Urticaria is a common problem. It is estimated that 20-30% of the general population will suffer urticaria at some time in their lives. Patients who have acute urticaria typically have symptoms lasting under six weeks. Potential allergic triggers include food allergy, drug allergy, latex allergy and allergy to bites and stings.

Patients who have chronic urticaria have symptoms lasting over six weeks. Those with long standing urticaria are divided into those with idiopathic chronic urticaria and those with physical urticaria. Patients with physical urticaria typically have symptoms induced by triggers such as heat, cold, water, vibration etc.

There is increasing evidence that patients with chronic urticaria have an autoimmune disorder. Experimentally, many of these patients have been shown to produce antibodies to mast cells which results in inappropriate degranulation. Generally laboratory tests are unhelpful in this disorder.

In this talk treatment options including high dose antihistamines will be discussed. Refractory patients will need to be referred to specialised units for dietary manipulation and other medications. In general corticosteroids have a limited role as high doses are required to control symptoms.

Adverse reactions to foods are a common clinical problem. In contrast, true food allergy, as documented by double blind placebo controlled food challenges, are less common. Food allergy can occur through a variety of immune mechanisms. Immediate reactions mediated by IgE antibodies are among the most severe and can be life-threatening. 

It is very important for an accurate diagnosis to be made in patients presenting with adverse reactions to food. Patients with allergic reactions to food will require allergy testing in the form of either skin or blood tests. 

Currently there is no specific treatment for food allergy apart from avoidance. Strict elimination diets carry nutritional risk and should be supervised by an experienced dietician. Novel forms of therapy such as anti-IgE treatment may prove effective in the future. 

Allergy prevention advice is controversial. The risk of sensitisation appears to be minimal during pregnancy. The delayed introduction of solid foods and avoidance of peanuts, tree nuts and seafood by lactating mothers is recommended.

Some forms of food allergy (eg milk allergy) are often time limited, while others are more likely to be permanent (eg shellfish allergy). CAP- RAST tests can be used to follow patients to determine when they may have achieved a remission. 

In this lecture advances in food allergy will be discussed including allergen desensitisation anti-IgE therapy etc.

 Allergic disorders are a consequence of an inappropriate IgE response to antigens (allergens) that are generally considered to be harmless. The precise genetic basis of allergy is yet to be determined. Management of allergic disorders consists of three components. Where possible, allergen avoidance measures should be undertaken. Patients who are allergic to indoor triggers such as dust mites, should obtain pillow mattress and duvet covers from Allergy New Zealand. It is usually difficult to avoid outdoor allergens such as grass pollens. The second aspect of allergy treatment is the use of drugs. Generally most patients with allergic rhinitis respond to steroid nose sprays and/ or antihistamines. This talk will focus on the last component of allergy treatment, desensitisation. Desensitisation has proved to be effective for inhalant allergies, hymenoptera (stinging insect) allergy and drug allergy. 

In general desensitisation consists of introducing gradually increasing amounts of allergen over a period of time. This in turn down regulates the immune response. Desensitisation carries risks, including the possibility of anaphylaxis. In general, initiation of desensitisation to stinging insects and drugs should be carried out in specialised settings. Maintenance for bee and wasp allergy can be done in GP practice. Inhalant desensitisation can be undertaken in GP as long as measures are in place to deal with anaphylaxis. It is strongly advised that patients with unstable asthma are not desensitised in general practice. These patients are at risk of fatal asthma. Practical aspects of immunotherapy will be discussed in the workshop.

Approximately 15% of children up to the age of 12 suffer from some Parasomnia, and 1% of adults continue to suffer from some Parasomnia such as Sleep Walking, Night terrors, or Nightmares. Whilst most are benign, requiring no specific treatment, they can be very distressing for parents or partners. Some however are markers of an underlying medical condition. These disorders are significantly under-diagnosed.

In addition, Parasomnias such as Restless Leg Syndrome (RLS), which is strongly associated with Periodic Limb Movement in Sleep (PLMS), is a genetic disorder affecting up to 10% of the population. Whilst more commonly presenting in the elderly, it is also present and frequently misdiagnosed in childhood. PLMS, along with OSA, is a major cause of poor quality sleep, and excessive daytime sleepiness. RLS is often responsible for difficulty initiating sleep, but it can be so severe as to result in suicide. 
Understanding of the pathogenesis, and therefore treatments of these conditions, has changed considerably over the past five years, and relief is now possible. 

REM Sleep Behaviour Disorder (RBD) is a disorder of older men, and up to 30% will subsequently develop some neurodegenerative disorder, especially Parkinson�s Disease. Symptoms are also treatable if correctly diagnosed. 

Chris has been with Westpac NZ since 2003, and his current role is National Manager Health Sector. Chris set up Westpac�s health sector team in 2006 to provide a niche service to health practitioners and business owners. Since then, the team has expanded nationally, with 15 Health Specialists now based around New Zealand from Auckland to Invercargill. 

Chris has a through knowledge of the health sector and its business environment, and has worked with clients around the country on medical property projects, practice amalgamations, risk management and providing general assistance with business planning. Prior to working in the Health sector, Chris held senior banking roles in commercial and corporate banking, which gives him and his clients a unique perspective on healthcare business models. 

Johnathan Bayley is a Private Investment Adviser at Westpac Private Bank. He has a Bachelor of Business Studies and a Diploma in Personal Financial Planning from Massey University, and a Bachelor of Property from the University of Auckland. He is also a Certified Financial Planner. Johnathan has worked in financial services for over 17 years in New Zealand, the United Kingdom, and France, working in Business Banking, Financial Markets, and Wealth Management. Johnathan has been a part of Westpac's Wealth Management team since April 2007, and works with a varied client base to construct investment portfolios that meet and achieve his customers investment and financial goals.

Medical Certification for work can be fraught with problems for GPs. There are potential conflicts with the doctor/patient relationship and the advocacy role perceived by some as a negative influence in rehabilitation. International consensus identifies that helping people back to work is beneficial for their health, but evidence suggests GPs don�t consider this to be their role. What is the situation in New Zealand? As consideration is given to a UK-style �Fit Note� how do we understand the issues, and what should we do about them?

Obesity is a common problem that now seems to have very effective surgical treatments available, but exactly how these work, and who may be appropriate for surgery is sometimes less clear to referrers.
Grant Beban and Richard Babor are both Upper GI and Bariatric Surgeons in Auckland, working both in public hospitals and in the private sector. They will describe the different operations available, and illustrate the sorts of outcomes that people get, warts and all, with the use of case studies. 
Questions and problems from participants are encouraged with the goal of facilitating worthwhile discussion.

An interaction-based session with Grant Beban and Richard Babor, both Upper GI and Bariatric Surgeons in Auckland.

Case examples of common Upper GI problems, such as reflux disease, gallstone disease, upper GI malignancy, or obesity will be presented for discussion. We are particularly keen for you to bring questions or cases of your own.

Obesity is a common problem that now seems to have very effective surgical treatments available, but exactly how these work, and who may be appropriate for surgery is sometimes less clear to referrers.

Grant Beban and Richard Babor are both Upper GI and Bariatric Surgeons in Auckland, working both in public hospitals and in the private sector. They will describe the different operations available, and illustrate the sorts of outcomes that people get, warts and all, with the use of case studies.

A GP who has had a gastric bypass will bring a patients perspective to the discussion.

Questions and problems from workshop participants are encouraged with the goal of facilitating worthwhile discussion.

Without an initial diagnosis, treatment is ineffective. The diagnosis must include not only the cause of the dysfunction, but also why conventional treatment has been unsuccessful.

Only then can an adequate Diagnosis, Management and Treatment Plan be implemented.

The emphasis is on the patient taking ownership of their management and becoming self reliant. 

Using this approach, many people who have been labeled as having chronic musculoskeletal pain can be more effectively treated, at least substantially reducing their pain, often returning them to an essentially pain free state and improving their quality of life.

Dr Rick Bernau 
Musculoskeletal Physician 
Australasian Faculty of Musculoskeletal Medicine 
Email: rick@baymsm.co.nz  
Phone: 07 575 8969 

We hope that after attending the workshop you will walk away being much more confident at extracting the key points in the pain history, instead ofdrowning in the long histories often presented to you. You will be comfortable at assessing the major neck findings that give certain pain patterns, and be mindful of the important role of breathing in the presentation and maintenance of musculoskeletal problems. You will have an overview on which investigations are the most useful, and what the place for needling has. But most importantly you will walk out from the seminar with 10 key take home points from a practical hands on points of exam and treatment, that will be practiced in multiple times during the seminar by examining each other. YOU can be confident to put this into practice on Monday morning, knowing , that , in keeping with General Practice, a musculoskeletal neck problem is highly likely to present in the next 24 to 72 hours that you return from this CME conference, and that unless skills learned from a conference are put into practice, within 24-72 hours, they are likely to be lost. Hence we wish to emphasize the common and relevant, with just a tincture of the rare, for the most satisfying outcome for you and your patient treating musculoskeletal pain and disability.

Ross Boswell practices as chemical pathologist and general physician at Counties Manukau DHB where he is Clinical Director of Laboratory Services and Clinical Director of IT. He is at present on sabbatical leave in Sydney, working at the Australian National e-Health Transition Authority which is charged with implementing a national electronic health record by July 2012. Ross is a former Chairman of the NZMA and former Chairman of the Board of Censors of the RCPA. 

Dr David Bratt, Principal Health Advisor to the Ministry of Social Development

• Pre-course reading 4-6 weeks in advance to help prepare for the test.
• Basic Life Support
• Advanced airway management (bag masking progressing to intubation)
• AED and rhythm recognition
• Adult and child collapse algorithms 
• Anaphylaxis management 
• A compulsory multi choice test and skills evaluation of airway management, defibrillation and some cardiac rhythms
  

Type 2 diabetes needs on -going treatment modifications due to progressive beta cell failure. There is no doubt that optimal glycaemic control reduces or prevents the development of microvascular complications. There are various insulin preparations and regimes available but therapy should be individualised according to patient�s wishes and needs. 

Insulin initiation in type 2 diabetes should be considered in a timely fashion and where possible it should be commenced in the primary care due to the increased prevalence of type 2 diabetes in our community. After initiation of insulin, on going titration of insulin doses to achieve desired glycaemic goals are also essential. 

1400-1430: Need to Insulinise early
1430-1500: Breaking Down Barriers to Insulinisation
1500-1600: Starting and Titrating Insulin
1600-1630: PM Tea
1630-1715: Switching Insulins
1715-1815: Managing the Practical
1815-1830: Q and A

Many patients with diabetes fail to achieve targets for glycaemic control because of inappropriate use of insulin. Patients and health care professionals face many potential barriers to insulin initiation and intensification in primary care. These can be categorised as low motivation, lack of familiarity or experience and time constraints. Type 2 diabetes is progressive in nature and many people with the condition will inevitably require insulin therapy to attain and maintain adequate glycaemic control. My presentation is about exploring the nature of these barriers and offers suggestions and practical solutions for addressing and overcoming these hurdles so that insulin can be initiated confidently and appropriately in order to improve diabetes care in Primary care. Goal of the workshops will be about different insulin profiles, selecting and using devices, troubleshooting injection issues and knowing what key information to impart when starting someone on Insulin.

Most patients are concerned about the possibility of throat cancer and in an era where the incidence of oropharyngeal cancer due to HPV is increasing (particularly in white middle-aged males), one has to be vigilant. We also see a regular number of non-smoking young adults aged 20-40 with tongue cancer where early diagnosis is crucial. The management of patients presenting with irritable throat, dysphagia, painful swallowing, otalgia and hoarseness will be discussed. 

This talk will concentrate on the presentation of thyroid pathologies. Emphasis will be placed on thyroid lumps and nodules and the investigations that are useful in determining which are likely to be malignant and therefore require surgery. Epidemiology will be discussed and indications for surgical management will be clearly outlined. 

Dr Peter Chapman-Smith
Skin and Vein Clinic
chappie@clear.net.nz 
Phone 0800 1 4 VEINS

A practical workshop to cover diagnosis, marking out on pig skin, punch biopsy, anatomy of needles, suture choice, excision technique, borders, and simple ellipse repair, dog ear repair, principles of wound healing, and sterile wound care. Instruments and gloves will be provided. 

A practical workshop to demonstrate and practice on pig skin some flap repairs suitable for skin cancer work as rotation and advancement flaps. Other flaps as Wolfe grafting, split skin grafts, Lazy S, VY repair,and Z plasty will be presented. Discussion on choice of technique, relaxed skin tension lines, and complications. Instruments and gloves will be provided. This workshop is more suitable for GPs with prior surgical experience, and attendance to one of the prior Basic Workshops is recommended. 

The Ellmann �Surgitron� machine will be demonstrated as a unique versatile method for haemostasis, and removal of benign skin lesions as tags, moles, and seborrheic keratoses. Red veins and hairs can also be treated, as well as skin incision and skin tightening applications. The 4 megaHz radiofrequency unit is distinctly different from hyfrecators, not commonly understood. This has clinical relevance in that tissue is not charred, and can be shaved off under local anaesthesia. An excellent cosmetic result is usual with very rare hypopigmentation or scarring evident. A wide range of electrodes are available. Industry enquiries: Medtel is the NZ agent for Ellmann technology. 

Dr Peter Chapman-Smith has regularly used this technology for 20 years , and would strongly recommend this unique radiofrequency device over hyfrecators, which cannot achieve the same efficacy. As director of the Skin and Vein Clinic and a Fellow of the NZ College of Appearance Medicine, he has taught this technology to many colleagues over the years including trainees of NZCAM. This is a device that any GP with a steady hand would find very useful in practice daily � for skin surgery or cosmetic removal of unwanted lumps and bumps.

On her return to New Zealand Marijke became the Northern Sales Specialist for Care Medical, who are the exclusive New Zealand Distributors for well known Pulmonary Function/Spirometry, Sleep Diagnostic and Respiratory equipment brands. 

Spirometry is invaluable as a screening test of general respiratory health, however the clinical value of spirometric measurements is dependent on the correct operation and accuracy of the spirometry device, as well as correct patient technique. 

The aim of this workshop is to highlight the purpose of spirometry, and the importance of correct operation and technique for performing spirometry in primary practice.

The diagnosis of diabetes mellitus has important implications for patients and their doctors. For decades the diagnosis of diabetes has largely been based on either the fasting plasma glucose or the results of the oral glucose tolerance test. In 1997, criteria were revised and based largely on the correlation between fasting plasma glucose and the earliest signs of retinopathy, a fasting glucose of 7mmol/l was used as a new threshold for diabetes. Various categories of �pre-diabetes� including impaired glucose tolerance and impaired fasting glucose were introduced. The HbA1C blood test, which reflects average blood glucose levels over a 2 -3 month period, was largely used to monitor glucose control. However, it has now been proposed as a diagnostic test. HbA1c has the advantages of not requiring fasting and correlating well with the risk of macrovascular disease and is reasonably standardised in most western countries. However, there are potential issues with AIC as well. While the various international diabetes groups debate the criteria, I will present a practical proposal for us to use in the meantime using the new international numbers. The new criteria may define a slightly different but perhaps more relevant population with diabetes than before. 

We will discuss in this session a number of short case studies to illustrate such issues as which drug to use after metformin in type 2 diabetes, when to start insulin and which insulin to choose, when and if metformin should be stopped in those with reduced renal function, issues with microalbuminuria, hypoglycaemia, and hopefully with time to answer your questions.

A range of children�s issues present to general practice, often tacked onto at the end of other consults, or at the end of the consult with the hand on the door handle �by the way doc...�. When do we need to act, and when can we relax. This workshop will cover a range of common GP scenarios , and discuss management options, when we need to react, when we can relax. Issues we intend to cover include the chronic cough, constipation, head shapes, behavioural issues, changes to the immunisation schedule, well child screening tools, skin rashes, vitamin D deficiency.

The practice nurse role is a very important front line role for parents with many common childhood issues. This is being expanded in many areas with practice nurses becoming more involved in well child services including the �B$ School check� This interactive presentation will cover :
� a quick update on recent immunisation issues: the 2011 immunisation schedule update, private market vaccines to know about, cool new research in immunisation, 
� Common childhood issues including the well child schedule and the role of the practice nurse, lift the lip dental screening, well child screening tools, common behavioural issues, skin issues.

This talk will focus on diagnosis that are critical for a GP to make urgently and symptoms and signs that will aid in this process. Diseases covered will include giant cell arteritis, acute glaucoma, and a discussion on when diplopia is dangerous.

This session will focus on practical tips to assist in the diagnosis of ophthalmic conditions without the use of technical equipment. Skills that will be discussed include: how to detect an optic nerve problem, the best way to perform confrontation visual fields, and how to classify various causes of loss of vision into "dangerous" and "not so dangerous". 

�Giving the diabetes consultation a communication makeover: how changing our language can transform behaviour �.

Diabetes management with its major component of lifestyle behaviour change is currently based on intervention approaches focused on health professionals driving the change process through provision of persistent, repetitive advice and education. 

Action research carried out by the TADS training programme has been supported by emerging data from a current diabetes study indicating that how we communicate with our patients can produce a negative effect on their behavioural change decisions, and why a change of approach to one of person focused facilitation can be a stress buster for both patient and practitioner.

Research interests in Wellington have included mental health care in General Practice, Health Service utilisation, quality in primary care and communication and interaction in the consultation. Current research includes evaluation studies of mental health models of care, and an RCT of antidepressant prescribing and the health care interactions of people newly diagnosed with diabetes.

The assessment and management of mental health disorders remains challenging for general practice and primary care. This presentation will bring together a number of themes in mental health care to provide a framework for general practice management. 
Topics will include: 
� The management of anxiety and depression. The present distinction between anxiety and depression is largely artificial has has meant that we have tended to under treat anxiety symptoms. 
� What exactly do we mean by Medically Unexplained Symptoms and what do we do about it? �Medically unexplained symptoms�are an important part of medical practice, yet our understanding of appropriate classification and management remains limited. A new framework for assessment and management will be suggested. 
� Mental health in childhood and adolescence. 
� Psychological therapies � do they work and is there any difference between them? What is a brief brief intervention and what should it include ?

This is an interactive workshop to support effective communication and team working in diabetes care. 

Diabetes is one of the most important chronic illnesses managed routinely in primary care settings. Management involves complex pathways of consultation and communication relating to symptoms, treatment options, health promotion and lifestyle modification, the management of risk and issues around adherence and follow up. 

This workshop will discuss ways in which diabetes care could be enhanced by exploring the consultation process with a particular focus on communication both within consultations and over time. 

The workshop will use information from a recently completed study which directly observed all interactions between health providers and a group of patients newly diagnosed with diabetes, over a period of six months. 

The study produced insights about how clinicians can build on what the patient already knows or wants to know about diabetes, how to best use time effectively in consultations and how to make the best use of contributions from different members of the primary care team. 

This is an interactive workshop to support effective communication in a consultation. 

The consultation is at the heart of General Practice and the interaction between the patient and doctor during the consultation has a major influence on patient health outcomes. This workshop will explore the complexity of that interaction using information obtained from studies which have directly observed and video recorded over 300 primary care consultations. Themes to be covered include:
� What makes great consultations great! 
� The language of the consultation: When to talk in sentences , how to use �So, but , OK Ummm�. 
� How to detect when consultations go feral and how to repair them.
� Dealing with confessions of compliance.
� What about the computer? 
� How to lengthen or shorten consultations with a single (polite) word.  

The consultation is at the heart of General Practice and the interaction between the patient and doctor during the consultation has a major influence on patient health outcomes. 

This presentation will explore the complexity of the consultation with a particular focus on the effective use of language and communication. It will be based on the results from a number of research studies using direct video observation of over 300 consultations. Observed interactions include routine GP consultations, consultations with the same patients in primary and secondary settings and consultations over time with patients newly diagnosed with diabetes.
Specific themes will include:
� Effective and not so consultations, and how to tell the difference.
� Consultations in Long Term Condition care with a focus on diabetes and mental health. 
� Using the computer to communicate. 
� The power of a single word � or two.

He is an investigational cardiologist performing coronary angiography, CT cardiac angiography and echocardiography and has a subspecialist interest in the acute coronary syndromes and in the prevention of ischaemic heart disease: the management of lipids, cardiovascular risk and hypertension.

The long awaited technology to accurately image the heart, especially the coronary arteries, in a non-invasive way is now here. Difficulties in imaging have been overcome with technically advanced CT scanners, and complex software, allowing extraordinary pictures of the heart to be created. Fascinating cardiac images will be shown. Based on case histories, the workshop will explore modern aspects of cardiac assessment and treatment whilst showing some fascinating images.

The ECG is the most basic of cardiology tests and still the most important. The methods used to read an ECG will be shown, with a variety of ECGs and clinical cases discussed to emphasise points made. The workshop aims to teach, refresh and leave attendees with confidence to develop their own ECG service.

This presentation will explore the exciting new technology and images available from CT cardiac angiography.

Accurate, non-invasive cardiac imaging with modern CT scanners has created huge clinician and public interest in the potential of this technology. The CT cardiac angiogram test is explained, and the areas of current and future use will be explored. Good science supports the ability to accurately 'rule out' severe coronary artery disease, which is where the test is being increasingly used. These scanners will soon be widely available across New Zealand in the public service, and will positively enhance cardiac care with the extraordinary images which can be created. Some examples of these will be shown.

Much of the department�s research at present relates to utilising the data from the SCOPE study. This is a large international cohort study of women having their first babies, looking at clinical and biochemical markers of pregnancy complications such as pre-eclampsia, fetal growth restriction and preterm birth. Deralie is investigating the relationship between antepartum haemorrhage of unknown origin and fetal growth.

Ngaire is a Research Fellow in the Department of Obstetrics and Gynaecology, University of Auckland. She is a senior RANZCOG trainee and is taking time out of training for RANZCOG Fellowship to complete an MD at the University of Auckland investigating ethnicity, BMI and adverse pregnancy outcomes. In 2010 she was awarded the prestigious Douglas Goodfellow Medical Research Fellowship from the Auckland Medical Research Foundation.

The place of the General Practitioner in antenatal care has not been well-defined in the New Zealand maternity system in recent years. The skills of a pregnant woman�s GP are often underutilised and this may result in her being referred to tertiary services for management of problems that are well within her GP�s scope of practice. GP�s have a great deal to contribute in this area and are likely to be called on to take a more active role. Unfortunately, the near-total demise of GP Obstetrics in New Zealand means that many young GPs have not had any post-graduate training in Obstetrics and feel uneasy about antenatal care. Previously highly experienced GP Obstetricians may feel they have de-skilled by lack of recent involvement in their patients� antenatal care. This workshop aims to cover important developments in pregnancy risk assessment and management of common problems. Topics will include: risk factors in early pregnancy, smoking cessation, nutrition in pregnancy, customised fetal growth charts.

Motor vehicle accidents are the leading cause of injury related deaths among 65 � 74 year olds and the second leading cause among 75 � 84 year olds (after falls). They have a higher fatality rate than any other age group except the under 25 year olds. Drivers over 75 years are involved in more accidents per kilometre than middle aged drivers. By 2030 the number of persons over 70 years old is predicted to triple. Although many older drivers self regulate their driving, it is not enough to keep crash rates down.

Driving is a key role in everyday life for NZ society for all cultures, which impacts on self esteem, independence, social, vocational and avocational activities. It is an intrinsically complex task, combining well learned routines and the ability to respond flexibly and safely to unpredictable events. It is also an emotionally laden subject, with the potential for huge repercussions for the patient, the patient�s family, and the GP.

This workshop will explore how a medical issue observed by a GP can translate to a driving safety concern. The effects of medical deficits on practical driving skills will be reviewed and practical tools and strategies will be provided for use in GP practices.

References: 
1. New Zealand Transport Agency
2. Sydney University, Occupational Therapy Driver Assessment & Training Course 
3. The American Society of Aging (ASA) and the National Highway Traffic Safety Administration (NHTSA), Drivewell, accessed on line on January 13 2010 http://www.asaging.org 
4. American Academy of Family Physicians 2006, Older Adult Drivers with Cognitive Impairment, 
5. OTRS Group Ltd Driver/Passenger Training Course 
6. Christchurch Neurotechnolgy Research Programme, Canterbury Driving Assessment Tool (CanDAT)
7. AA Driver Education Foundation, CarFIT
8. DriveSafe and DriveAware, Lynette G Kay and Anita C Bundy 2009

This will be a practical overview of what LFTs are, why we check them and what various abnormalities mean. I will also give rules of thumb on when a patient should be referred for specialist assessment.

Probiotics have been defined as �live microorganisms which, when administrated in adequate amounts confers a health benefit on the host�. Recent years have seen an increased interest in probiotics, following the outcome of several human intervention studies. 

This workshop will give an overview of probiotics and their use in dietary supplements and food, especially dairy products. Furthermore, the workshop will more broadly explore opportunities to use this type of microorganisms in complimentary medicine and nutrition.

This presentation examines the complexity of the requirements for the successful treatment of common sexual dysfunctions including the condition commonly called �sexual addiction� but more aptly described as out of control sexual behaviour or (OOCSB). At first glance this condition appears relatively harmless but, in reality, it does immeasurable harm to relationships and frequently leads to criminal activity and increasingly to prosecution. 

The presentation includes a review of the latest research on this disorder and discusses what to look for when considering treatment, a possible treatment model and where and how to source effective treatment.

Professor Shaun Holt lectures at Victoria University of Wellington, has started two clinical trials organizations and formed Research Review, a company that produce reviews of medical research. Shaun holds Pharmacy and Medicine degrees, has been the Principal Investigator in over 50 clinical trials and has over 80 publications in the medical literature. He is an Honorary Research Fellow at the Medical Research Institute of New Zealand, an advisor to the Asthma Foundation and Natural Products NZ and a regular contributor on TV1's Breakfast programme and national radio shows. He is the author of 6 books including the bestseller "Natural Remedies That Really Work".

Professor Shaun Holt
Clinicanz, Medical Research Institute of NZ, Victoria University of Wellington
http://flavors.me/shaunholt 
holtshaun@gmail.com 
Phone: 029 200 11 11

Breast cancer is a leading cause of female cancer related deaths in New Zealand. This will be a brief bullet-point overview covering: risk factors and reasons for our high incidence, current screening and diagnostic guidelines, and the very near future of breast surgery and adjuvant treatment: what�s just on the horizon.

An overview in photos�� the operations we do and why. This includes breast conservation treatment for early breast cancer through to breast reconstruction. Interesting and interactive.

This overview includes points for your practice: what to advise your patients for screening (personal vs population), when to start and when to stop. It will include common presentations of breast cancer and things to look out for and how we diagnose breast cancer. I will also discuss the role of newer modalities. This is as interactive as you�d like and I am happy to discuss particular cases if you wish.

We hope that after attending the workshop you will walk away being much more confident at extracting the key points in the pain history, instead ofdrowning in the long histories often presented to you. You will be comfortable at assessing the major neck findings that give certain pain patterns, and be mindful of the important role of breathing in the presentation and maintenance of musculoskeletal problems. You will have an overview on which investigations are the most useful, and what the place for needling has. But most importantly you will walk out from the seminar with 10 key take home points from a practical hands on points of exam and treatment, that will be practiced in multiple times during the seminar by examining each other. YOU can be confident to put this into practice on Monday morning, knowing , that , in keeping with General Practice, a musculoskeletal neck problem is highly likely to present in the next 24 to 72 hours that you return from this CME conference, and that unless skills learned from a conference are put into practice, within 24-72 hours, they are likely to be lost. Hence we wish to emphasize the common and relevant, with just a tincture of the rare, for the most satisfying outcome for you and your patient treating musculoskeletal pain and disability.

Brett has been in general practice at Ilam Medical Centre in Christchurch since 1986. He is a medical educator in the GP registrar programme and has been an examiner for the RNZCGP. Over the last fifteen years he has adapted and added to Dr Brian Broom�s seminal work on somatisation developing an approach relevant to the types of patients presenting in general practice and an approach for the standard general practice consultation. 

Brett has provided many seminars for general practitioners on somatisation including the MGP programme in Dunedin in 2008 and 2010, the General Practice Medical Education conference 2010, and the rural GP conference. These presentations have been very well received. He has had preliminary input into undergraduate education at Otago medical school regarding somatisation and has provided website material on somatisation for the national GPEP2 programme. 

The surgery had some totally unexpected benefits and challenges for me, they �operated on my stomach but mucked with my head�. 

Despite struggling with obesity all my life, reading about it, untold hours with dieticians, hours with a clinical psychologist and a technical knowledge of bariatric surgery I actually knew very little that was of any practical use to myself or to the patients I served. 

In 2008 I heard that a brave surgeon in Whangarei Hospital was doing some gastric bypass surgery and it was curing some people of their diabetes. The systems were not fully developed and it was not common knowledge in General Practice that this was happening. On a whim, I decided to phone one of the surgeons to find out if I would qualify. I didn�t know who was doing the surgery so I phoned the surgeon on call and asked if bariatric surgery was being done at the Hospital. He replied �You don�t want to refer your patients for that. It�s bloody awful surgery with bloody awful effects that last for life. All those fat, lazy bastards need to do is just shut their mouths and get off their fat arses.� I suspect this is an attitude held by some GPs and, if I was honest, an attitude I held to some extent myself. My personal experience was that it was as he said bloody awful surgery with some permanent downsides, but the benefits have overwhelmingly outweighed any of the risks and downsides. For others it may just be �bloody awful surgery� whose risks and downsides make it a bad idea. As GPs I think we need to know a bit more about morbid obesity, bariatric surgery, its aftermath and alternatives so that we can be a bit more useful to our patients.

Since the surgery I have learnt an awful lot and I�d like to share some of this with you. I would like to tell you openly about my experiences of being morbidly obese and the handicaps associated with this as well as my journey after the surgery. I hope this will assist you in your valuable work with the morbidly obese, those contemplating surgery and those who have had the surgery.

If you could bottle exercise, you�d have the closest thing there is to a wonder drug, yet many patients continue to lead sedentary lifestyles. This presentation will provide practical recommendations for counseling and motivating patients to exercise regularly for the prevention and management of chronic disease.

Learning Objectives:

1. Participants will describe the benefits of regular exercise on the prevention and management of chronic disease.
2. Participants will counsel patients about overcoming obstacles to physical activity and initiating a sustainable exercise program.
3. Participants will use the acronym FITT to write an effective exercise prescription.

Patients who struggle with a difficult love-hate relationship with food crave a positive, rational approach to eating. This session will deconstruct the Am I Hungry? Mindful Eating Cycle and explore the bio-psycho-social drivers of each decision point. Attendees will learn why mindful eating is a powerful and universal approach to the complex issues contributing to problematic eating behaviors.

Learning Objectives:
1. Participants will identify the six crucial decision points in the Mindful Eating Cycle. 
2. Participants will describe the psycho-social-behavioral patterns in instinctive eating, overeating and restrictive eating 
3. Participants will explain why mindful eating is a powerful and universal solution to the complex problem of yo-yo dieting and chronic diseases impacted by lifestyle choices. 

To stem the impact of lifestyle-related disease, it is critical to move beyond advice-giving and address the core issues that affect nutrition and physical activity choices. Using the Am I Hungry? Mindful Eating Cycle, this interactive workshop will explore six unconventional strategies that promote the fearless and mindful enjoyment of food. 

Learning Objectives:

1. Participants will list six specific strategies to help patients develop a sustainable healthy lifestyle. 
2. Participants can identify opportunities for counseling by utilizing the Mindful Eating Cycle during a clinical encounter.
3. Participants can teach self-awareness for selecting food that takes into account personal preferences, health considerations, and available options.

Even though it is a very common presenting to play to primary care, many healthcare providers often feel frustrated when treating vaginitis. However, failure of treatment in this situation is often truly a failure of diagnosis. The purpose of this presentation is for the participant to develop an awareness of the many manifestations and difficulties involved in correctly diagnosing vaginitis. We will discuss common erroneous assumptions and common errors made in the diagnosis of these conditions and ways to make more accurate diagnosis. Pearls about common STDs will also be presented. 

Anorexia and bulimia are more common than many healthcare providers realize. However, part of the lack of recognition is associated with patient�s attempts at evasion of detection. The purpose of this presentation is to help providers recognize the symptoms of anorexia and bulimia, understand the common complications associated with anorexia and bulimia, and develop a plan for management of anorexia nervosa and bulimia nervosa. 

His talk will focus on changes in the worldwide thinking on cervical cancer screening. We will specifically cover changes to recommendations on initiation of Pap testing, changes in Pap testing for adults, and review the ASCCP cervical cancer screening guidelines. 

Hair and nail disorders are common problems and/or common presenting problem for primary care providers. The purpose of this presentation is to examine the approach to the evaluation of hair loss, review of common causes of hair loss, and treatment options for these conditions. We will also examine common normal and abnormal nail variant and systemic diseases and infections that can result in nail abnormalities.

 The purpose of this presentation is to review current data and thinking on the impact of HPV infections. We will discuss the epidemiology of HPV and summarize the risk factors for HPV infection. We will also briefly discuss current primary and secondary measures to prevent the sequelae of these infections.

Bugs, bugs, and bugs!! Insect and arthropod bites and infestations have long been a plague of humankind. Many of the old scourges are still with us and some are making new headway against treatment of prevention methods. We will examine common bites and infestations, and consider their edification and treatments. 

Ultraviolet light has correctly been labeled the perfect carcinogen. Although some gains have been made in educating worldwide society on the prevention of sun related disease, much unnecessary morbidity and mortality remain from the sequelae of sun exposure. During this presentation will discuss disease states related to excessive UV exposure, briefly consider treatment options for these conditions, and discuss prevention strategies for this often preventable set of diseases.

Not telling!!

A practical workshop to cover diagnosis, marking out on pig skin, punch biopsy, anatomy of needles, suture choice, excision technique, borders, and simple ellipse repair, dog ear repair, principles of wound healing, and sterile wound care. Instruments and gloves will be provided. 

A practical workshop to demonstrate and practice on pig skin some flap repairs suitable for skin cancer work as rotation and advancement flaps. Other flaps as Wolfe grafting, split skin grafts, Lazy S, VY repair,and Z plasty will be presented. Discussion on choice of technique, relaxed skin tension lines, and complications. Instruments and gloves will be provided. This workshop is more suitable for GPs with prior surgical experience, and attendance to one of the prior Basic Workshops is recommended. 

Dr Morris has a particular interest in the relationship between health, employment status and compensation systems. He has a background in general practice medicine and obstetrics, occupational medicine, computer science and medical administration. Before joining the ACC, Dr Morris was a principal in a group general practice, the principal doctor of one of New Zealand�s first after-hours medical clinics and a consultant with a technology company developing software for medical practice management systems. Most recently he has completed a Masters in Public Policy at the School of Government, Victoria University Wellington. His research paper looked at the impact of lump sum compensation for non-economic loss on rehabilitation outcomes

Type 2 diabetes needs on -going treatment modifications due to progressive beta cell failure. There is no doubt that optimal glycaemic control reduces or prevents the development of microvascular complications. There are various insulin preparations and regimes available but therapy should be individualised according to patient�s wishes and needs. 

Insulin initiation in type 2 diabetes should be considered in a timely fashion and where possible it should be commenced in the primary care due to the increased prevalence of type 2 diabetes in our community. After initiation of insulin, on going titration of insulin doses to achieve desired glycaemic goals are also essential. 

1400-1430: Need to Insulinise early
1430-1500: Breaking Down Barriers to Insulinisation
1500-1600: Starting and Titrating Insulin
1600-1630: PM Tea
1630-1715: Switching Insulins
1715-1815: Managing the Practical
1815-1830: Q and A

Pre-Conference Workshop Questionnaire (click to download)

Prevalence of gestational Diabetes is increasing due to epidemic of obesity and increased maternal age. Similarly there is increasing prevalence of women with type 2 diabetes presenting in pregnancy. Recent literature supports the optimal maternal glycaemic control that has positive effects on perinatal and obstetric outcomes. Therefore revised glycaemic targets are being proposed.

It is also important that women with diabetes who are contemplating pregnancy should be counselled and their therapy should be modified to optimise control in order to avoid unfavourable foetal and maternal outcomes. In addition to non-pharmacological interventions, such as diet and exercise, insulin is generally used to treat diabetes in pregnancy. It is reassuring that Metformin can safely be used in pregnancy, though long term outcome data are awaited. 

Women with gestational diabetes need long-term follow-up because of their increased risk of type 2 diabetes and other vascular events.  

http://dermnetnz.org ; http://anzvs.org ; http://tristramclinic.co/nz 
oakley@wave.co.nz 
Phone: 027 271-6985 (urgent calls only) 

The first two hours will be beginner�s guide to skin surface microscopy, covering the basics of dermoscopic features and diagnosis of common pigmented skin lesions. This will be less hard work if you�ve read a book or done an online course first. 

The main thing is to use your dermatoscope frequently so you become familiar with the range of appearances of benign lesions. First step is to identify melanocytic lesions by their pigment network or globular pattern - if not, is this basal cell carcinoma, seborrhoeic keratosis, a vascular lesion or dermatofibroma? If it is melanocytic, its asymmetrical structure, atypical network or blue-whitish structures may indicate melanoma.

The second half of the workshop will present case histories, describe dermatoscopic features of various types of naevus and of nonpigmented lesions.

Those with difficulty distinguishing red-green colours may be challenged by dermoscopic subtleties and will have to depend on identification of structures.

Acne is a common reason for consultation in general practice. Those with mild acne are best treated with long term topical retinoids (tretinoin cream and adapalene cream/gel are now funded) and/or benzoyl peroxide applied to all affected areas. Wash with non-soap gentle cleanser once or twice daily. For those with moderate acne, also prescribe oral antibiotic (usually doxycycline) for 3 to 6 months and/or, in females, consider various hormonal contraceptive options. Ensure inappropriate comedogenic cosmetics are abandoned. Consider whether medications are contributing to the acne. The role of diet remains controversial but it�s probably appropriate to advise low glycaemic, low dairy foods. 

Consider isotretinoin for longstanding, treatment resistant, or severe acne. If keen to prescribe yourself, update your knowledge with at least the BPAC article / Decision Support tool and BMJ learning article on isotretinoin before applying for Special Authority approval for funding. Choose well-motivated and mature patients that will do well with low-doses and can be relied on not to get pregnant. As GPs rarely manage many patients with severe acne, refer these, as they may need additional treatment and higher doses of isotretinoin thus experiencing troublesome mucocutaneous side effects.

Dermatological photography is increasingly undertaken in general practice to document a condition, aid in follow-up, or to obtain a specialist opinion. Almost everyone owns at least one digital camera, including inexpensive consumer devices, sophisticated DSLR cameras and mobile phones.Editing and archiving software are also necessary.

Obtain patient consent for photography, preferably in writing, outlining its purpose. If you plan to send the image to someone else, explain that its use will then be out of your control. Minimise photographs that might identify the patientshould it be uploaded to Facebook, Wikipedia or porn sites (face, tattoos, jewellery).

Prepare by ensuring plain, non-reflective grey / blue / green background and plenty of uniform ambient light. Use a large image size and best quality JPG compression � you can reduce file size later if you are short of storage space. Although the automatic settings are often adequate, consider altering white balance to suit the lighting and reducing aperture to increase depth of field. Flash is usually best but can be difficult with macro photography. Hold the camera still and perpendicular to the subject. Many cameras struggle to focus on the skin; if so, fix focus on a straight line (pen mark, transparent ruler, skin-coloured paper or fabric).

Take several pictures to include a regional view to show site or distribution of the skin complaint as well as close-up and macro photographs. Make sure they are in focus and properly exposed. It can be helpful to include a rule to indicate the size of a skin lesion. Dermoscopic photographs are valuable, particularly for pigmented lesions.

Save the original image to your computer before editing a copy. Filenames might be those provided by the camera or your image archiving software � date-time names are helpful. Annotate the file with keyword metadata to identify the patient (NHI or practice ID number, not name) and diagnosis to easily find the picture in the future. 

Reduce the file size for emailing � use editing or archiving software to save copies of 640 x 480 px images. If sensitive subject, encrypt or upload to secure password-protected environment. Multiple images can be compressed into a zip file. 

A practical approach to anaemia with a focus on coeliac disease, iron study interpretation, gastrointestinal tract bleeding and low B12.

Prevention of infectious diseases is at the core of good health and vaccines represent one of the greatest achievements of biomedical science and public health. There have been significant advances in the development of vaccines, which hold promise for improving the health of New Zealanders. From July 2011, the Government will broaden the coverage of pneumococcal disease in New Zealand by replacing Prevenar with Synflorix (a 10-valent pneumococcal polysaccharide conjugate vaccine) on the National Immunisation Schedule. In addition to those vaccines on the Immunisation Schedule, there are others that are recommended and available in New Zealand but not yet funded. This interactive workshop will provide you with an update on the advances in pneumococcal vaccination in New Zealand and the implications for clinical practice. The workshop will also cover the latest developments in recommended but non-funded vaccines, including rotavirus and varicella vaccines.

Aircraft accidents and incidents, even minor, have to be reported to the authorities and are generally thoroughly investigated.

This is done on a �no blame basis� for the sole purpose of identifying causes of mishaps, learn from them, and prevent future occurrences.

This philosophy is becoming more and more accepted in the practice of medicine, particularly in anaesthesia and surgery. 

Most accidents and incidents are the result of human error. These errors are often related to a lack of safety culture, deficient management and failure to address �latent failures�. There are lessons to be leant for the practice of medicine from aircraft accidents. The workshop addresses some example of aircraft accidents to illustrate how errors and mishap do occur. It links these to the practice of medicine and hope to give General Practitioners better awareness of accidents causality and assist them in avoiding mishaps.

Prevention of infectious diseases is at the core of good health and vaccines represent one of the greatest achievements of biomedical science and public health. There have been significant advances in the development of vaccines, which hold promise for improving the health of New Zealanders. From July 2011, the Government will broaden the coverage of pneumococcal disease in New Zealand by replacing Prevenar with Synflorix (a 10-valent pneumococcal polysaccharide conjugate vaccine) on the National Immunisation Schedule. In addition to those vaccines on the Immunisation Schedule, there are others that are recommended and available in New Zealand but not yet funded. This interactive workshop will provide you with an update on the advances in pneumococcal vaccination in New Zealand and the implications for clinical practice. The workshop will also cover the latest developments in recommended but non-funded vaccines, including rotavirus and varicella vaccines.

Mr Ryall represents the Bay of Plenty Electorate, which includes the suburbs of Tauranga City (Papamoa, Bayfair, Maungatapu, Welcome Bay, and Ohauiti), and the surrounding rural areas of Te Puke, Kaimai, Omokoroa and Te Puna. 

First elected as MP for East Cape in 1990, Mr Ryall won his seat from the Labour Party. Following boundary changes he represented Eastern Bay of Plenty electorate (1993-96) and has represented the Bay of Plenty electorate since 1996. 

After schooling in the Eastern Bay of Plenty, Mr Ryall graduated from Massey University with a Bachelor of Business Studies (Accounting and Finance), and a Diploma in Business Studies (Accounting). 

In 1997, Mr Ryall was promoted into the Shipley Cabinet. He held the portfolios of Minister of Justice, Minister for State Owned Enterprises, Minister of Local Government, Minister of Youth Affairs and Minister Responsible for Housing New Zealand Ltd. While in Opposition Mr Ryall served first as Law and Order spokesman, then as Health Spokesman. 

Mr Ryall is married to Kara and has two children Maisie and Llewellyn.

�Medicine is an art, surgery is a skill�: the one hour session will cover both scenes of Jadelle. The introduction looks at the 
� pharmacologic aspect of Jadelle, including non-gynaecological actions (�side-effects�) and contraindications,
� and a comparison of Jadelle to oestrogen based contraceptives, and to other progestins.

 plenum question and discussion block concludes the theoretical part of approx 20 min. A brief animated video (your personal copy is included in the session registration) will set you up to try your skills on a dummy arm. During the hands-on session further small group discussion is encouraged.

He also writes for a number of magazines and is passionate about use of the media for educational purposes. 

He enjoys the outdoors with his family whenever he can and has had a new lease of life after relinquishing private obstetrics. 

www.dranilsharma.co.nz 
anil@dranilsharma.co.nz 

Anil undertook a one year postgraduate course in medical law during his registrar training whilst specialisation in Obstetrics & Gynaecology. He will mainly draw upon his 24 years of postgraduate medical experience to cover these topics with an emphasis on sharing experiences and mutual learning. The workshops will have mainly an experience-based flavour rather than be purely theoretical.

Anil undertook a one year postgraduate course in medical law during his registrar training whilst specialisation in Obstetrics & Gynaecology. He will mainly draw upon his 24 years of postgraduate medical experience to cover communication with an emphasis on sharing experiences and mutual learning. The workshops will have mainly an experience-based flavour rather than be purely theoretical.

Anil undertook some of his training at the tertiary Endometriosis centre at the University Hospital of Cardiff whilst he was on the Welsh training programme. Therapies for this condition have come in and out of fashion over the last 2 decades. He will review and discuss the topic and suggest management strategies and outcomes. The link with subfertiity will be explored as will the day to day management of this complex and enigmatic condition. He always aims to provide practical tips.

Anil firmly believes in the provision of choices to women where effective options exist. He utilises Mirena, Novasure endometrial ablation (having the largest NZ series) and hysterectomy. He undertakes vaginal, laparoscopically-assisted and abdominal hysterectomy and discusses what to do with ovaries and cervix. A discussion and clear guidelines for investigation and for who to investigate will be offered as will ways of guiding your patients through the maze of options.

This will be a mainly practical session along with helpful hints and tips as well lots of opportunity to take part. Given the ongoing issues with health provision in NZ, these techniques can do much to alleviate morbidity, both temporarily and for the longer term.

Around 50% of Anil's practice is devoted to the problems of prolapse and urinary incontinence and the irony of remedying these issues after delivering around 5000 babies (having now given up Obstetrics) has not gone unnoticed! This session will aim to debunk the unnecessarily complex diagnosis and treatment of these issues in a clear practical manner. The overactive bladder will also be discussed as will the pros and cons of non-mesh and mesh repair. Although he has the largest NZ series of trocar-free apical and anterior / posterior repair, he still discusses and undertakes traditional surgery as well. Pessaries and conservative management have a part to play and this will be covered.

I have 3 children and am married to Elspeth Dickson, also a local GP.

The workshop will cover how to get started with training & supervised practice, equipment requirements, patient selection, information provision and consent forms, operative procedure video, local anaesthesia methods, vasa occlusion methods, sedation, complications, semen analysis, failure rates, post vasectomy pain and audit, plus useful web resources. During this time, I will try to slay some of the mythology that still abounds!

If there is time, we can discuss contract negotiation with health purchasers.

Participants are welcome to take away electronic copies of the patient information leaflets and consent form to adapt for their own use. Please bring a USB stick.

Contact either: tsutton@middlemore.co.nz or tims@heartgroup.co.uk  

A bullet point tour from first diagnosis, what do we look for, when do we worry and what can we do to help keep our patients well through to interventions offered and care of patients post procedurally. 

Just how should a patient with AF and heart failure be managed. Can they be left in AF? What are the best medications to use? How can we best keep them well? This group can provide a challenge both diagnostically therapeutically. In this session I will try and answer the above questions and illustrate how pleasing the results can be.

An often unrecognised comorbidity in cardiac patients I will highlight some identified cardiac associations. As you will see this is an area in which we are early in the learning phase, but knowledge is growing, and the recognition that this places a huge challenge to health services in the future.

Dr Nikki Turner
Director, Immunisation Advisory Centre
University of Auckland
Phone: 09 373 7599 ext 82565
n.turner@auckland.ac.nz 

A range of children�s issues present to general practice, often tacked onto at the end of other consults, or at the end of the consult with the hand on the door handle �by the way doc...�. When do we need to act, and when can we relax. This workshop will cover a range of common GP scenarios , and discuss management options, when we need to react, when we can relax. Issues we intend to cover include the chronic cough, constipation, head shapes, behavioural issues, changes to the immunisation schedule, well child screening tools, skin rashes, vitamin D deficiency.

The delivery of vaccinations is probably the most evidence-based medicine we practice. The absence of disease may be a hard concept to sell, but the gains are dramatic. Furthermore the world is expanding rapidly with fantastic new vaccines available and coming on the market. As GPs we can no longer take coffee breaks through the immunisation updates and leave the practice nurses to know all the answers. This presentation will give a rapid overview of the schedule update this year, the private market vaccines our patients will want to know about, communication and myth, cool new research and future directions for vaccinology. 

The practice nurse role is a very important front line role for parents with many common childhood issues. This is being expanded in many areas with practice nurses becoming more involved in well child services including the �B$ School check� This interactive presentation will cover :
� a quick update on recent immunisation issues: the 2011 immunisation schedule update, private market vaccines to know about, cool new research in immunisation, 
� Common childhood issues including the well child schedule and the role of the practice nurse, lift the lip dental screening, well child screening tools, common behavioural issues, skin issues.

Dr Ian Wallbridge 
Musculoskeletal Physician 
Australasian Faculty of Musculoskeletal Medicine 
Email: iwallbridge@xtra.co.nz  
Phone: 07 348 7312

We hope that after attending the workshop you will walk away being much more confident at extracting the key points in the pain history, instead ofdrowning in the long histories often presented to you. You will be comfortable at assessing the major neck findings that give certain pain patterns, and be mindful of the important role of breathing in the presentation and maintenance of musculoskeletal problems. You will have an overview on which investigations are the most useful, and what the place for needling has. But most importantly you will walk out from the seminar with 10 key take home points from a practical hands on points of exam and treatment, that will be practiced in multiple times during the seminar by examining each other. YOU can be confident to put this into practice on Monday morning, knowing , that , in keeping with General Practice, a musculoskeletal neck problem is highly likely to present in the next 24 to 72 hours that you return from this CME conference, and that unless skills learned from a conference are put into practice, within 24-72 hours, they are likely to be lost. Hence we wish to emphasize the common and relevant, with just a tincture of the rare, for the most satisfying outcome for you and your patient treating musculoskeletal pain and disability.

HR Management in General Practice 
General practice is a complex and fascinating place to work with many challenges for those managing staff. For example if your new staff member hasn�t worked in this environment before, they won�t just walk in and do the job . . . you need to train and support them.

If you get it right, from the beginning of the employment relationship through to the end and all points in-between, staff will be your most valuable asset. Proactively managing performance will also reduce the cost and time spent on managing underperformance and disciplinary processes.

CORNERSTONE^TM accreditation further reinforces the need to have clear documented workplace policies and guidelines in place for the whole practice team - including GPs. And breaching your employer obligations in relation to employment agreements or employment law can land you in serious hot-water. 

Understanding the basics of current legislation and developing good policies and processes will help you manage and develop a confident and motivated team and ensure legislative compliance. 
This session will cover the requirements of:
� Recruiting well 
� Position descriptions & KPIs
� Employment agreements
� Induction
� Staff appraisals 
� Staff retention
� Training and development
� Underperformance and disciplinary procedures

Risk management is the process by which an organisation reaches decisions on the steps needed to adequately control the risks it generates or to which it is exposed. So what does this mean for you as managers of health practices? 

Developing a risk management plan will give you the ability to identify, assess, assign ownership, take actions to mitigate, anticipate, and monitor and review progress. 
� Some will be financial
� Some will be clinical
� Some business and legal related
� Some covered by insurance, but the majority covered by systems, processes and education.

This session will get you well on the way towards developing a risk management plan. You will be able to go back to your practice and know what to look for - the gaps you need to fill. And for the risks you have already managed, you will be able to give yourselves a pat on the back.