Shift work, which is defined as working �non-normal� hours (6pm to 8am), is now undertaken by up to 20% of the workforce in New Zealand. Shift work can have a significant impact on both the physical and emotional health of the worker, and in addition is likely to have a significant social impact. Shift work could be considered a lifestyle choice rather than a work choice. 

People may cope very differently with shift work. Depending on the timing of the work, early morning starts, late evening finishes or working overnight, the workers� individual circadian rhythm will make the work easier or more difficult. Some cannot manage any form of shift work that interferes with their normal sleep pattern.

Since the demand for shift work has been increasing for several decades, it is unlikely to go away. We therefore need to consider how to best manage this disruptive lifestyle, and reduce the risks involved. 

I will discuss why we find shift work so difficult, and both the similarities and differences from jet lag. Finally I shall discuss how we can best manage our sleep patterns that can have such a significant effect on our lives. 

One of the most common presenting symptoms to the GP is chronic daytime tiredness and lethargy. These complaints can be divided roughly into three categories: physical, psychiatric, and disorders of sleep. These conditions commonly overlap, but I will concentrate on the numerous disorders of sleep that affect a significant proportion of our patients. Up to 50% of patients will be suffering from either hypersomnolence, or fatigue without sleepiness, as a result of a sleep difficulty. 

I will discuss the background to these various disorders, the clinical features to look for, history and examination, and investigations that can be undertaken to uncover a possible sleep disorder. Finally I will discuss treatment options for the more common sleep disorders. 

Much time is spent on discussing nutrition, stress management, and the importance of exercise, but little time is spent on discussing the importance of sleep. This third of our lives is extremely active, and deserves greater recognition, as it has such a significant impact on our daytime functioning and health. 

Treatments for these sleep disorders are available, often simple, and usually extremely effective.

Sleep is so important to the physical, cognitive and emotional development of children that the assessment and treatment of sleep disorders in this age group is vital.

A simple and practical tool has been devised to assist with this process, and could be used by any health practitioner who has a little time to take a history. 

Approximately 25% of children experience some form of sleep problem. This may range from difficulty falling asleep and night waking, to the more serious sleep disorders such as sleep apnoea or narcolepsy.

Whilst many of these sleep disorders are transient and self limiting, the commonly held idea that they will �grow out of the problem� is not always a correct assumption, and can lead to long term consequences.

The assessment tool, with a simple acronym of BEARS, will be discussed. This screening device allows the practitioner to uncover any of the common underlying sleep disturbances that may present to the General Practice.

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. 

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?

The locomotor system is genetically programmed, it is a highly complex system under subcortical control integrating motor function, balancing muscle activity and ensuring centration of joints, essential for normal joint development and optimal motor function. Injury or disturbed motor function affects normal programmed motor activity, there is a reaction of the system to injury/pathology with compensatory and protective motor patterns developing, frequently influencing recovery and often perpetuating dysfunction and pain. In our current medical approach to musculoskeletal problems, there is a focus on pain and pathology, identifying the primary source of pain which often involves extensive investigation, imaging, local anaesthetic blocks, then a focus on treating pain, rather than assessing function, disturbance of function and rehabilitation aimed at restoring correct programmed motor function. The human body will cope remarkedly well with various injuries and pathology if programmed motor function is maintained and restored. Frequently the primary pathology can never be restored to the pre injury state, eg an intervertebral disc injury, but function such as spinal function can be maintained and restored, with resolution of pain. 

To assess injury/pathology and disturbance in normal function of the locomotor system we must understand the normal locomotor programme, which is never taught in our medical training. We must be able to assess the programme and identify disturbed function. Then we can treat the problem effectively and restore function, when this is achieved invariably pain resolves. 
Practical assessment of locomotor function will be presented and examples using specific cases will be discussed to demonstrate practical application.

Dr Mary Birdsall
Reproductive Medicine, Medical Director
Fertility Associates 
www.fertilityassociates.co.nz  
info@fertilityassociates.co.nz 
Phone: 0800 10 28 28

Irregular vaginal bleeding is a common presentation and there are traps for the unwary. Here are my top tips to diagnose and manage irregular bleeding:

1. Always exclude pregnancy
2. Examination is mandatory including abdominal palpation and a speculum examination
3. Perform a cervical smear even when not due
4. Remember infection as a cause of bleeding
5. Bloods: FBC, ferritin, FSH, LH, hCG, sometimes prolactin, testosterone
6. Pipelle endometrial sampling is an easy office based procedure
7. Pelvic ultrasound often useful
8. Progesterone will stop almost all hormonal bleeding

Dr David Bratt is first and foremost a General Practitioner who spent 30 years in front-line general practice enjoying the delivery of individual face-to-face health services. In 2002 a new opportunity presented itself to improve patients� access to specialist secondary services and close the gap in the primary/secondary interface with his appointment to the new position of GP Liaison and Primary Care Advisor to Capital and Coast DHB. This exposure to a large multilayered organisation required a whole new set of skills and an understanding of the relatively slow pace of change possible compared to a typical small business general practice. A further leap into the unknown occurred in 2007 with his appointment to the new position of Principal Health Advisor to the Ministry of Social Development. This is General Practice at a systems level � working with a population around the wider social determinants of health � employment, income, housing, education, and access to health services. In this position he had to opportunity to work on collecting together the substantial body of evidence on the health benefits of work, and the significant adverse health outcomes of worklessness.

This seminar offers some practical considerations for managing both beneficiaries and difficult patients. The two key gaps addressed are �communication� (are we speaking the same language?) and �knowledge� (what to you know?). As doctors we frequently drift into medical jargon, technical terms and abbreviations without noticing. We all have different preconceived ideas on what particular words mean � but this is strongly influenced by your �cultural� background. This gap is considered. Also recent surveys would suggest that many GPs are unaware of the services available to support beneficiaries. As a consequence 350,000 Work Capacity Medical Certificates are written each year by GPs advocating a workless path for patients with inevitable adverse health outcomes. You should leave with at least one key learning and one strategy to make your professional life less stressful.

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.

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

Varicose veins affect approximately half the population at some time in their lives. Impaired quality of life that results are often aching, tired, heavy legs, worse in hot weather, if standing for some time, or with menses. Leg cramps, burning feet and restless legs syndrome are common. Itchy eczema, haemorrhage of frank ulceration are heart sinks to GPs and nurses. 80% of leg ulcers are venous in origin. 

Symptoms do not match vein size. No veins may even be visible on the skin surface. Abnormal blood flow from the high pressure/ flow of the legs deep venous system connecting to the low pressure/ flow of the superficial system causes distension and increasing venous blood flow caudad towards the feet. Venous congestion, venous hypertension, and interstitial oedema with poor skin nutrition and oxygenation result. 

Nonsurgical outpatient methods to treat veins are popular and effective worldwide. Endovenous laser ablation (EVLA) under local anaesthesia is current best practice worldwide, a steady trend for over a decade. (There is very little place for surgery given the risks of anaesthesia, established 5% VTE rate, scarring , higher recurrence rates, and postop downtime and pain.) Eliminating all sources of reflux is necessary for a successful outcome, requiring detailed ultrasound guided foam sclerotherapy for distal disease and all incompetent tributaries. Primary success rates for EVLA are over 95% at 5 years. Return to work is immediate , with a high efficacy and safety. 

Ulcers can be readily healed by treating the underlying venous hypertension. Antibiotics rarely are required, but adequate compression and good nursing are important. All topical treatments confer benefit, but skin grafting without compression or treating the underlying varicosities is pointless. 

Veins of any size can be treated with EVLA, men and women suffer equally, and treatment pre and occasionally during pregnancy is useful. Heredity and obesity are common causes of varicose veins, as are multiple pregnancies. 

Post thrombotic syndrome is a miserable untreatable disease after DVT, and can be prevented by wearing class 2 compression hose for 2 years post DVT, especially if thrombosis extends above knee. 

Varicose veins remain poorly diagnosed and poorly treated , especially in ulcerative disease. 

A number of myths will be revealed as fantasy.

This workshop will discuss the Health Practitioners Disciplinary Tribunal, the Human Rights Review Tribunal, and the Disputes Tribunal. Cases with relevant learning points for GPs will be presented as well as brief introduction on how each Tribunal functions. As usual there will be plenty of opportunity for questions.

�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.

This presentation will summarise New Zealand data on pre-hospital and in-hospital treatment of acute coronary syndromes and detail therapies after hospital discharge. Rehabilitation programs, lifestyle interventions and multiple medications all contribute to reducing the risk of recurrent cardiovascular events in those who survive their first heart attack. We will discuss the management of 3 patients to review targets for risk factor management and patient education, and explore opportunities to improve evidence based care.

Atrial fibrillation occurs in up to 10% of us as we age gracefully. Although atrial fibrillation is often well tolerated, the risk of embolic stroke is increased. In this presentation we will discuss the management of symptomatic AF, tools to predict the risk of stroke and New Zealand Guidelines for the long-term prevention of stroke. Aspirin is recommended in those at low risk of embolic stroke. In those at higher risk of stroke, we now have a choice between warfarin and dabigatran (a new oral thrombin inhibitor). Dabigitran offers improved prevention of stroke and comparable risks of bleeding. But is it suitable for all your patients?

This includes:

1. the consultation process especially as regards the decisions around biopsies, margins, depth and orientation of excisions.
2. set up of the procedure room � instrument and suture choices, diathermy and dressings
3. excision techniques especially as regards avoiding incomplete deep excn. And appropriate excn of fat.
4. sites of concern and how to deal with them � esp neck, face, hands
5. closure techniques, esp the interrupted dermal suture and thus avoiding the need for an external suture.

This workshop will discuss the Health Practitioners Disciplinary Tribunal, the Human Rights Review Tribunal, and the Disputes Tribunal. Cases with relevant learning points for GPs will be presented as well as brief introduction on how each Tribunal functions. As usual there will be plenty of opportunity for questions.

General practice has changed significantly from the traditional small business model where all revenue flowed directly from the GP/Patient consultation. Most of these changes have added layers of complexity to those responsible for financial management including capitation and the transfer of financial risk, increased group practice compliance and quality standards, less direct GP/Patient consultation revenue, PHO projects, workforce shortages, different GP needs and many more. Business models have also changed with DHB, Community Trust, PHO and corporate ownership now being more commonplace alongside the traditional GP owner/operator. And we continue to see more amalgamations with the development of purpose built medical centres providing a broader range of primary care services. To be financially viable and successful general practice now needs good financial management and business planning skills.

This session will cover three key areas of good financial management:
1. Maximising income � including managing the practice register, consumables, debtors, fee policy and other revenue opportunities;
2. Managing expenses � including non-owner GP/staff costs and financial risks;
3. Business planning and budgeting � to help determine the future direction and performance of the practice and how this will be funded.

k.grimwood@uq.edu.au

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.

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.

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.

It's Friday afternoon, your last two appointments are scuba dive medicals slotted in by your receptionist as both are desperate to get their medical clearance for tomorrows open water sea dives. The first prospective scuba diver is the GP registrar in your practice with very mild asthma and the second is his girlfriend who was involved in a road traffic accident six months ago but made a full recovery despite a mild head injury necessitating two days in hospital for observation. You certify them fit to dive but shallow diving only.

Monday am the coroners officer asks for the medicalfiles as both have died tragically in a dive accident. 

This one hour course critically examines some of the aspects of scuba diving and how medical certification may be achieved using peer reviewed guidelines. Importantly resources and materials are provided to enable the most novice GP to understand the basic elements of the risk assessment process leading to certification of fitness to scuba dive.
Prepare to be challenged!

HANDOUTS:
1. AS 4005
2. Scuba Diving
3. SPUMS Medical
4. eMJA 

Approximately 2 billion passengers a year now fly on civilian aircraft. Air travel exposes passengers, air crew and pilots to a number of unique physiological stresses and health risks, particularly when there are pre-existing medical conditions. 

The new Air Bus A380 provides cheaper long haul flights at the same speed as the original long haul Boeings introduced over 40 years ago at nearly twice the distance covered with no stopovers. The A380-800 has a maximum range of 15,000 km, sufficient to fly from Auckland to New York nonstop.

The GP has an important role in minimizing the health risks associated with air travel though pre flight screening for medical fitness to fly; advice on risk reduction for long haul travel and managing medical conditions pre and post flight including jet lag and DVT.

This presentation will give GPs key skills in better managing their patients �in the air�

HANDOUTS:
1. Australian Doctor Flying & Health 2007

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

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

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. 

Type 2 diabetes rates have escalated to the extent that New Zealand is reported to have the third highest rates of diabetes in the world. It is widely accepted that patients with type 2 should primarily be managed in general practice and this includes the initiation of insulin treatment. The New Zealand Guidelines Group has updated evidence based guidelines regarding several key aspects of management. The session will present the new algorithms relating to identification of those at highest risk and requiring the most intensive management, blood pressure control and management of glycaemia including the initiation of insulin treatment. Copies of the new material which will be incorporated into the New Zealand Handbook of Primary Care and the diabetes quick reference cards will be available. New approaches to screening for type 2 diabetes will also be discussed briefly.

Diabetes is associated with an appreciably increased risk of several conditions and a number of specific diabetes related complications. In practice, management involves regular review, assessment of risk and optimising glycaemic control, blood pressure and lipid levels. The results of several recent large randomised controlled trials will reviewed but the session will principally be an interactive one based around case presentations.

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

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.

This includes:

1. the consultation process especially as regards the decisions around biopsies, margins, depth and orientation of excisions.
2. set up of the procedure room � instrument and suture choices, diathermy and dressings
3. excision techniques especially as regards avoiding incomplete deep excn. And appropriate excn of fat.
4. sites of concern and how to deal with them � esp neck, face, hands
5. closure techniques, esp the interrupted dermal suture and thus avoiding the need for an external suture.

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

Although most GPs will see relatively few women with this disease. Ovarian Cancer is an important cause of cancer death in middle age and older women in New Zealand. Approximately 300 women are diagnosed and 180 die every year making it the 4th cause of cancer mortality. Late presentation and delayed diagnosis are a feature of this disease. Most women will respond to treatment but recurrence is the norm. As a result women undergo radical and multiple treatments and palliative care is an important aspect of their management. There is sometimes a familial component to this disease. General practitioners, hospital specialists and community services need to work as a team to offer these women optimal care.

In this overview I will discuss our current understanding of the biology of this disease, diagnosis, screening, current management, palliative care and familial considerations of this disease with an emphasis on information that will assist general practitioners understand this disease and assist their patients.

Along the way he has always been keen to share his learnings with others - from first year medical students back in Sheffield, England and GP teaching at Pegasus Health in Christchurch to the wider community on radio and TV.

Regional Facilitator - Rural Medical Immersion Programme( 5th yr med students) - Otago Medical School
Trainer/Facilitator, Education and Risk Reduction Program, Asia-Pacific region, Medical Protection Society 
Executive Coach -Health and Wellbeing, Institute for Strategic Leadership

In 2009 had a regular local radio slot on �Health and Well-Being� and in 2002 presented the TV3 consumer health series �Bodywise�. 

This includes:

1. the consultation process especially as regards the decisions around biopsies, margins, depth and orientation of excisions.
2. set up of the procedure room � instrument and suture choices, diathermy and dressings
3. excision techniques especially as regards avoiding incomplete deep excn. And appropriate excn of fat.
4. sites of concern and how to deal with them � esp neck, face, hands
5. closure techniques, esp the interrupted dermal suture and thus avoiding the need for an external suture.

Ruth trained as a registered nurse in the UK and has worked internationally before settling in New Zealand in 1997. Upon arrival into New Zealand Ruth worked as the Clinical Nurse Practitioner at the Mercy Hospital in Auckland. The main responsibilities from this position were orientation of new personnel, ongoing education, quality control, risk management, change management, staff support, as well as maintaining and creating policies and procedures.

In 2000, Ruth undertook a new direction and was engaged as a clinical consultant to an architectural firm, which specialised in healthcare design. Ruth�s professional background and familiarity with healthcare was utilised in this role to ensure that the client�s brief was heard, understood, interpreted correctly and that their needs were met by the project design. 

Ruth�s Masters degree focused on population health and specifically explored the effects of the environment on both the clients and the personnel in the healthcare setting.

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

General practice has changed significantly from the traditional small business model where all revenue flowed directly from the GP/Patient consultation. Most of these changes have added layers of complexity to those responsible for financial management including capitation and the transfer of financial risk, increased group practice compliance and quality standards, less direct GP/Patient consultation revenue, PHO projects, workforce shortages, different GP needs and many more. Business models have also changed with DHB, Community Trust, PHO and corporate ownership now being more commonplace alongside the traditional GP owner/operator. And we continue to see more amalgamations with the development of purpose built medical centres providing a broader range of primary care services. To be financially viable and successful general practice now needs good financial management and business planning skills.

This session will cover three key areas of good financial management:
1. Maximising income � including managing the practice register, consumables, debtors, fee policy and other revenue opportunities;
2. Managing expenses � including non-owner GP/staff costs and financial risks;
3. Business planning and budgeting � to help determine the future direction and performance of the practice and how this will be funded.

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.

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.