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Published: 31st October, 2025
Contents
Remembering Dr Richard Tyler
It is with great sadness that we acknowledge the passing of Dr Richard Tyler, General Practitioner and champion for primary care. Among his many accolades, Richard was a member of the original bpacnz Board of Directors, including a tenure as Board Chairperson. Richard was a great supporter and advocate of education for general practice, and we were honoured to have his influence in shaping future endeavours of our organisation. We offer our sincere condolences to his family, friends and colleagues.
In case you missed it – COVID-19 antivirals: Eligibility and prescribing guidance
COVID-19 continues to circulate in the community, although at much lower levels than during the peak of the pandemic. Most people with COVID-19 now experience mild symptoms that can be managed with supportive care alone. However, some people remain at high risk for severe outcomes (i.e. hospitalisation and death) and are therefore likely to benefit from COVID-19 antiviral treatment.
This article details the access criteria for funded COVID-19 antiviral treatment, including factors that increase the risk of severe outcomes from COVID-19. It also includes guidance on nirmatrelvir/ritonavir (Paxlovid) dosing, medicine interactions, adverse effects and effectiveness of treatment.
Read the full article here. A B-QuiCK summary is also available.
bpacnz recent hits
It can often be difficult to keep up with the latest when you are regularly inundated with a multitude of information in your inbox. Here is a selection of our other recent resources that you may want to re-visit or have your first quick click on now:
#MedSafetyWeek coming up
The tenth annual #MedSafetyWeek is being held next week from 3rd – 9th November (this link will update to the 2025 campaign next week). This campaign is supported by medicine regulators and stakeholders across 117 countries, and aims to raise awareness of reporting suspected adverse medicine reactions. This year’s focus is “We can all help make medicines safer”. Look out for the campaign on social media next week; we will be joining in, so follow, like and share!
When prescribing or dispensing a medicine, take a moment to check that patients understand how to take it, even if it’s a regular prescription. This includes advice on reducing the risk of adverse effects, awareness of what potential adverse effects may occur, and when to report a suspected adverse reaction to their prescriber or pharmacist. Suspected adverse effects to medicines and vaccines can be reported to the Centre for Adverse Reactions Monitoring (CARM) or directly via your patient management system.
Measles risk escalates: More cases reported across the country
Thirteen new cases of measles have been reported in New Zealand (as of 30th October, 2025) and Health New Zealand, Te Whatu Ora, expects this number to rise. The cases are in Northland (one), Auckland (four), Taranaki (one), Manawatu (two), Wellington (four) and Nelson (one). Cases in the Northland region and Queenstown were reported in Bulletins 133 and 134.
Exposure events are listed here. Healthcare professionals should be alert for patients presenting with symptoms and signs of measles, and opportunistically check whether all eligible patients have received both doses of the MMR vaccine; offer vaccination where appropriate (see IMAC for clarification on MMR vaccination advice for older adults). Also ensure that patients with upcoming international travel are fully vaccinated with MMR if needed; the Ministry of Health, Manatū Hauora, has published a media release advising people to get protected before travelling.
Refer to the Immunisation Handbook for information on funded indications for MMR vaccination. As this is an evolving situation, changes to the indications for funded vaccination may be announced – the website version of this bulletin item will be updated if required.
IMAC is hosting an upcoming webinar on measles. This free webinar is expected to cover the latest MMR guidance and provides an opportunity for IMAC medical advisors to answer any clinical questions from the audience. The webinar will be held on Monday, 3rd November, from 5.30 pm. Click here to register.
Medicine news
The following news relating to medicine supply has recently been announced. These items are selected based on their relevance to primary care and where issues for patients are anticipated, e.g. no alternative medicine available or changing to the alternative presents issues. Information about medicine supply is available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.
Oxycodone immediate-release tablets re-supply delayed further
Re-supply of 5 mg, 10 mg and 20 mg oxycodone immediate-release tablets has been delayed further and is now expected in November. Stock issues have been ongoing for some time (last reported in Bulletin 134). Oxycodone 1 mg/mL oral liquid is available (a new prescription will be required), but clinicians are advised to consider prescribing an alternative analgesic. Check the Pharmac website for up-to-date supply information.
Depo-Testosterone in limited supply
Stock of testosterone cipionate injections (Depo-Testosterone) is limited due to global supply issues, and is likely to run out before re-supply, which is expected in December, 2025. Testosterone esters (Sustanon) or testosterone undecanoate (Reandron 1000) may be suitable funded injectable alternatives, however, a new prescription will be required. Transdermal testosterone gel is also available (funded; new prescription required) and may be suitable for some patients. Refer to the NZF for information about dosing and administration of different testosterone formulations.
For information on prescribing testosterone in ageing males, see: https://bpac.org.nz/2024/testosterone.aspx
Monitoring Communication: Estradot oestradiol patches
Medsafe has issued a Monitoring Communication to seek more information from clinicians on potential quality and efficacy issues affecting the Estradot brand of oestradiol patches, indicated for menopausal hormone therapy. This communication comes following reports from patients about the return of menopausal symptoms and issues with patch adhesion with this brand of oestradiol patches.
An initial investigation conducted by Medsafe did not identify any issues with the product that could explain patient reports. A letter for healthcare professionals from Sandoz (sponsor of the patches) about this situation is available here. Pharmac is advising patients to talk to their pharmacist or prescriber if they experience any difficulties with patch adherence or efficacy. General advice and troubleshooting for patients if they are having difficulty with transdermal patches is available here (UK-based) and includes useful tips, such as applying a surgical adhesive tape around the edges of the patch if adherence to the skin is a concern, and avoiding application on skin recently exposed to oils, creamy soaps or moisturisers.
Be alert to any patients who are having issues with Estradot oestradiol patches and report these to Medsafe: recalls@health.govt.nz and Sandoz: mi.new_zealand@sandoz.com or 0800-SANDOZ (0800 726 369).
Decision to fund new brand of methylphenidate
Pharmac has announced that a new brand of methylphenidate tablets, Methylphenidate Sandoz XR, will be funded with Special Authority approval from 1st December, 2025. This decision was made following consultation on a proposal (as reported in Bulletin 132). Methylphenidate Sandoz XR is an extended-release formulation; other funded extended-release formulations include Concerta and Methylphenidate ER – Teva. It will have the same Special Authority criteria as Ritalin, Rubifen, Rubifen SR and Methylphenidate ER – Teva (SA2411). Concerta and Ritalin LA are on a separate Special Authority form (SA2450). Methylphenidate Sandoz XR is not replacing any of the other currently available brands; it provides another option for patients given the ongoing supply issues affecting methylphenidate.
N.B. Methylphenidate Sandoz XR is approved by Medsafe for the treatment of ADHD. It can be prescribed for narcolepsy (funded with Special Authority approval), but this is not an approved indication (prescribed off-label).
RNZCGP position statement on 12-month prescribing
The Royal New Zealand College of General Practitioners (RNZCGP) has released a position statement on Twelve-month prescribing in general practice, ahead of amendments to the Medicines Regulations 1984 that will increase the period of supply limit from three months to 12 months, from 1st February, 2026. Clinicians are expected to use clinical judgement when making prescribing decisions, and this should include a risk/benefit assessment for each patient. The College recommends that practices adopt their own in-house policy to guide their clinicians, always consider equity and access when deciding on a prescribing period and to work collaboratively with pharmacists. Read the full document here.
A poster and FAQ sheet for patients have also been produced to help explain the changes.
New opioid substitution treatment guideline available
The Ministry of Health, Manatū Hauora, has published an updated opioid substitution treatment guideline, developed by Te Pou, the national workforce centre for addiction and mental health. The guideline provides information for healthcare professionals who deliver opioid substitution treatment and covers a broad range of topics such as access, treatment stages and key components, safety, managing pain and the prescribing of controlled drugs in addiction treatment. Section 8 of the guideline focuses on opioid substitution treatment in primary care.
Key updates from the 2014 version of the guideline include:
- Emphasis on the rights of people who access opioid substitution treatment
- Legislative changes that now allow nurse practitioners, designated nurse prescribers and pharmacist prescribers to provide opioid substitution treatment, and enable signature exempt prescriptions and extended supply periods
- Revised clinical advice on:
- Buprenorphine induction
- Care during pregnancy
- Switching from methadone to buprenorphine
- The use of long-acting injectable formulations
Read the full guideline here.
Online learning modules for bowel screening
Health New Zealand, Te Whatu Ora, has announced that four new learning modules for bowel screening are now available on regional learning sites (see below). The modules are designed to give clinical staff the information needed to clearly and confidently discuss bowel screening with patients. The module content includes bowel cancer and screening, the faecal immunochemical test (FIT), culturally safe communication and advice on responding to different situations when discussing bowel screening. The four modules are titled Introduction to bowel screening, Supporting bowel screening tests, Bowel screening conversations and Keep it sharp: Bowel screening conversations in action and take between five and 30 minutes each to complete. A quiz is also available.
The learning modules are available on:
These three learning management systems have replaced LearnOnline (as reported in Bulletin 124). To access the modules, log in (or register an account if you have not already done so) and search for "bowel screening".
Upcoming Goodfellow Unit webinars
The Goodfellow Unit, University of Auckland, is hosting several free access webinars in November and December. These webinars are intended to provide topical and relevant health information for primary care clinicians. Continuing professional development (CPD) points are also available. Webinars are often recorded and available to watch at a later date. Upcoming webinars include:
- Herpes zoster and cardiovascular disease, presented by General Medicine and Infectious Diseases Physician Hasan Bhally and Consultant Ophthalmologist Rachael Niederer. This webinar will be held on Tuesday, 4th November, from 7.30 pm. Click here to register.
- Beyond borders: Challenges in bariatric surgical tourism, presented by Upper GI and Bariatric Surgeon Nick Evennett. This webinar will be held on Tuesday, 11th November, from 7.30 pm. Click here to register.
- Asthma update: latest treatments and practical tips, presented by Respiratory and General Physician Angela Moran. This webinar will be held on Tuesday, 18th November, from 7.30 pm. Click here to register.
- Updates in gout and weight management, a Te Whatu Ora; Te Tiri Whakāro: Sharing Knowledge session presented by Academic Rheumatologist Lisa Stamp, Endocrinologist Rinki Murphy. Dr Sue Tutty will also provide clinical updates at the end of the session. This webinar will be held on Tuesday, 25th November, from 7.30 pm. Click here to register.
- Post-partum hypertension; practical management, presented by Cardiologist and General Internal Medicine Consultant Jamie Kitt. This webinar will be held on Tuesday, 2nd December, from 7.30 pm. Click here to register.
Podcast of the Week: When tremor becomes a trouble
A recent podcast episode of GPnotebook, a clinical education platform in the United Kingdom for primary care clinicians, discusses the frequently encountered symptom of tremor, including pathophysiology, evaluation, investigations and treatment approaches.
Read more about this episode
Tremor is not a diagnosis in itself, but rather a symptom that can be caused by a diverse range of conditions, e.g. familial essential tremor, Parkinsonian tremor, cerebellar tremor, medicine-induced tremor. A suspected cause can often be idenitified by asking the patient when the tremor appears e.g. if the tremor occurs at rest when the affected limb is fully supported, Parkinson’s disease is likely to be the cause. Frequency and amplitude of the tremor can also help determine the type.
Review when the tremor started, the extent of progression, family history of tremor, medicines that may exacerbate tremor, in conjunction with a peripheral neurological examination, e.g. muscle tone, reflexes, and observation of the tremor at rest, in posture, e.g. holding hands outstretched, and with action, e.g. finger-to-nose test. Management depends on the type of tremor and should be individualised to the patient. For example, treatment is generally not required for patients with a mild essential tremor, but if needed, propranolol is usually first line. Referral may be required for some patients depending on the underlying cause of the tremor.
Listen to the podcast here (~ 20 minutes).
Paper of the Week: Guess what...15 minutes isn't long enough
General practice is constantly evolving. New investigations, diagnostic tools and treatments in the community can help make a difference to a patient’s life. However, this evolution also brings challenges, including funding and resource limitations and increased workload. The general practice scope is already broad, and these mounting pressures are testing the resilience of all healthcare professionals.
Some primary care clinicians may feel that offering specialised or more advanced treatments or diagnoses that are typically co-ordinated in secondary or tertiary care is beyond their scope, and adds to the time and administrative burden, as well as cognitive load. Being able to bridge these barriers by facilitating access to treatments in the community can improve patient outcomes, but this must also be balanced to ensure that it is sustainable for primary care in the long term. Just because you can do something, e.g. widened access to a medicine, doesn’t always mean that you should, if the resourcing is not adequate, e.g. training and time. General practice is complex, but what does the evidence say?
A recent study published in the Australian Journal of General Practice examined video recorded general practitioner consultations to shed light on the wide scope of general practice in Australia. The results won’t surprise many of you… The average consultation time was almost 20 minutes and the number of issues on average that were discussed or mentioned was not one, two or three… but eight per consultation! The study demonstrated the complexities of general practice, and the skill needed to navigate such a wide range of health concerns across different medical specialities in a short time. Raising awareness of the day-to-day work of a general practitioner is not only important for the general public, but also for the politicians who make the decisions about funding and governance at a health system level.
What do you think your average consultation time is? How many issues on average do you and your patients discuss during a consultation? What strategies do you use to manage the increasing patient complexity and widening scope of general practice?
Read more
- Secondary analysis was carried out on video recordings of 54 consultations, involving four experienced general practitioners (two female, two male), that took place in Melbourne, Australia, between August, 2021, and June, 2024
- Over half of patients were female (55.8%) and aged over 45 years (47.1%). Many patients had low incomes, were healthcare card holders, on a pension or unemployed.
- Health items (as defined by the International Classification of Primary Care second edition) were classified as:
- Discussed – items that were talked about in depth or treated, or if a care plan was arranged
- Mentioned – raised but not discussed in detail, often in relation to another health issue or items that are earmarked for a future consultation
- The average consultation time was 19 minutes and 19 seconds; range – 03:35 – 39:59
- On average, five items were discussed (range: 1 – 14) and three mentioned (range: 0 – 8) in each consultation
- Cardiovascular (55.6 per 100 encounters), musculoskeletal (55.6 per 100 encounters) and psychological (29.6 per 100 encounters) were the most common themes in the consultations
- The most common original reason for the patient booking the consultation was general and unspecified (46.3 per 100 encounters), followed by respiratory (20.2 per 100 encounters), musculoskeletal and skin (15.3 per 100 encounters)
- Medicines were discussed in almost every consultation (98.1 per 100 encounters). Administrative tasks associated with a consultation were high (83.3 per 100 encounters), e.g. requesting laboratory tests or imaging, medical certificates, booking follow-up appointments, assisting with insurance paperwork, calling a pharmacist. Lifestyle counselling was also frequently discussed in consultations; advice on nutrition and weight occurred in 50% of consultations.
- A strength of the study was that recall and social desirability bias were eliminated due to the study being based on video recordings
- The main limitation of the study was the small number of participants and consultations that were analysed. The practices were in an urban setting which may not fully reflect the current spectrum of general practice, including rural care, and occurred during the COVID-19 pandemic when health seeking behaviour was different, e.g. increased health anxiety.
Norman K, Gunatillaka N, West K, et al. What happens in general practitioner consultations? A study of video-recorded Australian general practitioner consultations. AJGP 2025;54:737–42. doi:10.31128/AJGP-02-25-7561.
Giveaway! We are running a competition to give away five copies of Everything But the Medicine, written by Dr Lucy O’Hagan. Tell us about a time when you made an unusual diagnosis, or used your wide range of skills and knowledge to connect the dots and come up with a long-awaited answer or simply just solved a problem for a patient that changed their life for the better. The top five answers will be sent a copy of the book. Email your story, with the subject "Book Competition", by November 21st to: editor@bpac.org.nz.
This Bulletin is supported by the South Link Education Trust
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