GP Pulse 03.2010 - The Royal New Zealand College of General ...

ISSUE 5 MARCH 2010 

GPPULSE 

THE ROYAL NEW ZEALAND COLLEGE OF GENERAL PRACTITIONERS 

College 

Honours 

John Kirwan 

A mighty contribution to 

mental health 

Quality 

Symposium 

Inspiring 

Rangatahi 

Lincoln Nicholls

The Third Biennial 

GP Education Convention 

Supporting and Strengthening 

General Practice Education 

Friday 25–Saturday 26 June 2010, 

James Cook Hotel Grand Chancellor, 

Wellington 

Invitations will be sent to all current GP teachers in March 

For more information contact John Pearson: john.pearson@rnzcgp.org.nz

CONTENTS 

6 

Quality 

Symposium 2010 

20 

Inspiring rangatahi 

34 

The 2010 RNZCGP Annual 

Conference: Christchurch 

EDITORIAL 

4 Celebrating past successes, managing 

current challenges and looking to 

the future 

QUALITY 

6 The Annual Quality Symposium 2010 

8 The Quality agenda in your practice 

COLLEGE 

10 ‘More important than being 

an All Black’: John Kirwan and Mental 

Health 

CPD 

12 Prostate screening: defining the GP’s 

role 

14 Of pills and potions for coughs 

and colds 

RESEARCH 

16 Changes in community laboratory 

services in Auckland 

EDUCATION 

18 The (New) Educators 

19 Changes to your Maintenance of 

Professional Standards (MOPS) 

programme for 2011–2013 

20 Inspiring rangatahi 

PARTNERSHIP 

22 The evolving GP/physiotherapist 

partnership 

CORNERSTONE 

24 CORNERSTONE: the storage of 

patient records 

25 CORNERSTONE notches up 500 

POLICY 

26 The role of the GP 

28 Health insurance company requests 

for entire patient’s medical notes 

OBITUARIES 

29 William Grattan O’Connell QSM 

30 Brett Phillip Roche 

RURAL 

31 DHB Rural GP and Hospital Medicine 

Pilot Project 

LIFE & LEISURE 

33 Humour: Back to the Ark? 

Technophobia 101 

34 The 2010 RNZCGP Annual 

Conference: Christchurch 

36 Guide to New Zealand pinot noir 

regions 

MEMBER SUPPORT 

38 Becoming a member 

39 College services 

Cover picture—Photographer: Alistair Guthrie, The Collective Force 

 

 

Level 3, 88 The Terrace 

PO Box 10440 

Wellington 6143 

Phone: (04) 496 5999 

Fax: (04) 496 5997 

Email: rnzcgp@rnzcgp.org.nz 

Web: www.rnzcgp.org.nz 

© Royal New Zealand College of General 

Practitioners. ISSN 1176–5445 (Print), ISSN 

1178–6795 (Online). 

All Rights Reserved. No part of this 

publication may be reproduced, stored in an 

electronic form or transmitted in any form or 

by any other means electronically, mechanical 

photocopying, recording or otherwise 

without express permission of the College. 

GP PULSE | MARCH 2010 | 3

EDITORIAL 

GP Pulse is the official magazine of 

the Royal New Zealand College 

of General Practitioners. It is 

published four times a year. 

Publisher 

Karen Thomas, 

Chief Executive; 

pam.berry@rnzcgp.org.nz 

Editor 

Heather Watt, 

Group Manager, Member Support; 

heather.watt@rnzcgp.org.nz 

Associate Editor 

Alexander Bisley, 

Communications Advisor; 

alexander.bisley@rnzcgp.org.nz 

Associate Editor 

John Pearson, 

Education Officer; 

john.pearson@rnzcgp.org.nz 

Subscription or 

advertising queries 

Cherylyn Borlase, 

Publications Coordinator; 

publications@rnzcgp.org.nz 

A subscription to GP Pulse is 

available at a cost of $60 for 

national subscriptions and $85 for 

international subscriptions. 

Joint subscriptions to GP Pulse and 

the Journal of Primary Health Care 

(JPHC) are available at a cost of 

$150 for national subscriptions and 

$210 for international subscriptions. 

RNZCGP, 

PO Box 10440, 

Wellington 6143 

Phone: (04) 496 5999 

Fax: (04) 496 5997 

www.rnzcgp.org.nz/gp-pulse 

Celebrating past 

successes, managing 

current challenges and 

looking to the future 

Harry Pert 

President, RNZCGP 

The College’s 2010 Annual Quality 

Symposium was an opportunity to think 

about what we would like for the future 

of New Zealand primary care; to consider 

some current and looming challenges, but 

also to do something we do all too rarely, 

celebrate. To quote visiting King’s Fund 

experts Dr Candace Imison and Dr Nick 

Goodwin from the UK: ‘New Zealand 

already punches above its weight in delivering 

high quality primary care services 

with limited resources.’ 

Some of those past successes include the 

Aiming for Excellence standards and the 

CORNERSTONE practice accreditation 

programme. As only the second country in 

the world to introduce such a scheme, the 

Symposium was a fitting opportunity to 

acknowledge the 398 practices nationwide 

who have now achieved accreditation 

(including 44 who have completed 

a second accreditation). Speaking at the 

Symposium, Health Minister Tony Ryall 

thanked the College, general practices and 

GPs for their leadership in improving public 

health care quality and safety through 

CORNERSTONE. Presently another 350 

practices are also working towards their 

accreditation. 

We continue to review and refine 

CORNERSTONE. Proposed future 

developments include delivery of the 

programme via four modules: practice 

organisation; clinical care; patient- and 

community-centred approach; and professional 

development. Special modules could 

include teaching practices and environmental 

sustainability. We also need to 

review the business model that supports 

CORNERSTONE! 

This edition of GP Pulse includes some 

Quality Symposium highlights (pages six 

and seven), and an update on how the 

work being done for the College by the 

Wellington School of Medicine helps 

undertake and demonstrate Quality 

improvement activities within the context 

of your daily practice. 

One of the challenges in improving Quality 

has been that there are tremendous initiatives 

around the country which are not being 

shared and work is often unnecessarily 

replicated. The Quality Symposium was 

one opportunity to share and showcase 

quality work from around New Zealand 

and to hear from international colleagues 

from around the world. There are opportunities 

via networks and peer groups 

for us to share learning, so the really good 

initiative in Dunedin can be shared through 

the College and disseminated throughout 

the country. This would also allow the 

benchmarking and other Quality improvement 

activities to occur. 

If you are not already aware, I would also 

like to take this opportunity to inform you 

of changes to the governance arrangements 

of the College and to introduce 

members of our new Board. 

The College has been governed by a 

Council of 20, with additional observers 

also present at meetings. Fourteen 

members of Council were nominated by 

the College faculties and these nominees 

4 | GP PULSE | MARCH 2010

EDITORIAL 

changed quite frequently. Although this 

arrangement was good for debate and 

canvassing a range of opinions, it was too 

inefficient and time-consuming for fast 

decision-making. There was also a lack 

of clarity within Standing Committees of 

Council about governance versus operational 

matters and some confusion about 

lines of communication to both Council 

and the CEO. 

Council had recognised these problems 

and established the Constitution Steering 

Group in 2006: www.rnzcgp.org.nz/ 

review-of-the-constitution. The proposals 

from this Committee, which have been 

modified following wide consultation 

with members, are due to be implemented 

at the 2010 College AGM. 

However in November last year, when 

the new College Executive met for two 

days to consider priorities for the coming 

year, it became clear that the College 

urgently needed to rearrange its governance 

structures. we needed to accelerate 

the implementation of key recommendations 

from the Constitutional review 

and establish a small Board comprising 

the President and Deputy President, a 

nominee from Te Akoranga a Maui, two 

members appointed by Council and 

two independent members to establish 

the required skill-mix of the Board. The 

CEO would be an ex officio member of 

the Board. The changes could be made 

within the current rules and regulations 

of the College. In December at the 

College Council meeting this proposal 

was put to the meeting. Council decided 

that the President and the Deputy 

President should select the two Council 

members, ask the Chair of Te Akoranga 

a Maui to nominate their representative 

and seek suitable people to fill the other 

two places. 

The new Board members are: myself, 

Harry Pert, as President; Deputy 

President Tony Townsend; Te Akoranga 

Harry Pert: College President, Fellow since 

1995, practices at Ranolf Medical Centre 

in Rotorua. 

a Maui representative Peter Jansen; Tana 

Fishman to provide educational expertise; 

and Richard Tyler with his financial 

and governance experience. More 

information about each of us is provided 

below. As this edition of GP Pulse goes 

to print, the two others members are 

being sought (probably external appointments) 

to provide skills in governance, 

strategic thinking, marketing and business 

development. I look forward to working 

with them. I would like to emphasise 

these are interim arrangements, and will 

be reviewed at our September College 

Conference in Christchurch. 

Tony Townsend: College Deputy President, 

Fellow since 1988, Distinguished Fellow 

since 2008, practices at Whangamata 

Medical Centre. 

Peter Jansen : Te Akoranga a Maui nominee, 

Fellow since 1998, Distinguished Fellow since 

2008, Mauri Ora Associates and Senior 

Medical Advisor for ACC. 

Tana Fishman: Representative with 

educational expertise, Fellow since 2004, 

practices at Manurewa’s Greenstone Family 

Clinic, Auckland. 

Richard Tyler: Representative with financial 

and governance expertise, Fellow since 

1991, practices at the Johnsonville Medical 

Centre, Wellington. 


QUALITY 

THE ANNUAL QUALITY SYMPOSIUM 2010 

Around the keynote table 

College staff, Maureen Gillon and Cathy Webber 

Dr Michael Lamont and College Board member 

Dr Richard Tyler 

RACGP President Dr Chris Mitchell, Hon. Tony Ryall, Dr Peter Moodie of PHARMAC and Dr Jo Scott-Jones 

Group discussions 

Dr Candace Imison, Dr Nick Goodwin of the King’s Fund (UK) 

and College staff member Heather Watt 

Dr Jo Scott-Jones and College staff member 

Dr Frances Townsend 


IFHC Interactive Workshop 

QUALITY 

Dr Jim Vause, CORNERSTONE Assessor 

RNZCGP President Dr Harry Pert, Deputy President 

Dr Tony Townsend and keynote speaker Dr Nick Goodwin 

Highlights 

Keynote speaker Dr Candace Imison 

The 2010 Annual Quality Symposium in 

Wellington February 12–13 was attended 

by more than 220 key primary care 

stakeholders, with keynote presentations 

from Royal Australian College of GPs 

President Dr Chris Mitchell and British 

Kings’ Fund experts Dr Nick Goodwin 

and Dr Candace Imison. Goodwin and 

Imison pointed out that New Zealand can 

be very proud of its record: ‘New Zealand 

already punches above its weight in delivering 

high quality primary care services 

with limited resources.’ Goodwin argued 

that reputation motivates initiatives like 

CORNERSTONE, and that there’s nothing 

more important to a GP than reputation. 

Health Minister Tony Ryall announced 

the establishment of the 

Quality and Safety Improvement 

Commission. Past RNZCGP president 

Jim Vause led a lively, wideranging 

workshop on the Ministerial 

proposal for Integrated Family Health 

Centres (IFHCs). 

Papatoetoe (and ProCare) GP Karl 

Cole also gave an excellent presentation 

on employing technology in general 

practice. GP Jo Scott-Jones delivered an 

inspirational presentation explaining 

how Opotoki wiped out terribly high 

rates of rheumatic fever. 

Professor Peter Crampton, head of the 

Wellington School of Medicine, paid 

tribute to New Zealand’s world-leading 

public health system. According to the 

2009 Commonwealth Fund Survey, New 

Zealand primary care physicians have the 

highest levels of satisfaction in the world. 

On the challenging side of the ledger, 

we have relatively low doctor numbers. 

Professor Crampton illustrated how New 

Zealand has, by international comparisons, a 

lean, effective system and lots of successes. 

For more, visit: 

www.rnzcgp.org.nz/quality-symposium 

Rowena Gotty and Maureen Gillon Vicky Noble and Debbie Gell Dr Tane Taylor, Chair of Te Akorangi a Maui 


QUALITY 

The Quality agenda: 

How will it help your 

practice? 

The 2010 Annual Quality Symposium 

was an opportunity to hear about 

what the first year of work from 

the Wellington School of Medicine 

(WSM), on behalf of the College, has 

delivered. You’ll likely have heard 

about a Quality Framework and 

Quality Indicators, but how will they 

work in the real world of general 

practice? 

Paraparaumu GP Dr Chris Fawcett 

explains how the Quality Agenda will 

help him to ensure he delivers high 

quality care within his current day-today 

workload 

Like most GPs, Chris can identify some 

big health issues for his community. 

Many of them are common to communities 

across New Zealand, for example 

chronic diseases like CVD and diabetes. 

Others, like osteoporosis and mental 

health issues, are especially pertinent 

to the older Paraparaumu community 

where he practices. He does battle 

For Chris and his team, delivering quality 

care focuses on the patient in the consulting 

room with him, but he is aware 

there are many other concepts of quality 

which shape the health landscape. 

He is also aware that many factors affect 

patient care, both before the patient 

enters his/her room and after the 

patient leaves. 

But, how can he influence improved 

outcomes for his patients and his community 

across the board, and how can 

he demonstrate to the PHO and DHB 

that each successful intervention is 

one small battle won in the larger war 

on osteoporosis, CVD and diabetes? 

How can he be sure that he is doing 

the best and most effective things for 

his patients? 

The Quality Framework 

The framework is under development 

and is being built around existing GP 

demands, e.g. workforce; capacity and 

The health landscape is complex and 

constantly changing. The quality 

framework will help identify those areas 

which are crucial to delivering quality care 

with these conditions (sometimes in 

combination) on any given day at the 

Paraparaumu Medical Centre. He follows 

guidelines, gives advice, prescribes 

drugs, and often good patient outcomes 

are achieved. 

resources and is based on knowledge 

gained of the structural interactions, 

and relationships and allegiances that 

already exist within the quality landscape. 

The health landscape is complex 

and constantly changing. The quality 

framework will help identify those 

areas which are crucial to delivering 

quality care, and how to have meaningful 

conversations with those with 

different of competing agendas. Chris, 

for example is aware that there are 

multiple concepts of quality and multiple 

agendas; the patient has a point 

of view, as does the GP, the nurse and 

all the clinical team. The funders, for 

example the PHO and DHB, also have 

a particular view of quality. In order to 

understand and have a conversation 

about these different views of quality 

Chris needs a framework and shared 

understanding within which a useful 

conversation can occur. 

What the survey data tells us 

A survey conducted in 2009 on behalf 

of the College by the WSM showed 

significant quality work is already being 

undertaken by practices and elsewhere 

within the primary care sector, but 

there are substantial time and workload 

pressures that provide barriers for 

practitioners: 

• Practices noted that it is vital that 

they be given mechanisms which 

allow them to rationalise and prioritise 

quality related activity within the 

context of clinical workloads. 

• The most immediate concern 

for practices is their day-to-day 

clinical work, and they believe some 

bureaucratically imposed activity is 

irrelevant. 

• Important tension points impacting 

on quality activity in primary 

care include a perceived disconnect 


etween a population and individual 

health focus, and managerial and 

clinical perspectives. 

Drawing on the survey results, the 

key aim of the Quality Agenda is to 

make it easier to fit quality activities 

into daily practice. It will support 

clinical leadership to determine how 

best to improve quality and will 

provide general practices with quality 

tools and processes to embed into 

practice systems. 

The key is to work smarter and not 

harder, to identify those activities 

which really do deliver a better quality 

of care, and which activities can be 

discarded. 

Some initial examples include: 

A how-to guide: 

A guide that can be used by staff working 

in primary care teams to determine 

what is feasible with respect to 

undertaking quality activity within their 

day-to-day work. 

An Indicator Development Tool 

To enable choice and prioritisation 

(which indicators are the best/most 

important for my practice?) for example 

through identifying gaps; and drawing 

on sentinel event reporting systems. 

GPs need confidence that the tools and 

processes they use are robust and appropriate 

for use in their own practice 

populations. 

How the Indicator 

Development Tool will work 

In the words of King’s Fund expert Dr 

Nick Goodwin, speaking at the College’s 

recent Quality Symposium: ‘You can’t 

improve what you can’t measure’. The 

indicator development tool produced by 

the WSM will allow not just measurement, 

but will help ensure that we’re 

measuring the right things in our own 

communities, and identifying the best 

treatment and management options using 

robust, evidence based measures. 

There are several options: 

• Use the online indicator development 

and implementation tool to 

develop a locally appropriate indicator 

that you own to help address 

a specific local or population-specific 

issue. One example might be 

skin infections in children. A child 

and siblings present on a regular 

basis with serious skin infections. 

They are part of a large Pacific 

family that access the after hours 

service and general practice service 

on a regular basis for infections 

arising from skin conditions. The 

practice team report that other 

members of the extended family 

have presented with the same 

problem and have been frequent 

attenders at the practice and after 

hours for the last six months. The 

practice decides to investigate this 

issue. They want to know if they 

are delivering quality care in this 

area for Pacific children and families 

in their practice so they use 

the indicator sieve to filter the data 

they have on skin conditions in this 

group of their practice population. 

They want to isolate the causes 

to identify what clinical measures 

can be taken to prevent recurring 

infections. Using the sieve helps 

develop an appropriate indicator 

to measure improvement and to 

identify the best treatment and 

management options to achieve 

this. If the initiative is successful, 

the learning can be shared with 

other practices in the area via the 

common quality framework. 

• Use an indicator developed for New 

Zealand primary care from the online 

library. One example might be 

an indicator for the assessment of 

common mental health disorders. 

• Test an existing indicator being 

used in your practice/PHO/region 

against the ‘sieve tool’ on the website 

to ensure it is relevant for your 

patients and practice population. 

For example, the local community 

and funders consider that a GP 

isn’t doing a good job in the area of 

smoking cessation.. The GP is under 

pressure to measure and demonstrate 

improvement. The DHB 

wants him to measure number of 

patients giving up smoking, number 

of patients having counselling for 

smoking cessation, number of 

patients getting prescriptions for 

nicotine replacement therapy. The 

GP can use the sieve to determine 

whether the measures are 

evidence based in order to respond 

to the DHB indicating which are 

invalid measures and which are 

useful. He will then be able to demonstrate 

that his practice provided 

advice, tools and interventions 

even if this has not produced the 

smoking cessation results sought 

by the funder. His practice’s results 

can also be shown against local 

population features, for example a 

high proportion of mental health 

consumers. 

All of this aims to support self-evaluation 

and learning and dissemination 

of knowledge gained. Would we do it 

again? What would we do next time? 

How can we showcase and share what 

we’ve learned? It can also be for quality 

assessment: how will we use it to 

demonstrate how well we are doing 

or to meet the expectations of PHOs, 

DHBs, or the PPP? How can we benchmark 

ourselves against other practices 

locally and nationally and demonstrate 

the success of or need for specific 

interventions? 

And, what happens next? 

We’ll be talking to you and your 

networks about ongoing development 

and usability and how a quality 

framework and the tools might be put 

into place. 


COLLEGE 

‘More important than being an All Black’ 

John Kirwan and mental health 

Professor Bruce Arroll 

General Practitioner, Auckland 

John Kirwan became famous through 

his sporting achievements. His work for 

mental health in New Zealand will leave 

a similar legacy to Sir Edmund Hillary. 

Political Plenary 

Early 2008 I was seeing a man in his forties 

with depression. I made the comment 

that the whole process of talking about 

and treating depression had been made 

much easier by the work of John Kirwan 

and the patient agreed. In a television 

campaign (which can be seen on the 

website www.depression.org.nz), John 

tells people about his experience with 

depression and offers hope and advice 

on how to get help. I and many of my 

colleagues were hugely appreciative of his 

work and it occurred to me that John may 

not have been aware of this. Via email, 

it turned out that he was not aware of 

GPs’ enthusiasm for his work and was 

pleased to get the message. The next 

step involved getting him the Meritorious 

Service Award from the College of GPs. 

Tim Kenealy was very pleased to be dual 

nominator. He has been photocopying 

pages from John Kirwan’s biography for 

his patients for many years. The application 

was supported by the awards 

committee for presentation at the annual 

College Conference in Wellington in 

September 2009. 

The official citation read: ‘John Kirwan 

was born in New Zealand in 1964. He 

was an All Black from 1984 to 1994 and 

during his career he scored 67 tries 

in all matches for the New Zealand 

All Blacks. This record stood for 

many years. In health his contribution 

Professor Bruce Arroll pays tribute to John 

Kirwan’s achievements 

of depression. GPs in New Zealand 

are grateful to him for making it easier 

for male patients to come forward and 

discuss depression.’ It’s interesting how 

far his work goes in the community. 

An old friend who is a barrister in the 

Family Court said that he frequently 

There was a 19.1% decline from the Maori 

suicide rate in 1998 and a 46.6% reduction in 

the youth suicide rate since 1995 

John Kirwan with his College medal 

has been as the face of the National 

Depression Initiative. Market research 

has found a 96% recall of the ads, which 

is considered extremely high. Nationally 

there has been an increase in the 

public’s ability to recognise symptoms 

makes reference to John Kirwan when 

dealing with men who are depressed 

about marital separation. I spoke with a 

geriatric psychiatrist who says that she 

can now get elderly men in to groups to 

talk about depression. 


COLLEGE 

The Auckland award evening was attended 

by Auckland GPs, The Royal 

New Zealand College of General 

Practitioners, staff of advertising 

agency Draft FCB, National Depression 

Initiative leaders like Candace Bagnall, 

and John Kirwan’s family. William 

Ferguson was there, between patients, 

and said he could not miss such an occasion 

as JK’s award given the huge impact 

he has had on the issue of depression in 

New Zealand. I spoke about how much 

easier it was to work with men with 

depression as they were now willing to 

consider the diagnosis of depression. 

Twenty years ago patients were often 

convinced they had a physical condition. 

Kirwan’s work has contributed to the 

reduction of suicide rates. Latest figures 

(The Suicide Facts 2007 report) show 

there was a 19.1% decline from the 

Maori suicide rate in 1998 and a 46.6% 

reduction in the youth suicide rate 

since 1995. Market research says 96% 

of Maori men are aware of him and his 

message about depression. Such a high 

penetration rate among Maori men is 

unheard of in marketing terms. 

I spoke of John’s dedication. He has 

never been paid a penny, and when 

doing the filming he works tirelessly 

10 hours per day, five days per week. 

I have always been impressed with his 

work, but spending some time with 

John Kirwan and seeing him with the 

guests at the award ceremony I came 

to further realise how he is a special 

person. Speaking with everyone 

there, he showed himself to be a 

humble, sensitive and intelligent person. 

‘John, you’ve given New Zealand 

hope,’ I concluded. 

John paid tribute to his family’s love 

helping him through his depression. 

He spoke about how he was initially 

reluctant to get involved as he was 

‘scared people would think I was a 

freak’, but the (continuing) campaign’s 

been ‘one of the greatest things I’ve 

ever done.’ He recalled Andy Hayden 

Former College President Jonathan Fox and John Kirwan 

MOH National Depression Initiative leader Candace Bagnall and Peter Huggard of the 

Goodfellow Unit 

telling him ‘Once an All Black, always 

an All Black’… ‘I wanted to keep giving 

back.’ Kirwan feels a pride in the 

campaign similar to the feeling when 

he first ran onto a rugby field wearing 

the All Black Jersey. ‘It’s a very New 

Zealand thing, working together, helping 

each other out.’ He has had several 

people write letters to him and come 

up to him and thank him for saving 

their lives. ‘That’s more important 

than being an All Black.’ 

The ceremony received extensive media 

coverage, such as this TV3 piece: 

www.3news.co.nz/Former-All-Blackhonoured-by-doctors-society/tabid/317/articleID/135268/Default.aspx. 


CONTINUING PROFESSIONAL DEVELOPMENT 

Prostate cancer screening: 

Defining the GP’s role 

Jim Vause 

Past RNZCGP President, Blenheim 

The world of prostate cancer screening is 

awash with rhetoric, opinion and conflicting 

research, a world in which a GP needs 

a clear understanding of his or her role. 

That role, as the first and most appropriate 

clinician of call for a man considering 

screening, is to facilitate their informed 

decision-making through provision of 

unbiased, evidence-based information on 

the prostate gland, prostate cancer and 

the harms and benefit of screening. 

Central to defining this role is the 

Health and Disability Commission 

(HDC) code Clause 2, which covers 

both the content and the process with 

particular emphasis on Rule 6, the Right 

to be Fully Informed. 1 The process 

of patient communication should not 

need reiteration to vocationally trained 

GPs, except to emphasise that simply 

ordering a PSA test or doing a DRE test 

without first obtaining informed consent 

from the patient, could be regarded 

as an inappropriate standard of care. 

Note the importance of ‘informed’, for 

current media and interest group publicity 

is often poor in terms of quality and 

research base. Thus a man’s or, as often 

occurs, their spouse’s simple request 

for a PSA test flags the need to explore 

with the patient their knowledge and 

expectation of any such testing. 

Typically, the information provided to a 

man seeking screening should cover the 

anatomy, function and disease of the 

prostate, in particular the natural history 

of prostate cancer. This is the background 

information. More important is 

the foreground information, covering 

the harms and benefits of screening, 

including the full screening pathway 

within which lie the treatment options 

of prostate cancer, with all the regional 

practice variations which makes providing 

this information problematic to say 

the least. As for trying to meet the 

HDC standard of information on waiting 

times and service availability within a 

15-minute consult, after first prescribing 

a man’s blood pressure pills, dealing 

with his chest pain and checking his skin 

spots, the only answer that comes to 

mind is a Tui billboard. 

Fortunately, there are a few resources 

available to help, such as the New 

Zealand Guidelines Group (NZGG) 

pamphlet which provides background 

and some foreground information. 2 

Harms and benefits is a different story, 

but a story that can be focused by the 

patient orientated question: ‘What 

chance is there that prostate screening 

will save my life?’ (benefit) and ‘What 

chance is there that prostate screening 

will cause me harm or even kill me?’ 

(harm). Putting these questions to a man 

seeking screening helps focus thinking, 

for many men on first presentation 

presume benefit and ignore harm. That 

screening can kill you (through mortality 

from treatment of prostate cancer) 

seems to be a hidden fact. 

While we know a lot of the harms of 

screening, it was not until March 2009 

that research answered the benefits 

question. Two key studies, both 

published in the 26 March NEJM gave 

answers, one being that there was no 

benefit, the other showing a small benefit. 

Both showed harm. 

The better quality study methodologically, 

the American PLCO trial, found that 

there was no benefit from prostate 

screening. 3 Screening did not reduce 

a man’s chance of dying from prostate 

cancer but did significantly increase his 

chance of being found to have prostate 

cancer. The researchers commented that 

there was a higher death rate from non 

prostate cancer causes in the screened 

group, probably due to over-diagnosis of 

prostate cancer and treatment-related 

mortality. Commentators have pointed 

to the high number of patients in the 

non-screened (control) arm of this study 

who underwent screening; however the 

study design did allow for such contamination 

in calculating the power (number 

of men recruited) of the study. 

The other randomised controlled trial, 

the European ERSPC trial, did find a 

benefit, albeit small, from screening, 

with 1410 men having to be screened 

for nine years in order to prevent one 

man from dying from prostate cancer. 4 

This is the NNS (numbers needed to 

screen). Unfortunately, the study methodology 

was not as good as the PLCO 

study, there being variation in treatment, 

diagnosis and recruitment age between 

the many European study centres. 

So the benefit is most likely nil or possibly 

in the realm of one in 1410. The latter 

figure is comparable to other cancer 

screening such as breast and bowel (FOB 

test) cancer, but the difference is the 

high rate of harm from prostate cancer 

screening and the substantially older age 

of screening subjects (55–74) compared 

with breast cancer. For younger men, neither 

trial found benefit from screening. 

What of the magnitude of harm? In 

the ERSPC trial, one in three screening 

PSA tests were positive and one in six 



tested required a biopsy. One in 10 men 

screened were found to have prostate 

cancer and thus faced all the problems 

of deciding which therapy to have. This 

study also found that you have to detect 

by screening (and treat, including surveillance/watchful 

waiting) 48 prostate 

cancers in order to stop one man from 

dying from that cancer (numbers needed 

to detect) i.e. the other 47 did not benefit 

at nine years. These rates seem high 

but remember this is a research trial with 

a good consistent screening protocol, not 

the real world of NZ with our difficulties 

with access to diagnostics. 

Back at the consultation, how do you 

get this data across to a man asking 

about prostate cancer screening, for the 

judgement of whether these numbers 

mean it is worthwhile to screen lies not 

with the GP or specialist, but the patient 

whose perception of benefit is substantially 

different from a GPs and more so 

compared with a specialist. 5 There is 

extensive research on presenting statistics 

on harm and benefit to patients with the 

general consensus that graphic presentation 

appears better understood than 

numbers, as Goodyear-Smith et al. found 

in Auckland. 6 Whether you present (a) 

relative risk reduction, (b) absolute risk 

reduction, or (c) numbers needed to 

treat (NNT)/ screen favours (b) absolute 

risk reduction because of the difficulties 

of understanding NNTs/NNSs and 

the interpretation bias of relative risk 

reduction. However, there is significant 

work being done on what is the best way 

to present this type of data and how to 

achieve informed patient decision-making. 

Table 1 

Benefit 

Relative risk 

reduction death 

Harms of the magnitude in the above 

table, seems relatively easy to understand, 

qualified as always by the patient 

perspective, such as their feeling about 

being found to have a positive blood 

result for cancer (as might be influenced 

by their personality or mental 

conditions), their feeling about prostatic 

biopsy via biopsy needles inserted via 

the rectum or their understanding and 

feeling about the uncertainties around 

prostatic cancer treatment. 

Absolute risk 

reduction death 

Numbers needed to 

screen to prevent a death 

ERSPC 20% 0.71 in 1000 1 in 1410 

PLCO None None Infinite 

Harm, from the 

ERSPC trial 

a positive PSA 

needing a biopsy 

of a diagnosis of 

prostate cancer 

Chance if screened of 1 in 3 1 in 4 1 in 10 

Out of 1000 341 292 100 

Presenting the benefits is a greater 

problem. Chance, such as one in 1410, 

is small and does not present well on 

the bar graphs that Goodyear-Smith 

et al. used in their research. A better 

method is to use pictograms showing 

the total number of men being recruited 

to screening (1410) and highlighting the 

one who gains benefit (Appendix 1) a 

technique developed by Dr John Paling. 7 

The same pictograms displaying 1410 

stock men can be used to show harm. 

Similar pictograms are used in the excellent 

online resource to be found at 

www.prosdex.com. 

Currently, medicine needs to have more 

information on the patient perception of 

this magnitude of benefit versus harm on 

a screening issue and the impact of contextual 

factors, both individual and cultural, 

have on this perception. Until we have 

better information, the GP’s role will be to 

present statistical data to the patient in a 

manner which the patient—and family if 

necessary—can understand and interpret 

within their own context. It is also helpful 

if the GP understands the numbers. 

So, never simply just tick the lab box for 

a PSA test in response to an uninformed 

patient request. Make sure your patient 

understands the issues, has clarity 

around the outcome they are seeking, 

and make use of the written resources 

available, preferably the unbiased ones. 

Prostate screening charts available online 

at www.gponline.co.nz/Paling Charts.html 

References: 

1 The HDC Code of Health and Disability Services Consumers’ Rights Regulation 1996, 2. Rights of Consumers and Duties of Providers: Available online at http:// 

www.hdc.org.nz/theact/theact-thecodeclause2 

2 Testing for Prostate Cancer. Published by the New Zealand Guidelines Group. ISBN (print): 978–1–877509–02–5 ISBN (electronic): 978–1–877509–03–2. 

Available online at http://www.nzgg.org.nz/guidelines/0153/Prostate_Cancer_Consumer_Resource.pdf 

3 Andriole GL, Grubb RL, Buys SS et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310–1319. 

4 Schröder FH, Hugosson J, Roobol MJ et al. Screening and prostate-cancer mortality in a randomized european study. N Engl J Med. 2009;360:1320–1328. 

5 Steel N. Thresholds for taking antihypertensive drugs in different professional and lay groups: questionnaire survey. BMJ. 2000;320;1446–1447 

6 Goodyear-Smith F, Arroll B, Chan L et al. Patients prefer pictures to numbers to express cardiovascular benefit from treatment. Annals of Family Medicine. 

2008;6:213–217. 

7 The Risk Communication Institute. Available online at http://www.riskcomm.com 



Primum non nocerE: 

Of pills and potions for 

coughs and colds 

Jim Vause 

Past RNZCGP President, Blenheim 

Once upon a time, boys and girls, 

when you went to your GP with a 

cold, he would have a special little 

mixture, a secret brew of magic 

potions, the formula handed down 

from generation to generation, to 

help quell your nasty hacking cough. 

Alas it is no more, gone forever into 

the mists of time, banished by the big 

bureaucrats in Medsafe. People who 

have decided the potions, concoctions 

and elixirs used in cough and cold 

remedies might cause a little harm, 

like poisoning, overdosing and death. 

A paradigm shift. 

Those College readers with more 

than a few decades of experience 

Such prescribing was mirrored by 

pharmacists, who often had equally 

heinous brews. But progress has seen 

them superseded by the pharmaceutical 

companies’ OTC preparations. Did 

you know you can buy one syrup for 

a wet cough and another for a dry 

cough? An elixir for blocked noses, 

another for running noses, dribbling 

noses and bent noses. And for the different 

types of phlegm. 

Fortunately Medsafe have made 

things a lot easier. DO NOT 

PRESCRIBE COUGH MIXTURES 

FOR CHILDREN UNDER THE AGE 

OF SIX YEARS as per their following 

statement. 

In this new order we are not alone. 

Authorities in the USA, UK and Canada have 

issued similar advice 

will recall pet formulations of opioids, 

alcohol, chloroform, ammonium chloride, 

ipecac and glycerine that were 

prescribed, often willy nilly, to URTI 

sufferers of all ages. More advanced 

prescribers added ephedrine to ‘dry 

things up’ and a little antihistamine 

to counteract the resultant insomnia, 

whilst the true ‘master class’ was a 

touch of extract of liquorice, to reach 

the prescribing climax of a ‘Linctus 

Forte’. Strong taste makes for a great 

cough mixture. 

‘Use of Cough and Cold Medicines in 

Children—New advice 

Medsafe has continued its review of the use of 

cough and cold medicines in children with the 

assistance of the Cough and Cold Review Group. 

This Group assessed the available safety and efficacy 

data to support the use of cough and cold 

medicines in children. 

The Group have recommended to Medsafe that 

oral cough and cold medicines containing the following 

substances should not be used in children 

under six years of age: 

Guaifenesin, phenylephrine, doxylamine, 

ipecacuanha, brompheniramine, promethazine, 

dextromethorphan, chlorphenamine, 

triprolidine, pholcodine, diphenhydramine, 

pseudoephedrine 1 ’ 

Accompanying this is a list of 162 OTC 

cough and cold preparations that contain 

these medicines. 

In this new order we are not alone. 

Authorities in the USA, UK and Canada 

have issued similar advice and every 

GP should be aware that the cut-off of 

six years is simply an extrapolation of 

earlier Medsafe advice that set the cut 

off at two years. 

So why now? After all we have known 

of the disutility of cough mixtures 



for a long time, so is this just another 

example of left-leaning do-gooders 

inflicting their world view on the 

populace? Or is it a backlash against 

inappropriate marketing of ineffectual 

pharmaceuticals? 

Harm versus benefit is the issue. The 

benefit from cough mixtures is minimal, 

usually nil. Thus, it takes next to no harm 

to balance in the negative. We now have 

evidence on this harm! 

with these medications. 4 There is little 

reason to believe NZ is any different 

either in magnitude or in social 

distribution of these remedies’ impact, 

but the small size of our population 

results in a very small number 

of adverse events. One example is a 

recent Coronial Court finding which 

questioned the role of antihistamines 

prescribed by a GP, against Medsafe 

advice, in a child’s death from infection. 

There are issues around the 

How well informed are patients on the 

contents of cough mixtures when they 

receive advice from a health professional, 

be it a doctor, a nurse or a pharmacist? 

Recent papers in paediatrics have 

shown a small but significant association 

of cough and cold remedies with 

increased death rates in children in the 

USA, an association due to a number 

of possible mechanisms ranging from 

accidental overdose to anaphylaxis 

to maliciousness. A higher incidence 

in more deprived communities has 

also been noted. 2,3 Data from the UK, 

Canada and Australia indicate a small 

number of adverse events associated 

quality of the evidence, but one child 

poisoning or one death requires significant 

provable benefit to justify using a 

cough mixture. 

There are some other interesting 

issues to consider arising from the 

evidence, namely what of the safety 

of these medications in adults? Why 

are there such a large number of 

OTC cough and cold mixtures on the 

market anyway? How well informed 

are patients on the contents of cough 

mixtures when they receive advice 

from a health professional, be it a doctor, 

a nurse or a pharmacist? 

For many GPs, this restriction in 

prescribing will not be a problem. 

But for those used to reaching for a 

prescription pad when confronted 

by a toddler with rhinitis and cough, 

or a parent asking for a good syrup 

for wee Johnny’s hacking nocturnal 

cough, there will be a temptation to 

find an alternative not on the Medsafe 

list. But before you prescribe a little 

intranasal zinc, perhaps vitamin C, 

echinacea, Pelargonium sidoides or 

intranasal corticosteroids, check the 

evidence on the balance of their 

harms versus benefit. 

The best solution is not to prescribe, 

remembering that good advice and 

counselling offers not only a better 

subsequent patient behaviour but also 

provides greater patient satisfaction. 5 

If you must have a fall back, try linctus 

simplex, a simple solution to a simple 

problem. It might not be effective, but at 

least causes no harm, we think. 

For the list of OTC medications containing 

the mentioned medicines go to: 

www.medsafe.govt.nz/hot/alerts/ 

coughandcold/infooct2009.asp 

References 

1 Available online at http://www.medsafe.govt.nz/hot/alerts/coughandcold/infooct2009.asp 

2 Schaefer MK, Shehab N, Cohen AL, Budnitz DS. Adverse events from cough and cold medications in children. Pediatrics. April 2008;121(4):783–787. Available 

online at http://pediatrics.aappublications.org/cgi/reprint/121/4/783?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Melissa+K.+Schaefer&searchi 

d=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT 

3 Rimsza ME, Newberry S. Pediatrics. Unexpected infant deaths associated with use of cough and cold medications. August 2008;122(2):e318–e322. (doi:10.1542/ 

peds.2007–3813) Available online at http://pediatrics.aappublications.org/cgi/content/abstract/122/2/e318?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=& 

fulltext=Mary+E.+Rimsza%2C+MDa+and+Susan+Newberry%2C+MSW&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT 

4 Savage R. Review of OTC cough and cold medicines. Available online at http://www.medsafe.govt.nz/hot/alerts/coughandcold/Safety.pdf 

5 Welschen I, Kuyvenhoven M, Hoes A, Verheij T. Antibiotics for acute respiratory tract symptoms: patients’ expectations, GPs’ management and patient 

satisfaction. Family Practice. 2004;21(3):234–237. Available online at http://fampra.oxfordjournals.org/cgi/content/full/21/3/234 


RESEARCH 

Changes in community 

laboratory services 

in Auckland 

Susan Dovey 

Associate Professor, University of Otago, Dunedin School of Medicine 

The Labtests service in 

Auckland has improved a 

great deal since its start date 

in September 2009, but further 

improvements are needed. 

Making the right diagnosis, often assisted 

by timely laboratory results, is 

a major function of general practice. 

So when the established laboratory 

services were changed in the Auckland 

region in September last year, the 

College was concerned to ensure that 

the 40% of its members practising in 

the region could continue to provide 

the highest possible care. Three 

surveys were conducted between the 

start of the new Labtests services and 

the end of 2009. This is a report of the 

main results from these surveys. 

What College did 

The College invited all 1135 members 

practising in Auckland to complete a 

web-based survey about their experiences 

of the new laboratory service 

one, six and twelve weeks after the 

new service started. Retired GPs, affiliated 

members and GPs who may not 

have experienced the new laboratory 

services were included. There were 442 

responses to the first survey, 196 to the 

second, and 166 to the third: 345 responses 

(43%) came from GPs practising 

in the Auckland DHB, 270 (34%) from 

Waitemata GPs, and (11%) from GPs in 

Counties Manukau DHB. 

What the College found 

Over 70% of GPs responding to the first 

and second surveys indicated they had 

experienced ‘significant’ or ‘major’ problems 

with the new laboratory service. In 

the third survey, this decreased to 55%. 

Figure 1 shows GPs’ overall experience 

with the new laboratory services in 

surveys 1, 2 and 3. 

In survey 2, 64% of GPs reported an 

improvement in services since the start 

of September and 68% reported an 

improvement in survey 3. The laboratory 

service had become ‘much better’ for 

14% in survey 2 and 23% in survey 3. 

Problem areas 

Given a choice of eight potential problems 

with the new laboratory service, 

the mean number of reported problems 

reduced from 3.2 at survey 1 to 3.0 in 

survey 2 and 2.0 in survey 3. Table 1 

shows changes in respondents’ experience 

in the three surveys of problems in 

the eight areas listed on the survey forms. 

Figure 1: Overall experience with the new laboratory services in surveys 1, 2 and 3 

Number of respondents 

250 

200 

150 

100 

50 

0 

no impact minor significant major 

problems problems problems 

Impact 

Survey 

1 

2 

3 


RESEARCH 

Table 1: Percent of respondents indicating experience with the eight problem areas listed on the three survey forms 

Percent reporting problems 

Survey 1 Survey 2 Survey 3 

p-value for change 

across surveys 

Delayed access to tests or results 75.4 61.4 33.1

EDUCATION 

The (new) educators 

Samantha Murton 

Clinical Leader GPEP1 & PG Rural 

Approachable and dedicated, Sam Murton enjoys time with her family: 

husband, three children, dog and cat. She likes fishing and cooking. She lives 

in Wellington for its beautiful weather and outdoor opportunities. 

Medical Council 

impressed with the RNZCGP 

The Medical Council’s Education Committee 

has resolved that the RNZCGP be reaccredited 

as the standard-setter for GP 

education for the maximum period. ‘We’re 

pleased the Council was impressed with our 

report. They noted proposed “changes to 

the GPEP training programme are positive 

and will assist the College to develop a 

stronger training programme”,’ RNZCGP 

Chief Executive Karen Thomas said. The 

College is now accredited through to 2014. 

Anna Gilmour 

Co-Medical Educator, Otago/Southland 

Anna lives in Dunedin with her husband and two children. 

As a family they love living in Otago and having such easy 

access to some of their favourite pastimes such as skiing 

and mountain biking. She is a GP in urban Dunedin with a 

special interest in sexual health and is also a medical student 

tutor at the University of Otago. She has been involved 

with the GPEP1 programme for the last two years as a 

seminar facilitator and has been in the medical educator 

role since August 2009. Anna enjoys her involvement with 

the registrars, teachers and College staff and is looking 

forward to with enthusiasm. 

Craig Pelvin 

Co-Medical Educator, Otago/Southland 

Craig has returned to his home town of Dunedin again after 

living in various locations around the country. He works at the 

Gardens Medical Centre and maintains variety by doing fracture 

management at the local After Hours clinic and regular 

Emergency Department shifts. He has been involved in health 

politics over the last two years as a GP rep on a local PHO, 

and has some RNZCGP roles. What little time he has left, he 

spends with his wife and son, their cats and the veggie garden. 

His other interests include tramping, mountain biking and 

photography. He is a bit of a greenie and spends a lot of time 

trying to reduce his carbon footprint. 


EDUCATION 

Changes to your 

Maintenance of Professional 

Standards (MOPS) 

programme for 2011–2013 

Rhett Emery 

Assessment Manager, RNZCGP 

The MOPS programme is changing from 

June 2010 to reflect the direction of the 

Medical Council and the evidence base 

on the most effective methods of improving 

practice. From June, you will have 

the choice of two programmes for fulfilling 

the requirements for recertification. 

Option 1—Regular 

Practice Review (RPR) 

This option is based on a practice review 

visit undertaken by a trained vocationally 

registered peer. The completion of the 

practice review can occur at any time 

within the triennium and will satisfy the 

full MOPS credits for the triennium. The 

reviewer can also gain full triennium credits 

for their involvement in the review. 

Doctors will register their intent to 

undertake the RPR with the RNZCGP. 

Prior to having a visit, the participant 

will supply a report based on feedback 

from colleagues and patients, and 

provide the reviewer with a personal 

reflection summary along with details of 

their recent CPD portfolio and practice 

environment. 

The participant and the reviewer will arrange 

the practice visit for a time that is 

mutually acceptable. During the visit the 

reviewer will observe a series of patient 

consultations and review a selection of 

patient records. 

Following the visit, the reviewer will 

meet with the participant at least once. 

This meeting will be used to provide 

verbal and written feedback to the 

participant—including specific information 

related to strengths and any 

identified areas for development—and 

formulate the participant’s personal 

development plan and future learning 

and CPD requirements. 

The costs associated with the RPR visit 

will be the responsibility of the participant 

and the reviewer. 

Option 2—Professional 

Development Plan (PDP) 

This MOPS option is similar to the 

current programme, but is based on a 

Development Plan that identifies personal 

learning needs. This plan will be 

used to design the MOPS programme 

activities for the triennium. The MOPS 

credits are gained from the development 

plan and the activities that are 

undertaken as part of the plan. 

The annual submission of a completed 

Development Plan, reviewed by a peer, 

is required for the acceptance of all 

other credits. 

A minimum of 150 credits is required 

over the three years of the triennium. 

The credit requirement includes: 

• Development Plan (5 credits per 

annum)—compulsory 

• Clinical Audit (minimum 30 credits) 

• Peer Review (minimum 30 credits) 

• CME (minimum 30 credits). 

The College has designed the new MOPS 

triennium programme to give Fellows 

greater flexibility in creating personal programmes 

of relevance and meaning. There 

is now evidence that traditional methods 

of maintaining professional standards, 

such as lectures and conferences, aren’t 

always useful enough. The most effective 

methods of improving practice include 

educational initiatives that: are based on 

the real work of the practitioner; use 

individual practitioner data to compare 

with peers; take place in the working environment 

of the practitioner; and produce 

individualised education programmes 

based on identified learning needs. 


EDUCATION 

Inspiring rangatahi 

Alexander Bisley 

Communications Advisor, RNZCGP 

Lincoln Nicholls (Ngati Raukawa), an 

acclaimed Maori medical student leader, 

is currently undertaking the GPEP 

training programme. GP Pulse caught up 

with Linc after he’d finished February’s 

Coast to Coast. 

Why do you want to be a GP? 

I like the continuity of care that a GP gets 

in their role. Serving the community has 

also always appealed to me and is something 

that I’ve always enjoyed since my 

days as a secondary school teacher. I like 

the profile that a doctor can enjoy in the 

community and the role-modelling that 

comes with being a Maori doctor. I feel 

very passionate about being known as a 

Maori doctor so that our Maori rangatahi 

can be inspired and see that becoming a 

doctor is very achievable. We need more 

‘TKs from Shortland Street’ in Aotearoa 

and when this happens hey Maori health 

as a whole can only benefit. 

Anywhere in particular you’d 

like to practise once you finish? 

Currently I’m working as a GP Registrar 

in the NZ army and based at Linton 

Army Camp for two days a week, 

Consultation on a young Samoan girl with ‘Tsunami Lung’ 

Feilding Medical Centre for two days, 

and one day of lectures in Wellington 

while on the first year GP training 

scheme. Following my three years with 

the College I will need to complete a 

further two years of return service with 

the army. Following this the options will 

be open which is a very exciting prospect 

for me. That’s the beauty of medicine: 

you can go anywhere and almost 

do anything. Something that has always 

sounded appealing to me is perhaps 

working for a Super 14 franchise. 

What’s your pitch to encourage 

Maori to become GPs? 

We need to break down the stereotypes 

and help our Maori rangatahi see the 

truth—becoming a doctor is extremely 

achievable and that there are Maori doctors 

out there ‘doing it!’ You know, if I go 

out on the town for a social night out with 

the mates and someone starts chatting 

to me, they inevitably ask me what I do 

for a job. When I disclose I’m a doctor, 

they often take one look at my moko on 

my arm and say ‘yeah right mate!’ These 

are the stereotypes I’m talking about. We 

need to break them down. 

Lincoln and his 14-year-old daughter Awarangi 

Continuing with that topic, I’d like to say 

I’m disgusted with that New World ad 

that features a young ‘Maori Checkout 

Girl’. In the advertisement she goes on 

and on about how many of her whanau 

work at New World—this is feeding 

a stereotype that these are the jobs 

that Maori are good for and Maori do. 

It seems to me at times that in reality 

Aotearoa hasn’t come very far at 

all in closing disparity gaps. I quote a 

statement from the Director-General 

of Education from back in 1931 which 

reflects the attitudes of that time. He 

declared that after noting the successes 

of Maori at Te Aute College of the time: 

‘Maori aptitude for maths was interesting, 

but not relevant to their present or 

future needs as agriculturalists.’ 

Coming from a secondary school teaching 

background I see it as essential to 

expose Maori rangatahi to Maori doctors 

as role models and as real people in the 

community doing the business! This will 

help to break down those stereotypes. 

I take any opportunity I can to speak at 

colleges when invited, to promote medicine 

to Maori rangatahi. And when I can 

I send home the message to them about 


EDUCATION 

the importance of sciences as subjects 

at school. That’s what schools have to do 

for Maori rangatahi—they have to ‘G’ 

up the sciences, make it interesting and 

appealing and inspire our kids to take 

science. It’s here where the seeds can be 

sown to grow our future Maori doctors. 

What are the crucial health 

issues for Maori at the moment? 

Understanding! I feel that the average 

New Zealander doesn’t really know 

about the colonial history of Aotearoa 

and the impact of past unjust policies that 

have helped shape the current socioeconomical 

climate of Maori in Aotearoa. 

While at school as a student I remember 

learning about far away countries and 

their histories very often. I remain concerned 

however about the lack of NZ’s 

history that is taught in schools. Let’s face 

it; it’s our history that is so relevant to us 

as Kiwis. If we all know our past and the 

impact of the past and how it has shaped 

out today then we can understand why 

there are huge disparities in health between 

Maori and non-Maori. I believe that 

once there is understanding only then can 

we get together to reduce the gaps. 

How does being a father 

influence you? 

Being a role model to my daughter is 

tops for me. I’m stoked that one of her 

possible future pathways is to follow in my 

footsteps: becoming a doctor appeals to 

her, especially working in paediatrics. Every 

year I take her to the Te Ora hui (Maori 

Doctors Conference). There she is always 

surrounded by Maori doctors and I have 

no doubt that this provides a significant 

source of inspiration. They say that success 

breeds success and that’s what we should 

try to do for our kids. 

There I gained huge experience in working 

in a mass casualty setting. I truly felt 

that I made a real difference in people’s 

lives there. I found it a huge privilege to 

treat desperate locals in their time of need 

and an honour to assist with the cause. 

Tell me about a particular 

medical mentor? 

Sir Mason Durie. Mason’s my best mate’s 

dad and I have been lucky enough to 

have known him now for 20 years. As a 

teacher his name kept popping up in education 

circles and education books. It was 

always cool to nudge the person next to 

me and say, ‘Hey I know him’. 

Since switching to medicine I have realised 

how much of a true legend Mason is. 

I have seen him deliver keynote speeches 

at conferences and have medical world 

VIPs eating out of the palm of his hand. 

Sir Mason is truly an inspiration and a 

fantastic Maori role model for all Maori. 

We’re very proud to say he is ours. Even 

cooler than that, he’s one of my referees. 

Who else has inspired you? 

Our Maori forefathers—Maui Pomare 

(1st Maori doctor), Te Rangihiroa (1st 

Maori doctor to graduate from NZ), 

Tutere Wirepa (3rd Maori doctor) and 

Pohau Ellison (4th Maori doctor). 

At the finish of the Coast to Coast with Robin Judkins 

(founder of the Coast to Coast) 

The late Dr Paratene Ngata, one of the 

founding members of Te Ora. Dr Ra 

Durie, Sport Med Physician in Palmerston 

North. Dr Don Stewart, my Yoda at the 

Linton Army Camp MTC. 

How do you wind down 

from medicine? 

Multisport! I’m loving doing multisport 

events at the moment as a form of maintaining 

sanity, health and fitness. In the 

last three years I have done two Ironman, 

five half Ironman, four marathons, three 

Lake Taupo Cycle Challenges and just 

completed the Speights Coast to Coast. 

When I’m not playing Dad, training or 

competing, you may just find me chucking 

down a few karaoke numbers at the 

China Inn in Palmy. 

How has working for the 

army influenced you? 

Last year I was fortunate enough to deploy 

to Samoa to provide medical aid and 

assistance following the Samoan tsunami. 

Samoa Tsunami medics 


partnership 

The evolving GP/ 

physiotherapist partnership 

Janet Copeland 

Research and Professional Development, New Zealand Society of Physiotherapists 

What does partnership between GPs, 

physiotherapists and other health professionals 

in primary care mean? What 

should it look like? How can it work? 

Up until 1982 the partnership between 

GPs and physiotherapists had to be strong 

because it was based on referrals. All 

physiotherapy patients were referred by a 

doctor. At least theoretically, physiotherapists 

acted ‘under the direction, supervision 

or approval of a registered medical 

practitioner’. This provision, quoted from 

the 1922 Rules of New Zealand Society 

of Physiotherapists’ (NZSP) Auckland 

Branch, remained in force until the NZSP 

Ethical Rules of 1982 allowed direct access. 

In 1999 an ACC regulation change removed 

the GP as gatekeeper for accidental injuries, 

meaning that physiotherapists and other 

treatment providers could claim ACC 

treatment subsidies for patients presenting 

directly to them. Only a medical practitioner, 

however, can sign a patient off work. 

When patients began to access physiotherapists 

directly, the GP/physiotherapist partnership 

was challenged. Its nature changed. 

It had to evolve towards equality, which 

required a mind shift for both parties. 

• On the one hand, the GP needed to 

adjust to interacting with the physiotherapist 

as an autonomous health 

professional and colleague whose independent 

judgement and skills contribute 

to the rehabilitation of their patient. 

• On the other hand, the physiotherapist 

had to realise that collaboration 

remains essential. Keeping the GP 

informed regarding the progress of 

their patient is just as important (or 

perhaps sometimes more important) 

when the patient is self-referred. 

Knowing when to refer a patient to 

the GP or other health professional 

is a crucial element in the physiotherapist’s 

professional expertise. 

A simple example of the requirement for 

good communication is when 18-year-old 

Amanda consults a physiotherapist the 

day after a fall while climbing on rocks. 

During the initial assessment, the physiotherapist 

discovers that in her fall Amanda 

also cut her foot. Taking a medical history 

establishes that Amanda has recently been 

diagnosed with Type 1 diabetes. Amanda 

has not yet absorbed all the information 

relating to her diabetes, such as warnings 

about care of the feet. The physiotherapist 

immediately informs her GP, who sees her 

to assess and treat the cut. 

Partnership in primary 

health care 

The growing emphasis on primary care 

reinforces the need for collaboration 

amongst health professionals. The Primary 

Health Care Strategy stresses the importance 

of multidisciplinary involvement in 

offering access to comprehensive services 

for local populations. A requirement for 

the recent expressions of interest from 

groups keen to develop ‘better, sooner, 

more convenient’ health care was proof 

of multidisciplinary involvement. 

Key principles for delivering primary 

health care are relevant to the GP/physiotherapist 

partnership. 

• Collaboration: The primary health 

system must evolve away from ‘the 

silo mentality’ to work as a team with 

strong lines of communication. 

• The patient at the centre: Working 

together in the best interests of the 

patient, from the patient’s point of 

view. For instance, the decision on 

who should manage, say, a patient 

with COPD, is based on who is best 

for that patient. 

• Community base: Care is to devolve 

from the hospital to be delivered in 

patients’ own homes and in their own 

community. A patient needing chest 

physiotherapy, for example, is treated 

by the practitioner in a communitybased 

facility or their own home. 

• The need for clear pathways for the 

management of common conditions. 


partnership 

• Shared education for all practitioners 

involved. So each member of a 

multidisciplinary team implementing 

a particular pathway or programme 

understands their own role and how 

that fits with others. Understanding 

generates mutual respect as well as 

practical ways of working together. 

What can physiotherapists 

contribute to primary care? 

The traditional GP view of a private 

physiotherapist’s role is treatment of injuries. 

However, as New Zealand prepares 

to play its part in fighting the worldwide 

war against chronic non-communicable 

diseases, all health professionals need to 

be fully engaged. Physiotherapists (and 

other allied health professionals) are well 

placed to help the New Zealand public. 

Physiotherapists can add great value to 

the prevention and treatment of chronic 

diseases. There is good evidence to support 

physiotherapy treatment for various conditions 

such as COPD, diabetes, cardiopulmonary 

rehabilitation, and chronic musculoskeletal 

conditions like osteoarthritis. 

Inactivity is an independent risk factor for 

development of chronic diseases and of 

co-morbidities in those who already have a 

chronic condition. Overall, inactivity is estimated 

by the World Health Organization 

to cause 1.9 million deaths globally. 

‘Increasing physical activity is a societal, not 

just an individual problem. Therefore it demands 

a population-based, multi-disciplinary, 

and culturally relevant approach,’ the World 

Health Organization stated in 2004. 

Physiotherapists can make a huge contribution 

by developing individual activity 

programmes for those with existing 

conditions who are afraid to become 

active or do not know how. 

An evolving example 

The Canterbury Clinical Network, a consortium 

of primary health care providers 

covering half a million people, was one of 

the nine applicants (out of more than 70 expressions 

of interest) selected by the Minister 

of Health to develop a business case to 

deliver ‘better, sooner, more convenient care’. 

Canterbury practitioners were in a better 

position than most when the Minister of 

Health made the call for expressions of 

interest, because they had been reaching 

for years towards the above principles 

listed above. Through a project entitled 

Vision 20:20 they were already tackling the 

question, ‘If you redesigned primary health 

care in Canterbury, what would it look 

like?’ The Canterbury Initiative was working 

on clear pathways. Physiotherapists and 

a wide range of other health professionals 

were already involved. Physiotherapy 

already had a lot of credibility in the region, 

for instance with a physiotherapist on the 

Canterbury DHB Clinical Board. 

The planning group includes physiotherapists, 

practice nurses, GPs, pharmacists, 

community nurses, rural care practitioners, 

PHO representatives, and other 

people with specialised expertise. ‘It’s a 

paradigm shift in attitudes,’ says physiotherapist 

Greg Knight. He gives credit 

to the visionary planners in Canterbury 

who have understood from the beginning 

the need to include everyone. Before 

finalising the business plan to be submitted 

mid-February, a two-day workshop 

brought together ideas from working 

groups which allowed each discipline to 

represent its own issues. 

Partnership models will vary 

How partnership amongst health 

professionals will work may differ 

from one area to another, with varying 

models of primary health care provision. 

The Minister of Health is pushing for 

Integrated Family Health Centres, which 

may allow for flexible arrangements to 

meet local conditions. 

Different service models for Maori 

and Pasifika will no doubt continue to 

develop. Already physiotherapists form 

an integral part of some Maori PHOs. 

Co-location is one solution. There are 

some very successful integrated health centres 

in smaller towns, for example. Shared 

facilities are a start—shared reception staff, 

shared medical records—but maybe the 

sharing can be virtual. A Wellington GP told 

me recently that he and a local physiotherapist 

are discussing how to share medical 

records. ‘We’ll probably just put in a router 

so the two computer systems can talk to 

each other,’ he said. Obviously in such a case 

issues of access and privacy will have to be 

carefully considered. 

Regular professional networking for health 

providers in a local area also offers one way 

to start developing partnership further. 

With plenty of good will and patience, and 

keeping the welfare of the patient as our 

focus, our future collaboration in primary 

health care will improve the health of New 

Zealanders. 


cornerstone 

CORNERSTONE: the 

storage of patient records 

Cathy Webber 

Principal Advisor, Medico-Legal 

How often have we all heard the mantra 

‘patient-centred care’? Quite often. But 

if patients’ needs are truly to be paramount, 

the information that GPs write 

down about those patients should surely 

be a key concern as well. 

Patients don’t tend to like the idea of 

their medical records being accessible 

to all and sundry. Clearly security of 

information ought to be a key priority 

for general practices, and the importance 

of security and privacy is reflected 

in the College’s policy on storing medical 

records. But after discussions between 

the College and the Office of the 

able in public,’ and that non-lockable files 

be used only in non-public working areas. 

In response to a member’s concern, 

the College attempted to clarify a 2007 

pamphlet from the Commissioner in 

regards to storage of paper files. The 

pamphlet interprets Rule Five of the 

Health Information Privacy Code, 

which relates to storage and security of 

health information; the core question 

was whether practices should have 

lockable cabinets for paper files. 

The Commissioner made it clear that 

she expects all practices to ensure 

they have lockable cabinets—having 

The Commissioner made it clear that she 

expects all practices to ensure they have 

lockable cabinets—having them unlocked, 

but behind reception, was not enough to 

meet this expectation 

Privacy Commissioner, in future, that 

definition of ‘secure’ needs to change. 

The College’s standards for storing medical 

records—developed with extensive consumer 

input, and in keeping with relevant 

legislation—are found in our publication 

Aiming for Excellence. This states that ‘the 

content of medical records and documents 

(paper or electronic) is not identifithem 

unlocked, but behind reception, 

was not enough to meet this expectation. 

The College agreed to inform 

RNZCGP members that they should 

plan to meet this expectation within 

the next five years. Discussions on the 

matter are continuing: in the meantime 

we refer you to the standards found in 

CORNERSTONE through the Aiming for 

Excellence document. They can be found 

here: www.rnzcgp.org.nz/aiming-forexcellence. 

The Privacy Commissioner asked that 

the following note on storing paper 

records be passed on to GPs. 

Rule 5 of the Health Information Privacy 

Code requires that health agencies, such 

as GPs, take reasonable steps to keep the 

health information that they hold secure 

against loss, misuse and unauthorised access. 

It does not specify exactly how this 

should be achieved. What is ‘reasonable’ 

depends on the circumstances, such as 

the nature of the information, the possible 

harm if it is lost or inappropriately 

accessed, and the practicality (including 

space and cost) of securing it. In the context 

of complaints that she has received, 

the Privacy Commissioner has been of 

the view that having lockable cabinets in 

which to store sensitive personal information 

is an important component of secure 

information handling. Even where space 

is very limited, a range of lockable cabinets 

is now available to ensure information 

is secure. 

When deciding how to store your patients’ 

paper records therefore remember 

that, while considerations of cost and 

practicality are relevant, you need to 

ensure that you are protecting your 

patients’ records in a way that recognises 

their sensitivity and confidentiality and 

your own legal obligations. 


cornerstone 

CORNERSTONE notches 

up 500 

When GP Pulse calls, Dunedin North 

Medical Centre project driver and practice 

manager Ali Barbara has just chaired an 

enthusiastic CORNERSTONE assessment 

debrief. ‘We’ve got strengthened policies 

and procedures now. We had an incident 

yesterday and everyone knew what to do.’ 

The Centre is the 500th practice to have 

a CORNERSTONE assessment and, 

coincidently, the 100th practice funded 

under a Ministry of Health contract to 

be assessed. Staff, pictured below, found 

the process valuable. ‘CORNERSTONE 

drew the team together. It involved lots 

of teamwork, bringing all our information 

together. And the assessment visit 

highlighted the strength of our team.’ 

Barbara says CORNERSTONE Assessors 

Judy Simpson and Diane Kelly put the 

team at ease with really useful, constructive 

and positive feedback through the 

day. Simpson, too, was pleased with 

Dunedin North Medical Centre. ‘It was 

a really nice, friendly practice. Everyone 

was very open. The whole team had got 

behind and understood the important 

CORNERSTONE journey.’ 

In addition to ‘involving the whole team’, 

Barbara’s other key piece of advice to 

practices is having a CORNERSTONE 

project manager: ‘You’ve got to make 

sure your spokes and wheels are connected, 

driving the whole thing along.’ 

Celebrating the 500th CORNERSTONE assessment at the Dunedin North Medical Centre 


policy 

The Role of the GP 

Jo Scott-Jones 

General Practitioner, Opotiki 

A perfect storm has gathered over 

primary medical care. Sweeping changes 

are afoot, but it’s not yet clear what role 

medically trained professionals will have 

in primary care in 2020. 

GPs have evolved in a small business 

model of service provision. This model 

is becoming less attractive as the GP 

workforce ages. Fewer young GPs are 

prepared to invest in the ‘corner dairy’ 

business of family practice, and ongoing 

health disparities across our communities 

attest to the fact that the small 

business model did not always reach 

everyone equitably. 

Societal changes, including increasing 

democratisation, the breakdown of deferential 

attitudes, information technology 

creating a more knowledgeable population, 

workforce pressures, the recognition 

of the value of multidisciplinary 

All these factors have combined with the 

structural changes inherent in the ‘better, 

sooner, more convenient’ phase of the 

Primary Health Care Strategy to create 

a perfect storm requiring the role of the 

GP in primary care to be clearly defined. 

Without a clear definition of the role, 

there is a danger that the nature of the 

work GPs do will change in response to 

these pressures in ways which not only 

compromise the doctor–patient relationship, 

but also threaten the safety and 

quality of primary health care delivery in 

New Zealand. 

In a multidisciplinary team, who holds 

ultimate responsibility for patient care? 

What does it mean to work with a 

nurse who is autonomous? Should a 

GP be a part of every primary health 

care team? What is the value of medical 

training in primary care when so many 

The modern GP cannot function if 

isolated from the supportive network of 

others working in primary health 

teams and the extension of the scope of 

nursing practice put further pressure on 

primary medical care. 

Increasingly, whole-of-system approaches 

are being used in health policy development, 

and the language we use dividing 

care into primary, secondary and tertiary 

is coming into question, as it creates 

artificial barriers that keep funding and 

services in power vacuums. 

professions have the training, ability and 

legislative support to diagnose, investigate 

and treat conditions? 

The modern GP cannot function if 

isolated from the supportive network 

of others working in primary health. In 

particular, the future role of the GP is 

tightly bound to the future role of the 

nurse, along with the practice manager, 

and the wider team of Hauora, NGO 

and other professions working in the 

health sector. 

I sat on the Primary Health Care 

Advisory Council as RNZCGP representative 

until its demise in October 

2009, following the release of the 

Horn Report. Last year I also wrote 

a College occasional paper describing 

(appropriately in the year of the 

200th anniversary of Darwin’s birth) 

the ‘GP Genome’, and anticipating the 

‘GP Phenotype 2009–2020’ to help 

inform policy makers, planners and 

health professionals in the formation of 

new services as primary care continues 

to evolve. A copy can be found on the 

College website www.rnzcgp.org.nz/ 

defining-the-role-of-the-gp. 

What is the GP genome? Is it possible 

to describe the total collection of 

hereditary information held by a GP? 

What did the GP phenotype—the observable 

characteristics of a GP—look 

like in 2009? 


policy 

The International Labour Organisation 

(ILO) defines doctors as ‘clinical 

scientists who apply the principles and 

procedures of medicine to prevent, 

diagnose, care for and treat patients 

with illness, disease and injury and to 

maintain physical and mental health,’ 

ILO says. ‘They supervise the implementation 

of care and treatment plans 

by others in the health care team 

and conduct medical education and 

a vocationally registered GP; every 

person should be able to identify the 

GP with whom they have a relationship; 

every primary health care team should 

function well as a multidisciplinary 

team; every primary health care team 

should have a well functioning network 

of interdisciplinary connections; every 

primary health care team should be a 

learning environment; effective planning 

for change requires the engagement of 

It is clear that within primary health 

every day, all professionals are making 

difficult decisions in situations of clinical 

complexity and uncertainty. Is it the role of 

the GP to take ‘ultimate responsibility’ for 

those decisions with the patient? 

research.’ A combined UK medical 

college consensus statement in 2009 

states: ‘Doctors alone amongst health 

professionals must be capable of regularly 

taking ultimate responsibility for 

difficult decisions in situations of clinical 

complexity and uncertainty, drawing 

on their scientific knowledge and well 

developed clinical judgement and relationship 

with the patient.’ It is clear that 

within primary health every day, all professionals 

are making difficult decisions 

in situations of clinical complexity and 

uncertainty. Is it the role of the GP to 

take ‘ultimate responsibility’ for those 

decisions with the patient? 

As we move forward into the future 

I would suggest that: every person 

should have an identifiable primary 

health care team; every primary health 

care team should include at least one 

GP; all medical professionals working in 

primary health care should be working 

towards vocational registration or be 

those involved in change; primary care 

teams should continue to be actively 

engaged in the continuous development 

of quality services. 

Feedback on 

Dr Scott-Jones’s paper 

The RNZCGP invited comment on Dr 

Jo Scott-Jones’s paper Defining the role 

of the GP in a primary health care team: 

The GP genome and phenotype 2009– 

2020. Jo and the College have received 

responses to his paper reflecting 

a wide range of viewpoints. Most 

respondents agreed with the general 

direction of the paper. There was some 

divergence of opinion both from the 

views put forward in the paper, and 

between respondents on several issues, 

including: 

1. Evidence-based practice. The 

influences of large corporations on 

what research is undertaken and 

2. 

3. 

4. 

5. 

disseminated, the degree to which 

GPs follow scientific method, and 

the research base of nursing were all 

commented on. 

Practice size. The advantages 

of smaller or moderately sized 

practices in providing the ongoing 

one-to-one relationship at the core 

of patient care were noted. The 

problem with the small business 

model was seen as its lack of attraction 

for investors. 

Multidisciplinary teams (MDT). This 

topic attracted a lot of comment. 

Some respondents considered 

these teams the obvious way of 

the future, while others said that 

their practices already functioned as 

MDTs. Others referred to MDTs as 

‘management by committee’ and an 

institutionalised approach which was 

less conducive to patient-centred 

care. One respondent said ‘interdisciplinary 

environment yes, multidisciplinary 

teams—maybe, but very 

very carefully, and not merely to appease 

some group on a philosophical 

bandwagon.’ Others commented 

that a small team, such as already 

exists in many general practices, had 

advantages over a large team. 

Should GPs focus more on health 

and less on illness? Opinion was 

expressed that the focus should be 

more on areas such as nutrition and 

less on medication and the management 

of illness, accompanied by their 

expense and side effects. 

How much input should GPs seek 

into areas such as social work, housing, 

education etc? The view was 

expressed that although GPs need a 

good understanding of how health 

is affected by personal and social 

factors, it is more appropriate that 

there be good referral systems to 

appropriate agencies. 

The role of the GP continues to be a 

subject of much activity within the sector. 

The College welcomes further feedback 

via policy@rnzcgp.org.nz. 


policY 

Health insurance company 

requests for entire patient 

medical notes 

Cathy Webber 

Principal Advisor, Medico-Legal 

Over the past two years the RNZCGP, 

as part of the GPLF (General Practice 

Leaders Forum), worked with the 

Privacy Commissioner and the insurance 

industry in resolving the issue of health 

insurance companies’ requests for entire 

patient medical notes. 

In July 2009, the Privacy Commissioner 

published the results of her inquiry into 

this issue. * The (NZMA) also released a 

guidance note for its members. † Despite 

this information being available, a College 

member raised her concerns with us 

that the average GP is probably still not 

aware of the outcome of the recent 

events and requested that the College 

also bring it to your attention. 

information that is necessary to make 

insurance decisions. 

As the holder of the medical record, you 

need to be sure that the patient has properly 

authorised the insurer to collect the full 

medical record (for a specified period) and 

that the insurers that collect full medical 

notes (for a specified period) are collecting 

personal information that is necessary for 

the insurance decisions they have to make. 

The need to answer insurers’ questions 

will mean that in some cases 

considerable time may be required by 

your practice. The NZMA has provided 

clear advice on how to charge for this. ‡ 

Essentially, ensure that the fee you charge 

The Privacy Commissioner has expressed 

her view that, in most cases, insurers 

that collect full medical notes—even for a 

specified period—are at risk of breaching 

the Health Information Privacy Code 

The nub of the issue is that the Privacy 

Commissioner has expressed her view 

that, in most cases, insurers that collect 

full medical notes—even for a specified 

period—are at risk of breaching the 

Health Information Privacy Code. 

Insurers can only collect personal health 

for the time spent meeting the request is 

reasonable and provide full details of this 

in your invoice. 

If you have a request for full medical 

notes, we recommend you respond with 

a brief letter along the lines of: 

Your request for full patient notes 

I am informed by the June 2009 Privacy 

Commissioner ruling on the collection of full 

medical notes by insurers that your request 

must be authorised by my patient and that it 

must be relevant to the decision you must make. 

I take my responsibilities under the Health 

Information Privacy Code seriously, but also 

do not want to jeopardise my patient’s insurance 

application. To this end I will provide the 

relevant medical information on receipt of a 

more specific request and with evidence of 

my patient’s authorisation. 

The College appreciates members raising 

issues with us and encourages you to 

contact us with your queries. Email cathy. 

webber@rnzcgp.org.nz. 

Footnotes 

* The full report can be found at www.privacy.org.nz/collection-of-medical-notes-by-insurers-inquiry-by-the-privacy-commissioner/. If this link fails, go to the www.privacy. 

org.nz, go to the news and publications: commissioner inquiries section. 

† www.nzma.org.nz/membersonly/privacy-confidentiality/Patient%20notes%20and%20Insurers.pdf. 

‡ Ibid. 


OBITUARY 

William Grattan 

O’Connell QSM 

Ellis Greive 

Retired General Practitioner, Auckland 

William Grattan O’Connell FRNZCGP 

died November 27 th 2009 aged 84 

years, thus ending a notable career 

in general practice and service to the 

community. 

Educated at Sacred Heart College, 

St Patrick’s Silverstream (where he was 

Head Boy) and Otago University, he 

began general practice at Glen Innes, 

Auckland in 1953 and never moved. 

With the initiation of a local work roster 

Grattan and I began playing golf on 

Thursday afternoons and continued to 

do so for more than 40 years. Sweet 

times indeed. 

He was devoted to his patients, devoted 

to medicine, devoted to excellence; an 

attribute shown by his three daughters. 

He was meticulous in everything. This did 

not compromise a wry sense of humour. 

His pastime was golf, his profession was 

medicine, his passion was the Rotary 

movement, achieving high honours. 

International board member, a director of 

the committee to eradicate polio, which 

was very successful. For these services he 

was awarded the Queen’s Service Medal. 

He is survived by his wife Verna whose 

unflagging support and care played a 

large part in Grattan’s success. 


OBITUARY 

Brett Phillip Roche 

Kate Braddock 

General Practitioner, North Shore 

Brett Roche MBChB, died tragically 

and unexpectedly at his home on 10th 

December 2009 aged 46. 

He will be missed by all who knew 

him—for his passion about general practice, 

for his caring, and for his challenging 

and penetrating wisdom regarding the 

future of primary care in New Zealand. 

Brett did a BSc, graduating in 1986, before 

going on to qualify from Auckland 

Medical School in 1992, and become 

one of the first registrars that I worked 

with at the Warkworth Medical Centre 

in 1996. Even then, he had an intense 

desire to better the care that was given 

in general practice and was full of ideas 

to help that happen. 

He went on to become a Member of the 

RNZCGP, and subsequently obtained a 

Diploma in Sports Medicine in 2005. He 

was involved in the medical care of the 

North Harbour Rugby Team and went 

on to be part of the Birkenhead Medical 

Centre, when he bought the practice 

from Peter Cunningham. 

During the last three years of his life 

he became very involved with the 

future of primary health care at a 

political level—sitting on the boards 

of the Independent Practitioners 

Association Council, Best Practice 

Advisory Council and Comprehensive 

Health Services (an Independent 

Practitioners Association based in 

North Harbour), and a member 

of the Performance Management 

Programme Governance Group 

representing the General Practice 

Leaders Forum. 

In all of these forums he presented 

thoughtful, penetrating and innovative 

ideas and was a well-respected and 

highly committed contributor. 

He was a reserved person in his public 

life but cared deeply and passionately 

for his patients and the care he could 

and did give them. 

He worked endlessly to extend his 

understanding and management of the 

problems he saw in primary care, and 

the work that he started will be continued 

by those who knew him and shared 

his passion. 

He will be sorely missed. 

The College publishes short obituaries in GP Pulse. 

Notifications can be submitted to the Editor via the College 

address, RNZCGP, PO Box 10440, Wellington 6143, or email 

alexander.bisley@rnzcgp.org.nz. Pictures are encouraged. 


ural hospital medicine 

West Coast: 

DHB Rural GP and Hospital 

Medicine Pilot Project 

Anu Frances Shinnamon 

General Practitioner, RHM Registrar, West Coast 

Let’s be honest here, I am one of those 

new generation doctors, Generation Y 

according to Wikipedia. The ones they 

talk about at conferences when they 

labour over workforce planning and 

how the government can attract junior 

doctors to generalist roles in rural areas. 

During the past few years, the RNZCGP 

has fostered two pilot programmes that 

have captured my attention. 

Luckily, I’ve been able to join a pioneering 

group of colleagues to test the waters as 

the College develops new ways of training 

and credentialling rural generalists. The 

Type A in me was chomping at the bit to 

be one of the first on the block to undertake 

the Rural Hospital Medicine (RHM) 

pilot in 2009 and the GP/RHM Registrar 

Pilot at the West Coast DHB in 2010. The 

Type B wanted to live rurally and indulge 

in the surrounding geography. GP Pulse has 

asked for some comment on my experience 

with the 2010 Pilot but I cannot 

restrain a bit of overlap with RHM. 

We are in the early days of 2010, but I 

dare say the College has hit the nail on 

the head in getting this training off the 

ground. Greville Wood, the brainchild 

behind the West Coast DHB pilot, 

enticed me with an email that included 

this description: ‘The purpose of the 

programme’s to foster GP specialist skills 

whilst retaining the hospital skills that 

have been practised for years.’ To make 

the deal even sweeter, the year long 

Multi-Employer Collective Agreement 

(MECA) contracted post, meets the 

Primex requirements of GPEP1 and 

allows me to cross-credit the experience 

in the ever-flexible RHM programme. I 

love efficiency. 

The strengths of the WCDHB pilot are 

context and mentorship/collegiality. The 

West Coast catchment of roughly 31000 

residents stretches between Haast and 

Karamea (which is in the midst of the 

best Rata bloom in 40 years). The pilot 

takes full advantage of the uniqueness 

of this geography and puts the trainee in 

the deep end of helping to oversee the 

community’s needs. For a relatively small 

head count, there is remarkable social 

diversity. There is a blend of haves and 

have nots. Dairy, mining, fishing, conservation, 

education, tourism and health care 

dominate the workforce here. Grey and 

Westland High are decile four and six. 

The median individual income is $14,800. 

Many areas have no cell coverage. 

Seventy-five percent of households have 

no access to the Internet. These social 

complexities combined with issues of 

physical geography (which is very isolated 

at times) make for a satisfying and challenging 

training ground. I am honing my 

clinical acumen and my resourcefulness in 

the context of the available services. This 

is further enriched by the pairing of the 

in- and out-patient experience. The ability 

to follow patients between hospital 

and community is an invaluable educational 

modality. The continuity of looking 

after my chronic patients on the ward 

and following up the acute admissions in 

the community is the beauty of the training 

programme. It allows me to see the 

full cycle of the patient throughout their 

journey in the health care system. 

In a former career I evaluated health 

services education reform. A recurring 

theme in successful training programmes 

was good mentorship. Not the humiliating, 

bedside pimping style, but the dedicated, 

no question is too stupid, teaching is my 

modus operandi, type of mentorship. The 

pilot has liberal amounts of protected 

mentorship and teaching time, alongside 

real-time advice and guidance during 

consults. The mentorship style brings 

together students, registrars and senior 

staff to challenge each other and learn 

together. It breaks the barrier of hiding 

weaknesses, which has dominated medical 

education through the years). Instead 

it fosters an open, case-based learning 

format which, put simply, suits me down 


ural hospital medicine 

to the ground. Coming from the world of 

public health and social services, I never 

quite adapted to the abrupt change in 

hierarchy that seems to dominate much 

of medicine. The smouldering adolescent 

certainly rejected the pecking order that 

put students at the bottom. I thought 

on graduation I might be embraced in a 

new-found collegiality with my peers and 

senior colleagues. I will forego the diatribe 

on that topic and acknowledge that I seem 

to have found my niche in rural medicine. 

The GP/RHM pilot is maximising the 

benefits of shared learning by fostering a 

refreshing collegiality. 

The two dominating highlights of the GP/ 

RHM pilot are the lifestyle of the Coast 

and the unpredictability of the clinical 

presentation. At risk of sounding like a 

West Coast recruitment poster child, I’ve 

drunk the proverbial Kool Aid and can 

proselytise endlessly about the benefits of 

training and living here. There is the usual 

spiel about the coastline, forests, glaciers, 

tramping, climbing and paddling. It is all 

true. Even my husband, who has been at 

the mercy of the registrar life, can attest. 

You need to move on from your visions 

of endless rain and thoughts of parochialism. 

We have had dry skies for weeks and 

Tchaikovsky is being performed at the 

Cathedral this weekend. There is a sense 

of community on the Coast, even if you 

are not born and bred. there It is an easy 

and fun place to live, without having to 

fight traffic to do the things I enjoy. 

For a person who likes order and 

predictability, I am always amazed at the 

rush I get from the unexpected. So far, 

there has been no predicting the variety 

of presenting complaints with which I’ve 

been faced. It is the essence of generalist 

medicine. It is the reason I’m doing this 

training. In the space of six weeks, I’ve 

been forced to resurrect medical school 

lectures I thought I’d never use and try 

to expand my RAM to keep pace with 

the patients that land in my care. Thank 

God for Google. Tempting as it may be to 

brag about what we treat on the Coast 

(in that macabre doctor way that we do), 

I’ll spare you the full list. Suffice it to say, 

however, I did not think I would come 

to manage cardiovascular risks, vaginal 

atrophy, career counselling, an ischemic 

bowel, a dislocated patella and a gaggle of 

testosterone-poisoned, drunken teenagers 

with scalp lacerations all in one day. 

Unlike a big tertiary centre, there is no 

clamour to ‘get the interesting’ patients— 

when you are the only doctor in the 

hospital at night, all the patients are yours. 

Whether it is the injured farmer being 

flown in from up country or the octogenarian 

who needs advocacy and support 

for rest home placement, in this Registrar 

post I am seeing it all and learning how to 

manage it in the context of a rural setting. 

So, what more can I say? If you are one 

of those new generation (X, Y, or Z) 

doctors (Type A or B) consider a training 

opportunity that has come of age. 

Blending GP and rural hospital medicine 

opens up the best of both worlds and 

serves as meaty training grounds. 


wine • travel • books • humour and more 

Life&leisure 

Humour 

Back to the Ark? Technophobia 101 

Buzz Burrell 

General Practitioner, Blenheim 

She slowly moves her expressionless 

face towards the expectant questioner. 

With a detached, passive, defeated 

voice she announces the bad news: 

‘Computer says “No” ’. 

If only this were a real scene from Little 

Britain. Sadly it’s my receptionist imitating 

with scary accuracy the Little Britain character 

and she has two agendas. Firstly 

to raise a smile, since the TV sketches 

are funny to both of us. Secondly, to 

defuse the reality that for the third time 

this week the computer has completely 

locked up, and is as useful as a light bulb in 

an Auckland power cut. 

I feel old. I’m young enough to have 

attempted waterskiing over the summer 

holidays, and endure high-speed high 

colonic washouts trying to morph from 

anchor to floating towed vessel at 30 

miles an hour behind a speedboat. But 

I’m old enough to digress. Sorry. 

I’m also old enough to remember 

the days of my youthful entry into a 

small rural general practice where the 

only electronic gadget was a desk-top 

calculator. Computers were for playing 

space invaders, and a power cut was 

inconvenient only if it were dark and 

candles needed to be lit. Eventually 

we did invest in a fax machine, but this 

graduate from Technophobia 101 would 

usually phone immediately afterwards 

with the disbelieving ‘Did you really just 

get the fax?’ 

I identify so well with the story of the 

young executive spotting the CEO 

standing in front of the shredder late 

one evening. ‘Listen lad,’ the CEO 

shouts: ‘This is a really important document, 

and I don’t know how this thing 

works?’ Eager to impress, the lad turns 

on the machine, inserts the paper, and 

presses the start button. Touched, the 

CEO exclaims: ‘That’s excellent, lad. 

Now where does the copy come out?’ 

Sixteen years on, and I’m in a paperless 

environment. My notes, results, letters, 

recordings, referrals are all electronic, 

and for my peripheral clinic everything is 

also completely at the mercy of a fragile 

Internet connection between Havelock 

and Blenheim. When the connection 

is lost, the relationship between my 

terminal and the network collapses 

like a Hollywood marriage, and .... the 

computer says ‘No’. 

Perhaps it would help if I could type. In 

Australia, like an innocent schoolboy, I 

faithfully typed my referral letters before 

handing them into the cyber-teacher’s 

pigeon-hole for electronic spellchecking. 

I used to try to type ‘Thanks 

for your opinion’ etc. The ‘Thakns’ 

would be cleverly corrected, but the 

veggie mistake which always followed 

would slip through, and for my first 

few months in Western Australia many 

Perth specialists must have wondered 

who this weird gardener was writing to 

them from the bush with the opening 

line ‘Thanks for your onion’. 

There are times when I feel like I’ve just 

crawled off the Ark. 

I think I’ve managed to trust the fax 

machine at last, largely because I don’t 

know how to use it, and my receptionist 

takes control. My trust of emailing new 

addresses remains unsure, cognisant of 

vegetable typos, I frequently consider 

the case of the Illinois man who left 

the snow-filled streets of Chicago for 

a vacation in Florida. His wife was on 

a business trip and was planning to 

meet him there the next day. When he 

reached his hotel, he decided to send his 

wife a quick email. Unfortunately when 

typing her address, he missed one letter, 

and his note was directed instead to an 

elderly preacher’s wife whose husband 

had passed away only the day before. 

When the grieving widow checked her 

email, she took one look at the monitor, 

let out a piercing scream, and fell to the 

floor in a dead faint. At the sound, her 

family rushed into the room and saw 

this note on the screen: ‘Dearest Wife. 

Just got checked in. Everything prepared 

for your arrival tomorrow. P.S. Sure is 

hot down here.’ 

Back to the Ark, I wonder how things 

would have worked with today’s technology 

assisting. The post-Ark days have 

special laws against relationships flourishing, 

I decide, after visiting www.datemypet.com. 

Little genetic thought has gone 

into the series of ‘this is sooooo cute’ 

photos we receive in our email inbox, 

usually involving a big goofy dog sleeping 

with a duck. How did they manage to get 

all those animals on-board without an IT 

team, data entry clerks, spreadsheet and 

software designer, and the constant virus 

protection upgrades? 

I can just imagine my receptionist being 

there. ‘And who is in charge here?’ ‘The 

computer says Noah’. 


Life&leisure 


2–5 September—THE 2010 RNZCGP ANNUAL CONFERENCe 

Christchurch 

Attending the 2010 RNZCGP Conference 

in Christchurch in September will offer 

the added benefit of some great nonconference 

enticements. 

Stroll leisurely around the beautiful, famous 

gardens; eat delicious Canterbury 

food and wine in the fine cafés and 

restaurants; or see the exhibitions at the 

excellent museums and galleries. 

For more on what’s on while you’re 

there: www.christchurchnz.com 



Life&leisure 

Top things to do in Christchurch 

Suggestions from RNZCGP staff and GPs with Garden 

City connections 

1. Take Christchurch Bike Tours’ two-hour excursion 

from Cathedral Square 

—Annie Fleetwood, Resources and Representation 

Coordinator 

2. Book ahead for The Bodhi Tree, great Burmese 

food on Colombo St near the conference centre 

—Margaret Metherell, GP 

3. View the engaging exhibitions at Christchurch Art 

Gallery and eat at the enticing Arts Centre market 

—Alexander Bisley, Communications Advisor 

4. Go to the Antarctic Centre and the Crumpet Club 

(tapas bar)—Waveney Grennell, CORNERSTONE Manager 

5. Visit picturesque Akaroa or Canterbury vineyards 

—Karen Thomas, Chief Executive 


Life&leisure 


Guide to New Zealand 

pinot noir regions 

Jules van Cruysen 

New Zealand Pinot is gaining international momentum and reputation (and in my opinion rightly so), but while all 

good Kiwi Pinot share some characteristics, the differences between the regions are significant. Here I look at what 

to expect from the different regions in terms of style and look at the heavy hitters, the best value wines and what to 

avoid in Kiwi Pinot. 

WAIRARAPA 

The Wairarapa is the only significant Pinot region in the North Island and is centred on two sub-regions; Martinborough to the 

South and Gladstone in the North. Martinborough is surrounded by terraces of dried riverbeds and produces a number of the 

‘Grand Crus’ of Kiwi Pinot—notably Ata Rangi and Dry River, but for my money I would suggest Escarpment, Craggy Range 

Te Muna and Aroha and the wines of Kai Shubert. None of these are cheap. The wines are masculine with characteristic Black 

Dorris plum fruit, Earl Grey—like tannins (dry but floral) and a lot of oak—the best wines can be awkward in their youth but can 

last a long time. For something more accessible try Strugglers Flat. Avoid Martinborough Vineyards and Te Kairanga as these producers 

have both lost their edge in the last few years. Gladstone is based on old riverbeds but seems to produce softer, elegant, 

affordable wines that are less suited to ageing—as the vines age this will change. Johner Estate makes an excellent range of wines 

from this region at different price points. 

NELSON 

Nelson breaks down into two sub-regions: The Waimea Plains which centre around the towns of Hope and Brightwater on 

the flat gravel just to the south of Nelson, and the Moutere, to the west in the hills across the bay from Nelson where the soils 

are clay- based. From the Moutere go for Rimu Grove and Neudorf—from their entry level Tom’s Block to their Moutere and 

extremely rare Home Block the wines are stylish—full of ripe cherry, chocolate and spice! Greenhough and Brightwater make 

excellent wines on the flat. 

MARLBOROUGH 

Pinot has become the rising star of Marlborough—at their best they are light but intense, a balancing act between savoury and 

sweet, masculine game and feminine floral. Most of Marlborough is flat and is planted on old riverbed soils interspersed with other 

soil types, while the hills around the area are clay-based. There are a handful of high performing affordable wines coming out 

of Marlborough like Spy Valley and Momo, but the top end really inspires. For supple, restrained, long-lived wines, producers like 

Dog Point, Seresin, Herzog and Fromm (and their second tier labels William Thomas and La Strada) cannot be beaten. The most 

complete Marlborough Pinot I have tried was the ‘07 Eaton Vineyards by Pyramid Valley. Intensely concentrated fruit balanced by 

acid and supple tannins with a beautiful floral lift—sadly it will be the last vintage of the wine that is produced. Like everything else 

in Marlborough there is a lot of commercial rubbish produced—avoid the mass-produced wines as, when it comes to Pinot they 

rarely offer good value. 



Life&leisure 

NORTH CANTERBURY 

The wine growing region of North Canterbury (often referred to as the Waipara, 

but this also refers to a town and sub region as well) stretches about 50km along the 

inland of the east coast of the South Island from Amberley and Glasnevin in south 

moving up through Waipara and then Omihi and finishing at Waikari. Understandably 

it is a geographically diverse area which ranges from gravel plains in the south 

through to hillside sites heavy in clay and lime. The best wines are heavy, savoury, 

powerful beasts that only time will tame; the worst are foursquare, awkward and 

clumsy… and don’t get better. Pegasus Bay is the big name in the area and this reputation 

is well deserved as is that of Mountford. The new kids on the block are Crater 

Rim in the Waipara, Black Estate in Omihi. In Waikari Pyramid Valley and Bell Hill are 

commanding Grand Cru prices after only a couple of vintages. That’s if you can even 

get a hold of it. 

CENTRAL OTAGO 

The popularity of Central Otago Pinot has been driving the craze, both domestically 

and internationally, for NZ Pinot. There are some stunning wines out there, but 

there is also a lot of dross, and expensive dross at that. It is a region that spans several 

geographically distinct sub-regions but the wines share some similarities—whether 

by style or soil (or more likely a combination of both). The wines are brightly fruited 

with ink black cherry fruit and many have a wild thyme herb and bramble component. 

There are some big wines out there—14.5% ABV is pretty normal but with 

the best wines the fruit carry it well. The Grand Crus are Felton Road’s Block 3 and 

Block 5 wines from Bannockburn (their other wines are stunners as well) if you are 

prepared to wait five years before getting your money’s worth. Otherwise Grant 

Taylor’s Valli wines (he makes wines from the Bannockburn and Gibbston sub-regions) 

and Rippon based in Wanaka are very exciting. For something more affordable 

try Saddleback by Peregrine or Rabbit Ranch—both are a great introduction to the 

Central Otago style but are still pretty expensive for easy drinking reds. 

NORTH OTAGO 

I am particularly fond of the Waitaki as it is my home region and is one of 

New Zealand’s most recently planted. The wines are very savoury and classically 

Burgundian in style—they vary depending on soil composition. The region has pockets 

of deep lime as well as schist and gravel and is already making serious, age-worthy 

wines that are getting better vintage after vintage. My picks are Ostler Caroline’s 

Pinot Noir as well as the Valli and Craggy Range wines. At five years’ old the Craggy 

Range Otago Station Vineyard is still a stunner—light and full of feral porcini, truffle 

and violets. And that was the first vintage. A region to watch! 

None of these wines are cheap. If you are going to invest in Kiwi Pinot I think it’s better 

to spend a few bucks and wait a few years and be rewarded rather than go for 

something cheaper and be let down. 

Jules van Cruysen is a wine critic and sommelier. He blogs at thewinewanker.blogspot.com 

Best Wine of 2009 

2009 being a year of recession 

it only fits that my favourite 

wine of the year is affordable 

and immediately drinkable: 

Forrest’s The Doctors’ Riesling 

2009, Marlborough. This wine 

is such a step up from previous 

vintages that it seriously blew 

me out of the water—and is 

textbook off dry, low alcohol 

(that is Germanic) Riesling. Clean, 

fresh and pure. Green apple, 

pear, stony minerality and just a 

hint of floral meadow honey and 

honeysuckle. Just beautiful! 

forrestwines.co.nz/selectProduct.asp?RangeID=The%20 

Doctors&Product=Riesling 

Thanks to Forrest Wines 

we have six bottles of 

the lovely 2009 Doctors’ 

Riesling to give away. 

Give us feedback about 

what you like and don’t like 

about GP Pulse to get in the 

draw. Access the survey at 

the following link: 

www.surveymonkey.com/s/ 

GPPulseReader Survey 


member support 

Becoming a member 

The College has over 4000 members, 

representing around 94 percent of all general 

practitioners in New Zealand. 

To Join 

Application forms may be obtained from the College 

office, PO Box 10440, Wellington 6143. They should be 

completed and sent to the Assessment Administrator 

Lynn Frew at the College office. Faculties are notified of 

applications. 

Categories of Membership 

Full Membership and Fellowship is attainable only by 

examination and assessment. Associate membership 

therefore carries no implication of academic or professional 

achievement or status. 

Fellow (FRNZCGP) 

Fellowship of the College is attained by completing the 

two-stage General Practice Education Programme, passing 

Primex (the primary membership exam) at the end 

of Stage 1, and the Fellowship Assessment in Stage 2. 

Fellows have full voting rights and have the privilege of 

the floor at general meetings. They may also hold any 

office within the College. Fellows are entitled to use the 

designation FRNZCGP. 

Member (MRNZCGP) 

The College awards Membership after successful completion 

of Primex at the end of GPEP1 or an equivalent 

programme. A Member who is of good standing is 

entitled to the privilege of the floor at general meetings, 

may vote and may hold office except where the office 

requires that it be filled by a Fellow. Members are entitled 

to use the designation MRNZCGP. 

Associate 

Most Associates of the College are engaged in general 

practice; however, doctors who are practising within 

a College-recognised special interest area of primary 

care are also entitled to Associate membership. 

Associates may take a full part in College affairs, except 

that they may not vote at the Annual General Meeting 

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Affiliate status may be granted to any individual who has 

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affiliated with the College. It may also be granted to 

organisations that have special links with general practice. 

Affiliates may not vote or hold office. 

All RNZCGP resources, including the GP Pulse and the Journal of Primary Health Care (JPHC), are produced using 

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in compostable film wrap. 


member support 

College services 

Everything we do is aimed at strengthening and supporting you in your practice. 

Advocacy 

You have tasked us with making your collective voice heard 

at the highest levels of Government about the issues facing 

general practice. Working as an integral part of the General 

Practice Leaders Forum, we harness the power of a united GP 

voice on major issues. 

College policy positions are developed using the expertise of 

members. Once approved by the College Council they are 

posted on the College website: www.rnzcgp.org.nz/submissions 

If you would like to contribute your expertise to the development 

of College policy positions please contact policy@rnzcgp. 

org.nz or 04 496 5999. 

Education 

As a member of the College you can access our full range of 

education programmes and resources that help you gain, then 

maintain, registration in the vocational scope of general practice, 

allowing you to practise independently. This includes online 

resources, particularly the highly-respected BMJ Learning that 

the College provides free to members. 

BMJ learning online 

Working in conjunction with the British Medical Journal, BMJ 

Learning offers a range of learning resources which deal with 

everyday issues in primary care, general practice and hospital 

medicine. BMJ Learning currently offers over 500 evidence-based 

learning modules, which are regularly updated. Plans are in development 

for specific New Zealand content. BMJ Learning forms 

part of the structured learning for the GPEP programme. 

Online resources 

MOPS Online allows you to enter and keep your Maintenance 

of Professional Standards credits up to date. Already, our registered 

providers provide course attendances online and this year 

we have plans to make MOPS more interactive. It is all aimed at 

simplifying your compliance and reducing your paperwork. 

Quality 

Quality in everything we do is a focus of the College, with 

the member-developed Aiming for Excellence standard, 

together with CORNERSTONE practice accreditation. 

CORNERSTONE is gaining momentum as the vehicle to assure 

the delivery of a quality environment at your practice. 

Research 

The Journal of Primary Health Care (JPHC) is the College’s 

peer‐reviewed journal designed to meet the information needs 

of New Zealand general practitioners, practice nurses and community 

pharmacists plus other primary health care practitioners 

and the patients and communities we serve. It is also available 

on the College website, and we provide a local search engine 

for you to search the issues. 

Information 

At the core of the College is our website: www.rnzcgp.org.nz 

It’s there as your pathway to health information, and the services 

the College can provide. 

ePulse is our electronic newsletter, bringing you the fastest and 

latest news in the health sector each week. We also publish ads 

for locums or GPs and, as a Fellow or Member, that service is 

FREE. 

GP Pulse, which you’re reading at the moment, covers every 

facet of the College’s work for you. It includes the latest news 

on College operations, the decisions of your representatives 

on the Executive and Council and the current issues facing the 

primary care sector. 

GP Pulse is the vehicle for you to have your say, either in response 

to something you’ve read, or as a request for a specific 

need you have identified. We welcome your comments on 

GP Pulse at gppulse@rnzcgp.org.nz or on 04 496 5999. 

We publish resources in response to the changing environment 

in general practice. All publications are free to members for the 

initial copy. They are also available online at the College website: 

www.rnzcgp.org.nz/college-resources 

Articles from previous issues of GP Pulse and from the earlier 

College publication NZFP are available in the website archive. 

The Annual College Conference 

We rotate among our faculties with our annual conference, 

choosing a venue and theme that will stimulate and educate 

you. Registration is discounted for members. 

The 2010 Annual Conference will be held in Christchurch, 

2–5 September. 

Every year we also host a Quality Symposium noted for the 

input from national and international speakers and for the 

informed, erudite discussion generated by that input. Again, 

members get a substantial discount 

Every second year we host an Education Convention, bringing 

together GP teachers, educators and examiners and others 

interested in medical education. 

Advice for Members 

Sometimes it can all become too much for you. Where do you 

go, who can you speak to? 

Ring our HELPLINE: 0800 RNZCGP (769 247); we can proffer 

helpful suggestions. It is part of our mission to support you and 

in doing so to improve the health of all New Zealanders.

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