primary options for acute care (poac) information manual - waikato · • any patient where the...

POAC Manual – Waikato (12/18)

Primary Options for Acute Care

(POAC)

Information Manual - Waikato

December 2018

Please note: This manual is a living document and will be updated from time to time. We

encourage you to access this document online for the most up-to-date version instead of

relying on a printed version.

Created December 2018


Table of Contents

Introduction ............................................................................................................... 1

Primary Options Acute Care (POAC) ......................................................................... 1

Business rules for POAC ......................................................................................... 1

Patient eligibility criteria ......................................................................................... 1

Lodging a Referral ................................................................................................. 2

Contact details ...................................................................................................... 2

Clinical Section ........................................................................................................... 3

Eligibility Criteria ................................................................................................... 3

Exclusions ............................................................................................................ 4

Entry Criteria ........................................................................................................ 5

Clinical responsibility .............................................................................................. 5

What you can claim ............................................................................................... 6

Services Available .................................................................................................. 7

Services to Rural communities ................................................................................ 8

Exit Criteria and Claiming Process ............................................................................ 9

Clinical Oversight of the programme ...................................................................... 10

Additional information .......................................................................................... 11

One point lessons ................................................................................................ 11

Frequently asked questions ...................................................................................... 12

Appendix 1 : Clinical Manual - Primary Options Acute Care (POAC) ........................ 16

Abdominal pain ................................................................................................... 17

Asthma .............................................................................................................. 19

Cellulitis and ACC Cellulitis- IV treatment ............................................................... 20

Chest pain .......................................................................................................... 22

Congestive heart failure - exacerbation .................................................................. 23

COPD ................................................................................................................. 24

DVT/ACC DVT and DVT in pregnancy ..................................................................... 25

Dehydration ........................................................................................................ 27

ENT ................................................................................................................... 28

Fever unknown origin - children ............................................................................ 29

Gastroenterology ................................................................................................. 30

Hyperemesis gravidarum ...................................................................................... 31

Ingested foreign body .......................................................................................... 32

IV Adenosine in the management of SVT ................................................................ 33

Musculoskeletal ................................................................................................... 34

Neurology ........................................................................................................... 35

Pneumonia/Respiratory infection ........................................................................... 36

Renal/Urological .................................................................................................. 37

Respiratory ......................................................................................................... 39

Respite care ........................................................................................................ 40

Severe allergic reaction ........................................................................................ 41

Women’s Health .................................................................................................. 42

Appendix 2 : Full invoicing schedule (POAC) ........................................................... 44

Appendix 3 : One Point Lessons ................................................................................ 46

Appendix 4: Tips – Abdominal Pain .......................................................................... 54


Appendix 5: Tips – Cellulitis and ACC Cellulitis – IV Treatment ................................ 59

Appendix 6: Tips –Fever unknown origin - child ....................................................... 61

Appendix 7: Tips - Musculoskeletal ........................................................................... 62

Appendix 8: Respite referrals process (POAC) .......................................................... 65

Appendix 9 : Tips - Severe allergic reaction .............................................................. 66

POAC Manual – Waikato (10/18) 1

Introduction

Primary Options Acute Care (POAC)

POAC is a programme designed to improve health outcomes and patient experience. The

programme funds primary care to provide safe, acute care within the community. This

reduces demand on acute hospital services by preventing unnecessary referrals to the

emergency department and consequently hospital admissions.

The POAC programme supports primary care through specific clinical pathways, to

provide safe, acute care within the community where, in the absence of POAC

funding the patient would be referred to hospital.

Where possible POAC funding should be targeted towards the 2 groups known to present at

emergency departments in high volumes which are:

• Maori, Pacific and high decile patients

• Frail and elderly patients >75yrs or > 65yrs if Maori or Pacific

Business rules for POAC

The Clinical Coordination Centre (CCC) is responsible for the management of Primary Options

for Acute Care (POAC). This service is provided to all General Practices across the Waikato

region.

The CCC team also provide clinical coordination of a range of other district wide and PHO

specific programmes.

CCC services may be modified from time to time. The CCC team will notify providers through

normal PHO communication channels of changes to this manual, policies or procedures.

It is the provider’s responsibility to ensure they are following the most up to date policies and

guidelines.

This does not replace the responsibility of the professional to manage patients according to

their best judgment applying best practice principles.

Patient eligibility criteria

Please refer to individual service information documents for specific criteria, but in order to

receive a funded service patients must:

• Be eligible to access funded New Zealand health care services. To ascertain eligibility for

primary healthcare funding please refer to the Ministry of Health’s web site (insert

current hyperlink to the relevant page: https://www.health.govt.nz/new-zealand-health-

system/eligibility-publicly-funded-health-services

• meet the individual eligibility criteria for the service

https://www.health.govt.nz/new-zealand-health-system/eligibility-publicly-funded-health-services

https://www.health.govt.nz/new-zealand-health-system/eligibility-publicly-funded-health-services


• have given their consent to the recommended treatment

• have been advised and agree that they may be liable for costs should the claim be

declined

• agree that their information may be shared with another health provider as part of their

treatment plan.

Providers must ensure:

• it is clinically safe and appropriate to manage the patient’s care in the community

• cases where in the absence of POAC funding the patient would be referred to hospital

• the treating clinician is able to take responsibility for the patient’s care, or has the option

to hand over the patient to another clinician

• the services will be delivered within the business rules

Lodging a Referral

All cases require a referral/request for funding from a primary care/service provider (e.g. GP or

nurse practitioner). Each referral must meet individual service eligibility criteria and contain

the necessary information required to process the referral.

All invoices will be held for payment until the outcome of the case has been lodged. Cases on

hold for more than 2 months will be declined.

A referral should be submitted as soon as possible following the episode of acute care. All

cases must be invoiced, closed and submitted within 2 months of the episode of care. Cases

submitted after 2 months will be declined.

A full list of fee schedules are available in this manual – see Appendix 2: Full Invoicing

Schedule

Contact details

Call the 0800 number to speak directly with the CCC team. In the unlikely event that all the

team are busy, the caller will be asked to hold or leave a message (during business hours

only). Should a message be left, the team will respond in the priority order it was left.

Clinical Coordination Centre Team

Phone: 0800 646 764

Fax: 07 838 8485

email: [email protected]

mailto:[email protected]


Clinical Section

Funding is available to patients for both in-clinic and third party services e.g. radiology, respite

care. See flow chart next page

Eligibility Criteria

NO The patient is not eligible for POAC.

Manage the patient in the usual way

YES

Refer the patient to ED/Secondary

Services

Use the alternative funding stream.

POAC is not to be used as a top up

to funding

Manage the patient in the usual

way/refer the patient to hospital/

use alternative funding stream

Is the patient unwell enough that you will

acutely refer them to ED?

Refer the patient to ED/Secondary

Services

NO

YES

NO

YES

Is it safe & appropriate to treat the patient in

the community?

Can the patient be treated under an

alternative funding stream?

e.g. ACC/Maternity etc.

Is this condition an exclusion under the POAC

business rules?

Can you, another GP or an Urgent Care take

clinical responsibility for the patient for the

duration of the episode of care?

Submit a referral / request for funding to

Primary Options Acute Care (POAC)

NO

NO

YES

YES


Exclusions

The investigation and treatment of the following conditions are excluded from POAC. They will

be declined and not funded:

NB: Individual services also have specific exclusions – see Appendix 1: Clinical Manual

• Abscesses including incision and drainage

• Anaphylaxis requiring adrenaline

• Suspected acute appendicitis

• Testicular torsion

• Abdominal aortic aneurysm

• Pulmonary embolism

• Virtual consults both initial and/or follow-up

• Services where alternative funding streams are available (even if the funding is

considered inadequate or partial), including but not confined to

a) ACC (excluding ACC DVT & ACC Cellulitis)

b) Maternity and pregnancy related services

c) PRIME funding

d) Innovation or other funded services through your PHO

e) Point of care ultrasound

f) Palliative home visits

g) Contracted services to resthomes

h) GP beds

• Any patient care that would not require presentation to hospital as indicated in individual

POAC pathways.

• Any patient where the initial plan or heath pathway involves admission to hospital (i.e.

high acuity) – refer to hospital.

• In no circumstances should a patient be managed in Primary Care if the level of acuity is

beyond the service provider’s capability and compromises patient safety

• POAC is not to be used as a top up to alternative funding available to a patient/practice.

Exclusion criteria to access POAC funding should not preclude emergency treatment

of any medical conditions


Entry Criteria

There are a number of entry points into the POAC service. Once referred, all services are free

to the patient (excluding the initial 15 minute GP/NP consultation) whilst the patient is acutely

unwell. Once the patient is no longer acutely unwell, they should be exited from the service.

Referrals to POAC can only be initiated following a full clinical assessment of the

patient in a face-to-face consultation, by either a Registered General Practitioner,

Nurse Practitioner or Physician Associate.

a) General Practice

The patient is assessed by a GP/Nurse Practitioner/Physician Associate in an initial

consultation, then referred to POAC. The patient pays for the first 15 minute GP/NP/PA

consultation.

b) Ambulance services

Ambulance officer assesses the patient and determines they meet the criteria for one of

the agreed POAC pathways. The patient is then transported to an urgent care clinic or a

general practice. The initial consultation and further treatment are free to the

patient.

c) Urgent Care Clinic

The patient is assessed by a GP/Nurse Practitioner/Physician Associate in the initial

consultation then referred to POAC. The patient pays for the first 15 minute GP/NP/PA

consultation.

d) Hospital Emergency Department (ED)

The patient presents to ED, either as a walk in or by ambulance. Following triage, the

patient is assessed as meeting the criteria of one of the agreed clinical pathways and can

be appropriately managed through POAC. The patient is then referred to an urgent care

clinic. The initial consultation and further treatment are free to the patient.

Clinical responsibility

The initiating doctor/NP/physician associate carries clinical responsibility for managing the

patient’s care unless the clinical responsibility can be handed over to a colleague within the

practice, to a clinician in an urgent care clinic, or to the patient’s registered GP.


What you can claim

Under POAC, the initial 15 minutes is always charged to the patient at the usual

practice rate prior to the funded ‘in-clinic’ or third party services being commenced.

• The patient must be informed and agree that the information on the claim form and other

information relating to the illness will be made available to the clinical co-ordination

centre team and sub-contracted health care providers.

• The patient must also be informed and agree that they may be liable for costs if the

claim is declined.

Please refer to individual pathways for what types of invoices would be appropriate to claim

depending on the treatment provided to the patient. See Appendix 1: Clinical Manual including:

• Abdominal pain

• Asthma

• Cellulitis and ACC Cellulitis – IV treatment

• Chest pain

• Congestive heart failure - exacerbation

• COPD

• Deep Venous Thrombosis - DVT / ACC DVT and DVT in pregnancy

• Dehydration

• ENT

• Fever unknown origin - children

• Gastroenterology

• Hyperemesis gravidarum

• Ingested foreign body

• IV Adenosine in the management of SVT - Frequent ED presentations

• Musculoskeletal

• Neurology

• Pneumonia/Respiratory infection

• Renal/Urological

• Respiratory

• Respite care

• Severe Allergic Reaction

• Women’s Health

General practice and urgent care clinics can claim GMS for casual patients at the initial

consultation where POAC is initiated and the patient pays the usual consultation fee. GMS

cannot be claimed for subsequent consultations once a patient has been entered in to the

POAC programme - including where a practice or clinic sees a POAC patient who has been

referred by another doctor.

A full list of fee schedules are available in this manual - see Appendix 2: Full Invoicing

Schedule


Services Available

Services accessed through POAC can include a mix of the following within an episode of care:

Clinical documentation must evidence the care provided

a) Urgent diagnostics - X-Ray, ultrasound and ECG

Radiological investigations are limited to:

• Pelvic ultrasound: for suspicion of ruptured ovarian cyst or where patient no longer

qualifies for maternity funding i.e. more than 14 days post TOP/miscarriage or more than

6 weeks post vaginal delivery.

• Abdominal ultrasound: for investigation of acute biliary colic in a haemodynamically

stable patient

• Renal ultrasound: for suspicion of renal colic/stones in pregnant women and women

under 35 years

• Ultrasounds under the DVT pathway

• Chest X ray: for suspicion of pneumonia or pneumothorax and for foreign body

ingestion

• Hip X ray: for suspicion of SUFE

• X ray: for suspicion of pathological fracture where there is no history of injury

Urgent diagnostics can be accessed and co-ordinated by general practice or urgent care

clinics without contacting the CCC team. Bookings can be made by the practice, CCC or

the patient.

Patients can arrange their own radiological investigation provided they have the required

documentation with them, which includes the referral from the practice and the primary

options claim number. This is dependent on the investigation being one of those listed

above. Any investigations not listed will not be funded, irrespective of whether the

practice has provided the patient with a claim number

Patients who are not acutely unwell and do not require a same day diagnostic test are

not funded under POAC and should be referred to primary referred radiology. Radiology

is only funded for same-day investigations, with the exception of ultrasounds though the

DVT pathway which can be the next day with Clexane coverage.

GP provided point of care ultrasound is excluded from POAC services – it is expected that

patients will be charged for this service.

b) Extended GP consultation

Extended consultations may be claimed when the initial consultation (funded by the

patient) exceeds 15 minutes in instances where patients meet POAC criteria. Patients are

expected to pay for the first 15 minute consultation, the “extended consult time” begins

from that time onwards. An extended consult may also be claimed by an urgent care

clinic or general practice when a patient has been transferred from another general

practice (this also applies to St Johns redirect and ED redirect to urgent clinics).


c) Follow up GP and/or practice nurse consultation

Follow-up GP and nurse clinic or home visits may be funded for those patients who are

acutely unwell and require follow-up. These are limited to one per episode of care within

3 days of the initial consult, and cannot be claimed on the day of the initial consultation.

NB A nurse follow up consult invoice can be raised to fund an ECG. This can only be

funded under the chest pain pathway

d) Intravenous (IV) therapy

These invoices are a package of care i.e. they include an allocation for staff time as well

as consumables, they are not to be claimed along with any other claims.

e) Patient observation

In-clinic observations can be claimed based on 3x10 minute baseline observations per

hour, for up to 3 hours (6 hours for Urgent Care clinics). Practice observations can only

be claimed at the time of the initial consult

f) Referral to an Urgent Care Clinic when the GP practice is unable to complete the

episode of care.

Where a GP/NP/Physician associate cannot provide services, they may refer the patient

to a local urgent care clinic or out of hours facility. The referring GP must do a clinical

handover with the accepting treatment provider. A letter of referral must also be

provided to the patient including the POAC case number, to be handed to the accepting

treatment provider on presentation. The treatment provided to the patient will remain

free as long as the patient meets POAC criteria.

g) Patient transport – Waikato only (ambulance and/or taxi/ free community

transport)

Transport to and from care/treatment locations if the patient cannot drive themselves

and has no other option of transport i.e. Family member or friend. This has to be

arranged with the CCC team.

h) Rest home placement for a maximum of 3 days.

Placement is arranged by the CCC team and is dependent on availability at one of the

POAC contracted providers. Every effort is made to find a placement to provide the

appropriate level of care required to meet the patient’s needs. Family, cultural needs and

locality are also taken into consideration. This funding can only be utilised as part of an

approved POAC pathway

POAC cannot be used for acute residential respite care in a locality where there is a

primary care inpatient service in place (GP Beds). Should demand exceed supply for GP

beds, the GP can contact the CCC team to access acute respite care under POAC.


Exit Criteria and Claiming Process

Once the episode of care is completed and the patient is no longer acutely unwell, they exit the

POAC programme.

Once the patient exits the POAC programme, the case requires a clinical outcome to be lodged.

No payment will be made for any claims unless the outcome is completed.

Where treatment in the community is no longer clinically appropriate, the patient may be

admitted to hospital during a POAC plan of care. This must be indicated in the clinical

outcome.

Complete the claim process and submit an outcome for the episode of care.

Do you require a funding for any other type of third party service?

No Yes

Does your patient require respite/homehelp acutely?

No Yes

Do you require radiology services?

No Yes

Submit a referral/request for funding to

Primary Options Acute Care

Add the generated case

number to the radiology

referral form and book an

appointment.

Complete a referral and

contact the CCC team. The

CCC team will organise

respite/home help.

Complete a referral and

contact the CCC team.


Services to Rural communities

Rural communities have different issues for patient care.

DHB’s provide a range of funded services to rural communities. Some of these include; GP

beds, radiology, emergency department, weekend clinics etc. POAC does not cover care where

DHB funded services are available and provided by DHB staff, GPs or third-party providers.

Normal referral pathways and access criteria should be used. Services cannot be claimed under

more than one funding stream.

Clinical Oversight of the programme

Clinical oversight is provided to the CCC through the clinical governance structure of Pinnacle

Incorporated. The POAC service has specific clinical oversight built into the delivery and

includes the following:

a) A Clinical/Medical Director: a General Practitioner is available for case review,

education, clinical audit and service development.

b) A Clinical Audit Group: a group of clinicians is available (representing all PHOs) to audit

referrals to the POAC services for clinical appropriateness, safety and business rules

adherence. The group is responsible for making recommendations to ensure clinicians

are supported to use the services. See FAQs – GP Peer Review Group

c) District Wide Governance Group: oversight of the programme has been subject to

review by the Waikato DHB demand management group, but currently the contract

holder, Pinnacle MHN, has responsibility for overall governance of POAC.

d) Please refer to the specific service agreement for further information such as:

o Audit

o Qualifying providers

o Disputes

o Payment for services

o Indemnity & professional liability

Information required

The CCC team review each referral, invoice and outcome to ensure the following:

• The request for funding for a service meets the business rules

• The referral is not a duplicate

• All claims are supported by clinical notes

If there are any issues with claiming, the team may amend the invoice and indicate the reason

why they have amended it. This will appear on the remittance advice, so adjustments can be

made at the practice. Where additional information is required, the case will be declined and a

request for further information made.

All invoices will be held for processing until the outcome of the case has been lodged

Any cases that have been inactive for more than 2 months will not be funded.


Additional information

• Any claim exceeding $300, including ALL costs incurred by a practice, will be reviewed by

the CCC team and the full claim may not be paid

• Should a claim be declined, the initiating provider is responsible for all in-clinic charges.

Where third party providers have delivered a service against a declined claim, please be

aware the cost may be passed on to the patient by the third party provider.

• Where demand for POAC services exceeds funded contract volumes, the Clinical

Coordination Centre reserves the right to restrict access to the particular service and/or

revise the service schedule fees with minimal notice. Providers will be advised

immediately should this occur.

Where referral/claiming volumes are deemed excessive or inappropriate in the POAC service,

the CCC team will initiate the following process:

Step 1: A letter will be sent to the clinicians with POAC information.

Step 2: A letter will be sent offering a visit from the CCC to ensure the clinicians have an

understanding of the principles of the programme and understand the referral

process.

Step3: A letter will be sent advising that the POAC Clinical Director will visit the practice to

work with the clinicians to better manage their referrals.

Step 4: The practice will have their POAC volumes capped

Step 5: The practice will no longer have access to POAC.

One point lessons

These can be found in this manual – see Appendix 3: One Point Lessons

i) How to lodge a referral

o Electronic: Medtech, Indici,

o Manual (faxed)

j) How to submit an invoice


o Manual (faxed)

k) How to close a case/outcome


o Manual (faxed)

More one point lessons can be found here if needed:

https://www.pinnacle.co.nz/programmes/primary-options-acute-care-waikato

https://www.pinnacle.co.nz/programmes/primary-options-acute-care-waikato


Frequently asked questions

1. Does the patient have to pay?

The initial 15 minute GP consultation incurs the usual GP consultation fee paid by the

patient. All POAC services thereafter are provided at no cost to the patient. If the claim

is declined by POAC, the patient may be liable to the practice for the fees incurred.

2. Does the practice need to phone for approval to initiate a claim?

No, but if a GP is uncertain about the eligibility of a case please phone the Clinical

Coordination Centre team for assistance. The GP should start an electronic claim at the

time of initial consultation.

For X-Rays and Ultrasound, the practice can initiate the services at the time of

consultation.

For respite care and transport the practice needs to contact the Clinical Co-ordination

Centre team who will arrange these services for you. Alternatively, the Clinical Co-

ordination Centre team can arrange all 3rd party services on behalf of the practice if

requested.

3. Will POAC pay for after-hours follow-up or home visits if needed?

Yes. Either the GP, the deputised after hour’s service, or a local urgent care clinic can

provide after-hours care to the POAC patient. The referring GP will need to print off the

original claim form that shows the POAC reference number and consultation notes and

give it to the patient to provide when they attend an urgent care clinic after hours. If

PRIME services are involved or the practice has rural after-hours support that applies,

then claims under POAC cannot be made.

4. Can services be accessed for the same patient for more than one

episode?

A patient can access POAC funding more than once if acutely unwell, if the service

prevents hospital admission. However, funding will be declined if the service provided is

consecutive or in support of a chronic condition that would normally be managed in

primary care.

5. What hours is the service available?

POAC provides funding to all in clinic services in general practice and Urgent Care clinics

regardless of the time the treatment is provided. A request for funding/referral can be

made at any time. Third party services such as radiology are available according to the

opening hours of your local contracted providers.


6. What happens if a claim is initiated by one doctor and completed by

another?

A claim can be started by one doctor and completed by another doctor. For example, a 3-

day Cellulitis pathway could be started by the patients GP on a Friday, referred to an

urgent care clinic for days 2 and 3 on Saturday and Sunday. The urgent care clinic doctor

can discharge the patient on day 3 and submit an invoice and outcome.

7. How can I lodge a claim if the invoice and outcome has already been

completed by another doctor or practice?

If the case has already been completed by another GP/NP/PA or Urgent Care Clinic, an

invoice can still be claimed for the portion of care you wish to claim. This can be done by

opening an ‘invoice only’ form on the original case number.

8. What level of clinical notes do I need to submit to POAC?

POAC is a DHB funded service designed to avoid an ED referral and subsequent hospital

admission. GPs are therefore required to provide sufficiently detailed consultation notes

to determine appropriate use of POAC funding otherwise the referral will be declined. It

has been recommended that in addition to a good assessment and history, the full range

of appropriate observations should be documented, especially where the diagnosis is

undetermined. It is important to state the time of consultations and interactions with the

patient. The notes can be easily added by clicking the ‘add clinical notes’ button, or by

copy/pasting from your clinical records. Other providers are not able to see your clinical

notes so referrals, made in the usual way to third party providers, need to have some

detail to maintain continuity of care.

Call the Clinical Co-ordination Centre team between 8.30am and 5pm Monday-Friday for

all administrative queries.

9. When should an episode of care end?

POAC only funds the acute episode following an agreed clinical pathway. The patient

should no longer utilise POAC funding when they are no longer acutely unwell.

10. How often should the patient be seen while utilising POAC funding?

The referring GP is responsible for seeing the patient as often as clinically required while

they are utilising POAC funding. One follow up consultation is funded. If a patient is in

respite care there is no available funding for a follow up consultation.

11. If more than one clinician or nurse is involved in the patient’s treatment,

can a claim be made to cover the time each clinician spends with the

patient?

No, only one clinical consultation can be claimed for a specific timeframe. POAC will fund

the total time the patient spends in the practice from the time of the initial

GP/NP/physician associate assessment that deems the patient to be acutely unwell.

Consecutive time spent with clinical staff needs to be evidenced in documentation.

Time spent in triage will not be funded.


12. Does POAC still fund the case if the patient ends up in the emergency

department/being admitted to hospital?

It is essential patients are admitted to hospital when necessary and risks should not be

taken to avoid hospital admission. POAC will fund services provided to the patient up

until the point the decision is made to refer them to hospital. This usually happens when

the GP/NP/Physician associate thinks it is clinically safe to treat the patient in the

community once they have completed their initial assessment, but, either the patient

does not respond to treatment or their condition deteriorates. If the GP/NP/physician

associate then decides to send the patient to hospital, POAC will fund treatment up until

this decision is made. POAC funding does not cover the time taken between the decision

to refer the patient to hospital and the time the patient leaves the practice.

13. How does a contracted practice get paid for the services/treatment they

provide to a patient?

All services require a claim to be made. This is done via the electronic claim management

system integrated into your PMS. To set this up please contact the CCC team. Some

PMS’s do not integrate with the electronic claim system so a manual claim form can be

submitted via fax or email. Please note each manual claim form has a pre-allocated case

number and cannot be used for more than one episode of care. If you require more

forms to be sent to your practice, please request these through the CCC team.

Once the claim has been accepted and an outcome lodged for the case, payment will be

made on the date listed in the service contract.

14. Does POAC fund dressing changes under the IV Cellulitis pathway?

The IV cellulitis pathway invoices are all inclusive of the treatment provided to the

patient, including GP/Nurse time, IV antibiotic, dressing and any other consumables.

Once the patient no longer requires IV antibiotic treatment, any ongoing dressings should

be referred to district nursing or paid for by the patient.

15. How does the practice receive payment for consumables and materials

for in-clinic procedures?

POAC does not fund procedures apart from those specifically outlined in the invoice

schedule. For those procedures that ARE funded, an all-inclusive invoice can be claimed

where materials and consumable have been accounted for.

16. What is the timeline of referring into Primary Options?

A referral from an acute care episode should be lodged as soon as possible following the

initial patient assessment. All cases must be fully completed including invoices and

outcomes within a two month period from the date of the episode of care. If cases are

outside of this timeframe, referrals will be declined.

17. What is the GP Peer Review Group and what does it do?

The POAC GP Peer Review Group is a group of clinicians consisting of both GPs and

nurses. The group meets once a month to audit a selection of cases that have been

submitted under the POAC programme.


This group has a wider function than just POAC services and works across the Waikato,

Tairawhiti, Taranaki and Lakes localities. The value of this wider function is to make

efficient use of their time, and to advance regional consistency of these services. Each

locality and PHO is welcome to provide a representative to attend the group meetings.

The CCC team compile a selection of cases to review. The cases may be chosen for a

number of different reasons such as:

a) The CCC team would like clarification regarding a particular case that sits outside of

the usual type of cases submitted for funding.

b) The team have noticed a pattern of claiming by a GP/practice and would like the

group to provide feedback that may help to educate the GP/NP/ Physician associate

regarding the appropriate use of the service.

c) The amount claimed for the case has triggered an automatic audit.

d) Random selection of accepted cases.


Appendix 1 :

Clinical Manual - Primary Options Acute Care

(POAC)

• Abdominal pain

• Asthma

• Cellulitis and ACC Cellulitis – IV treatment

• Chest pain

• Congestive heart failure - exacerbation

• COPD

• Deep Venous Thrombosis - DVT / ACC DVT and DVT in pregnancy

• Dehydration

• ENT

• Fever unknown origin - children

• Gastroenterology

• Hyperemesis gravidarum

• Ingested foreign body

• IV Adenosine in the management of SVT

• Musculoskeletal

• Neurology

• Pneumonia/Respiratory infection

• Renal/Urological

• Respiratory

• Respite care

• Severe Allergic Reaction

• Women’s Health


Abdominal pain

Eligibility criteria – Primary Options Acute Care (POAC) funding

• Patients who are haemodynamically stable and can be safely managed in the community

with abdominal pain.

• Detailed clinical notes to clearly support POAC claim including vital signs.

Exclusions – not eligible for POAC funding

• Any patient with an acute abdomen/ severe abdominal pain/ suspected bowel obstruction

– refer acutely to general surgery or gynaecology as appropriate.

• Suspected ruptured abdominal aortic aneurysm – refer acutely to vascular surgery.

• Suspected appendicitis – refer acutely to general surgery or paediatric surgery.

Investigation by ultrasound not funded by POAC as hospital admission is inevitable.

• Investigation of an abdominal mass/suspected malignancy –Urgent scans through primary

referred radiology via ‘High Suspicion of Cancer’ pathway should be used.

• Hernia management – strangulated/ obstructed hernia – refer acutely to general surgery.

Certain hernias may be accepted by ACC for funding – see tips.

• Investigation by ultrasound of a large post-operative collection that would necessitate a

hospital admission. As the hospital admission in such a case is inevitable, POAC cannot

fund this.

Inappropriate for POAC funding - (including examples of low acuity cases

that don’t meet the criteria)

• Surveillance scans of known AAA – scan via vascular surgery.

• Investigation of incidental finding of abnormal liver enzymes with no abdominal pain with

an ultrasound.

• Post-operative wound dressings.

• Constipation –Abdominal X-Rays are generally not useful in diagnosing chronic

constipation.

Invoices that may be claimed (based on treatment provided as evidenced in

clinical notes)

• IV medication invoice - administration of pain relief

• IV fluids if moderate dehydration present – see dehydration pathway (hyperlink)

• Practice observations (if no IV administration invoices are claimed)

• GP/nurse follow up

• GP extended consult

• Ultrasound scan – Abdominal if clinically indicated

This is NOT a clinical guideline for the management of abdominal pain in primary care


Tips

Health pathways: gallstones; acute general surgery assessment; ultrasound abdomen; X-Ray

– abdomen.

Some hernias may be accepted for cover by ACC: see Appendix 4 : Tips - Abdominal Pain


Asthma


• Patients with moderate asthma exacerbation that can be safely managed in the

community.


Exclusions (not eligible for POAC funding)

• Any patient with severe, life threatening asthma, including the pre-hospital treatment that

has been provided, as admission to hospital is inevitable.



• Mild asthma exacerbation

• Repeat asthma medication consultations


clinical notes)

• Practice observations (to cover spacer/nebulizer treatment)

• GP extended consultation


Tips

Health pathways: acute asthma in children; acute asthma in adults; asthma in adults; asthma

in children.

This is NOT a clinical guideline for the management of asthma in primary care


Cellulitis and ACC Cellulitis- IV treatment


• Adult >= 15 years with cellulitis not responsive to oral treatment OR where oral

treatment is not appropriate.

• Has a clear diagnosis of cellulitis and is haemodynamically stable.

• Refer to Community management of soft tissue infections for careful patient selection

criteria see tips.

• If needing to extend the course of IV antibiotics for longer than 3 days – please discuss

with infectious diseases specialist and document this in the notes. Additional doses will

only be funded if the discussion is clearly documented and included in the case notes.

• Detailed clinical notes to clearly support POAC claim.


• < 15 years old

• Systemically unwell patient

• Allergy to cephalosporin or anaphylaxis to penicillin (discuss with infectious diseases

specialist or ED specialist).

• Septic arthritis

• Underlying fracture

• MRSA carrier

• Prosthesis present

• Pregnancy



• Mild to moderate cellulitis where oral antibiotic treatment is appropriate.

• Administration of IM antibiotics.

• Incision and drainage of abscesses and associated dressing changes.

• Post-operative wound dressings.


clinical notes)

• IV cellulitis invoices – Day 1, 2, 3 (medical) Day 2 surcharge, Day 3 surcharge (ACC –

POAC does not fund the Day 1 surcharge, claim via ACC for each day).

• GP Follow up –when the patient returns on day 4 if the GP is considering extension of

the IV cellulitis pathway beyond the 3-day period. If IV antibiotics are administered on

day 4 (approved by Infectious diseases)

• GP follow up consult cannot be claimed – IV cellulitis invoice only.

This is NOT a clinical guideline for the management of cellulitis in primary care


Tips

Health pathways: cellulitis in the community.

See Appendix 5 : Tips – Cellulitis and ACC Cellulitis – IV treatment


Chest pain


• Patients with low risk undifferentiated chest pain that can be safely managed in the

community.

• Patients with suspected acute coronary syndrome (ACS) with:

1. chest pain > 8 hrs since the onset of last symptoms

2. no current chest pain

3. a normal ECG



• Any patient with suspected MI/unstable angina/pulmonary embolus/cardiac related

syncope/symptomatic arrhythmia. Not eligible for POAC funding including the pre-hospital

treatment that has been provided, as admission to hospital is inevitable.

• Any patient who is haemodynamically unstable. Not eligible for POAC funding including

the pre-hospital treatment that has been provided, as admission to hospital is inevitable.

• < 8 hours since onset of last episode of chest pain.



• Chest pain without cardiac features e.g. musculoskeletal chest pains, anxiety,

hyperventilation.

• Repeat medication/medication review and initiation of new medication consultations.

• Investigation of palpitations that are not present at the time of presentation and where

the pulse is regular.


clinical notes)

• Practice nurse follow up consult (this funds the ECG) this can only be funded under the

chest pain pathway



Tips

Health pathways: chest pain – investigation of low risk undifferentiated pain; acute coronary

syndromes; angina; palpitations; acute cardiology assessment; chest pain.

This is NOT a clinical guideline for the management of chest pain/acute coronary

syndrome in primary care


Congestive heart failure - exacerbation


• Adults with acute heart failure that can be safely managed in the community.



• Patients with severe acute symptoms/signs or red flags as indicated below including pre-

hospital treatment that has been provided as admission to hospital is inevitable.



• Patients with mild symptoms or signs.


clinical notes)

• IV medications if clinically safe and indicated



Tips

Health pathways: heart failure suspected.

Red Flag Emergency

The following may indicate potential life threatening event in patients with dyspnoea

Consider acute referral when any of the following exist:

• Altered mental status

• Hypoxia and cyanosis

• Hypotension

• Abnormal pulse rate and rhythm indicating arrhythmia

• Stridor indicating upper airways obstruction - difficulty breathing without air movement

• Unilateral tracheal deviation and unilateral breath sounds indicating pneumothorax

• Tachypnoea (>40/m) and intercostal/sternal retraction

• Chest pain which may indicate - unstable angina, MI, pulmonary embolism, dissecting

thoracic aortic aneurysm, pericarditis, or pneumonia • Severe orthopnoea

• Severe intractable oedema

• Acute renal failure

• Myocardial infarction within previous 2 weeks

This is NOT a clinical guideline for the management of heart failure in primary care


COPD


• Patients with moderate COPD exacerbation that can be safely managed in the community.



• Any patient with severe COPD exacerbation including the pre-hospital treatment that has

been provided, as admission to hospital is inevitable.



• Mild COPD exacerbation

• Repeat COPD medication consultations

• Spirometry


clinical notes)

• Practice observations



• CXR if clinically indicated

Tips

Health pathways: Acute exacerbation of COPD.

This is NOT a clinical guideline for the management of COPD in primary care


DVT/ACC DVT and DVT in pregnancy


• Suspected DVT (excluding pregnancy) with a Wells Score of >= 2 or a positive D-dimer.

• Pregnant women with a clinical suspicion of DVT. No Wells score or D-dimer required.

• Superficial venous thrombosis

• Detailed clinical notes to clearly support POAC claim including a Wells Score as detailed

below and/or D-dimer (except in pregnancy and superficial venous thrombosis).

• Repeat scans funded in following circumstances:

1. Wells score >= 2, D-Dimer positive and 1st scan negative.

2. Below knee DVT on first scan with no initial anticoagulation given.

3. Persisting superficial venous thrombosis at 7-10 days with no risk factors in an ambulatory

patient.


• Patients with DVT and co-existing PE. Not eligible for POAC funding due to acuity of PE.

Refer to Respiratory Medicine acutely.



• Leg swelling secondary to other causes (ruptured Baker’s cyst, calf sprain, muscle tear).

Consider ACC funding if injury related.


clinical notes)

• DVT prophylactic enoxaparin - ACC DVT prophylactic enoxaparin

• DVT positive treatment GP - ACC DVT positive treatment GP

• DVT positive enoxaparin - ACC DVT positive enoxaparin

• DVT negative GP follow up - ACC Doppler ultrasound surcharge

• Doppler ultrasound- (if the ultrasound negative, claim follow up via ACC)

Tips

1. Wells score >= 2:

➢ POAC funds a Doppler venous ultrasound. D-dimer via usual lab testing (2 negative tests

required to rule out DVT as per Health Pathways)

➢ If the D-dimer is positive and the first ultrasound is negative repeat Doppler venous

ultrasound in 5-8 days is funded by POAC.

2. Wells score <2:

➢ Arrange D-dimer as per Health pathways:

➢ If negative: DVT excluded – POAC will not fund ultrasound.

This is NOT a clinical guideline for the management of DVT in primary care


➢ If positive: POAC will fund a Doppler venous ultrasound – if this is negative no further

follow up scans will be funded.

3. If pregnant (Health Pathways):

➢ No Wells Score or D-dimer needed for POAC funding of ultrasound.

➢ POAC will fund Doppler venous ultrasound based on clinical suspicion.

➢ Seek acute haematology advice re: treatment if DVT positive.

4. If superficial vein thrombosis (Health Pathways):

➢ No D-Dimer needed for POAC funding of ultrasound.

➢ POAC will fund Doppler venous ultrasound if:

➢ There is an involved segment of vein 5cm or more

➢ Either the great or small saphenous vein is involved, or

➢ There is asymmetrical leg swelling.

5. If Below Knee DVT (Health Pathways):

➢ POAC will fund Doppler venous ultrasound follow up scan in 5 to 8 days if no initial

anticoagulation given.

➢ Seek haematology advice if uncertain re: treatment.

6. If superficial venous thrombosis with no risk factors (presence of DVT/superficial

venous thrombosis within 3cm of sapheno-femoral junction) and the patient is

ambulatory:

➢ POAC will fund Doppler venous ultrasound follow up scan in 7 to 10 days if no resolution at

the time.

Health pathways:

Visit website : DVT in pregnancy -

https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37b.pdf

Modified Wells Criteria

Active cancer (treatment in past 6/12 or palliative) +1

Paralysis, paresis or recent plaster immobilisation of lower leg +1

Recent immobilisation > 3 days, or major surgery < 12 weeks +1

Localised tenderness along the distribution of the deep veins +1

Calf swelling > 3cm difference from asymptomatic side(Measure at 10cm below the tibial tuberosity) +1

Pitting oedema confined to symptomatic leg +1

Distended non-varicose superficial veins on symptomatic side +1

Previously documented DVT +1

Entire leg is swollen +1

Is alternative diagnosis as likely or more likely than DVT -2

Total Score:

If score is 1 or less, order D-dimer (low risk); If score is 2 or more, refer for ultrasound (high risk)

https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37b.pdf


Dehydration


• Adults with moderate dehydration not responsive to oral fluids +/- antiemetic that can be

safely managed in the community.

• Children with moderate dehydration or at risk of getting severely dehydrated due to

gastroenteritis that can be managed safely in the community.

• Detailed clinical notes to clearly support POAC claim, including signs of dehydration and

vital signs.


• Adults and children with severe dehydration. Pre-hospital treatment that has been

provided cannot be claimed, as admission to hospital is inevitable.

• Administration of IV fluids in children <15 years.

• Diabetic ketoacidosis treatment with IV fluids. The pre-hospital treatment that has been

provided cannot be claimed, as admission to hospital is inevitable.



• Adults and children with mild dehydration.


clinical notes)


OR

• IV fluid invoice (cannot claim practice observations + this invoice) NB cannot claim for

children <15 years.



Tips

Health pathways: adult gastroenteritis.

This is NOT a clinical guideline for the management of dehydration in primary care


ENT


• ENT conditions that can be acutely and safely managed in the community, such as

epistaxis.



• Any patient with severe epistaxis and haemodynamic instability. The pre-hospital

treatment that has been provided cannot be funded by POAC, as admission to hospital is

inevitable.

• Sore throat swabs – MHN only – separate pathway



• Any patient with other ENT conditions such as tonsillitis/ear infections/ insertion of ear

wick in otitis externa.

• Management of BPPV/dizziness/ vertigo.


clinical notes)

• Practice observations (for management of epistaxis with nasal tampon or cautery).

• GP/nurse follow up for removal of nasal tampon

Tips

Health pathways: nasal cautery video.

This is NOT a clinical guideline for the management of ENT conditions in primary care


Fever unknown origin - children


• Febrile (>38 C) children with moderate/amber symptoms or signs that can be safely

managed in the community – see tips.



• Any child with severe/red symptoms or signs – see tips. Any pre-hospital treatment that

has been provided cannot be funded via POAC, as admission to hospital is inevitable.



• Any child with mild/green symptoms or signs – see tips.


clinical notes)




Tips

Health pathways: fever in children.

NICE traffic light system for identifying risk of serious illness - see Appendix 6: Tips –Fever

unknown origin

(https://www.nice.org.uk/guidance/cg160/resources/support-for-education-and-learning-

educational-resource-traffic-light-table-189985789)

This is NOT a clinical guideline for the management of a febrile child in primary care

https://www.nice.org.uk/guidance/cg160/resources/support-for-education-and-learning-educational-resource-traffic-light-table-189985789

https://www.nice.org.uk/guidance/cg160/resources/support-for-education-and-learning-educational-resource-traffic-light-table-189985789


Gastroenterology


• Adults with moderate dehydration secondary to gastroenteritis not responsive to oral

fluids+/- antiemetic that can be safely managed in the community.

• Children with moderate dehydration or at risk of getting severely dehydrated due to

gastroenteritis that can be managed safely in the community.


vital signs.


• Adults and children with severe dehydration due to gastroenteritis. The pre-hospital

treatment that has been provided cannot be funded by POAC, as admission to hospital is

inevitable.




• Adults and children with mild dehydration due to gastroenteritis.

• Constipation. Abdominal X-Rays are generally not useful in diagnosing chronic

constipation.


clinical notes)


• IV fluid invoice (cannot claim practice obs. with this invoice) NB: cannot claim for children

<15 years


Tips

Health pathways: adult gastroenteritis; gastroenteritis in children; foreign bodies ingested by

children.

This is NOT a clinical guideline for the management of gastroenterological conditions in

primary care


Hyperemesis gravidarum


• Pregnant women with moderate dehydration not responsive to oral fluids+/- antiemetic

that can be safely managed in the community.


vital signs.


• Pregnant women with severe dehydration. The pre-hospital treatment that has been

provided cannot be funded via POAC, as admission to hospital is inevitable.




• Pregnant women with mild dehydration not requiring IV rehydration or IV medication.


clinical notes)

• IV fluid and/or IV medication invoice (cannot claim practice observations with this invoice)

Tips

Health pathways: pregnancy related nausea and vomiting.

This is NOT a clinical guideline for the management of hyperemesis gravidarum in

primary care


Ingested foreign body


• Ingested metal foreign body in children – with no red flags (disc battery, sharp object,

Object >5cm, multiple magnets)

• Detailed clinical notes to clearly support POAC claim, including vital signs.


• Ingested foreign body – disc battery, sharp object, object >5cm, multiple magnets.

• Inhaled foreign body in children.




• X-Ray following eligibility criteria on health pathways.

Tips

Health pathways: foreign bodies ingested by children; foreign bodies inhaled by children.

This is NOT a clinical guideline for the management of an ingested foreign body in

primary care


IV Adenosine in the management of SVT


• Patients with rapid palpitations and a systolic BP >100, where an ECG performed shows a

regular narrow complex (QRS<= 120msec) tachycardia in whom vagal manoeuvres have

been unsuccessful.



• Any patient who is haemodynamically unstable, including the pre-hospital treatment that

has been provided, as admission to hospital is inevitable.

• Any patient who has palpitations not caused by SVT.



• Routine medication reviews in managing palpitations.

• Patient presenting with a history of palpitations in the absence of palpitations at the time

of being seen in practice.


clinical notes)

• IV Adenosine (all-inclusive invoice including GP/nurse time, consumables)

Tips

Health pathways: Management of SVT in the community (once pathways are localised)

This is NOT a clinical guideline for the management of SVT in primary care


Musculoskeletal


• Adults for suspicion of pathological fracture where there is no history of injury

• Children for suspicion of SUFE



• Suspected septic arthritis, osteomyelitis. The pre-hospital treatment that has been

provided cannot be funded via POAC, as admission to hospital is inevitable. Refer acutely

to ED/orthopaedics.

• Suspected spinal tumour. Please refer via orthopaedics using the high suspicion of cancer

tab.

• Injury related X-Rays/ ultrasounds/consultations/procedures – These are funded by ACC.



• Chronic rheumatological conditions management/ investigations including joint injections.

This is routine GP business for GPs with a special interest.


clinical notes)

• X-Ray invoice


Tips

Health pathways links: Low back pain; Slipped upper femoral epiphysis; X-Ray.

X-Rays in lower back pain - https://choosingwisely.org.nz/professional-resource/australasian-

faculty-occupational-environmental-medicine/

See Appendix 7: Tips - Musculoskeletal

This is NOT a clinical guideline for the management of musculoskeletal conditions in

primary care

https://choosingwisely.org.nz/professional-resource/australasian-faculty-occupational-environmental-medicine/

https://choosingwisely.org.nz/professional-resource/australasian-faculty-occupational-environmental-medicine/


Neurology


• Patients with acute neurological conditions that can be managed safely in primary care

e.g. migraine.



• CVA/TIA – too acute to be treated under POAC, please refer to health pathways for

referral information.



• The administration of IM medications

• Medication reviews for migraine medications, mild migraines.


clinical notes)

• IV fluids in the management of dehydration secondary to migraine. (cannot claim

practice observations with this invoice) NB: cannot claim for children <15 years

• IV medications given to treat acute severe migraine.

Tips

Health pathways: Headaches in adults; Stroke; TIA.

This is NOT a clinical guideline for the management of neurological conditions in

primary care


Pneumonia/Respiratory infection


• Adults with pneumonia that can be managed safely in primary care – moderate

pneumonia (CRB65 score 1 or 2 – see below) with no other co-morbidities.

• Children with pneumonia that can be safely managed in the community.



• Severe community acquired pneumonia (CRB65 score >= 3 – see below) – refer acutely

to Respiratory medicine. These patients cannot be funded via POAC for pre-hospital

treatment, as the hospital admission is inevitable.

• Severe pneumonia in a child or any pneumonia in a child< 3 months of age or any child

with chronic lung disease, who is immunocompromised or has red flags as per fever in

children pathway - refer acutely to Paediatric medicine.



• Mild community acquired pneumonia (CRB65 score 0– see below)

• Viral URTI.


clinical notes)


• CXR if clinically appropriate

Tips

Health pathways: community acquired pneumonia in adults; pneumonia in children; X-Ray –

chest – adult; X-Ray – chest – child.

CRB65 severity score

Score 1 point for each feature present

• Confusion

• Resp rate > 30 breaths/min

• Blood pressure systolic<90mm Hg or diastolic< 60mmHg

• 65 years or older

This is NOT a clinical guideline for the management of Pneumonia in primary care


Renal/Urological


• Patients with acute urological problems that can be managed safely in primary care– e.g.:

➢ Acute indwelling catheter insertion for patient in acute urinary retention in the absence of

red flags i.e. acute trauma – straddle injury/fractured pelvis, perineal haematoma

➢ Blocked catheter, which cannot be unblocked by flushing.

➢ Uncomplicated pyelonephritis

➢ Renal colic with no red flags i.e. AAA, temperature >38, pyelonephritis, peritonitis, biliary

colic, testicular torsion, ovarian torsion, ectopic pregnancy



• Investigations for torsion of testes/torsion of testicular or epididymal appendage – refer

acutely to urology.

• Indwelling catheter claims for: Routine change of catheter/flushing of catheter resulting in

blockage resolving.

• Complicated pyelonephritis – refer acutely to general medicine.

• Investigations for painless haematuria/palpable mass/suspected malignancy in renal tract

or testes – Urgent scans through primary referred radiology via High suspicion of cancer

pathway should be used.

Severe epididymo-orchitis with systemic features or abscess – refer acutely to urology.

N.B. POAC funds a maximum of 3 catheter insertions in a 6-month period.



• Routine catheter changes, leaking catheter changes in patients with long term IDCs.

• Mild uncomplicated pyelonephritis treated with oral antibiotics.

• Investigations of testes to diagnose or rule out hydrocele/varicocoele/epididymal

cyst/hernia/haematoma/epididymo-orchitis.


clinical notes)

• Acute urinary catheter procedure (all-inclusive charge for GP/nurse time and

consumables)

• IV medication invoice


• GP/ nurse follow up


• Renal colic pathway – renal ultrasound for women <35 yrs. +/- KUB

This is NOT a clinical guideline for the management of renal/urological conditions in

primary care


Tips

Health pathways: Pyelonephritis; catheter change or trial of void; change catheter;

blocked/leaking catheter; scrotal lumps in adults; epididymo-orchitis; scrotal pain and swelling

in children; ultrasound testicle scrotum; renal colic; acute urology assessment; renal colic.

N.B. If there is a suspicion of a blocked catheter - trial flushing, then document in the referral

that you have done so. This will expedite the acceptance of your claim.

N.B Waikato DHB only: Renal Ultrasound for renal colic only funded for women < 35 yrs. All

other patients have access to CTU via Waikato Hospital.


Respiratory


• Patients with acute respiratory conditions that can be managed safely in primary care e.g.

suspected small pneumothorax, suspected small pleural effusion.



• Pulmonary embolus- refer acutely to Respiratory Medicine.

• Suspected large pneumothorax – refer acutely to Respiratory Medicine.

• Investigations to rule out malignancy. Urgent CXR through primary referred radiology via

High suspicion of cancer pathway should be used.



• URTI


clinical notes)


• CXR if clinically indicated

Tips

Health pathways: X-Ray - chest- adult.

This is NOT a clinical guideline for the management of respiratory conditions in primary

care


Respite care


• Patients who are acutely unwell and for whom 3 nights of respite care would be sufficient

to avoid a hospital admission

• Patient have to be assessed in general practice in the 48 hours prior to the request for

respite

• A definitive plan has to be in place for the patient on discharge from Primary Options

funding and is to be communicated at the time of the placement


• Patients funded under ACC

• Patients under the care of Hospice

• Patient with a current DSL allocated carer support respite

• Patients with mental health or social issues

• Patients who are unsafe to be in a respite facility i.e. prone to wander

• Patients who would require more than 3 nights respite

NB: Respite care under POAC is not to be utilised to support discharge from hospital or a failed

discharge from hospital

The request for respite care is to be made via the CCC team who will then co-ordinate the

placement of the patient. Contracted respite providers are funded directly through CCC.

Respite referral process – see Appendix 8: Respite Referral process flow chart

Tips

Contact DSL to ascertain patient’s current level of funding/package of care.

For patients discharged from hospital GPs can initiate support for the patient through ‘Acute

Home support’ on 07 8581075.

The START programme can be initiated for patients accessing respite or home help through the

service. Please indicate to the CCC team if the START programme would be appropriate for

your patient.


clinical notes)

• GP extended consult for the assessment of the patient’s suitability for respite care.


Severe allergic reaction


• Patients with a severe allergic reaction, who have not had anaphylaxis, are

haemodynamically stable and can be safely managed in the community.

• Moderate allergic reaction requiring observation in general practice.



• Any patient with anaphylaxis including the pre-hospital treatment that has been provided.

• Any allergic reaction covered by ACC. ACC covers certain allergic reactions –

https://www.acc.co.nz/assets/provider/ACC7822-cover-allergic-reaction.pdf.



• Mild allergic reactions/urticarial rash.


clinical notes)




Tips

Health pathways: allergy; anaphylaxis; angioedema; see Appendix 9 : Tips Severe allergic

reaction

https://www.acc.co.nz/assets/provider/ACC7822-cover-allergic-reaction.pdf

This is NOT a clinical guideline for the management of severe allergic reactions in

primary care




Women’s Health


• Patients who are haemodynamically stable with pelvic pain and can be safely managed in

the community.

• Investigation of retained products of conception – where patient no longer qualifies for

maternity funding i.e.

o TOP/Miscarriage – more than 14 days post event.

o Vaginal delivery – more than 6 weeks post-delivery.



• Any patient with an acute abdomen – refer acutely to Gynaecology

• Pregnancy related conditions including suspected ectopic pregnancy and heavy bleeding

due to miscarriage. Please use maternity funding stream for investigations and

management related to TOP/Miscarriage –for up to 14 days post event and vaginal

delivery –for up to 6 weeks post-delivery. If acutely unwell, refer to O&G.

• Suspicion of malignancy – please use the “high suspicion of cancer” flag and use primary

referred radiology and gynaecology clinic for investigation and management.

• Postmenopausal bleeding - Urgent scans through primary referred radiology via High

suspicion of cancer pathway should be used.

• Pelvic mass - Urgent scans through primary referred radiology via High suspicion of

cancer pathway should be used.

• Severe PID (acute abdomen, systemically unwell, mass suggestive of tubo-ovarian

abscess) – refer acutely to Gynaecology.

• Bartholin’s abscess – I&D not eligible for POAC funding.

• Suspected ovarian torsion – Refer acutely to gynaecology.



• Chronic pelvic pain – an ultrasound rarely useful unless a mass is palpated. If a mass is

palpated, please use primary referred radiology for scanning.

• PID:

1. Mild PID: considered to be routine GP business.

2. Moderate PID: considered routine GP business Refer acutely to Gynaecology if no response

to treatment within 72 hrs.

3. Severe PID – see exclusions.

• Abnormal uterine bleeding – investigation and management of this condition is routine GP

business.

• PCOS – investigation and management of this condition is routine GP business.

• Endometriosis – investigation and management of this condition is routine GP business.

• STI screening and treatment.

This is NOT a clinical guideline for the management of women’s health conditions in

primary care


• Lost Mirena – investigations considered routine GP business.

• Administration of IM medication


clinical notes)

• IV administration of pain relief

• Pelvic ultrasound scan if clinically indicated (Tip: Ultrasound scans are rarely indicated in

the diagnosis of endometriosis)


• Practice Observation unless IV medication is administered (all-inclusive invoice)


Tips

Maternity funding should be used to fund an ultrasound in a confirmed pregnancy to

investigate retained products of conception after:

➢ TOP/Miscarriage –for up to 14 days post event.

➢ Vaginal delivery –for up to 6 weeks post-delivery.

Free ultrasounds are available to patients for threatened miscarriage at ‘The Ultrasound Clinic’

in Hamilton during normal business hours, at other providers there may be a surcharge.

Health pathways: pelvic pain; endometriosis; dysmenorrhea; ovarian cancer symptoms; PID;

Lower abdominal pain in young women.


Appendix 2 : Full invoicing schedule (POAC)


Appendix 3 : One Point Lessons

How to lodge a referral (pg.1)


How to lodge a referral (pg.2)


How to lodge additional notes (pg.1)


How to lodge additional notes (pg.2)


How to lodge an invoice only (pg.1)


How to lodge an invoice only (pg.2)


How to lodge an outcome (pg.1)


How to lodge an outcome (pg.2)


Appendix 4: Tips – Abdominal Pain

https://www.acc.co.nz/assets/provider/ACC7912-Incisional-hernia.pdf

https://www.acc.co.nz/assets/provider/ACC7912-Incisional-hernia.pdf


https://www.acc.co.nz/assets/provider/ACC7913-Primary-abdominal-wall-hernias-including-

groin-hernias-guide.pdf

https://www.acc.co.nz/assets/provider/ACC7913-Primary-abdominal-wall-hernias-including-groin-hernias-guide.pdf

https://www.acc.co.nz/assets/provider/ACC7913-Primary-abdominal-wall-hernias-including-groin-hernias-guide.pdf


Appendix 5: Tips – Cellulitis and ACC Cellulitis

– IV Treatment


Appendix 6: Tips –Fever unknown origin - child


Appendix 7: Tips - Musculoskeletal


Appendix 8: Respite referrals process (POAC)


Appendix 9 : Tips - Severe allergic reaction

primary options for acute care (poac) information manual - waikato · • any patient where the...

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