The following updates are provided by Hauora Tairāwhiti GP liaison Anna Meuli. Anna works 0.2FTE in this role (Thursday and Friday mornings) and can be contacted at firstname.lastname@example.org.
Te Kuwatawata contact
The team really appreciate when GPs take the time to call in a tono (referral). But please do not give the red phone number to whānau, this is a referral line for GPs only. Whānau are welcome to use the reception desk 868 3550 number.
Syphilis and STI screening
It is the party season, and syphilis rates are still on the rise. Please be mindful that current sexual health guidelines suggest ALL people having a routine STI test should have a blood test done for syphilis serology and HIV. Many patients with syphilis are asymptomatic, and have not had 'high risk' exposure. Please discuss in your practice team how to ensure all patients have appropriate testing initiated and followed up. Here is a summary of recommended sexual health checks and specific information on syphilis management. We are hoping to have an education meeting on syphilis this year.
Direct access to colonoscopy
The service specific referral form for direct access to colonoscopy has been available on BPAC e-referrals since 2017. This is not currently being widely used, but the surgical team would like to move to using this for all symptomatic and surveillance colonoscopy referrals. It ensures the appropriate criteria for direct access are met, and enables equitable triaging of referrals. It has useful information such as links to who fits surveillance screening criteria and it will self-populate what the referral urgency is based on your patient's symptoms. This means you will be able to accurately let your patient know the expected timeframe for their procedure. There is a free text box for any extra information that will help with triage, and for those where the need for colonoscopy is uncertain, an FSA can be arranged. There is also a link on the front page as to the criteria for direct access to colonoscopy which contains useful information about which patients may be more suitable for CT colonography if elderly or frail. Please always remember to discuss the procedure with your patient and ensure they want to proceed before sending the referral (recently there have been several patients who have declined to come for the procedure after being booked. This unfortunately wastes valuable resource). Please let me know if any questions or issues with the form.
Update on GP requested ACC CT scans
There has been confusion recently around the longstanding rule that GPs can not directly request a CT scan in an ACC patient. While GPs, ED, hospital specialists and radiology can see circumstances where the GP may be the best placed to order the scan and deal with the results, after discussion with ACC the rule is firm - no CT requests from GPs will currently be funded. If you have a patient who has an acute injury and you suspect a CT may be needed, please refer them to ED for further evaluation. The ED doctor involved will make the decision as to whether a CT is warranted (they request respectfully you do not set the patients expectation that they will definitely be getting a scan. There have been circumstances where the ED has said a CT is not necessary and the GP has tried to refer for one after this, which causes confusion and difficulty for all). If the symptoms have changed or you have further information that the ED was not aware of, you should refer to ED for reassessment with this information, but the decision to order a scan is still made by the ED team as they feel appropriate. If it is an old injury and non-urgent, please refer the patient to the appropriate outpatient specialty (such as orthopaedic) for assessment. All hospital specialists and ED doctors will also be reminded of this rule to ensure there is no confusion when you are trying to refer patients.
ACC is making some changes to high tech imaging access for GPs, this involves direct access to MRIs for patients who meet certain criteria, where the GP has undergone the appropriate training to be accredited to order musculoskeletal MRIs. This training will be arranged in Gisborne for March 2019. There are no current plans to include CT in this access.
Well Stop Service
This is a free service that provides child, youth and family wellbeing counselling. They have a focus on sexual abuse counselling and give priority to these referrals. However they also offer generic counselling services and referrals for other behavioural/emotional concerns are welcomed. ACC referrals can be done by phone or email, the referral itself is completed by the client at first appointment.
For family wellbeing (whānau support, brief intervention counselling) and also crisis counselling, people can self refer or be referred by an agency/professional, referral form attached. Their team includes:
They are happy to provide advice or discuss referrals over the phone during normal business hours. Contact Andrea Haisman for any enquiries on 027 531 1811 or email@example.com. Andrea is available from 21 January to come and talk about the service if your practice is keen to know more.
Hepatitis C update
There has been a pharmac announcement to fund a pangenotypic treatment for hepatitis C from 1 Feb 2019. This drug can treat all genotypes in an eight week treatment, so provides a real opportunity to eradicate hepatitis C. Hepatitis C testing and treatment pathways are being updated to reflect this, I will keep you updated when available.
There has been significant progress in catching up on the backlog of referrals. From 700 who were awaiting first appointments, all but 75 have now been allocated an appointment. The rest will be booked in the new year, and there will be a focus on catching up on those awaiting follow up appointments. Around 200 patients were discharged following phone triaging. You and the patient will have received a letter to notify of discharge and the reason. Please continue to provide good detailed information for all new referrals so the patients can be triaged appropriately.