General Practice Services QUICK GUIDE Services for patients Enrolled & Funded with WBOP PHO
“WBOP PHO Guide to Programmes & Funding for Patient Services” supports this guide with greater detail and includes CPO Mental Health and Acute Demand Services
Service/Programme
Service
Eligibility Criteria
Outreach Support Service to encourage women to be screened.
No patient co-payment unless otherwise stated Free Breast Screening for women between the ages of 45 – 69 years who are Māori or Pacific & all other women who have never been screened, or haven’t had their free mammogram for more than 5 years.
How to Refer and / or Claim
Breast Screening – GP Support & Outreach CarePlus
Aims to support and coordinate care of people with high health needs. Offers 4 x nurse or GP consults (1 Assessment & 3 reviews) at a reduced cost to the patient.
Patient to meet at least one of the following criteria: 1. 2 or more chronic health conditions or 2. 2 or more medical or mental health admissions in last 12 months (excludes surgical admissions) or 3. 6 first level service primary care visits/services in the last 6 months or 4. Has terminal illness & likely to die in 12 months or 5. Is on active review for elective services
No referral process. MedTech & My Practice - submit an Advanced Form. Profile & Houston - enter clinical details into PMS. Then generate an invoice & fax to 07 5773191 or email Annette; annettel@wboppho.org.nz
Service for priority women who are due for their cervical smear, are under screened /unscreened.
1. Māori women 2. Aged 20 to 69 years 3. Provider’s service must comply with the Guideline for Cervical Screening in NZ & National Cervical Screening Programme (NCSP) policies
No referral process. MedTech - submit an Advanced Form. Non-MedTech - complete a Manual claim form.
Cervical Screening – GP Support & Outreach
GP Outreach Support Service to encourage women to be screened.
Free Cervical Screening for women between the ages of 20 – 69 years who are Māori, Pacific or Asian & other women who have never had a Cervical Smear, or have not had a smear in more than 5 years since the last one.
Medtech - submit BPAC Midland eReferral. Non-MedTech - complete H&W referral template & fax to 5782657.
COPD Management
Funding to support GOLD standard management of COPD patients - up to 4 GP or Nurse consults.
1. Clinician has done WBOPPHO COPD training within last 12 months 2. Spirometry confirms COPD 3. Patient is high needs or is a CSC holder or newly diagnosed COPD in last 12 months or admitted to hospital in last 12 months (COPD related issue) 4. ‘Blue Card: Plan for People with Lung Conditions’ completed 5. Care Plan developed with patient
BPAC Midland eReferral. For 23PPV Sanofi vaccination administrated after eReferral submitted, send manual invoice to the WBOP PHO.
A free COPD rehabilitation programme & education provided by Asthma & Respiratory.
Patients with a diagnosis of COPD who: 1. Require close monitoring of exercise & risk reduction therapy 2. An impairment that could benefit from pulmonary rehabilitation 3. A medical clearance/GP referral
1. Written referral with relevant clinical history & diagnostic data sent via fax to Asthma & Respiratory on 07 578 5100 2. Discharge letter will be sent to practice prompting booking of Post Programme GP consultation 3. After GP consult send manual invoice & discharge summary to PHO
DAR: An annual assessment to establish health status of a diabetic patient. DCIP: Funding to support management of patients with diabetes to improve their health outcomes.
Patients diagnosed with Type 1 or 2 diabetes, excluding Impaired Glucose Tolerance (IGT) & gestational diabetes
MedTech - submit BPAC Common Form. My Practice - complete Diabetes template. Manual invoice to PHO. Profile - enter details in Encounter screen. Manual invoice to PHO. MedTech - submit BPAC Common Form. My Practice - enter clinical details in Best Practice. Manual invoice to PHO. Profile - enter clinical details in PMS. Manual invoice to PHO.
Package includes 6 patient contacts to deliver education, advice & time required to safely initiate insulin therapy.
1. Clinician had WBOP PHO approved Insulin Therapy training in last 3 years 2. Had a DAR in last 12 months 3. Diagnosed Type 2 > 6 months 4. Most recent HbA1c > 64mmol/mol 5. Patient suitable for primary care diabetes management 6. Enrolled in Care Plus or has valid HUHC
$69.91 per nurse or GP consult $279.64 p.p. per year Co-payment may be charged
Cervical Screening $27.93 per woman
$184.00 p.p. per year + $46.00 for 23PPV Sanofi vaccination
COPD Rehabilitation $109.70 p.p. per year
Diabetes Annual Review $65.58 p.p. per year
Diabetes Care Improvement Programme $238.51 p.p. per year
Diabetes Insulin Starts $190.81 p.p. Limited to once only
1. Had a DAR in last 12 months 2. HbA1c > 75mmol/mol 3. Referral to diabetes self-management group education is offered to patient
September 2018 version 1 Medtech - submit BPAC Midland eReferral Non-MedTech - complete H&W referral template & fax to 07 578 2657
MedTech - submit a form via BPAC. My Practice - enter details into patient notes & email manual invoice to PHO. Profile - complete the Diabetes Insulin Start template in the Encounter screen & email manual invoice to PHO.