No images? Click here Kia ora koutouThank you for all the work you are doing to keep the primary health care system running and your dedication to keeping our communities safe and healthy. This edition contains information on:
Thank you to all the contributors for adding in your items. If you would be interested in contributing in the future, please email kenya.leong@health.govt.nz. COVID-19 vaccine and immunisation programmeTrainingThe immunisation Advisory Centre (IMAC) is launching COVID-19 vaccine training for general practitioners (GPs) this week as well as a refreshed COVID-19 educator training module for vaccinators. IMAC has also begun a train the trainer programme supporting the current immunisation workforce with information to support their teams in training later. IMAC is also hosting a range of webinars and weekly drop-in online Q&A sessions to share what we know on COVID-19 vaccines and the rollout with health professionals. Upcoming topics include: IMAC is also hosting a range of webinars and weekly drop-in online Q&A sessions to share what we know on COVID-19 vaccines and the rollout with health professionals. Upcoming topics include: IMAC is also hosting a range of webinars and weekly drop-in online Q&A sessions to share what we know on COVID-19 vaccines and the rollout with health professionals. Upcoming topics include:
Find out more and register here. Keep an eye out for a COVID-19 vaccination discovery course that will be freely available on the IMAC website to help orientate people on key aspects ahead of the full training being widely available for vaccinators. In addition, IMAC is developing a new COVID-19 website which is expected to be available shortly. WorkforceA number of allied health professions have been cleared to be included in the vaccination workforce. Health regulatory authorities have advised that Physiotherapists, Occupational Therapists, Medical Science professions (Medical Laboratory Scientist, Medical Laboratory Technicians, Medical Laboratory Pre-analytical Technicians and Anaesthetic Technicians) and Medical Radiation Technologists professions (Medical Imaging Technologists, Radiation Therapists, Nuclear Medicine Technologists, Magnetic Resonance Imaging Technologists and Sonographers) are able to vaccinate within their current scope (with appropriate training). Our Surge Workforce database for people who have previously been regulated health workforce and who want to register their interest in being involved in the vaccination programme delivery has risen to around 5000 people. We do need more vaccinators – but please remember this database is for people not currently in the health workforce but willing to be involved in the roll out, especially in the second half of the year. If you know of anyone who might be interested please ask them to complete the registration of interest form. COVID-19 community clinical advice lineOn behalf of the Ministry, the National Telehealth Service is providing a COVID-19 clinical advice line available for primary and community health providers including general practice, nurses, pharmacy and midwives. The service offers clinical support and advice Monday to Saturday 8am -7pm (with the exception of public holidays). The helpline is staffed by primary care nurses and general practitioners. Most calls are managed by a nurse, with a GP available at all times to provide specialist advice. Other professionals such as midwives and dentists are available to answer questions as required. The helpline offers general advice about management of COVID-19, peer review of presenting problems and advice on specialist referral or connection to other services. Having a dedicated number ensures that community clinical staff can access advice from peers. Please note, as this number is not intended to be accessible nor visible to the public the 0800 number has been circulated directly to stakeholders in New Zealand, if you have not received the 0800 number, please email Kimberly at Kimberly.Leuila@health.govt.nz to get access. Immunisation updatesCo-ordinating COVID-19 vaccination with other immunisation programmesThank you for continuing to focus your efforts on reaching as many 15-30-year olds for measles, mumps, rubella (MMR) as part of the measles immunisation campaign. MMR and influenza continue to be important priorities for the National Immunisation Programme and we hope the following advice will be useful in progressing these before COVID-19 vaccines become available to the general public. For more information on immunisation updates, click here. Advice from Ministry of Health on administering MMR and the COVID-19 vaccine to Tier 1 workersWe recommend having a four week gap between receiving the MMR and the Pfizer COVID-19 vaccine. There may be an overlap between the 15-30-year olds targeted by the MMR immunisation campaign and people working at the border or MIQ facilities and their household contacts who are eligible for the first roll-out of COVID-19 vaccine (Tier 1 workers).
Eligibility for the first roll-out of COVID-19 vaccineThe people who are eligible for the COVID-19 vaccine during the Tier 1 roll-out are covered by the current Required Testing Order (2020). This means they’re currently undergoing mandatory testing as a result of their employment and are considered most at risk of exposure to COVID-19. These people know who they are. Their household contacts are also within the first phase and will know that the person they live with is going through mandatory testing – or will be informed by the worker. The current Pfizer COVID-19 vaccine cannot be administered within two weeks of an influenza vaccine, or four weeks of any other vaccine. Having a gap between two different vaccinations makes it easier to judge which vaccine may be responsible for any adverse events. This is important in the current context because the COVID-19 vaccine is new. To find out more about eligibility, click here. Sequencing of COVID-19 and influenza vaccinesThe Ministry will be developing vaccination plans with providers that take into account the current recommended spacing of at least two weeks between receiving a Pfizer vaccine COVID-19 and an influenza vaccine, shown in the following example schedule: To find out more information about sequencing of COVID-19 and influenza vaccines, click here. Information for primary care: Reminder of the process when requesting an emergency ambulance response from St JohnPlease refer to the information below for primary care personnel when requesting an ambulance response from St John. Key points:
More information about requesting an ambulance response from St John, including the request template, is available here. If you have any questions or queries, please contact Kris at St John directly, at kris.gagliardi@stjohn.org.nz. Thanks for your help and support. Kris Gagliardi Assistant Clinical Director St John News from the National Screening UnitThe National Screening Unit (NSU) is within the Ministry and is responsible for the development, management and monitoring of national, population-based screening programmes. The following is a snapshot of current projects and future plans for each of our screening programmes. Find out more about the NSU here. Antenatal and newborn screeningThe Universal Newborn Hearing Screening and Early Intervention Programme (UNHSEIP) has just turned ten years old. Since it began in 2010, the programme has changed the lives of many children and their families and whānau. When the programme first started, the average age that hearing loss was identified was 14 months. Today, it’s around 5 months. Each year, around 135 babies are born in New Zealand with mild to profound permanent congenital hearing loss. By identifying problems early it means they can get timely help with language, learning and social development. The programme’s 10 year milestone will be formally celebrated in May. A new best practice - Newborn Metabolic Blood Spot Collection e-learning module has been developed for midwives and other health professionals. Read more here. Bowel screeningThe National Bowel Screening Programme (NBSP) is in the last year of implementation. The phased rollout began in July 2017, after the successful Waitemata pilot, and now 15 out of 20 district health boards (DHBs) offer the programme to more than 70 percent of eligible New Zealanders, aged 60 to 74. As a result of the pause in the programme, due to the COVID-19 response, invitations in screening DHBs are running around two months late. The five remaining DHB’s (Capital & Coast, West Coast, Taranaki, Northland and Bay of Plenty) are expected to join the NBSP by the end of 2021. The Ministry continues to actively look at options for lowering the starting age for screening for Māori and Pacific peoples to address equity issues. More about the National Bowel Screening Programme can be found here. Breast screeningBreastScreen Aotearoa (BSA) requires women to enrol in the BSA programme and we appreciate the important role primary care plays in encouraging women to do that. Improving access to screening services for wāhine Māori and Pacific women is a priority focus for BSA. Recently we have changed the online enrolment form so that an email address is no longer mandatory. This was reported to be a barrier. Breast screening providers are working to catch up on approximately 28,000 screening appointments which did not occur during the COVID-19 Alert Level 4 suspension of services. Prior to COVID-19 BSA had achieved its 70% coverage target. The impact of COVID-19 has seen coverage reduce, as per the table below. The effect of the equity gap is especially significant because rates of breast cancer are higher for wāhine Māori than for non-Māori. More wāhine Māori and Pacific women die from breast cancer than non-Māori non-Pacific women, however wāhine Māori who have their breast cancer detected through screening have the same outcome as non-Māori. Lead providers are making good progress on catching up but in most areas it is expected to take up to a year. Providers are prioritising wāhine Māori and Pacific women when scheduling women for screening appointments. They will also be working collaboratively with stakeholders to develop screening equity plans to achieve further improvements. Find out more about the BSU here. Cervical screeningPrimary health care providers, support to screening services and National Cervical Screening Programme (NCSP) services have all been working hard to support women to return to screening. This is after routine screening services resumed in June 2020 after a pause due to the COVID-19 level 4 lockdown. While recovery rates are encouraging, screening rates amongst wāhine Māori and Pacific women have been disproportionally affected. To prevent equity gaps widening, the NCSP has secured additional funding which will focus on encouraging Māori and Pacific women to be screened. This will include a social marketing campaign, following on from the successful ‘Start to Screen’ campaign, to encourage a broader age range of women (25-69) to book their test. The Ministry remains committed to introducing human papillomavirus (HPV) primary screening and self-testing as international evidence convincingly shows it is the most effective test. More on this issue can be found here. Influenza immunisation programme 2021You can now find information about the 2021 influenza immunisation programme on the Ministry's website. This year, the programme starts 14 April for people aged 65 and over, with PHARMAC funding an additional vaccine, FLUAD QUAD for this group. From 21 April, vaccination can be extended to all groups of people eligible for funded Afluria Quad and Afluria Quad Junior vaccinations, and then to the general population from 28 April. The Ministry has worked closely with its partners to give immunisation providers more reliable access to the influenza vaccine. The later than usual start date is based on delivery dates, and to ensure there is plenty of vaccine available to meet demand from the start of the season. Information about groups eligible for a funded vaccination is available here. We will work with IMAC and our sector working group to produce and distribute information for the public about influenza immunisation closer to the start of the programme. If you require further information or if you have questions, please contact us at influenzaimmunisation@health.govt.nz Updates from the Long Term Conditions TeamNew appointmentsCarmela Petagna – Manager, Long Term Conditions My name is Carmela Petagna, the new Manager, Long Term Conditions, within the Population Health directorate at the Ministry. I stepped into the role in mid-December 2020 and am eagerly building a deeper understanding of where our efforts need to be to improve equitable outcomes across the continuum of long term conditions. Especially, how we translate what we are learning through COVID-19 and its impact on those managing these conditions. I'm keen to make sure our team provides the very best leadership, influence, advice and support possible to advance improved outcomes for people experiencing long term conditions, including (and not limited to) diabetes, cardio-vascular disease, stroke, asthma/COPD (chronic respiratory disease) and gout. This will require us to engage at all levels – from system levers and enablers, to prevention and management; prioritising equity, integration and consumer engagement. These are important pillars that have guided my involvement in primary care quality improvement programmes, in my previous role at the Health Quality & Safety Commission. I have a passion for bringing people and organisations together, working collectively within our respective spheres of influence. This will apply both internally at the Ministry of Health, and externally with other partner agencies and stakeholders. You will be hearing from us more regularly - stay tuned! Ngā mihi nui Carmela Sue Tutty – National Clinical Lead, Diabetes I grew up in Wairoa, Northern Hawkes Bay and, after completing Part 1 GP training, returned there to work in rural general practice with my father for four years. My family then moved to Sydney where I worked for 5 years before returning to New Zealand and working for Tamaki Health in Otara for over 20 years. I continue to work there one day a week. In 2000 I became a fellow of Royal New Zealand College of General Practitioners (RNZCGP) and in 2012 completed a M.Med Sci with first class honours. In 2015 I got a position at Counties Manukau Health as a GP Liaison and continue to work in this role 3.5 days a week with interests in diabetes, women’s health and advance care planning/end of life care. My additional roles are Chair of the Auckland faculty of RNZCGP and on the RNZCGP National Advisory Council, the National Maternity Monitoring Group and the Maternal Mortality Review Working Group of the Perinatal and Maternal Mortality Review Committee (PMMRC). I have five children and one grandson. Over my years in general practice I have seen the impact of long term conditions on the lives of people with diabetes and their whānau. Taking up the role as Diabetes Clinical Lead for the Ministry of Health is an exciting opportunity to promote health equity and quality improvement. Te Tiriti o Waitangi needs to be central to all of this work. I look forward to the opportunity to be involved in developing new strategies and models of care that have the potential to improve outcomes for people with diabetes. It is a time of change with the Health and Disability System Review, a relook at the Living Well with Diabetes strategy and new diabetes medications becoming available. There is much to be done at multiple levels: improving cultural understanding, the health literacy of health professionals as well as consumers, providing opportunistic care, combating clinical inertia and encouraging team based care, to name a few. I am keen to learn what others see as the important issues for people with diabetes, what is happening all across New Zealand, the issues other DHBs are struggling with and what they have found useful; and working towards a model of care that will lead to improved outcomes for people in New Zealand with diabetes. For any enquiries about the Long Term Conditions team, please contact the Programme Manager Vivienne at vivienne.stanley@health.govt.nz. New diabetes medications funded by PHARMACPHARMAC has approved funding for two new medicines with substantial health benefits for around 53,000 New Zealanders with type 2 diabetes. Funded empagliflozin (with or without metformin) became available in New Zealand from 1 February 2021. Funded dulaglutide will become available if it obtains MedSafe approval. Evidence suggests these medicines do more than just reduce sugar levels in people with high-risk type 2 diabetes. They can also help manage type 2 diabetes-related complications like kidney and heart disease in people who are at high risk of these complications. PHARMAC decided to specifically name Māori and Pacific peoples within the Special Authority criteria for these medications – a win for equity. This is the first time that this has been done. PHARMAC’s Chief Executive Sarah Fitt said, “This was an intentional move to proactively promote equity of access to these treatments for population groups who are at high risk of complications of type 2 diabetes and for whom there is direct evidence of inequities in access to medicines.” You can find out more about this decision to fund two new medicines here. Health professionals can refer to the updated diabetes guidance by the New Zealand Society for the Study of Diabetes for best practice advice on how to prescribe these medications here. Type 2 Diabetes Management Guidance update With the support of the Ministry, The New Zealand Society for the Study of Diabetes (NZSSD) has developed national, up to date, and evidence-based guidance for the management of type 2 diabetes in adults. The guidance is designed as a concise pragmatic resource for all health professionals working with people with type 2 diabetes in New Zealand and will continue to be updated as evidence and practice changes. Dr Helen Snell, President of NZSSD says, "The update is timely as it is almost a decade since the last guidance was released in 2012, and clinical guidance on the appropriate use of the ‘new’ diabetes medicines being funded by PHARMAC from 1st February 2021 was required." The updated guidance is available on the NZSSD website. Release of new CVD risk calculation toolIn early March 2021, the Ministry will make available the national Cardiovascular Disease (CVD) risk calculation tool. The tool will enable identification and accurate assessment of people’s CVD risk, which is an essential first step in appropriately managing disease and improving equity of outcomes in CVD. The tool will be available free of charge. Primary care providers have previously indicated they wanted a CVD risk calculation tool that was able to seamlessly integrate with their patient management system (PMS), and the tool being provided will be able to be integrated, by PMS providers, to look and feel as though it is part of the locally used system. The Ministry has adapted a cardiovascular disease risk assessment calculator that was initially developed by WellSouth Primary Health Network for people in its region. We’ve purchased this tool and contracted DataCraft Analytics, who initially developed the tool for WellSouth, to adapt it for use nationwide. Cardiovascular disease causes ten thousand deaths in New Zealand each year, and almost 1 in 4 of these deaths could be avoided. The burden of cardiovascular disease falls unequally in New Zealand with those most affected being Māori, Pacific peoples and South Asian people, people on low incomes and people with severe mental illness. The availability of this CVD risk calculation tool is an important step towards improving heart health across New Zealand. Subscribe to Health and Disability System Review Transition Unit updatesAs you may be aware, the Health and Disability System Review/Hauora Manaaki Ki Aotearoa Whānui has been presented to the Government. The Government has started the process to consider the recommendations and to shape its thinking on next steps. As part of this process, a Health and Disability System Review Transition Unit has been established within the Department of Prime Minister and Cabinet to lead this work and will provide updates on progress. If you would like to be kept informed about the Transition Unit’s work, you can email: enquiries.tu@dpmc.govt.nz with the subject line "Opt-in to Transition Unit updates". Please note that the current health system settings remain in place until the Government has made decisions on Health and Disability System Review implementation and the reforms are in place. Updates from the National Ethics Advisory Committee (NEAC)Release of NEAC's publication Ethics and Equity: Resource Allocation and COVID-19Last year the NEAC publicly consulted on an ethical framework for resource allocation (the Resource Allocation Framework). NEAC sought feedback on: 1. Whether the draft Resource Allocation Framework:
2. The Te Tiriti principles and their application to resource allocation decisions. 3. Any further comments and suggested changes for NEAC to consider for the final draft. After reviewing and incorporating feedback, the final copy of the Resource Allocation framework has been completed. We would like to thank those you who contributed feedback and perspectives and advise that the framework is now available on the Ministry's website. Your responses were thoughtfully articulated and detailed, with a wide range of views and valuable insights into the circumstances that informed the different views and experiences of clinicians, decision makers, health consumers and whānau. You can view the final version, along with a summary of submissions received with permission to share on the NEAC website at: NEAC understands that resource allocation affects everyone in society, and would appreciate if you can forward this newsletter to anyone you think might be interested in the publication. Upcoming NEAC workNEAC is the author of the 2007 document 'Getting Through Together: Ethical Values for a Pandemic’ (Getting Through Together). Getting Through Together considers the ethical issues which may arise during any pandemic. NEAC is currently starting a substantial review of Getting Through Together, which will build on the work done to develop the Resource Allocation Framework. NEAC believe that Getting Through Together needs to be updated for two reasons. The first is to consider ethical issues not covered by the 2007 document, including the use of digital technologies, specific guidance on public health interventions essential in the elimination strategy to deal with COVID-19, the impact on routine standards of care, and consideration of equity. The second relates to the structure of the document. The target audience of a pandemic ethics document is broad, and includes decision-makers making and implementing policy, as well as members of the community. The aim is to create clear and easy-to-navigate guidance able to be used across a number of interested groups. We welcome any feedback on Getting Through Together at neac@health.govt.nz. Also any experiences of utilising Getting Through Together in the primary health sector during 2020, that might be relevant to a re-write of this document. Reduction in blood lead notification levelThe current level before the public health unit is notified is 0.48 (or greater) micromoles (a blood lead level measure) per litre of blood (µmol/l) is to be reduced.
The notification process is triggered when a person returns a blood lead test that shows an elevated blood lead level. If the results of the blood test meet or exceed the notification level then the health practitioner (or medical laboratory) reports this to their to their local medical officers of health for further follow-up. This allows the source of the lead exposure to be identified and health risks managed.
The most common source of lead exposure in a household setting is from lead-based paint that was used on older houses. Over time such paint can deteriorate, or be removed in renovations. If not managed properly people can be exposed to it. To find out more information about lead poisoning, symptoms, prevention, and lead notifications, click here. Latest Ministry newsletters
All Ministry newsletters are on our website here. SubscribingIf you don't wish to receive this newsletter, please unsubscribe using the link at the end of this email. You're welcome to share this newsletter with anyone who would find it useful or interesting. They can subscribe on the Ministry of Health website. Primary Health Care | Ministry of Health - Manatū Hauora |