Vol 2, no 64, 24 June 2009
 


Community based assessment centre for H1N1 patients

A flu treatment centre can be formed if necessary, now that the first confirmed case of influenza A H1N1 has been identified this week in Gisborne.

Tairawhiti District Health Medical Officer of Health Geoff Cramp hosted a meeting on Tuesday with primary health sector representatives and said TDH is ready to help.

“The primary care sector will need to be ready to free up clinic time as much as possible to increase capacity. If demand is too great or staff shortage has an impact then TDH is ready to offer help.”

Geoff said the virus is now freely spreading in our community like the rest of New Zealand and a flu treatment centre known as a Community Based Assessment Centre can be set up if necessary. 

“The aim for this is to take the pressure off primary care. It will be based in the Public Health Nurse clinical room in the Morris Adair Building and will be only for cases of flu.” To help assess demand we will contact GP practices twice weekly to see how the flu season is impacting, he added. 

“Tamiflu will be only for those that are very unwell or with other conditions, and we will develop strict clinical guidelines for its use with GPs. Tamiflu will be given to practices to be prescribed MPSO.”

Geoff said there is no longer any need for quarantining or isolating people or treating the contacts of cases. The containment stage is over and we have moved to the "manage it" phase. “This means that anyone with flu like symptoms should be managed as they always have been. The aim is for people to self manage at home and if the condition gets worse they need to contact their family doctor.”

“Of course the difference with this flu is that we do not know how many people will get it, how quickly, or if staff in a particular health care setting are going to be affected.” 

Geoff reminded general practitioners that there is a GP Helpline run by the Royal New Zealand College of General Practitioners on 0800 111 515.

Devolution of the Species

Devolution paper author Dr Fergus AitchesonTuranganui Primary Health Organisation wants your thoughts on picking up some hospital services after a call from the Health Minister to “step up” and show Tairawhiti District Health Board how it can help.

“There is no better time for primary care to show individual DHBs how you can help Boards manage acute demand,” said Health Minister Tony Ryall at a PHO Alliance meeting this month.
 
Kaiti Medical Centre GP Fergus Aitcheson has an interest in system design and health care economics and has given devolution serious thought. In a presentation to the PHO Board last week he suggested three local hospital services which could be targeted for devolution.
 
They are: Primary care management of anticoagulation services; suspicious skin lesions and minor surgery; and musculoskeletal injury and rehabilitation services.
 
“Gisborne patients have a lot to gain if we move more health care out of the hospital and into the community.” But it wouldn’t be without its challenges, says Fergus. It would be a “fundamental and important shift in the dynamics of the healthcare system and the three I selected illustrate a range of complexity”.
 
Minister Tony Ryall has given DHBs around $6.5 million this year and $13 million a year from 2010 to kick start devolving more secondary services to primary care.
 
He told PHO’s to expect DHBs to be in touch. “My expectation is that this year DHBs will engage strongly with you about how this can happen in your district and region, with specific devolution and delegated funding arrangements in place for the start of the next financial year.”

Turanganui PHO Chief Executive Keriana Brooking said by sharing Fergus’s paper today, she and the PHO Board hoped to stimulate thinking and receive feedback from individuals and relevant groups.
 
“Turanganui PHO recognises that the devolution conversation is an important one to be having within TPHO, and there is little point in engaging with the DHB before we have settled our position within primary care.”

“ I welcome all opportunities to discuss this with people involved in primary care, and look forward to hearing your comments.”

Turanganui PHO Board Chair David Scott said he was pleased with the paper presented as it fits the philosophy currently being discussed around the table at the New Zealand Primary Health Care Advisory Council “and it allows TPHO to move forward with positive workable clinically sound suggestions for discussion.”

TDH has confirmed it and Turanganui PHO have had some positive conversations regarding the devolution of some services but the details are still being progressed. “Both organisations are committed to making the process work” said a TDH spokeswoman. 

[Click here] to read Fergus’ paper ‘Service Devolution to Primary Care: A Briefing Paper for Turanganui PHO Board’.

A Starter for Three - Aitcheson

Fergus AitchesonA hospital physician for 20 years, a Kaiti Medical Centre GP for two years, and recently appointed Turanganui PHO HealthRight Clinical Advisor, Fergus has a unique insight into primary-secondary integration.

He says there are dozens of hospital-based services that could be considered for transfer to the community setting, and to stimulate thinking he selected three that illustrate the range of complexity of services which could be targeted.

Fergus says improving the patient “journey” through the healthcare system was the impetus for his paper. Common themes are minor and major changes to information systems, service locations, and staff expertise.

For example, he says implementation of a primary care based anticoagulation service could take place immediately given the existing capacity and capabilities within the sector.

Take a patient suffering a deep vein thrombosis (DVT). Currently ongoing treatment straddles the primary and secondary sector and a patient receiving oral anticoagulation with warfarin must negotiate multiple providers and wait for diagnostic results. The “hassle factor” is high for patient and practitioner.

Removing roadblocks for patients taking warfarin could begin with locating specialised blood testing machines in general practice, and training staff in their use. Known as Point of Care International Normalized Ratio (POCINR) machines, they are already being used successfully on the East Coast.

Devolution of the management of suspicious skin lesions and minor surgery into primary care would be slightly more complex. Changes to current practice might involve giving GPs training in dermoscopy, and having appropriate lesion removal and follow up care occurring in general practice.

Devolution of primary referred radiology and outpatient physiotherapy towards a musculoskeletal injury and rehabilitation service would be more complex again, says Fergus. “But possible, if there was a series of pilots and the process was clinically led.”

With the current “hum” around improving the patient journey, he says change in the sector is inevitable.
Turanganui PHO can step up and help organise itself, the DHB, and other providers in the district to ensure better care for patients.

 “Management of the devolution process and the contracts which emerge is a logical extension of the function of PHOs”.

[Click here] to read Fergus’ paper ‘Service Devolution to Primary Care: A Briefing Paper for Turanganui PHO Board’.

Minister Ryall on Devolution

Health Minister Tony RyallDuring his speech this month Health Minister Tony Ryall said progress for better integration of the primary and secondary care sector was lagging. The party’s catch cry is ‘better/sooner/more convenient’ for the patient,  and PHO’s that showed leadership and capacity are in line to receive funding for devolution projects.

The worsening economic situation and the uncertainty around future finances meant DHBs needed partners to help them deal with patient needs. “The Government is open to DHBs entering into arrangements with PHOs to better manage acute demand.” One advantage of devolution for DHBs was the unburdening of a system which is groaning under the pressure of workforce, capital, and funding shortages.
 
He said there is an important opportunity for general practice, for greater provision of more assessments and straightforward procedures currently restricted to the secondary sector.

Mr Ryall cautioned that only PHOs with appropriate skills, clinical leadership and capacity will be able to accept additional responsibilities and the delegated funded that will go with them.

3rd Generation Journo for PHOnetic

New PHOnetic journalist Helen Peterson

Third generation journalist and former Gisborne Herald reporter Helen Peterson has joined the PHOnetic editorial team.

Helen was at The Gisborne Herald for almost 17 years. With a passion for writing about people, Helen’s best work brought readers face-to-face with unsung heroes in feature-length personality profiles. She was a general and court reporter also.

“I love people and am always fascinated about what they do and why they do it. Over the years I have mixed with people from all walks of life and feel it is privilege to highlight a person’s  achievements particularly those that benefit the wider community.”

Helen is the daughter of long time Gisborne Herald news man and recently retired chief reporter John Jones. She was in Wellington last year when John received a Queen Service Medal for services to journalism and sport. Her grandfather, the late Jack Jones, was also a Gisborne Herald chief reporter  and sports writer.

“Writing has been an important part of my life so joining the Gisborne Herald after finishing high school in 1986 was just a natural progression. There was nothing else I wanted to do and I was fortunate enough to secure a job as a cadet reporter.”

When it comes to local research, interviewing and writing, Helen has a number of strengths. She produced many historical narratives about this district’s people and places for the newspaper, and regularly wrote the Daffodil Day supplements on behalf of the Gisborne East Coast Cancer Society.

She was locally schooled and has enjoyed interaction with a broad spectrum of the community during her years as a journalist.

“Her knowledge of this district’s families and passion for telling it like it is make her a valuable addition to the reporting team,” says PHOnetic editor Hayley Redpath.

When she’s not being a journalist Helen donates time to Tairawhiti Museum and Art Centre. She helps with updating computer archive information, proofing indexes, as well as assisting with  front desk duties. She says after years of being a reporter and making requests to the museum for information with short deadlines, she wanted to give something back. Helen is married to Farmer’s Air pilot Bruce Peterson and is mum to Connell and Anya.

Helen and Hayley are supported by photographer Brett Mead who is ex-Gisborne Herald and now runs his own successful company Brett Mead Photography.

 

 

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Virtual Clinics: Dr Robin Briant is prepared to visit any GP practice and spend time with a GP or nurse reviewing diabetic patients. It is not necessary for the patient to be present. If interested please contact Dr Briant by email robinb@tdh.org.nz to arrange a time. 

Tairawhiti District Health Board
meeting, Tuesday 28 July
, 10am, Morris Adair Building, Gisborne Hospital.

Community and Public Health Advisory Committee/Disability Support Advisory Committee meeting Tuesday 21 July, 12.30pm, Morris Adair Building, Gisborne Hospital. 

Hospital Advisory Committee
meeting, Monday 27 July, 10am, Morris Adair Building, Gisborne Hospital. 

Visit www.tdh.org.nz for all TDH meeting agendas. 

The PHOnetic is produced on behalf of Turanganui PHO by Redpath Communications Ltd with photographs by Brett Mead Photography.

 

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