September 2021 Nick Letter re updated Assessment Framework Letter FINAL

All District Health Boards 3 September 2021 Dear PHO Chief Executive Officers COVID-19 Assessment Framework in General Practice On 1 July 2020 I advised all PHO CEOs of the amendments of funded COVID-19 assessment consultations.

This included incorporating the Ministry of Health’s Higher Index of Suspicion (HIS) criteria. The Ministry of Health has recently included the following criterion into the HIS criteria: “People who meet the HIS criteria are those who have, in the 14 days prior to symptom onset: •

Travelled from an area with an evolving COVID-19 community outbreak (including in New Zealand and in any country/area with which New Zealand has quarantine free travel)”.

This has been added to the Level 3 criteria of the COVID-19 Assessment Framework (see Appendix 1).

The Ministry of Health has clarified an “emerging outbreak” includes any area that has locations of interest within it. As at the date of this letter, this includes Auckland, Coromandel and Wellington for the current outbreak. The Ministry of Health has advised all symptomatic people within Auckland, Coromandel and Wellington are to be regarded as HIS. The $250 fee is higher to support a full patient assessment, including a history, consideration of preexisting medical conditions, clinically appropriate examination and a management plan, undertaken in a practice clinic room setting. It also covers practice decontamination after the patient has left.

Anyone who does not receive a full assessment, is tested in a car and who meets the HIS criteria, or where practice decontamination is not required will continue to be funded at $120.

Large-scale drive through CBAC models are excluded from the scope of this Framework. The DHB will commission these separately.

DHBs will work with the sector to review this Framework at a more suitable Alert Level.

If you have any questions, please contact your local DHB portfolio manager.

Yours sincerely

Dr Nick Chamberlain Chief Executive, Northland District Health Board Lead District Health Board Chief Executive for Primary Care and Public Health cc:

Liz Stockley, CEO, GPNZ GMs Planning and Funding, All DHBs

Al l Di st ri ct He a lt h Bo ar ds PO Box 23075 Wellington 6140

04 801 2430

Appendix:

General Practice-Based COVID-19 Assessments: Three Tier Framework

COVID-19 Assessments Tier

1 COVID-19 Triage or Telehealth Assessment of patient with symptoms of COVID-19 in community

Setting

Telephone or video

Risk Level Examination

Assessment by Nurse, NP or GP including risk assessment, and detailed consultation

Follow up care Infection control

2

3

COVID-19 symptoms

COVID-19 symptoms plus Higher Index of Suspicion (HIS) criteria

Must be seen in-person by clinician in appropriate setting (e.g. clinic, car*)

Low (symptoms without epidemiological criteria) Visual +/- basic examination and obs. with swab, according to clinical discretion**

Car* Seen by a clinician in a car*

Visual +/- basic examination and obs. with swab, according to clinical discretion**

Advise Test results included in fee

-

Full PPE to take swab.

Cleaning as appropriate.

Self-isolation requirements in line with Ministry of Health guidance.

$60 no swab $120 with swab

$60

Condition of claiming fee

No fee to patient (including no charge for prescription).

No claim for Clawback.

Limited to one claim per day per person, per practice.

No simultaneous claiming against any other funding stream.

Patient must consent to a swab being taken.

Seen by a general practitioner in a clinic room (red stream)

Must meet the Ministry’s HIS criteria, as amended from time-to-time.

-

Fee Claim

Clinic Room

Visual + full assessment including respiratory assessment and obs. with swab**

Full PPE to take swab.

Cleaning as appropriate.

Self-isolation requirements in line with Ministry of Health guidance.

Full PPE to take swab.

Practice decontamination as required.

Medical Officer of Health Notification.

Self isolation while test result is pending - refer to Ministry of Health advice for specific detail.

$120

$250

* Large-scale drive through CBAC models are excluded from the scope of this Framework. The DHB will commission these separately. ** If the patient is sent to hospital, then they should not be swabbed in the general practice/testing centre.