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Published: 28th November, 2025
Contents
New from bpacnz: Clinical Audit - Reviewing type 2 diabetes management in patients at high risk of cardiovascular and renal complications
Some people with type 2 diabetes are at increased risk of cardiovascular or renal complications and therefore may be eligible for funded treatment with either empagliflozin or a GLP-1 receptor agonist (dulaglutide or liraglutide). The Special Authority criteria for these medicines were originally the same for patients with type 2 diabetes but now differ; empagliflozin must have been trialled first (where clinically appropriate) before treatment with a GLP-1 receptor agonist is funded.
This audit helps healthcare professionals identify patients with type 2 diabetes who are at high risk of cardiovascular or renal complications and meet the relevant Special Authority criteria to ensure that their type 2 diabetes management regimen is optimised to include one of these medicines.
A “working audit” option is also provided, where data are collected opportunistically over time when you have a consultation for any reason with an eligible patient. This format may be better suited to locums or urgent care clinicians, or other healthcare professionals who prefer a different approach to identifying eligible patients.
Read the audit here.
For further information on prescribing empagliflozin and GLP-1 receptor agonists (dulaglutide and liraglutide) for patients with type 2 diabetes, see: https://bpac.org.nz/2021/diabetes.aspx
In case you missed it - Upfront: The medicinal use of cannabis, today
Earlier this year the Medical Council of New Zealand convened an interagency hui to assess the regulatory, safety and educational needs for the medicinal use of cannabis in New Zealand. The discussions exposed critical challenges to the legitimate, safe and effective use of this new class of medicines. Martin Woodbridge, pharmacologist and regulatory policy analyst, provides an update to our audience, alongside pragmatic solutions to current challenges.
Read the full article here.
N.B. This article was contributed by an external author. The views expressed are those of the author and not necessarily those of bpacnz.
Rewind: Wrap-up of recent key messages
Key dates and news items from recent editions of Best Practice Bulletin:
- The number of measles cases in New Zealand has risen to 21, with an additional three cases in Nelson since last reported in Bulletin 136. View the update from Health NZ here.
- Stock of oxycodone immediate-release tablets, codeine and podophyllotoxin has now arrived. These medicines were previously affected by supply issues, as reported in Bulletins 135 and 136.
- From 1st December, 2025, Special Authority renewal requirements will be removed from specific medicines and medical devices to align with upcoming changes to the Pharmaceutical Schedule from February to support extended prescription lengths (as reported in Bulletin 134). These include:
- Insulin pumps and continuous glucose monitors (interoperable and standalone) for type 1 diabetes
- Long-acting muscarinic antagonists with long-acting beta2-agonists (LAMA/LABA inhalers) for respiratory conditions
- Febuxostat for gout
- Budesonide capsules for Crohn’s disease and microscopic colitis
- Methylphenidate Sandoz XR will be funded with Special Authority approval from 1st December, 2025, providing another option for patients given the ongoing supply issues affecting methylphenidate. Read more here.
- Pharmac has advised, however, that the arrival of stock of this brand has been delayed and supply may not be available until mid-December
Book competition winners announced!
Congratulations to the winners of our book competition: Greg Judkins, Mel Sutton, John Guthrie, John Dumsday and Christina Beckmann. Thank you to all those who entered and shared their stories with us.
Read more about the winning entries
It was a joy to read all the submissions, and our winners certainly impressed us with their ace medical detective work, hilarious tales and heartwarming accounts of what it is like to be in general practice in New Zealand. We learnt about rare diagnoses (Wegener’s granulomatosis), serendipitous recollection of a key piece of information delivered by an influential senior consultant over 40 years prior, and the power of the “pause” where patients can reveal information that has not yet been asked: “I share the good news that all her tests have come back normal. She shares the bad news that her loose motions are no better. I advise that she needs a colonoscopy…She seems dubious…Can Crampeze cause diarrhoea? she asks. I quickly check and confirm my suspicions. Crampeze contains magnesium. Magnesium sulphate was an old treatment for constipation. The box said to take two at night to prevent cramp, she explains, but two didn't do anything so I had to increase the dose. Now I take six each night and the cramp isn't as bad, but...”
We were reminded to never underestimate the value in observing a patient as soon as they present: “The 20 metre walk from the waiting chairs to the consult room is a time where you take a breath between the stories of the last patient and enter the world of the next. A time where you say no more than pleasantries so as not share their private information to the listening corridors. A time, where the examination begins.” And to always read the label: “…This was enough of an exam to suggest we give her more salbutamol. Out came boxes. Green inhaler. Spacer in packing. White inhaler...It looked like a reliever. It quacked its contents into aerosol. But this inhaler was one I'd never seen. I pulled out the canister and read ‘Placebo’.”
Working in smaller, rural communities brings about a different style of medicine, where patients are not just familiar names on the list, but people who serve you your coffee and pack your groceries, fix your car, cut your hair and teach your children or grandkids. Often what hits hardest is when patients get sick – really sick: I live in a rural community, I know most people… I was so devasted when she died... it rocked me to the core, and I wonder what I could have done to save her…I still blamed myself to not have picked it up earlier. When someone dies from cancer or has symptoms of cancer it creates a ripple effect in the community, and it becomes hard to decide who could be genuinely sick or if they are just really worried.”
We will leave the last word with one of our entrants who ruled themselves out as a winner, but we thought what they said was perhaps the most important point of all: “At the age of 80, I do not really need another book. I need to tell stories about how GPs make so many differences in people’s lives. Sadly, we usually only hear about things that go wrong. Hopefully 90% of the time things go right and we never get feedback from that”.
Please continue to share your stories with us, the good times and the bad, and we will make sure your words are read.
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.
Supply issue affecting oxycodone oral liquid
Due to supply issues affecting oxycodone immediate-release tablets (as last reported in Bulletin 135), supply of the oxycodone 1 mg/mL oral liquid (Lucis) is now constrained. An alternative brand of oxycodone oral liquid (Rosemont) will be listed on the Pharmaceutical Schedule from 1st December, but stock will only be released once supply of the original brand (Lucis) is exhausted. Re-supply of oxycodone oral liquid (Lucis) is currently expected in early December.
Supply issue affecting Norimin 28 Day
Supply of Norimin 28 Day (ethinyloestradiol 35 microgram with norethisterone 500 microgram and seven inert tablets) is likely to be limited until late January, 2026, due to shipment delays. An alternative product is being listed on the Pharmaceutical Schedule from 1st December, 2025. It is the Australian version of the same product and will come in a four-month pack (112 tablets), rather than the standard three-month pack (84 tablets). The PSO has been adjusted to 112 so the Australian product can be given. The boxes for both the 84- and 112-pack products are the same size; pharmacies could consider keeping the stock separated to minimise potential for mix up.
Upcoming enalapril brand change
The funded brand of enalapril 5 mg, 10 mg and 20 mg tablets is changing from Acetec to Ipca-Enalapril. Ipca-Enalapril will be listed on the Pharmaceutical Scheule from 1st February, 2026, and will be the only funded brand available from 1st July, 2026.
Advise patients taking enalapril that their brand will change between February and July next year, and that the packaging will look different and the tablet shape will be round (rather than triangular). Reassure patients that there has been no change to the active ingredient. However, there are changes in the excipients; prescribers and pharmacists are advised to document any adverse effects associated with the brand change, and report these to CARM.
A patient information sheet about the upcoming brand change is available here.
In brief: Updated COVID-19 vaccine to be listed on Pharmaceutical Schedule
Medsafe has approved an updated COVID-19 vaccine by Pfizer, that targets the LP.8.1 strain. It has not yet been announced when the vaccines will be available for use. LP.8.1 was identified as suitable target for the 2025/2026 vaccination season by overseas medicines regulatory agencies, e.g. European Medicines Agency. It is part of the Omicron lineage and is in circulation in New Zealand at low levels; it is not currently a predominant circulating variant.
The following vaccines will be listed on the Pharmaceutical Schedule from 1st December, 2025 (Xpharm and access criteria apply):
- 3 microgram SARS-CoV-2 spike protein (mRNA) LP.8.1 per 0.3 ml, 0.48 ml multi-dose vial (yellow cap), for eligible infants aged six months to four years
- 10 microgram SARS-CoV-2 spike protein (mRNA) LP.8.1 per 0.3 ml, 0.48 ml single-dose vial (light blue cap), for eligible children aged 5 – 11 years
- 30 microgram SARS-CoV-2 spike protein (mRNA) LP.8.1 per 0.3 ml, pre-filled syringe for people aged 12 years and over
The Comirnaty Omicron JN.1 vaccines will be delisted from the Pharmaceutical Schedule on 1st June, 2026.
Eligibility criteria for funded COVID-19 vaccination are available here.
Proposal to fund another new brand of methylphenidate
Pharmac has released a proposal to fund another new brand of modified-release methylphenidate, Rubifen LA, supplied by AFT Pharmaceuticals. It is a generic version of the Ritalin LA brand of modified-release methylphenidate capsules and would be available in 10 mg, 20 mg, 30 mg, 40 mg and 60 mg* strengths. This would provide another option for people with ADHD and narcolepsy (unapproved indication), given the ongoing supply issues affecting methylphenidate (last reported in Bulletin 118). It is also intended to support the anticipated increase in use when prescriber restrictions for stimulant medicines change to allow initiation for patients aged 18 years and over in primary care from February, 2026.
* Ritalin LA is also available in a 60 mg capsule, but this strength is not funded
If the proposal is accepted, Rubifen LA would be listed on the Pharmaceutical Schedule and funded with Special Authority approval from 1st July, 2026. It would have the same Special Authority criteria as Ritalin, Rubifen, Rubifen SR and Methylphenidate ER – Teva and Sandoz XR (listed from 1st December, as reported in Bulletin 135).
Consultation closes Thursday, 4th December. This link contains an online form to complete, or feedback can be emailed directly to: consult@pharmac.govt.nz.
N.B. bpacnz will be publishing an article early next year, outlining the different pharmaceutical profiles of the funded psychostimulant medicines for ADHD and how to prescribe them.
HIV medicines to be dispensed three-monthly
Pharmac has announced that from 1st March, 2026, patients will be able to collect up to three-months supply of all antiretroviral medicines used for the prophylaxis and treatment of HIV at one time (i.e. stat dispensing will be permitted). This decision was made following consultation on a proposal (as reported in Bulletin 133). Note that the start date has been delayed from what was originally intended (1st December, 2025).
Also included as part of the consultation were proposals to remove Special Authority funding restrictions and to enable access on PSO for these medicines. Following significant feedback received, Pharmac will be reassessing these proposed changes; a new consultation around funding restrictions is expected to be issued in 2026.
Upcoming webinar on 12-month prescribing
Health New Zealand, Te Whatu Ora, is hosting an upcoming webinar on the changes that are being made to support 12-month prescribing which is being implemented from 1st February, 2026. The webinar is expected to cover upcoming changes to regulations and the Pharmaceutical Schedule, what extending the maximum prescription length means for patients, prescribers and pharmacists and how this process will work.
The webinar is being held via Microsoft Teams on Monday, 8th December, from 5:30 pm. A direct link to the webinar is available here; registration is not required.
Puberty blockers: Guidance from RNZCGP
The Government has announced that new regulations will be introduced to restrict the prescribing of gonadotropin-releasing hormone analogues (puberty blockers) for young people with gender dysphoria or incongruence, pending the results from a trial in the UK about using these medicines for this purpose. The changes are reportedly being implemented from 19th December, 2025, but they will not affect patients already prescribed these medicines for gender dysphoria or incongruence.
The Royal New Zealand College of General Practitioners (RNZCGP) has released guidance advising general practitioners to continue prescribing puberty blockers to patients who are already taking them, and to continue to refer patients who present with gender dysphoria to the appropriate services. The changes will not affect patients who are prescribed these medicines for other conditions such as precocious puberty.
IMAC news: Upcoming webinar + MMR screening tool
The Immunisation Advisory Centre (IMAC) is hosting an upcoming webinar on immunisation catch-ups. This free webinar will cover the principles of catch-up vaccinations, the changes to catch-up recommendations in the past year (e.g. COVID-19, Varilrix, Shingrix, hepatitis B, polio), eligibility criteria and resources to support decision-making. The webinar will be held on Monday, 1st December, from 12:30 pm. Click here to register.
A new MMR screening tool has also been developed by IMAC to support vaccinators during the screening and consent process. The tool is only suitable for use when delivering the MMR vaccine (Priorix) as a single vaccine for people aged three years and over.
Results from the 2024/2025 Health Survey: Chronic pain affects one-third of adults
The results from the latest New Zealand Health Survey show that almost one in three adults have chronic pain, and that this was most common among people of European/Other and Māori ethnicity. Also included in the survey for the first time were data on COPD diagnoses; 5% of people in New Zealand have COPD and it is more common among Māori and people living in low sociodemographic areas. The number of daily smokers and vapers were similar to last year, and the time taken to get an appointment continues to be the most common reason for not seeing a general practitioner.
Key findings
From July, 2024, to July, 2025, over 9,200 adults and 2,800 children (aged 0 – 14 years) participated in the survey. The results showed:
- The numbers of daily smokers or vapers were similar compared to the last reporting period (6.8% versus 6.9% for daily smokers; 11.7% versus 11.1% for daily vapers). Daily vaping was particularly prevalent among people aged 18 – 24 years (23.0%) and Māori (27.5%) and Pacific (20.0%) adults. Overall, smoking rates have declined over time, while daily vaping rates have increased.
- One in seven (14.3%) adults experienced high or very high levels of psychological distress in the four weeks prior to the survey, up slightly from 13.1% in the previous year. This rate was highest among young adults; approximately one in five (22.9%) people aged 15 to 24 years had high or very high levels of distress. Young adults also reported the highest level of unmet need for mental health support. More adults with a disability reported high to very high levels of psychological distress (35.5%), compared to adults without a disability (12.2%).
- One in five (21.4%) children lived in households where food ran out sometimes or often, and this was more common in children of Māori (32.3%) and Pacific (44.3%) ethnicity. N.B. Interpreting trends for this indicator is difficult as rates have fluctuated over time.
- Fewer than half of adults (46.2%) met weekly physical activity guidelines. One in three adults were classified as obese (similar to the previous year).
- Approximately one-third of adults and children did not brush their teeth with fluoride toothpaste at least twice per day. 43% of adults had unmet need for dental care due to cost (down slightly from the previous year; 44.9%).
- Almost 5% of adults aged 45 years and over had been diagnosed with COPD. COPD was more prevalent in Māori (6.9%), and those living in areas of highest socioeconomic deprivation (6.6%).
- Almost one in three adults (27.5%) reported chronic pain, and this was highest in European/Other (30.4%) and Māori (30.2%)
- Time taken to get an appointment continued to be the most common reason for not seeing a general practitioner, with one in four adults (25.5%) citing this as a barrier, similar to the previous year
An interactive web tool is available here. There is also an associated news release detailing some of the key findings.
Latest Notifiable Diseases report published: Pertussis cases up significantly last year
PHF Science (formerly ESR) has published the latest Notifiable Diseases in New Zealand: Annual Report 2024. The report summarises key trends in Notifiable Diseases throughout 2024. There was a significant increase in notifications for pertussis, cryptosporidiosis, hepatitis A, dengue fever, mpox and tuberculosis, while significantly fewer notifications were received for campylobacteriosis, COVID-19, legionellosis, leptospirosis, malaria, measles, paratyphoid fever and yersiniosis compared to 2023. A news release detailing some of the key findings from 2024 is available here. Note that this data covers 2024; the spectrum of Notifiable Diseases reported in New Zealand has changed again in 2025, e.g. with the latest measles outbreak.
Take a closer look at the numbers of Notifiable Diseases of interest
- Pertussis - 1,748 cases (32.7 per 100,000) were notified in 2024, up from 141 (2.7 per 100,000) in 2023. This coincided with a pertussis epidemic being declared in November, 2024 (as reported in Bulletin 113); the epidemic has not yet ended, but cases have been decreasing in 2025. The highest numbers were notified in infants aged under one year, and in the Wairarapa District.
- Cryptosporidiosis - 1,234 (23.1 per 100,000) cases were notified in 2024, up from 831 (15.8 per 100,000) in 2023. Most cases were notified in Autumn and Spring, and were highest in children aged 1 – 4 years. The majority of notifications were received from the South Canterbury District.
- Hepatitis A - 68 (1.3 per 100,000) cases were notified in 2024, up from 34 (0.6 per 100,000) in 2023. People aged 20 – 29 and 1 – 4 years were most commonly affected. Most notifications were received from Bay of Plenty, Capital and Coast and Canterbury Districts.
- Dengue fever - 124 (2.3 per 100,000) cases were notified in 2024, up from 55 (1.0 per 100,000) in 2023. People aged 30 – 39 years had the highest notification rate, and all had travelled overseas during the incubation period (Indonesia was the most common country visited).
- Mpox - 23 (0.4 per 100,000) cases were notified in 2024, up from eight (0.2 per 100,000) in 2023. Most notifications were received from the Canterbury District and in those aged 30 – 39 years. All of the cases were male.
- Tuberculosis - 365 (6.8 per 100,000) cases were notified in 2024, up from 305 (5.8 per 100,000) in 2023. Most were new cases but just under 5% were reactivations. People aged 30 – 39 years had the highest notification rate, and most cases were born overseas.
- Campylobacteriosis - 5,801 (109 per 100,000) cases were notified in 2024, down from 6,092 (116 per 100,000) in 2023. Most notifications were received from South Canterbury, Taranaki, Southern and Wairarapa Districts. The highest notification rates were reported in children and people aged 70 years and over.
- COVID-19 - 163,718 (3,067 per 100,000) cases were notified in 2024, down from 418,761 (7,984 per 100,000) in 2023. Most notifications were received from Hutt Valley, Auckland, Capital and Coast and Canterbury Districts. The highest notification rate was in people aged 70 years and over. COVID-19 wastewater detections are higher than reported case numbers but have been declining over time, with the occasional peak.
- Legionellosis - 183 (3.4 per 100,000) cases were notified in 2024, down from 238 (4.5 per 100,000) in 2023. Bay of Plenty, Canterbury and Counties Manukau Districts had the most notifications, and people aged 70 years and over. The most common Legionella species identified was consistent with previous years: L. longbeachae and L. pneumophila.
- Measles - one (0.02 per 100,000) case was notified in 2024, down from 14 (0.3 per 100,000) in 2023. New Zealand is currently experiencing a measles outbreak: the number of known measles cases nationally is 21.
Paper of the Week: Faecal calprotectin – where does it fit for older patients?
Faecal calprotectin is a marker of mucosal intestinal inflammation. It is most often requested in primary care to exclude inflammatory bowel disease (IBD) after investigating other possible causes, as well as for monitoring symptom relapse in people with IBD. As faecal calprotectin is a non-specific inflammatory marker, levels may also be elevated in people with other inflammatory gastrointestinal pathologies, e.g. colorectal cancer. However, faecal calprotectin has previously been reported to have a low sensitivity for the detection of colorectal cancer and therefore testing is generally not recommended if colorectal cancer is suspected, e.g. in older patients presenting with gastrointestinal symptoms.
A study published in the British Journal of General Practice aimed to evaluate the performance of faecal calprotectin testing in detecting IBD and other significant gastrointestinal pathologies in older adults (i.e. aged ≥ 50 years) compared to younger adults. Faecal calprotectin was confirmed to be highly sensitive for detecting IBD and other organic pathologies versus non-organic pathologies (e.g. irritable bowel syndrome [IBS], other functional gastrointestinal disorders). The sensitivity of faecal calprotectin testing was comparable in older and younger patients. However, the low specificity and positive predictive value of faecal calprotectin testing for IBD in both groups confirms that it is most useful for ruling out an IBD diagnosis rather than making a definitive diagnosis. This was especially the case for older adults where there is an increased likelihood of pathology in addition to IBD that can cause a raised faecal calprotectin level, such as colonic polyps and diverticular disease. Faecal calprotectin testing could not reliably detect colorectal cancer and did not outperform faecal immunochemical testing (FIT) in older people.
Faecal calprotectin testing may therefore have a role in older patients with lower gastrointestinal symptoms for excluding IBD. However, if colorectal cancer is suspected, referral for gastroenterology assessment or colonoscopy (if they meet criteria) is the appropriate action. The findings of this study do not suggest that faecal calprotectin testing will assist in the detection of colorectal cancer.
When do you request faecal calprotectin as part of investigations for patients presenting with gastrointestinal symptoms? Does age influence your decision? When you do request faecal calprotectin in older adults, what is your clinical justification for these requests? Are there any other investigations you might consider while a patient with ongoing gastrointestinal symptoms is waiting for a gastroenterology assessment or colonoscopy?
Read more
- This UK-based retrospective observational study reviewed electronic health records of patients who had undergone faecal calprotectin testing (of which 80% occurred in primary care) prior to a colonoscopy
- Of the 669 patients included in the study (58% female), 423 were aged 18 – 49 years (younger cohort) and 246 were aged 50 years or over (older cohort). Patients previously diagnosed with IBD were excluded.
- Diarrhoea was the most common indication for faecal calprotectin testing in both age groups (30%). Other reasons included a change in bowel habit, rectal bleeding and abdominal pain.
- More patients in the younger cohort were diagnosed with IBD (12.1% vs. 6.5%, P = 0.02); patients in the older cohort were approximately twice as likely to be diagnosed with other significant gastrointestinal pathologies. More patients in the older cohort were diagnosed with colorectal cancer, although the difference between groups was not statistically significant (2.0% vs. 0.5%, P = 0.11).
- Faecal calprotectin testing had a high sensitivity for detecting IBD versus non-organic gastrointestinal pathologies, e.g. IBS, other functional or non-significant gastrointestinal disorders; a threshold of 50 micrograms/gram had a negative predictive value for IBD of > 98% in both cohorts
- A faecal calprotectin result of < 50 micrograms/gram makes a diagnosis of IBD highly unlikely, independent of age
- The specificity of faecal calprotectin testing for detecting IBD was low in both cohorts; the positive predictive value of a threshold of 50 micrograms/gram was lower in older patients (~13% vs. ~21%), likely reflecting the increasing frequency of non-IBD diagnoses in this group. All patients diagnosed with colorectal cancer in both cohorts (two in the younger group, five in the older group) had a faecal calprotectin result > 50 micrograms/gram.
- A faecal calprotectin threshold of 50 micrograms/gram is not useful for distinguishing IBD from other organic gastrointestinal pathologies, including colorectal cancer
- Increasing the faecal calprotectin threshold from 50 micrograms/gram to 150 micrograms/g did increase specificity for IBD, but the positive predictive value remained low for both cohorts (~35% and ~19%) and test sensitivity decreased
- Applying a threshold of 150 micrograms/gram means that more people with this result will have IBD, but it provides little benefit as it increases the risk of not detecting IBD and other organic gastrointestinal pathologies
- Faecal calprotectin testing was found to have higher sensitivity for IBD compared to faecal immunochemical testing (FIT) with a threshold of 10 micrograms/gram but with lower specificity. N.B. In New Zealand, FIT testing is only used in the National Bowel Screening Programme; 40 micrograms/gram is used as a rule in threshold to identify potential colorectal cancer in asymptomatic people.
- Study limitations:
- The single centre design may limit the generalisability of the results
- There is potential for selection bias among the study population as faecal calprotectin testing results may have influenced the decision to perform a colonoscopy for some patients
Perry RW, Foulser PF, Zhang D, et al. Evaluating the role of faecal calprotectin in older adults: a retrospective observational study. Br J Gen Pract 2025; BJGP.2025.0169. doi:10.3399/BJGP.2025.0169
For further information on the use of faecal calprotectin in primary care, see: https://bpac.org.nz/2021/ibd.aspx
This Bulletin is supported by the South Link Education Trust
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