General Practice Services QUICK GUIDE Services for patients Enrolled & Funded with WBOP PHO
Service/ Programme GST incl.
Service
Eligibility Criteria
“WBOP PHO Guide to Programmes & Funding for Patient Services” supports this guide with greater detail and includes CPO Mental Health and Acute Demand Services
No patient co-payment unless otherwise stated
How to Refer and / or Claim
January 2020 version 2
Supports access to primary care afterhours services for High Needs and Community Service card holders. Provides free access to after-hours First Level and Urgent Care services for enrolled and casual children < 14years.
▪ 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
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.
Breast Screening – GP Support & Outreach
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
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: • 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
Service for priority women who are due for their cervical smear, are under screened /unscreened.
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 who have never had a Cervical Smear, or it has been more than 5 years since the last one.
No referral process. MedTech - submit an Advanced Form. Non-MedTech - complete a Manual claim form.
GP Outreach Support Service to encourage priority women to be screened.
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.
Submit a BPAC Midland eReferral.
After Hours for High need and CSC $50.00 per visit
After hours Under 14s $10.00 per visit
$71.30 per nurse or GP consult $285.20 p.p. per year Co-payment may be charged
Cervical Screening $27.93 per woman
Cervical Screening – GP Support & Outreach
COPD Management $184.00 p.p. per year + $46.00 for 23PPV Sanofi vaccination
Funding to support GOLD standard management of COPD patients - up to 4 GP or Nurse consults.
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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
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, send manual invoice to the WBOP PHO or email to: GPSadmin@wboppho.org.nz
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Service/Programme Incl. GST Diabetes Annual Review $66.88 p.p. per year
Diabetes Care Improvement Programme $243.26 p.p./p.a
Diabetes Insulin Starts $194.60 p.p. Limited to once only
Discretionary Funds Co-payment may be charged
Green Prescription & Active Families Sport BOP
Health & Wellness
Outreach Immunisation Service
Opioid Substitution Treatment G.P. Shared Care (GPSC) Package of Care $121.90 p.a Discretionary Funding Up to $230.00 p.a Pneumococcal Vaccine PCV13 $260.00
Service
Eligibility Criteria No patient co-payment unless otherwise stated
How to Refer and / or Claim
DAR: An annual assessment to establish health status of a diabetic patient.
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.
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.
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Had a DAR in last 12 months HbA1c >75mmol/mol Referral to diabetes self-management group education is offered to Patient
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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
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
January 2020 version 2
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.
WBOP PHO Nursing services.
Services include General Practice Outreach support, Outreach Support Whānau Nursing, Dietician, Whānau Cancer Nurses, Diabetes Nurse Educator and Diabetes Self- Management Groups.
BPAC Midland eReferral under WBOP PHO Nursing Service.
Mobile immunisation service to assist general practices in the delivery of timely immunisations to their enrolled children.
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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
BPAC Midland eReferral.
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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).
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.
Aims to achieve improvement in the physical and psychological health and wellbeing of people who use opioids.
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Service/Programme Incl. GST
Service
Palliative Care Co-payment may be charged.
Supporting general practice continuity of care for terminally ill patients & their whānau.
Palliative & End-of-Life Care Just in Case Action Plans $160.00
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.
Email Ardell Unsworth on ardell.triplep@kaitiakiservices.co.nz Enrol online at www.triplep-parenting.net
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People in the community with moderate risk (or higher) of medicationrelated problems and/or People who are identified as high risk of hospital admission via the PHO risk stratification tool
BPAC Midland eReferral to Medwise.
Parenting Support Triple P programme
Eligibility Criteria No patient co-payment unless otherwise stated • • •
Terminal patients likely to die within 12 months Care Plan development preferred Patients to be enrolled in WBOP PHO, not necessarily funded.
How to Refer and / or Claim
January 2020 version 2
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. Complete feedback form and attach to invoice. Email to GPSadmin@wboppho.orgnz
Pharmacy Community Medicines Medwise
Service provided by specialist clinical pharmacists to optimise medicine utilisation to improve individual patient health related outcomes.
Podiatry Services for At-Risk & High-Risk Foot
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 at-risk 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.
Retinal Screening for Diabetics
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.
Smoking Cessation General Practice team Service Delivery $138.00 p.p. claimable at the completion of programme
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See below 3 programmes. Funding to enable practices to invest in clinical resources to support smokers to quit. Ideally over 4 contacts.
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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
MedTech - submit an Advanced Form. Non-MedTech - complete WBOPPHO claim template & email to GPSadmin@wboppho.org.nz
Hāpainga
Support for BOP residents motivated to quit smoking.
Current smokers who reside in the Bay of Plenty.
BPAC Common Form
Ūkaipō for Hapū Māmā
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 non-smoking, 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: $95 p.p. 1 - 3 visits Level 2: $300 p.p. 4 - 7 visits
Funding routine wound care cases which can be managed by general practice rather than secondary care.
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.
MedTech practices to complete Advanced Form. My Practice, Profile & Houston practices complete template provided by WBOPPHO. Template & invoices to be emailed to GPSadmin@wboppho.org.nz
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