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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