Increasing the Dose of Services for General Practice with Clinical Pharmacists making a Difference for Communities – Spotlight, Waikanae Health

Over the past few years, Tū Ora has been supporting General Practice through a variety of roles to diversify the offering of services enrolled patients can access. This has been for a variety of reasons, and one of those key roles has been that of the Clinical Pharmacist who has been supporting several practices in the Greater Wellington region. The team caught up with Clinical Pharmacist Hilary Krebs, to talk about her role and the difference it’s making to the patients out at Waikanae Health.

Clinical pharmacists work in general practice to support other clinicians in optimising medicines according to best practice and to support patients with their medications, including improving understanding of their benefits and adverse effects, reducing medication waste from patients not taking their medication and improving self-management with medications. 

Clinical Pharmacists who have completed a postgraduate prescribing course can optimise medicine therapy by prescribing medications for patients, particularly for long-term conditions. The unique value-added aspect of clinical pharmacists and pharmacist prescribers is the specialised in-depth knowledge and understanding of pharmacotherapy which is used to reduce drug-related morbidity and mortality and achieve the best possible medical health outcomes.

Hilary Krebs is a Clinical Pharmacist who has been with Tū Ora for 20 years after previously working as a primary care pharmacist in the UK.

She has been supporting the Kāpiti community at Waikanae Health for more than 10 years and has become an asset to the practice. In 2021 she completed the pharmacist prescribing course and has since extended her prescribing area over the past 12 months to allow her to manage long-term conditions including diabetes, cardiovascular disease, gout asthma and Chronic Obstructive Pulmonary Disease (COPD).

“I began working at Waikanae Health in 2013 and feel I have become an integral part of the general practice team and a trusted face in the Waikanae community. I enjoy being able to support patients with their medication needs and being able to build that rapport with patients, many of whom have not previously engaged with general practice. This has helped improve our equity outcomes at the practice, with more people accessing services and taking control of their conditions, helping them to live well and live longer” Mrs Krebs said.

READ MORE HERE

Changes to General Practice services   

Kia ora 

You may be aware that NZ faces a severe shortage of medical personnel and also a health funding crisis. This has a significant impact on how General Practitioners (GPs) are able to deliver services. Waikanae Health has had a number of doctors retire or move away, and we have been unable to find replacements. This puts enormous strain on our remaining workforce. This GP shortage necessitates changes in how we operate to maintain the best possible care to you in a sustainable fashion.  

Waikanae Health is a Healthcare Home practice: 

This model aims to deliver the right type of patient care at the right time and delivers care by the most appropriate healthcare worker. This way of working has already been in place in our Urgent Care Unit for several years. We will be applying this model to unplanned and planned care in the near future.  

Triage and appointment scheduling:  

To better understand your medical need, we request that you communicate the reason for your visit to reception when booking. This information is critical to ensure you are booked with the most suitable clinician. Your privacy will be maintained.  

Improved range of clinicians:   

Despite a dwindling number of GP’s, we have employed a team of non-doctor prescribers who all offer different specialist skills and expertise. Nurse practitioners, nurse prescribers, pharmacist prescribers and a number of other healthcare workers now form part of our workforce.  

Urgent care unit wait times:  

We understand that your time is valuable, however, Urgent Care Unit appointments are an approximate timeslot only. The nature of urgent care is that the sickest patients are prioritised and there often is a wait. Your patience and understanding will help as we work to provide the best urgent care with limited resources. We will inform you if wait times exceed 30 min. 

Limitations on what can be managed in a Consultation:  

Content: Patient safety is our top priority. Our clinicians can usually only effectively address up to a maximum of two medical issues in a single 15-minute consultation (depending on the complexity).  

If you have more than two concerns, please make another appointment or consider booking a double appointment to allow for a thorough evaluation. We cannot safely deal with lists of problems.  

ACC claims:  Any injury requiring a new ACC claim to be lodged or a certification done needs a separate, full appointment. ACC issues can no longer be addressed in the same consultation as routine care. 

Charges for work done outside of consultations:  

Workforce shortages across NZ healthcare has resulted in an ever-increasing workload on our team. Many hospital services have now simply been shifted onto General Practice.  

This includes the monitoring of blood results and repeat prescribing of medications previously managed by hospital doctors.  

Inadequate funding and GP shortages to manage this increasing workload has regrettably forced us to start charging for all work that takes place outside of a consultation, including work generated by outside parties.  

Management of results, shared care agreements and work devolved to General Practice by hospitals and requested by third parties  

We will now charge fees for the interpretation, notification (Follow-up phone calls/ emails) to communicate results of investigations. Previously we would have arranged a consultation for this. (This includes results ordered in consultation by us and those requested by others).  

There will also be charges for referrals, work shifted onto us by hospitals or private specialists, requests to have forms completed, requests for special authorities from pharmacists and similar requests.  

Previously we were able to sustain the workload by charging a fair consultation fee when you were seen. The government has both underfunded General Practice and restricted our ability to charge fairly for our consultation services for the last 6 years. Regrettably we now have to pass this cost on. We encourage you to discuss charges that may apply before requesting services or requesting that your results are copied to us. If we really need to see your results, we can log into the lab or hospital system.

 

Cost of Health Care 

We understand that many New Zealanders are facing financial challenges, and your well-being is our top priority. To support you during these tough times, we are actively exploring the introduction of flexible payment plans and subscription options. Our goal is to make healthcare more accessible and affordable while maintaining the highest standards of care. We are committed to ensuring that your health needs are met without added financial stress. We will keep you updated on these options as they become available. Thank you for entrusting us with your care, and please don’t hesitate to reach out if you have any questions or concerns. 

Prescription and certificate charges 

The same drivers have necessitated some changes into how we handle prescription requests. 

Additional fees also apply to: 

Requests for a prescription on the same day – 

Prescriptions previously issued by hospitals and private specialist that have not been captured on our system and requires to be added due to changes in their operating environment in addition to existing repeat prescriptions, and special authorities arising from those prescriptions. 

Items not previously prescribed by us, e.g., antihistamines or painkillers that would otherwise be available over the counter at the pharmacy. 

Updated Prescription charges:  

Child under 14 Years 

One item (non-repeat)– $6.00 
3 monthly (repeat)
– $6.00 
Urgent charge (may apply if required in less than 4 working days)
– $15.00 
Immediate charge (same day service)
– $20.00 

Adult Non-CSC Holder 

One item (non-repeat)– $25.00 
3 monthly (repeat)
– $30.00 
Urgent charge (may apply if required in less than 4 working days)
– $45.00 
Immediate charge (same day service) –
$60.00 

Adult CSC Holder 

One item (non-repeat)– $20.00 
3 monthly (repeat)
– $20.00 
Urgent charge (may apply if required in less than 4 working days)
– $35.00 
Immediate charge (same day service)
– $50 

 

Changes to Long term Opiate prescribing  

Cabinet has recently amended the Misuse of Drugs Regulations  

Opioid drug prescriptions have reduced from a maximum limit of a 3- month supply to a ONE MONTH supply. This includes Class C opioids (e.g., codeine and tramadol; previously exempt) now limited to one month supply at a time. 

To reduce financial hardship because of this change on patients who require long-term opiates we will reduce the prescription charge for single repeat opiate prescriptions to $15.00. (NB: This only applies to patients previously stabilised on a fixed regular dose and not for one off prescriptions.) 

Laboratory Services Notice: We want to inform you about further industrial action by Awanui Laboratories (formerly Wellington SCL) from 16 October to 27 October 2023. Local collection centre opening hours will be affected by this:  

16 – 22 October 2023 

Waikanae  

Mon 8am-4pm Tue 8am-4pm Wed 8am-1pm Thu 8am-4pm Fri 8am-1pm 

Paraparaumu  
Mon 7.30am-4.30pm Tue 12.30pm-4.30pm Wed 7.30am-1.00pm Thu 12.30pm-4.30pm Fri 7.30am-1.00pm 

23 – 27 October 2023 

Waikanae 

Mon Closed Tue 8-4pm Wed 8am-1pm Thu 8-4pm Fri 8am-1pm 

Paraparaumu  

Mon Closed Tue 12.30pm-4.30pm Wed 7.30am-1.00pm Thu 12.30pm-4.30pm Fri 7.30am-1.00pm 

 

We understand that the changes in the practice may be inconvenient, but we are committed to ensuring the safety and well-being of our patients and the viability of our practice. We appreciate your cooperation and understanding as we navigate these challenges. 

We are happy to discuss any questions or concerns. Your health is our priority, and we are here to support you during this time of transition. 

Thank you for entrusting us with your healthcare needs. 

 

Nga Mihi  

Notification: Telehealth Services, Radiology Services and Medical Staff Shortages 

Radiology 
Waikanae Health has been informed that Pacific Radiology’s Paraparaumu branch will be closed temporarily from 9 October 2023, for eight weeks. This is to allow installation of a range of advanced imaging equipment that will improve access for Kapiti residents. Patients may be directed to their other branches or other providers. They recommend that appointments should be booked for non-urgent services.  

Team Medical has an X-ray facility with limited capacity. This is open from 8.30 am to 3 pm during the week. They require patients to book appointments on 04 297 3000 themselves. (Waikanae Health does not have the capacity to phone and book everyone’s appointments.) Other providers are available in the area but are already heavily booked. Please expect delays, or expect to travel to Porirua, Wellington or even Palmerston North. 

 

Telehealth After Hour Service 
The New Zealand Nurses Organization and Public Service Association have advised strike action from their members working for Whakarongorau (After hour teleservice) for 24 hours from 5pm Sunday 8 October 2023 to 5pm Monday 9 October 2023. Calls will get answered but it might take longer to speak to someone. 

 

Reduced Capacity at Waikanae Health 

We are experiencing major staff shortages. You may have noticed media coverage that almost all of NZ’s GP practices are severely affected by a medical workforce and funding crisis.  

This means we will have to change the way we work, using a team approach, rather than everything resting on the shoulders of a single doctor, as patients have been used to. We have added a range of new clinicians to our team to facilitate this. Full information will follow. 

We continue to work hard behind the scenes to ensure that everyone’s health needs are met appropriately. We remain committed to your well-being and that of our community.  

New virtual after-hours health service

We have been reporting to you over the past four years about the GP shortage here in NZ, and that Kapiti is now experiencing this. To protect our GPs from long hours and burnout, we are joining Coastal Medical, Paraparaumu Medical, Cammack & Evans & Raumati Road Surgery in making some changes to our after-hours service.

In February we introduced to you a telehealth service called Practice Plus. This service is run by Whakarongorau Aotearoa, who not only look after our phones out of clinic hours, but also provide the services of Healthline. This has been going well, with many of our patients already having experienced Practice Plus. The team at Practice Plus can see what medications you are current taking, any medical warnings or allergies, lab results and long-term medical conditions. They also send a report back to your doctor so they can be kept in the loop.

From 5.30pm Friday 2 September, if you call our after-hours number, the nurse will either –

  • Advise you to call emergency services if deemed necessary;
  • Be able to resolve your issue without any further consultation needed;
  • Refer you to Practice Plus for a telephone or video consultation; or
  • Refer you to either Team Medical or Kenepuru Accident and Medical

Our current clinic hours are 8am to 5.30pm Monday to Friday. After hours services run from 5.30pm-10pm Monday to Friday, and 8am – 10pm Saturday and Sunday. Should you need medical assistance after hours, please continue to call the practice on 04 2936005. The biggest change to you, is that if you need to get advice from a doctor, or need to be seen personally, this service will not be delivered by our doctors. You can of course go directly to www.practiceplus.nz and book a virtual consultation – if the doctor or nurse practitioner in consultation thinks you need to see a doctor in person they will refer you to Team Medical or Kenepuru Accident and Medical.

While it will be tempting to go directly to Team Medical, their resources are also extremely stretched. We ask that you do not go to Team Medical unless:

  • you have had an accident and need urgent treatment for an injury;
  • you have a child under the age of 14 who is acutely unwell; or
  • you have been referred by the team at Whakarongorau Aotearoa to do so

We wish to assure you that there is medical care available for you should you need it. Waikanae Health, Coastal Medical, Paraparaumu Medical, Cammack & Evans and Raumati Road Surgery have been working for some time with Tu Ora Compass Health, your Primary Health Organisation (PHO), to find some help with our after-hours services, and we are grateful to have Practice Plus available for you.

Practice Plus costs

Practice Plus costs vary for adults, children and community service card holders. This is detailed at https://practiceplus.nz/pricing/

We encourage you to get ready for Practice Plus now rather than when you need to use their services, by going to www.practiceplus.nz and setting you and your family up for the service.