WBOP PHO Quick Guide - General Practice Services - November 2021

General Practice Services - QUICK GUIDE Services for patients Enrolled & Funded with WBOP PHO Service/ Programme GST incl.

After Hours for High need and CSC $50.00 per visit

After hours for Under 14s $11.50 per visit

Breast Screening – GP Support & Outreach

Service Supports access to primary care afterhours services for High Needs and Community Service card holders.

$74.79 per consultation, per year (1 x registration + up to 7 reviews)

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Aged 14 years and over Enrolled in a WBOP PHO practice and casual patients Meeting the High Needs definition (Maori, Pacific or living in Quintile 5) or Community Service Card holders

How to Refer and / or Claim

Invoices are sent to PHO monthly.

Electronic or Excel spreadsheet.

General practice can claim a subsidy for enrolled and casual children seen after hours at their premises.

Invoices are sent to PHO monthly. Electronic or Excel spreadsheet.

Outreach Support Service to encourage women to be screened.

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.

Submit a BPAC Midland eReferral

Aims to support and co-ordinate care of people with high health needs. Offers up to 8 consults (1 assessment and up to 7 reviews) at a reduced cost to the patient.

Patient to meet at least one of the following criteria: • 2 or more chronic health conditions or • 2 or more medical or mental health admissions in last 12 months • (excludes surgical admissions) or • 6 first level service primary care visits/services in the last 6 months or • Has terminal illness & likely to die in 12 months or • Is on active review for elective services

Claim using the Halcyon form.

Medtech, MyPractice and Profile practices An invoice will automatically be created in your PMS and a claim will be electronically sent to the PHO on completion of the Halcyon form.

Houston practices An invoice will need to be manually created in your PMS for internal reconciliation purposes. A claim will be electronically sent to the PHO on completion of the Halcyon form

Priority Women for Cervical Screening (as defined by the Ministry of Health) are between the ages of 25 – 69 years who are: • Māori, Pacific or Asian • All other women (30 – 69 years) who have never had a Cervical Smear, or it has been more than 5 years since the last one.

Claim using the Halcyon form.

Medtech, MyPractice and Profile practices An invoice will automatically be created in your PMS and a claim will be electronically sent to the PHO on completion of the Halcyon form.

Houston practices An invoice will need to be manually created in your PMS for internal reconciliation purposes. A claim will be electronically sent to the PHO on completion of the Halcyon form

Co-payment may be charged

Cervical Screening for High Priority Women

Eligibility Criteria No patient co-payment unless otherwise stated

Provides free access to after-hours First Level and Urgent Care services for enrolled and casual children < 14years.

CarePlus

for up to 8 consultations

“WBOP PHO Guide to Programmes & Funding for Patient Services” supports this Quick Guide with greater detail and includes CPO Mental Health & Acute Demand Services.

Service for priority women who are due for their cervical smear, are under screened /unscreened.

$28.77 per woman

Updated November 2021

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Service/ Programme GST incl.

Cervical Screening – GP Support & Outreach

COPD Management $189.12 p.p. per year + $73.60 for 23PPV Sanofi vaccination

Service GP Outreach Support Service to encourage priority women to be screened.

Funding to support GOLD standard management of COPD patients - up to 4 GP or Nurse consults.

$262.88 for combined COPD & Pneumovax claim

Diabetes Annual Review $70.69 p.p. per year

Diabetes Care Improvement Programme $257.12 p.p./p.a

Diabetes Insulin Starts $205.69 p.p.

Limited to once only

Discretionary Funds Co-payment may be charged

Green Prescription & Active Families Sport BOP

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.

Package includes 6 patient contacts to deliver education, advice & time required to safely initiate insulin therapy.

High Needs and Minor Surgery Funds available for patients in need.

To increase patient physical activity & help manage chronic conditions.

Updated November 2021

Eligibility Criteria No patient co-payment unless otherwise stated

How to Refer and / or Claim

Free Cervical Screening for women between the ages of 25 – 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.

• Clinician has done WBOPPHO COPD training within last 12 months • Spirometry confirms COPD • 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 for a COPD related issue • ‘Blue Card: Plan for People with Lung Conditions’ completed • Care Plan developed with patient

Submit a BPAC Midland eReferral.

Patients diagnosed with Type 1 or 2 diabetes, excluding Impaired Glucose Tolerance (IGT) & gestational diabetes

All 3 Diabetes programmes: Re-enrolment can occur 11 months from the last claim.

• • •

Had a DAR in last 12 months HbA1c >75mmol/mol Referral to diabetes self-management education is offered to Patient

•

Clinician had WBOP PHO approved Insulin Therapy training in last 3 years Had a DAR in last 12 months Diagnosed Type 2 > 6 months Most recent HbA1c > 64mmol/mol Patient suitable for primary care diabetes management

• • • •

group

For more information on discretionary funds please see the High Needs Discretionary Fund and Minor Surgery Fund sections in the “WBOP PHO Guide to Programmes & Funding for Patient Services”.

• Green Prescription: Patient aged ≥ 18 years • Active Families: Patient aged 4 to 17 years & is whānau based • Must be medically stable & able to undertake physical activity

BPAC Midland eReferral NOTE: Claim sends to PHO, but invoice is not generated in the PMS. PMS invoice needs to be created manually.

For 23PPV Sanofi vaccination administrated after eReferral submitted, sends invoice by email to: GPSadmin@wboppho.org.nz

Claim using the Halcyon form.

Medtech, MyPractice and Profile practices An invoice will automatically be created in your PMS and a claim will be electronically sent to the PHO on completion of the Halcyon form.

Houston practices An invoice will need to be manually created in your PMS for internal reconciliation purposes. A claim will be electronically sent to the PHO on completion of the Halcyon form Claim & refer using the Halcyon form.

No referral process.

Practice may have an internal approval process.

Record of utilisation to be maintained for six monthly reporting to PHO. BPAC Midland eReferral to Sport Bay of Plenty.

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Service/ Programme GST incl.

Health & Wellness

Service

WBOP PHO Nursing services.

Impaired Glucose Tolerance (IGT)

Eligibility Criteria No patient co-payment unless otherwise stated Services include General Practice Outreach support, Outreach Support Whānau Nursing, Dietician, Whānau Cancer Nurses, Diabetes Nurse Educator and Diabetes Self- Management Groups.  

1st appt: $60 2nd appt: $40 3rd appt: $40 4th appt: $60

Aims to reduce or normalize the HbA1c of patients with IGT.

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Long Acting Reversible Contraception (LARC) LARC Consult - $45 IUCD Removal - $60 Jadelle Insert - $120 Jadelle Removal - $150 IUCD Insert - $150 IUCD removal and Jadelle insert $180 IUCD Replacement - $210.00 Jadelle Replacement - $270.00 Jadelle removal and IUCD insert - $300

Outreach Immunisation Service

To deliver wāhine-centred contraception services in settings accessible and convenient to the target population.

Mobile immunisation service to assist general practices in the delivery of timely immunisations to their enrolled children.

Updated November 2021

Patient is enrolled and funded with the WBOP PHO; and HbA1c 45-49mmol/mol (within previous 12 months); and Aged between 15 and 76 years; and Either a CSC holder, Māori, Pacific, or Asian ethnicity.

Not classified as having type 1 or type 2 diabetes and/or taking short term steroids

How to Refer and / or Claim

BPAC Midland eReferral under WBOP PHO Nursing Service.

Claim using the Halcyon form.

Medtech, MyPractice and Profile practices An invoice will automatically be created in your PMS and a claim will be electronically sent to the PHO on completion of the Halcyon form.

Houston practices An invoice will need to be manually created in your PMS for internal reconciliation purposes. A claim will be electronically sent to the PHO on completion of the Halcyon form

Target Population is women who are:    

• • • • •

under 26 years of age; or live in quintile 5 areas; or hold a community services card (CSC); or are at high risk of unplanned pregnancy and poor health and social outcomes. (Including; young women, Māori, Pacific, wāhine with substance abuse issues, and wāhine in receipt of a statefunded benefit.)

Children <6 years old & Children who are behind in their immunisation schedule or Children of anxious or needle phobic parents or Children who are anxious or needle phobic or Children who cannot be contacted or DNA appointments

Complete LARC Fillable PDF Form & Submit electronically. No copies of invoices needed. alongside invoice to GPS Team.

Email: GPSAdmin@wboppho.org.nz Fixed prices came in as of 1st July 2021.

BPAC Midland eReferal.

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Service/ Programme GST incl.

Service

Eligibility Criteria No patient co-payment unless otherwise stated •

Opioid Substitution Treatment G.P. Shared Care (GPSC) Package of Care $121.90 Discretionary Funding Up to $230.00 Pneumococcal Vaccine PCV13 $260.00

Palliative Care Co-payment may be charged.

Palliative & End-of-Life Care Just in Case Action Plans $160.00 Parenting Support Triple P programme Pharmacy Community Medicines Medwise

Podiatry Services for At-Risk & High-Risk Foot Retinal Screening for Diabetics

• Aims to achieve improvement in the physical and psychological health and wellbeing of people who use opioids.

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Supporting general practice continuity of care for terminally ill patients & their whānau.

• • •

Eligible patients are referred from an OST Specialist Service.

Patients need to be enrolled with the WBOP PHO and live within the BOP DHB. The doctor or nurse must meet training criteria (see guide for details).

Eligibility to continue within the funded GPSC programme depends on client’s attendance at annual review and ongoing stability.

Each patient will enter a Service Agreement with both their treating GP and Specialist Mental Health Services (SMHS).

Terminal patients likely to die within 12 months Care Plan development preferred Patients to be enrolled in WBOP PHO, not necessarily funded.

A shared-care Action Plan to improve access to care for palliative clients, including anticipatory medications.

Anyone considered palliative.

Positive parenting for parents, caregivers & whānau.

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Children must be aged 12 years & under Offers Individual & Discussion group support.

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People in the community with moderate risk (or higher) of medication-related problems and/or People who are identified as high risk of hospital admission via the PHO risk stratification tool

Service provided by specialist clinical pharmacists to optimise medicine utilisation to improve individual patient health related outcomes.

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How to Refer and / or Claim Invoices should be submitted to the WBOP PHO quarterly and accompanied by a completed quarterly Reporting Template.

An electronic version of the template is provided by email.

No referral process / practice may have an internal approval process.

A record of expenditure including utilisation details, $ value, & if care plan was developed is to be maintained for six monthly reporting.

Clinician to complete and upload the Action Plan to Health Records/ CHIP via BPAC. Send invoice to invoices@wboppho.org.nz Email Ardell Unsworth on ardell.triplep@kaitiakiservices.co.nz Enrol online at www.triplep-parenting.net

BPAC Midland eReferral to Medwise.

Service provider is Foot Mechanics for diabetic feet & at-risk / high-risk feet.

People at risk of developing foot complication due to a chronic condition, esp. type 1 or 2 diabetics with high atrisk feet. Refer to the “WBOP PHO Guide to Programmes & Funding for Patient Services” for full eligibility criteria.

MedTech, My Practice & Profile - submit BPAC Midland eReferral.

Houston send via HealthLink to Foot Mechanics or fax 07 577 1222.

Service provider is Tauranga Eye Specialists.

People with a diagnosis of Type 1 or 2 Diabetes.

Gestational diabetes & pre-diabetes are excluded.

BPAC Midland eReferral.

Updated November 2021

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Service/ Programme GST incl.

Smoking Cessation

Service

Eligibility Criteria No patient co-payment unless otherwise stated

See below 3 programmes.

• General Practice team Service Delivery $141.84 p.p. claimable at the completion of programme

Hāpainga

Ūkaipō for Hapū Māmā

Funding to enable practices to invest in clinical resources to support smokers to quit. Ideally over 4 contacts.

• • •

Provider must be GP, Reg. Nurse &/or Quit Card Provider.

Service delivery must adhere to NZ National Guidelines for Helping People to Stop Smoking Current smoker ≥ 15 years old.

Not enrolled in WBOPO PHO Smoking Cessation programme in the previous 3 months

Claim using the Halcyon form.

Medtech, MyPractice and Profile practices An invoice will automatically be created in your PMS and a claim will be electronically sent to the PHO on completion of the Halcyon form.

Houston practices An invoice will need to be manually created in your PMS for internal reconciliation purposes. A claim will be electronically sent to the PHO on completion of the Halcyon form

Support for BOP residents motivated to quit smoking.

Current smokers who reside in the Bay of Plenty.

BPAC Common Form

Marae based 4-day programme, supports hapū māmā to quit smoking & a smokefree home.

Smoking, hapū Māori woman or a non-smoking, hapū woman (any ethnicity) with a Māori partner or a nonsmoking, hapū woman (any ethnicity) with Māori whānau around her who smoke.

Contact Tiana Bennett at the WBOP PHO for next course dates, locations & an enrolment form on phone 07 577 3195 or email tiana@wboppho.org.nz

Wound Care Level 1: $96.89 p.p.

1 - 3 visits

How to Refer and / or Claim

Funding routine wound care cases which can be managed by general practice rather than secondary care.

Level 2: $305.96 p.p.

4 - 7 visits

Updated November 2021

Referrals are sent from Community Co-ordination Centre (CCC) to practices for patients needing Level 1 or 2 wound care.

Practice needs to have had a Registration of Interest (ROI) accepted by the BOP DHB.

Claim using the Halcyon form.

Medtech, MyPractice and Profile practices An invoice will automatically be created in your PMS and a claim will be electronically sent to the PHO on completion of the Halcyon form.

Houston practices An invoice will need to be manually created in your PMS for internal reconciliation purposes. A claim will be electronically sent to the PHO on completion of the Halcyon form

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