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Published: 27th February, 2026
Contents
In case you missed it: New ACC Medical Certification dashboard
The ACC Medical Certification dashboard is now live for providers, replacing the previous “Your ACC Dashboard” reports. The new interactive dashboard displays information on the number of medical certificates issued by a provider over the past two years, the ratio of ‘fully unfit’ and ‘fit for selected work’ certificates, average incapacity durations and return-to-work timeframes. Clinicians can review their data to identify trends and compare over time or with national and regional averages.
The ACC Medical Certification dashboard is available through BPAC CareSuite. For further information on how to use the dashboard, click here.
Looking for bpacnz Recovery at Work clinical education resources? Click here.
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
- 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; see Bulletin 137
- Consultation on the Pharmaceutical Schedule closes on 13th March; see Bulletin 141
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.
Upcoming varenicline brand change
The funded brand of varenicline is changing from Champix to Pharmacor Varenicline. Pharmacor Varenicline has been listed on the Pharmaceutical Schedule since January, however, stock will not be available until March. It will be the only funded brand of varenicline available from June.
Advise patients taking varenicline that their brand will change between March and May, and that the packaging will look different: the starter pack will have two wallet-style blister packs, and continuation tablets will now come in a bottle (rather than a blister pack). Reassure patients that there has been no change to the active ingredient.
A patient information sheet about the upcoming brand change is available here.
Chloramphenicol eye ointment: limited stock
Supply of chloramphenicol eye ointment is low due to manufacturing delays; other presentations of chloramphenicol are not affected. New shipments are expected to arrive in February and April. Other funded anti-infective eye ointments are available, but these are not usually prescribed in primary care. Chloramphenicol or fusidic acid eye drops* may be suitable alternatives; however, some patients prefer eye ointment for various reasons, e.g. difficulty administering eye drops, therefore may require additional support. A new prescription will also be required.
* There is currently a supply issue affecting fusidic acid eye drops (Fucithalmic). Alternative brands are available and must be prescribed under Section 29A of the Medicines Act 1981.
Stock of olanzapine 10 mg orodispersible tablets to run out
Stock of 10 mg olanzapine orodispersible tablets (Zypine ODT) is expected to run out by the end of February due to manufacturing and shipping delays. Re-supply is currently expected in early March. Two alternative brands of 10 mg olanzapine orodispersible tablets (Olanzapina Mylan Pharma and Olanzapina Mylan) will be listed on the Pharmaceutical Schedule from 1st March, 2026; the package labelling is not written in English and they are not approved by Medsafe, so must be prescribed for supply under Section 29A of the Medicines Act 1981. Pharmac also advises that if 10 mg tablets are out of stock, two 5 mg orodisperible tablets (Zypine ODT) may be suitable.
Sensocard blood glucose test strips discontinued
Sensocard blood glucose test strips for people with vision impairment are being discontinued by the supplier; any remaining stock expired at the beginning of February. Pharmac is advising patients affected by this discontinuation to speak to their pharmacist; a new glucose meter (CareSens N Voice) will be arranged for them at no cost. Patients will, however, require a new prescription for CareSens N blood glucose test strips. N.B. The CareSens N Voice meter is not currently funded; the free replacement glucose meter is only available to people who have been using Sensocard blood glucose test strips.
Standard post-vaccination wait time now 15 minutes for all vaccinations
A new standardised post-vaccination observation wait time has been approved by the National Immunisation Technical Advisory Group (NITAG) for publicly funded vaccines in New Zealand. This change applies to all age groups and all vaccines, whether administered alone or at the same time as other vaccines. The new wait time standard simplifies guidance for vaccinators, improves efficiency and lowers barriers to vaccination access while maintaining safety by ensuring identification and management of serious adverse events, e.g. anaphylaxis.
A shortened wait time of five minutes can also be considered in people who meet all of the following criteria:
- No known history of severe allergic reactions
- Has been assessed for immediate post-vaccination adverse reactions (after five minutes)
- Knows when and how to seek post-vaccination advice
- An adolescent or adult will be with them for the first 15 minutes post-vaccination
- Agree not to drive, skate, scoot, ride a bike or operate heavy machinery until 15 minutes post-vaccination
- Can contact emergency services if required
Vaccinators may consider advising post-vaccination observation wait times longer than 15 minutes, in some clinical situations, e.g. history of allergy, syncope.
A flow chart for vaccinators is available here.
Medical Council seeking feedback on new cultural competence, cultural safety and hauora Māori statements
The Medical Council of New Zealand is currently seeking feedback on two draft statements on cultural competence and cultural safety and hauora Māori (Māori health and wellbeing). The two statements are intended to replace the current Statement on cultural safety (2019).
The consultation closes on Tuesday, 24th March, 2026. This link contains an online survey to complete or your submission can be emailed to: strategic@mcnz.org.nz.
New Zealand-based online CBT courses for coping with stress and an introduction to mindfulness
Just a Thought is a New Zealand organisation that offers free online cognitive behavioural therapy (CBT) courses and other resources for a range of mental health conditions. Two new courses have been released: Coping with Stress and Just a Pause – An Intro to Mindfulness. Both courses involve four lessons and can either be completed by the patient in a self-guided manner or through prescription by a clinician.
The Coping with Stress course introduces patients to evidence-based strategies and techniques to manage stress and build resilience. The Intro to Mindfulness course explains mindfulness and teaches skills with the goal of helping patients to feel more grounded, present and calm. View all the courses available from Just a Thought, here.
March is Endometriosis Awareness Month
Next month (March) is Endometriosis Awareness Month. Endometriosis is estimated to affect around 120,000 people in New Zealand. It is characterised by the presence of endometrial-like tissue outside the uterine cavity, causing mainly cyclical symptoms and, often, reduced fertility.
A clinical diagnosis of endometriosis can be made based on the patient’s symptoms (e.g. pelvic pain, dysmenorrhea, dysuria, bloating, abdominal pain) and evaluation of risk factors (e.g. family history, shorter or longer than normal menstruation). The non-specific nature of endometriosis symptoms, varied clinical presentation and limited benefit of laboratory testing and imaging make recognition challenging, often leading to a delay in diagnosis. Given the high prevalence in New Zealand, clinicians should consider a potential diagnosis of endometriosis early in a patient with ongoing pelvic pain.
Hormonal treatment (e.g. a combined oral contraceptive pill or progesterone) is often first-line management for those with endometriosis who do not wish to conceive in the near future. Analgesics may also be required to manage cyclical pain. Surgical treatment may be an option if hormonal treatment is ineffective, not tolerated, contraindicated or not wanted.
For further information on the diagnosis and management of patients with endometriosis, see: https://bpac.org.nz/2021/endometriosis.aspx
The Specialist GP: New podcast series by Dr Louise Kuegler
‘The Specialist GP' is a New Zealand–based, independently funded podcast for primary care health professionals, created and hosted by Dr Louise Kuegler. Each episode centres on a real-life case submitted by a listener, which is unpacked with an expert guest to explore clinical reasoning, evidence-based management and the nuances of day-to-day general practice. The aim is to provide engaging, practical learning, with every episode ending with “clinical pearls” that listeners can immediately apply in their consulting rooms.
Listening to an episode is a CME-eligible activity. Recent topics have included perimenopause management, diving medicine, kindness in healthcare and new insights into osteopenia management.
Upcoming episodes will continue to focus on under-discussed and challenging areas in primary care, supporting clinicians to feel more confident and up to date in their practice.
Click here to listen (also available on Apple Podcasts and Spotify)
Work of general practice: Seen and unseen
Results of the RNZCGP’s Your Work Counts project have recently been published in the Journal of Primary Health Care and those who work in primary care will not be surprised by the results. The key finding was that general practitioners in New Zealand spend 56% of their time in patient-facing care (consultations) but approximately 44% in non-patient-facing work, suggesting almost half of all general practice work is unrecognised and unfunded under the current capitation model. This non-contact work is essential for the delivery of quality primary care services but is not sustainable under the current circumstances. It is hoped that the results of this study (and future work) will provide evidence to assist workforce planners and policymakers in decisions that will help support the general practitioner workforce into the future.
Read more
Information was gathered from 566 general practitioners who recorded their time spent in various activities during their working day. The main categories were patient-facing consultations, non-contact clinical work, training and education, clinical governance and practice improvement and organisational management. Table 1 provides the breakdown of time spent in the various work activities. A category (“other”) was provided for work that did not fit into one of the specified categories but accounted for < 1% and was not included in the final breakdown of the figures. Overall, the average breakdown of work was 56:31:7:3:4. In addition, over 70% of respondents reported that they worked during the weekend, with the majority of time spent in non-patient-facing work.
In contrast to the findings on work carried out in primary care, all work, whether it be patient-facing, non-patient contact or other professional work carried out by hospital-based specialists is recognised (and therefore paid).
Table 1. Average proportion of time spent in various types of general practice work (N = 566)*.
| Type of work |
Summer study (N = 417) |
Winter study (N = 303) |
Overall |
| Consultations (patient-facing) |
56.4% |
55.4% |
56% |
87% clinical work |
56% patient-facing |
| Non-contact clinical work (non-patient-facing) |
30.8% |
31% |
31% |
44% non-patient-facing |
| Training/education |
6.4% |
6.6% |
7% |
14% |
| Governance |
2.6% |
3.3% |
3% |
| Management (“running things”) |
3.3% |
3.7% |
4% |
* 154 general practitioners completed both summer and winter studies
Bradford L, Wright S, Schulde J, Murton S. The seen and unseen work of general practice: a national diary study of New Zealand General Practitioners. J Prim Health Care 2026. doi:10.1071/HC25195.
Paper of the Week: Unexplained GI upset - could an ACE inhibitor be the culprit?
Angiotensin-converting enzyme (ACE) inhibitors are regularly prescribed in primary care for cardiovascular and renal conditions. Angioedema, affecting the lips, tongue and upper airways, is an established adverse effect for this medicine class, however, angioedema can affect any mucosal surface. Towards the end of last year, the Medicines Adverse Reactions Committee (MARC) met to discuss the risk of intestinal angioedema when taking these medicines. After reviewing the evidence, it has now been listed as an adverse effect in medicine data sheets for both ACE inhibitors and angiotensin II receptor blockers (ARBs). The risk of angioedema associated with ARBs is lower than ACE inhibitors; this is acknowledged by MARC. Intestinal angioedema was discussed in the most recent edition of the Medsafe Prescriber Update; the NZF has recently updated the relevant therapeutic notes and monographs with this information as well (as reported in Bulletin 141).
There have been no cases of intestinal angioedema related to ACE inhibitors or ARBs reported in New Zealand, however, the non-specific nature of gastrointestinal symptoms means it is likely to be under reported. As a practical example, we examine a case report published in the Canadian Family Physician journal, that discusses three patients who presented with gastrointestinal symptoms that turned out to be caused by an ACE inhibitor. Despite good outcomes, two of the three patients experienced prolonged symptoms (longer than six months) and underwent unnecessary testing. Intestinal angioedema is a rare adverse effect, but these cases highlight the need for primary care clinicians to add this adverse effect to their mental list of differential diagnoses for unexplained gastrointestinal disturbance.
Were you aware that intestinal angioedema was a potential adverse effect of ACE inhibitors or ARBs? Would you ever consider this as a potential explanation for abdominal pain/diarrhoea? Do you discuss the possibility of angioedema when initiating patients on ACE inhibitors or ARBs?
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Case summary
- Three female patients (aged 43 – 76 years) presented with a history (ranging from one month to one year) of daily watery stools following initiation of ramipril for hypertension (and ischaemic heart disease)
- No other gastrointestinal symptoms, e.g. blood, mucus or abdominal pain, were noted with the diarrhoea
- One patient experienced weight loss (13.6 kg in the previous year) and another developed a chronic cough
- Two of the patients reported that their symptoms started within days of first taking the ACE inhibitor
- Common causes of changes in bowel movement, e.g. recent travel, other new medicines, changes in medicine doses or dietary changes, were absent
- Two of the patients in whom symptoms were present between seven months and one year (aged > 70 years) underwent various testing including full blood count, coeliac screening, stool culture and parasitological investigations, colonoscopy and computed tomography (CT) scans. All investigations were negative.
- In all cases, symptoms improved within days of stopping ramipril (and switching to an ARB)
Recognising and managing intestinal angioedema as an adverse effect of ACE inhibitors (and ARBs)
Intestinal angioedema is a rare adverse effect of ACE inhibitors (and ARBs); there have been no cases reported in New Zealand. In comparison, more than 300 cases of facial and upper airway angioedema involving either an ACE inhibitor (278) or ARB (26) were reported in the New Zealand Pharmacovigilance database between January, 2010, and September, 2025.
The mechanism for angioedema is believed to involve bradykinin accumulation and release of substance P—a potent vasodilator that causes fluid leakage into tissues. ACE inhibitors prevent the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) by inhibiting angiotensin-converting enzyme, resulting in a reduction in blood pressure. Angiotensin-converting enzyme is also involved in the breakdown of bradykinin. Bradykinin acts on bradykinin 2 receptors leading to increased vascular permeability and substance P release.
Symptom onset is variable and can occur within days or in some cases, years after starting treatment. Abdominal pain is typically the first symptom reported along with other non-specific symptoms including nausea, vomiting and diarrhoea. In some cases, symptoms resolve spontaneously without stopping the causative medicine.
Early recognition of this adverse effect will prevent unnecessary investigations and anxiety for patients. Diagnosis can be made clinically, however, in a hospital setting segmental thickening of the small bowel or straightening or elongation of bowel loops may be visible with a CT scan in the process of excluding more significant causes, e.g. inflammatory bowel disease, vasculitis, small bowel lymphoma, obstruction and mesenteric ischaemia.
Management involves stopping the ACE inhibitor and supportive care, e.g. hydration. Symptoms are expected to improve within 48 hours. If an antihypertensive is still indicated, consider trialling an ARB as the risk of angioedema reoccurrence is low and rechallenging with an ACE inhibitor is contraindicated. Close monitoring for adverse effects is advised.
Ekram R, Pereira M, Saif M, et al. Diarrhea induced by angiotensin-converting enzyme inhibitors. Can Fam Physician 2026;72:104–5. doi:10.46747/cfp.7202104.
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