change. Where they clearly meet the criteria for a test we refer to CBAC. Where they have a number of symptoms but don’t clearly meet the definition we refer them to their general practice.
- We don’t think a telephone help line is the right place to be ‘suspecting’ Covid because of no prior knowledge of the patient or the social situation
- General practice should expect to see a lot more people coming through that Healthline has suggested speak to general practice.
- Experience in the UK was that the telephone helpline was given the job of identifying suspect cases and isolating people at home with no knowledge of comorbidities, clinical history and people ended up deteriorating quite quickly.
- Working with MoH on clinician advice line for practitioners working in the community. This has had a soft launch this week. This provides point of access for clinicians from across primary and community care to access advice. Very familiar with MoH guidelines, case definition, NHCC etc. Provides peer to peer support.
- Looking for additional staff for the peer to peer line (GPs and practice nurses) so if you have any capacity please get in touch - particularly Auckland, Wellington, Chch, because of ease of training.
- Starting to see increase in 1737 volume – working on a plan to get more resource into this. Seeing significant levels of distress in people who have never used services before
- Quality improvement plans esp access for disability sector, Māori and Pacific. Keep the feedback coming
- Messaging needed about general practice is safe to visit needs to be incorporated into the College’s comms resources which are going live today
- General practice is clean, good systems in place and it is safe
Update from Bryan Betty
- College campaign on General Practice being open for business: https://rnzcgp.org.nz/RNZCGP/Advocacy/GPs_are_open_for_business/RNZCGP/Im_a_member/Support/Covid-19/GPs_open_for_business.aspx?hkey=5439bfd2-0480-42c3-ba73-3b1b4b0418b9
- Primary care subgroup at TAG being refocussed with smaller core group – a steering group to filter issues and send back out to sector for consultation. This is to address the speed issue because TAG is a large group
- Vulnerable workforce in primary care issue for rapid response has gone out through Jo Scott-Jones to PHO Clinical leads
- Increased funding for pathways
- Flu vaccines – issues have been heard, assured the MoH is working on this very hard and understand this needs to be sorted for the long term
- PPE messages have been heard
- CBACs – variability in how results are fed back to patients around the country – looking for consistency
- Sustainability of general practice messages have been heard – not a topic for TAG
Update from Liz
- Comms – MoH is listening and has delivered messages in national addresses
- Issue with MoH sending remittance advice in error. Payments have not been received.
- Weekly PHO Clinical leads meeting Thursday evening
- Clinical leads have asked for a webinar on CBACs – agreed to do this next week
- Well South CBAC plan will be circulated tomorrow
- Philip Balmer identified a challenge with the Northland CBAC that whānau see it as OK to go and get tested so they bring all of their health issues
- Harvey Norman have a shipment of webcams arriving next week and will prioritise health and education. Details from Fiona is you need to order some
- Next meeting next Tuesday, will probably meet weekly after this.
Round the table
- Northland, Covid lite – adding about 1 case a day. 7 day testing centres. Seeing primary care tension around activity levels, getting them involved in CBACs. Positive experience going to virtual care. Utilising those who have contracts (e.g. Wellchild) to staff.
- Auckland – Auckland PHO CBACs Waiheke and AUT running well, no funding yet from DHB. Great Barrier no funeral director, trying to get a quasi- registered funeral director, challenges with getting people home to the island. Comprehensive putting effort into getting patients engaged with practices on the phones. Steady as she goes now. No consistency in funding for CBACs. DHBs getting $6 per ESU. Loretta, concern is that PHO is funding and haven’t received funding in from DHB as yet. Noting regional costing differences so consistency might be difficult. Alliance Health Plus – Pacific based CBAC in Otara. Biggest issue practice sustainability. Practice don’t necessarily want to share balance sheet.
- Pinnacle – putting in home monitoring kits, quick pilot, for GPs to put with patients who are discharged with covid or other vulnerable patients: scales, thermometers, pulse oximeters.
- Hauraki – Kaupapa Māori iwi provider running a CBAC, contract from DHB – all costs are be considered by the DHB
- BOP – CBACs primary care playing a big part running rostering, ICT, results etc. Relationship with DHB has been positive. Māori, primary, secondary working in a very integrated way. Dedicated CBAC in Whakatane, rolling out 2 mobile CBACs in Eastern Bay at remote isolated community locations.
- NHC – remote consult clinic – good feedback, got clinicians helping out remotely e.g. clearing an inbox. GP Receptionist and nurse in the PHO office delivering this service.
- HB – 6 CBACs across the region.
- Think Hauora – 5 designated testing centres being run by primary care. Indici working well as a platform. The PHO is doing the negative results, public health doing positives. Working with Māori, Pacific and Iwi (with support from Army) on packs for vulnerable people.
- TeAHN – 5 CBACS, including camper van mobile clinic, identifying high needs communities to position mobile clinics. Expecting CBAC contract today.
- Ora Toa – contract due today for CBAC. One in canons creek – redeployed community health contract nurses to work within practice or CBAC. WO commissioning agency has been great, and delivering packs for vulnerable population.
- Nelson – 2 main CBACs and small triage centre in high need community, transport arrangement to take people to CBAC if needed. Welfare requirements increasing. GP Sustainability concern, many working at CBACs as well as practices. CBACs run by PHOs, collaborative support with DHB. Rosters for 7 days a challenge – majority PHO staff helping. Looking at mobile CBAC for isolated communities who may not be accessing.
- Canterbury – good support from DHB. Welfare communities in rural working well. Vulnerable people identified. Chch – CBAC activity over weekend really quiet – will be interesting to see what happens over Easter weekend. Questions about what to do if a practice has to close – buddy system to support. Locum practice nurses and Occ Health nurses looking for work. Urgent care centres trying to manage workload. Promotion of general practice and mental health services required.
- Well South – 3 CBACs. Designated practices e.g. red stream, swab for own population and anyone else. Considering decrease in flow over the weekend at CBAC. May reduce hours over weekend. Working on practice sustainability and model going forward.
From the Chat
- SOPs on the shared drive were excellent we have used them and modified them (Philip Balmer)
- It would be good to discuss business continuity plans that PHOs have developed at some stage
- Use of buddy system for smaller practices who are concerned about providing care
- Acknowledgement of GPNZ work from Liz and Jeff (thanks guys)
Update 3rd April
Please find below a response to our letter of 27 March, from the DG. Things have moved on somewhat since we wrote.
We had a great meeting with the PHO Clinical leads last night, chaired by Dr Jo Scott-Jones. The Clinical leads have asked for the following on their behalf:
- A 1-2 page paper around 3 issues (Flu Vaccs, General Practice sustainability and Case definitions & Swabbing) to feed into TAG by Monday
- A Letter to the DG re No public announcements until resources and systems are in place to meet the resulting demand
- Active promotion of general practice being open for business – due to concern for the long term clinical impact of people not seeking treatment / diagnosis
- Jeff to raise the issue regarding lack of DHB consistency when it comes to current secondary referrals
Networking for Practice Development/ Change Facilitators
The HCH Collaborative continues to support the wider PHO network to share relevant resources to support general practices during the pandemic. To ensure that the resources are directed to those that are working directly with general practice we ask that details of your Practice Development/ Change Facilitators leads be passed onto email@example.com. There are opportunities to share learnings fast and gather resources that are needed - in particular clinical triage, telephone and video consults, payment option, ePs and financial modelling tools to support scenario planning. Please refer to the HCH Collaborative website that includes relevant links as well as some of the aforementioned resources https://www.healthcarehome.org.nz/hch-moc-overview.
MPS Seminar on Remote Consulting
Join Dr Samantha King for a discussion about the medicolegal considerations of remote consulting for doctors and other healthcare providers.
During this 30-minute interactive webinar, Dr King will explore the regulatory expectations and provide practical tips on how to practice this safely. She will also discuss MPS indemnity cover.
This webinar is available to Medical Protection members and has a maximum capacity of 1000 participants. Register now via PRISM
This afternoon’s CEO Meeting
- Keriana Brooking and Nick Chamberlain will be joining us
o Flu Vaccs
o Nationally Consistent approach to Secondary referrals
- Hazard premium for CBAC workers
Let me know if you have any other agenda items.
Ngā mihi & Kia Kaha
Update 30th March 2020
This morning’s update:
Apologies for the lateness of the comms today – I stayed in bed listening to the battering rain! Finally some relief for the parched fields, I hope you all get some relief from your hard work this weekend.
Outstanding Queries with the MoH:
MOH view of practices particularly solo GPs that may fall ill and the practice needs to close for a period, what stance on continuation of capitation?
UPDATE: Dr Nick Chamberlain, Lead DHB CE for Primary Care and Public Health, has agreed on behalf of all DHBs that capitation payments will continue to be paid during the COVID-19 pandemic if a general practice:
- needs to close and is unable to see patients face-to-face because their clinicians are isolating, or
- has had to cease services completely because their clinicians are sick and unable to even provide telehealth services.
Expired IMGs who are still in the country and wanting to work – expediting renewals – queried with the college, the hold up is Med Council – still waiting for update will raise with GPLF today. This query has not yet been answered.
From the network:
PPE guidance - Please find attached PPE Guidance which has been circulated to PHO Clinical Leads. This has been through infection control at MoH. Also attached a version from THINK Hauora, which has been through the Mid Central IC team.
Implications of Covid – thank you to Comprehensive care for providing the attachments on financial implications and FAQ on employment implications. These are not specific to any particular general practice, so please do encourage practices to get specific guidance for particular situations, but they may help in general.
Cash flow advice and applying for recovery assistance - Attached are two useful resources provided by the HCH collaborative for all to use, which may be useful for your practices.
- key information that Jess has developed to support comms around applying for recovery assistance
- Notes from Nicky Hart re HCH Cash flow advice and processes
Level 4 Guidance for Tangihanga/funeral – MoH poster advice on what to expect when a love one dies during level 4. Thanks to THINK Hauora for sharing.
Government Support Systems
Here is a short guide to the government support systems in place (thank you Fiona / Health Hawke’s Bay)
The government has out support systems in place to help with business that are effected during this time.
They criteria to apply for this funding is if your business has had a 30% decrease in turnover from the months January 2020 to June 2020 compared to this time frame in 2019. They can then apply and if they are successful they will be paid out for a 12 week period of $585 per staff member working 20 hours or more and around the $300 per staff member working less than 20 hours.
If the business applies they need to be aware they could be audit down the track and if it becomes that they weren’t eligible they may be required to pay it back. I have put some helpful links below 😊
Employer Application - https://services.workandincome.govt.nz/ess/employer_applications/new
Self Employed Application - https://services.workandincome.govt.nz/ess/trader_applications/new
The Clinic and Professional (paid) versions of doxy.me use Stripe as their payment gateway to process credit card transactions too. Stripe charges 2.9% + $0.30 per transaction. Here is some further information on the doxy.me payment functionality https://help.doxy.me/en/articles/2444816-payments-how-to-link-your-stripe-account . This Youtube video really simply explains the Stripe/Doxy set up and integration https://www.youtube.com/watch?v=15zlsB04qLM
Bryan Betty advised at our CEO catch up yesterday that whilst community pharmacies are not allowed to share their vaccines with general practice, this regulation is being over-ridden to allow for this, so please ask pharmacies for access to their supplies.
From MOH HCL have received an unprecedented number of orders over the last two weeks, and have been working hard to meet them. By the end of this week the entire first shipment of influenza vaccine into New Zealand will be in the community, and further shipments are on their way in the next couple of weeks. Most of this vaccine is still in providers' fridges, judging by claims and NIR data. As you note, some practices have run out of stock, and we are asking Immunisation Co-ordinators to work with practices and redistribute vaccine from those who have more than they need until the next shipment arrives into New Zealand. We would appreciate your support in asking your members not to stockpile vaccine - more than enough will be supplied to vaccinate our most vulnerable members of the community.
Influenza immunisation doesn’t normally start until April, and the flu season doesn’t normally start until late May, so we ask for people’s patience while our health system works through any backlogs. There will be more stock available in April, and we're working with suppliers to ensure that the next shipments are directed to those in greatest need. We attach for your information a table of vaccine doses supplied to DHBs, practices, pharmacies and other clinics by DHB, alongside our estimate of vaccines administered.
We have also had correspondence from members of the public who have been discouraged from getting vaccinated by their general practice on the basis that they are over 70 and should be in lockdown, or that they are unable to make bookings until May. While vaccine supply is an obvious barrier to the continuation of the seasonal influenza programme, practice capacity and awareness may also contribute in some cases. The Ministry of Health and Immunisation Advisory Centre have developed advice to the sector to enable it to carry out this priority health service safely. We attach it for your information, and invite you to pass it on to your members.
Maintaining the seasonal influenza programme is a priority for the Ministry and we hope with assistance from providers that it can continue in all areas over the coming weeks.
Pharmaceutical Society NZ
PSNZ has cleared access to all our pharmacy sector Practice Advisory notices and updates since set up in February. On the COVID 19 page on our website one can view the daily and weekly Updates as we continue through the month of April as well.
These notices interpret regulatory change and provide advice for pharmacists.
Just go to www.psnz.org.nz and click on the COVI19 Blue notice.
Please let me know if there is anything else you need from me. Here to help.
Ngā mihi & Kia Kaha
General Practice New Zealand
Level 4, The Willeston Centre, 22-28 Willeston Street, Wellington, 6141
Update - 26th March 2020
Queries from PHOs
A couple of comments updates:
Has anyone any suggestions for a workaround for telehealth / phone consults with the phone lines dropping out and bandwidth throttling?
- Messenger within facebook and Viber have been working but only if others have that device downloaded although note these are not officially secure.
Has anyone experienced a staff not willing to support the CBACs where asked - considering how this is managed when there is no health reason to not help so ideas welcomed
- Some staff that are elderly or have conditions are not prepared to work on the frontline, these staff have been assigned telephone triage. We had a GP owner advising he will not work during this time (elderly), we have supported this practice through surrounding practices picking up the patients and in return looking to have the rest of the practice staff support the other practice.
Is PHO an essential service?
- Yes, advice made to the PHO clinical leads was to keep ID with you and put a business card on your dashboard.
Outstanding Queries with the MoH:
These are the outstanding queries:
- MOH view of practices particularly solo GPs that may fall ill and the practice needs to close for a period, what stance on continuation of capitation?
- Expired IMGs who are still in the country and wanting to work – expediting renewals – queried with the college, the hold up is Med Council – still waiting for update will raise with GPLF today.
- Will pharma be rationed during level 4 – Awaiting advice from Bryan Betty/Peter Moodie
- Do clinicians need to be wearing scrubs in general practice? – Awaiting advice from Bryan Betty/Peter Moodie. Guidance coming out this morning re PPE.
Clinical Triage & Telehealth Resources Webinar (Zoom)
The session for GPs and practice managers was well attended with over 150 attendees for the webinar with Dr Andrew Miller, Dr Janine Bycroft and Ken Leech covering Telephone Triage and Telehealth resources in all general practices. Here is the link to the recording which is available to anyone:
PLEASE SHARE WITH YOUR NETWORKS - the feedback was great.
From HQSC on Advanced Care Planning with Covid-19
This is a Covid-19 response update from those at the Health Quality & Safety Commission working on advance care planning, the serious illness conversation guide and shared goals of care. We have been working with stakeholders and the sector to identify what we can most usefully do to support you in this unprecedented and rapidly changing situation.
New ‘Talking Covid’ webpages for health professionals live
- See hqsc.govt.nz/talkingCOVID for resources to help clinicians have conversations about what matters most to people and whānau, including Covid-19 diagnosis and treatment planning. The initial focus is conversations and planning in a hospital setting. We will work with the sector to develop resources for other health settings next.
- These webpages are now live. Please share widely with your colleagues. We welcome feedback on how they can be expanded and improved.
Key messages for consumers and whānau
- We are developing messages for consumers and whānau, which will be delivered through a variety of channels. We will share these messages with you in the coming days.
The College webinar on Sunday night was difficult to get in to. There is a link available to those who want to watch and Allan Moffit’s summary is attached.