Home' GP Pulse : GP Pulse February 2014 Contents Features
ISSUE 30 : February 2014 : P7
universalism – a universal base of health
care provision for all our children and
then being able to identify who needs
propor tionately more ser vices, which you
can do when you have universal enrolment
and effective attention and screening. I’d like
to see enrolment antenatally for children
and early engagement with a general
practice home, so that we all know our
childhood population and who are the
most vulnerable. I personally will continue
to push for free access to primar y care and
prescriptions for all children.
Child pover ty: I would really like to see
a countr y that acknowledges we have a
huge problem with inequality and child
pover ty that affects the shor t and long term
outcomes for a significant minority of our
kids – we need to pay this the attention
it deser ves, make a proper integrated
global plan, measure and monitor. We have
a bad histor y of cherr y picking issues in
child pover ty, rather than taking a broader,
integrated approach. For example, I find
it sad that the countr y has put lots of
time into setting up sore throat clinics for
rheumatic fever prevention in schools but
still our children cannot access free health
care ser vices or prescriptions 24 hours
a day – sore throats do not appear just
in school hours and fur thermore, these
children need broader health care attention.
We’ve got a lot of positive learnings from
the immunisation stor y, I’d like to see us
apply them more broadly to the issue of
child pover ty.
You’re incredibly busy with your work with the
Child Poverty Action Group, Conectus and the
Immunisation Advisory Centre, lecturing at the
University of Auckland and working as a GP.
How do you find time do all of this and what
helps you relax at the end of the day?
It’s team work – I hate working alone and I
work alongside some amazing, energetic and
inspiring people. Things can change when we
can effectively work together to a common
Relaxation is a strong suppor tive family,
riding my bike and lots of time with my
bloke and kids!
dramatic shift and how can these rates be
It really comes down to focus, attention and
effective, integrated responses. As a countr y,
and a health sector, we decided we needed
to do something about immunisation rates.
The improvements had star ted before the
national targets were introduced but the
national targets cer tainly gave impor tant
impetus for ever yone to put effor t in. And
what made a difference was the routine
‘bread and butter’ stuff – getting systems
right at all levels, alongside champions to
keep the attention and not let go. The key
General practice systems working
effectively to enrol, engage, pre-call, early
recall and then early referral to effective
outreach ser vices
Suppor t at national and DHB levels for
Feedback loops to DHBs, PHOs and
general practices about their progress
Champions at ever y level to keep the
issue on the agenda
A national target to keep the attention
I see the immunisation coverage
improvement as a fantastic example of being
able to fix a problem with good, effective
attention, integration and good systems.
I believe the model has a lot to teach us
about improving other aspects of child
Can we maintain it? Yes, our systems,
approaches and commitment are so much
better than they were and we know now
we can achieve and maintain high coverage.
However, I’d like to see it remain a national
target, as I fear we could slip backwards if
we take our eye off the ball.
Immunisation is a topic that can incite deeply
held views, both for and against.What advice
can you give your GP colleagues for dealing
with patients, to make sure they have the right
information to give properly informed consent?
Recognising the emotional side is really
impor tant. The absence of disease is a
difficult concept emotionally and for a
parent when they can see an upset child and
a large needle.
Firstly, we should suppor t and positively
reinforce parents who get their children
immunised; they’re doing a great job in giving
their children the best protection we can
offer. New Zealand now has confidence that
we are vaccinating effectively and getting
better disease control, and it’s good to
Secondly, the science behind immunisation
is really strong; use of vaccines is probably
the most evidence-based approach we have
after good hygiene and nutrition. We can be
ver y confident in our medical evidence here.
Recognising that different parents have
different fears is also really useful, and being
able to identify their specific concerns – ver y
few parents are totally against the science.
They’re often fearful from specific myths,
such as autism links, or the coincidence
factor, when a child has a vaccination and an
event happens afterwards – ever yone has an
aunty or a neighbour with a stor y!
A good GP communicates immunisation
just as they do with so many other issues
that are a mixture of our personal fears,
the influences from our neighbours and
confusion over the science base.
Last year saw talk of the effectiveness of a live
nasal spray influenza vaccine for all children.
What other issues do you see becoming
hot topics in preventative child health and
immunisation this year?
Immunisation: We look to seeing more
effective vaccines such as the zoster
vaccine (the live herpes zoster vaccine)
being available, the live attenuated
influenza vaccine for children as soon
as possible, other improved flu vaccines,
and possibly a meningococcal B vaccine.
And better strategies, such as focusing
more on community protection with
flu vaccines rather than just individual
protection. Fur ther vaccines needing to
be considered for the schedule include
varicella (chickenpox) vaccine universally for
children, and universal meningococcal C or
quadrivalent vaccines for young children and
Preventative child health: I’m keen we put
more focus on what we call propor tionate
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