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GP CME 2019 conference highlights


The NZMA GPCME is the largest GP conference in New Zealand with 1,200 delegates, approximatey 200 speakers over the four days and a packed agenda. Pinnacle MHN medical director Jo Scott-Jones attended, here's his reflections on the event.

The last time I went to a GPCME was about 10 years ago, I recall being overwhelmed by the number of concurrent streams and coming away with a feeling that this was death by a 1,000 PowerPoint slides, but an easy way to get CME points.

This event was far from that experience.

Great presentations, fantastic speakers, lots of opportunities to mix and mingle with colleagues from across the country. Sessions are interactive and GP focussed and all slides and notes are provided through the conference app. I came away from every session with great learning points in my bag (as well as heaps of pens and chocolates - for the kids, honest). 

You will find notes and summaries from the sessions on the  Pinnacle GPs closed facebook group and I am going to try and share some of those take home messages here.

During the final session of the GPCME conference in Rotorua  chaired by convenor Peter Chapman-Smith on Sunday morning Des Gorman challenged us not to wait for change to come to us, but to change the system from where we are now.

Quoting Eistein, Sartre and Voltaire (as you do) we were exhorted to stop expecting different results even though we keep doing the same things, because this is a sign of insanity. We have to acknoweldge the truth that we cannot choose not to choose to change, because that in itself is a choice. We need to make changes now, because although good changes may not be perfect, they are better than nothing.

And why do we need to change? Our system is broken - evidenced not least by inequitable outcomes for Māori.

I think the conference gave numerous opportunities to pick up some tools for change, and I didnt get a chance to go to everything.

I know the nurses and practice managers concurrent conferences had lots of sessions around the Health Care Home as there is a growing realisation that we need to do things differently, and practices around the country adopt the principles to inform the changes they need to make to create better acute care, improved proactive care, more effective routine care and business efficiency. 

I also missed out on the wonderful Dr Glen Davies talking about lifestyle medicine and the shared medical appointment model but know the feedback from those sessions was very positive. (You can also check out the Pinnacle step-by-step guide to shared medical appointments, login details here)

Clincal updates

A conference highlight was hearing Kerry Macaskill-Smith and Sam Mostafa talking about pharmacogenomics. If you haven't already signed up to the Pinnacle learning module about this now is the time!

This is a great tool to help underestand why a medication might be failing in a patient or producing more side effects than expected for the dose, and Pinnacle Ventures are bringing internationally accredited information about the impact of a person's gene profile into the prescribing decision - this is a fantastic additon to the armoury for GPs across the country.

Translating 20 years of evidence into daily practice is not easy but it's great to see this starting to be brought into mainstream medicine. Register for the online training by contacting dna@ventures.health.nz

Dr Rinki Murphy highlighted in another session the role that gender, body habitus and genetics may play in the prescribing decision around pioglitzone and vidagliptin in type two diabetes, and is seeking patients for a study that is going on now to explore this.

The ACC breakfast session on treatment injury was well attended - free food and a warm coffee always a draw card!

Treatment injury claims can take up to nine months to be decided, and the stress involved for the 40 per cent of people whose claims are declined is huge. Whilst the definition may be complex the ACC have produced a guide that can help us to help our patients to make an appropriate claim to ACC.

Heart failure treatment has a new tool in the tool box in a combined therapy Valsartan and Neprilysin "Entresto" - look for detailed information on the New Zealand Formulary. You need to have an echo before prescribing because it is only useful in patients with heart failure with reduced ejection fraction, which apparently is only 50 per cent of patients with heart failure.

We can, and should be trying, to cure all of our patients with Hepatitis C - look for them in some unlikely places - what we did in the sixties may have stayed inthe sixties, but now we are sixty it might be coming back to bite us.

You don't need to know the details of risky behaviour, but promoting Hep C antibody screening for all patients who have been at risk, and thinking about active hepatitis in people with unexplained symptoms and fatigue may be useful.

Pre-exposure prophylaxis for HIV infection has been around in New Zealand for just over 12 months now. It requires a special authority and recommendation from a specialist every three months, but for men who have sex with men who would otherwise not use a condom this is very effective therapy to prevent HIV transmission if taken continuously.

Condoms are the only way to protect against gonorrhoea, syphilis (which is growing alarmingly in New Zealand) and lovely jubbly things like warts - but PrEP seems to be being used and people are not using condoms - not a good idea.

Joint injections are easy-peasy according to the sports medicine specialists - "anything can be injected with a long enough needle and a strong enough arm" - there isn't a great online resource I know of for this but why not ask your local sports medicine or orthopaedic team for an education session?

I dont think the evidence is there to encourage patients to seek stem cell therapy for for OA yet, but it was fascinating to hear Dr Tom Grogan from the USA who has had lots of experience in this talking about his approach. 

Skin cancer is part of our daily bread and butter. I went along to the session about high risk skin cancers and came away with a desire to do more shave biopsies with a 50c blade available from EBOS and a plan to discuss Nicotinamide supplementation with patients who are at risk of SCC and BCC, and maybe even start taking it myself.

New skills

I attended a half day introduction to ultrasound in primary care run by Sonosite. This modality is clearly the next stethoscope. Just google #pocus (point of care ultrasound) and see what I mean. A session like this whets the appetite but clearly shows the value of more intensive training, currently the gold standard of which is the Otago University course.

We continue to work with Sonosite on a way to try and bring access to USS and good enough training closer to your home. Watch this space!

We are traditionally quite bad at helping people make lifestyle changes so I thought I'd attend another half day on the  healthy start workforce programme as it promised to help me maximise  time and impact to help patients create change. This session ended with profound personal lifestyle planning and clear illustrations of how a simple tool could really help. It was awesome!

Politics (there's always some!)

Kate Baddock gave a shout out to join the NZMA a vital cog in the medico-political wheel for GPs, and it is their conference so fair enough.

We heard how bad the New Zealnd workforce situation is and how badly the mental health system is doing, and then Dr David Clarke as Minister of Health told us that things are going to get better.

It's great to see a desire to support Te Tumu Waiora and other mental health initiatives in the budget, for those of us in rural communities it was really impressive to hear the things we have been banging on about for years rolling of the Minister's tongue - supporting rural students in rural areas throughout their undergraduate and postgraduate years, thinking about the spouse and family needs, considering the issues of capital investment for rural health services, making the job attractive.

Des Gorman was part of a session closing the conference and basicaly said "don't hold your breath" if you are waiting for ths system to change.

Antimicrobial resistance is one of the WHO top ten things most to fear about the future - and despite great intentions in New Zealand we are failing to properly address this issue which like climate change seems to be a clear and present danger that we are all hurtling towards without applying the brakes. This is an area that clearly illustrates the links between environment, animal health and human health and needs joined up approaches to address. Sadly in New Zealand the presenters told us, we have decided to split our planning between the MOH and MPI.

Choosing wisely may be part of the puzzle that we can adopt in primary care to help us to reduce the 50 per cent of antibitocs we prescribe that have no clear indication or purpose, but antimicrobial stewardship is only one part of the solution. Point of care testing with CRP, information for patients, and being confident that following guidelines will be supported by the NZMC when the s**t hits the fan may be part of the answer. I would be interested in your opinion.

The Medical Protection Society led a great workshop on avoiding adverse outcomes, but having attended a few of their workshops around the country these are a great resource for all GPs. 

Some simple tips and tricks

  • Communicate well - be personable, make eye contact, make a human connection, don't interrupt, summarise, use closed loop communication, watch your body language and be careful about using humour in the consultation.
  • Manage your results - have a policy and stick to it, always tell your patients about significant results,  you don't have to tell them of every normal test, but you need them to know how to find out results, have a recall system to chase up results that you dont want to go astray.
  • When dealing with a complaint - ask the MPS early for advice and from personal experience they are great at providing it. Oh and keep great notes.

Will I be back at conference next year? Yes.

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