I will also give an opinion on the scope of anaesthesia in local practice!

The key to risk management is to identify and anticipate any possible risks beforehand, rather than learn lessons the hard way after an event - as many Christchurch businesses unfortunately did after the earthquakes of 2010 and 2011. 

In this session we will discuss some on the non-clinical risks that must be managed in general practice including: 
� financial risks
� business, employment and legal related risks.

Some of your business related risks can be covered by insurance, but many will be covered by policies and procedures or managed by having good systems in place.
Following this session you will be able to go back to your practice and know the risks you need to identify and how best to manage them.

New Zealand has the highest vasectomy rate in the developed world, with 57% of men aged 40-49 firing blanks.

John provided a primary care based vasectomy service in the UK for 20 years, logging over 5000 procedures. Initially using a cut & tie technique, John switched to the no-scalpel method in 1998. 

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.

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.

How evidence can improve your patient's health

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.

In the usual no nonsense approach taken by Gareth Morgan Investments creating wealth is one thing but how do you make sure you don�t �loose the bloody stuff!�.

In addition to her role as National Tobacco Control Programme Manager for the Ministry of Health, Karen is also a registered physiotherapist and chair of the Physio Cardio Thoracic Special Interest Group. Karen holds a Master�s degree in Cardio Respiratory Health Science and brings a depth of experience both in the field and within the public sector to her role as the Target Champion for the �Better Help for Smokers to Quit� government health target. 

The Ministry�s tobacco control programme covers a broad spectrum of activities ranging from funding the provision of cessation and health promotion services through to the introduction of initiatives such as the recent ABC programme designed to support clinicians in their role helping more smokers to make more quit attempts, using the support of NRT more often.

Karen sees her role as working to engage the hearts and minds of clinicians with the importance and relevance of supporting people to quit smoking. Karen also uses her role, and the overview of the sector it affords, to help connect others with resources, support and examples of good practice from across the sector.

Smoking cessation is a life-saving intervention. More smokers are making more attempts to quit thanks, in large part, to the advice they are receiving in general practice. Encouraging smokers to use treatments (behavioural and pharmacological) increases their chances to stop smoking for good.

Primary care has been actively involved in helping people who smoke to stop by using the ABC approach (Ask, Brief advice, Cessation support) which systematises the key steps needed to prompt quit attempts and enhance smoking cessation outcomes. 

This presentation will provide an update on the effect of brief advice and offer of treatment provided by healthcare professionals and clinical management for smokers who want to quit, including evidence-based pharmacotherapy and behavioural support. It will also provide key messages about tobacco use and smoking cessation. The session will also cover: active management of smoking in pregnancy, easy ways to record smoking status, advice, and outreach approaches that work and using hospital discharge information to your advantage.

Ed Gane is Associate Professor of Medicine at the University of Auckland, New Zealand and Director of the New Zealand Liver Transplant Unit at Auckland City Hospital. He trained in Hepatology at the Institute of Liver Studies, King�s College, London. On his return to New Zealand in 1996, Associate Professor Gane was appointed Chief Transplant Physician for the first New Zealand Liver Transplant Programme. 

Associate Professor Gane has been the Government Clinical Advisor to the National Hepatitis B Screening Programme since 1998 and this year was appointed as Champion for HCV for the Ministry of Health. He is involved in several current phase I, II, III and IV clinical trials of new antiviral therapies for HBV and HCV before and after liver transplantation. 

Associate Professor Gane is extensively published, with over 100 first author papers, including in Lancet and New England Journal of Medicine.

Currently in GPEP 1 based in Southland.

Born and raised in Southland, want to be able to give back to the community - plan to enter rural general practice - still thinking about the rural hospital medicine training scheme also.

Dr. Cameron Grant is an Associate Professor in the Department of Paediatrics: Child and Youth Health at the University of Auckland and a paediatrician at Starship Children�s Health. He is the Associate Director of Growing Up in New Zealand and of the Centre for Longitudinal Research � He Aka ki Mua, at the University of Auckland. He graduated MBChB from the University of Otago and PhD from the University of Auckland. His postgraduate paediatric training was as a resident at Duke University Medical Center and then a fellow at the Johns Hopkins University. 

Dr. Grant returned to the Johns Hopkins University in 2008 as a Fulbright Senior Scholar. In 2008 he became an overseas fellow of the National Institute of Health Research National School of Primary Care (UK).

His teaching skills have been recognised with faculty and university teaching awards including a University of Auckland Teaching Excellence Award for sustained excellence in teaching. 

His research focuses on health problems that are common, affect New Zealand children disproportionately, and are preventable by immunisation or improved nutrition. He has published more than 70 refereed research papers, reviews and book chapters.

Choice of removal and repair, Langers lines, needle anatomy, simple repair , subcuticular deep buried sutures, and wound cares post surgically . How to handle instruments and care for them.

Covers one rotation flap, and one advancement flap ( say VY), to teach the difference. As time allows, Z plasty, S ellipse repair, Burows triangles, dog ear repair. Previous attendance at the Basic Surgical Skills Course, or prior practical experience a pre-requisite for attendance.

The overhead page �Could any onboard doctors please identify themselves to a crew member� can strike fear or excitement into any travelling doctor. 
- What am I going to be asked to do? 
- What medical equipment do aeroplanes carry anyway? 
- How am I supposed to work in such a cramped space? 
- Do I have to make the decision about redirecting a flight? 
- Do I get any help up here or am I on my own? 
- What are the legal implications of getting involved?

Doctors have at least a moral obligation to assist in a medical emergency if asked, but assisting with a medical emergency on board an aircraft can be stressful. Here is your opportunity to familiarise yourself with the medical resources on board an Air New Zealand aeroplane and the procedures for handling in-flight medical emergencies. We will discuss common in-flight emergencies and their management, the Physicians Kit, use of oxygen and CPR/defibrillator, ground based assistance and legal responsibilities and implications. 

We all have patients who fly either as passengers or pilots. This workshop will be an extremely practical session with tips that can be used in your daily practice. 
- We will briefly address the physiology of altitude and the practical effects this has on passengers with medical conditions.
- The focus will be on specific medical conditions and current recommendations on fitness to travel for passengers. 
- The process for obtaining medical clearance for travel for your patients (MEDA form) will be explained. 
- The equipment available to assist passengers will be described.
- The legal requirements for doctors who treat recreational and commercial pilots will be outlined along with medical conditions of potential concern among pilots.

From 1992 until 1998 he held Senior Staff Radiologist positions and Clinical Senior Lecturer status until 2003. In 2003 Ross moved to Perrett Medical Imaging which was subsequently incorporated into Medical Imaging Australia Group (MIA). It was at this time that Ross became a founding Partner of Adelaide Cardiac Imaging (ACI), a joint radiology-cardiology venture. Dr Keenan worked with Professor Stephen Worthley (Cardiologist) in setting up the cardiac MRI arm of this venture.

Ross returned to New Zealand in 2004 and joined Christchurch Radiology Group (CRG) as a partner and was instrumental in the formation of Heart Vision a joint venture specialising in provision of cardiac CT, being Managing Director since 2007. 2009 saw Ross further expand CRG cardiac imaging with establishment of an echocardiography service.

Ross currently holds a 7/10 position as a Neuroradiologist in Christchurch Hospital and provides cardiac CT/MRI expertise in both public and private settings.

In 2010 Dr Keenan was credentialed with CTCA Specialist status by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography (CCRTCTCA). This conjoint committee comprises RANZCR, CSANZ and ANZAPNM.

Dr Keenan has fulfilled the training criteria for NZ CT-PET specialist recognition, and is currently in the process of a formal application. 
Ross has been extensively involved in RANZCR affairs in both Australia and NZL, sitting on the RANZCR executive for 6 years including a year as Treasurer. Teaching has been a large part of Ross�s career being seconded as a Neuroradiology examiner for the College of Radiologists since 2000 and actively involved in the Christchurch Radiology Training programme.

In his current role, Manish is actively engaged in linking with primary care via satellite diabetes clinics. He is also leading in directly educating primary health care professionals through lectures and workshops besides reaching out via online learning modules. This engagement with primary care is particularly relevant if we are to successfully tackle the current epidemic of Type 2 Diabetes. As wide range of professionals are involved in providing diabetes related care, there is an ever increasing need to efficiently coordinate this so as to ensure that all subjects receive quality care in a timely and patient centred manner with rapid access to secondary care when needed. This calls for setting up an integrated model of care where barriers between primary and secondary care are broken down so as to facilitate seamless escalation to secondary care and subsequent de-escalation as appropriate with a view to provide a quality service in a timely and cost effective manner.

The significant morbidity and mortality associated with this condition is a direct result of the associated complications. Strong evidence exists to suggest that improved glycaemic control significantly reduces the risk of microvascular complications in subjects with diabetes. Early diagnosis and appropriate treatment is hence pivotal in reducing the risks associated with this condition. As many subjects with type 2 diabetes need to be initiated and maintained on insulin therapy to obtain satisfactory glycaemic control, it becomes even more important to have this process managed in primary care where possible. This calls for provision of robust education and support to the primary care team. The �Commencing Insulin in General Practice� workshop is precisely aimed at catering to this need so as to facilitate safe and timely initiation of insulin in the community setting.

NZ Guidelines for the management of suspected cancer in primary care were published in 2010- how relevant are those when dealing with your patient with possible lung cancer? When should one be worried it might be cancer? A Lung cancer (CT) screening update after a pivotal 2011 paper will be given. The Lung cancer patient journey in NZ in 2011: ideal and reality. New treatment options available in 2011. Patients have completed their cancer treatment � what should then follow? : the (potential) role of the primary care teams will be addressed.

Sue is an agent on the Child and Youth Mortality Group and supervises a multi �disciplinary team who specialise in providing services for children with care and protection needs.

Contraceptive implants provide another reliable long acting reversible method of contraception, suitable for the young through to older women.

Jadelle, the levonorgestrel-releasing subdermal implant, provides contraception for up to 5 years. It is fully subsidised in New Zealand. 

Implanon releases etonorgestrel and provides contraception for 3 years.

Objectives of the workshop: 

1) To prepare for counselling women, younger and older, about the use of contraceptive implants
2) Availability of Jadelle and Implanon in New Zealand.
3) Overview of mode of action, efficacy, risks, benefits, possible side effects, drug interactions of each method.
4) Insertion and removal of implants � video demonstration and the opportunity to practice on a model arm.

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.

Choice of removal and repair, Langers lines, needle anatomy, simple repair , subcuticular deep buried sutures, and wound cares post surgically . How to handle instruments and care for them.

Covers one rotation flap, and one advancement flap ( say VY), to teach the difference. As time allows, Z plasty, S ellipse repair, Burows triangles, dog ear repair. Previous attendance at the Basic Surgical Skills Course, or prior practical experience a pre-requisite for attendance.

Choice of removal and repair, Langers lines, needle anatomy, simple repair , subcuticular deep buried sutures, and wound cares post surgically . How to handle instruments and care for them.

Covers one rotation flap, and one advancement flap ( say VY), to teach the difference. As time allows, Z plasty, S ellipse repair, Burows triangles, dog ear repair. Previous attendance at the Basic Surgical Skills Course, or prior practical experience a pre-requisite for attendance.

He is the Clinical Director of the Pain Management Centre for the Canterbury District Health Board in Christchurch. He is Vice-Dean of the Australian and New Zealand Faculty of Pain Medicine. 

He is the author of 125 publications in peer-reviewed journals, of several Book Chapters, and of the Book, �Pain, Acute and Chronic�, published by Arnold in London.

Patterns of chronic pain in the New Zealand are similar to those found internationally.  This indicates that chronic pain represents a major health issue in New Zealand. Optimal management of acute and chronic pain conditions should start with careful assessment of the patient's expectations, and with weighing of the pros and cons of potential drug therapies to determine an individualised treatment strategy.  Thorough patient assessment combined with regular clinical review and pharmacovigilance ensure optimal efficacy and safety in prescribing.  Future therapeutic prospects include focal therapy with sustained analgesic efficacy (capsaicin patches, botulinum toxin), and treatments acting on new targets, such as cytokine inhibitors, metabotropic glutamate inhibitors, and TRPV1 antagonists.

Handout:  My Advance Care Plan Form

Email: ian.stgeorge@mckesson.co.nz 
Phone: 027 2407919

With the health workforce pressures, particularly in rural and regional areas virtual healthcare delivery is being increasingly used to match patient demand and provider supply. Ian St George and Davis Lemke will take you under the bonnet of a new Online Care Portal which is being used in the US and Australia. They will also discuss the legal, ethical and social impacts of this trend.

Nicholas has been with Westpac NZ since August 2005, and his current role is Health Sector Specialist. Nicholas joined the Westpac�s Health Team in January 2007 to assist the bank to provide a premium service to health practitioners and business owners. 

Nicholas has a thorough 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, Nicholas worked in Westpac Business Banking, Chartered Accountancy and spent 8 years back-packing around the world � nice! 

Handout: Childhood Anorexia Nervosa

Handout: ADHD

Major areas of research include clinical nephrology focusing on cardiovascular risk factors in chronic kidney disease, acute kidney injury, drug handling by the kidneys and drug nephrotoxicity, as well as management of chronic kidney disease and dialysis outcomes in the elderly.

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

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.

In this session we will explore the challenges and solutions for successful debt management from two key angles: 
1. Managing a small business, focusing on how to ensure that you receive cash from patients as quickly as possible.
2. Confronting the issues specific to general practice - juggling your ethical and social obligations to meet patient needs versus their ability to pay the bill.
We will discuss key strategies for keeping debt under control including:
� How to encourage patients to pay 
� Internal credit control processes that work 
� What to do when they just won�t pay! 
� Managing government agency debt such as HealthPAC and ACC 

Over 500 general practices in New Zealand subscribe to HealthyPractice� � MAS�s online business support and education service. With employment document templates available for download and customisation, a financial toolkit to help with planning and budgeting and a regular subscriber newsletter, we bring together a comprehensive portfolio of information and tools tailored to the evolving needs of general practice. 
This session will showcase how you can use HealthyPractice� to help meet accreditation standards and maintain best practice business requirements including:

� CORNERSTONETM General Practice Accreditation Programme resources
� employment compliance and process � getting it right
� management reporting � monitoring and measuring what counts
� staff training � developing your team
� practice ownership and governance � reviewing the business model and practice agreement; and financial management and planning. 

Even our experienced and long-term HealthyPractice� users can learn something new from this session.

In his talk Dr Young will discuss the findings of several recently published studies on COPD and provide simple �take home messages� on novel approaches to diagnose, assess and manage patients with COPD. He will focus on new data showing that while lung function testing (spirometry) is central to identifying patients with airway obstruction, symptom- based assessment should direct the use of medications. He will also discuss the wider implications of identifying patients with COPD and how they could be better managed to reduce symptoms, reduce hospital admissions and reduce mortality.