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Changes to the Waikato Primary Options Acute Care programme

Pinnacle MHN manages the regional Primary Options Acute Care (POAC) programme across the Waikato region for the whole population, regardless of PHO. This funding allows primary care to provide safe, acute care within the community to reduce demand on hospital services.

We are well aware this programme is highly valued by practices, with high utilisation and a history of good patient outcomes. This has resulted in good support from Waikato DHB in the past, with overdelivery permitted and reimbursed over the past three years. This year we have been informed the programme must operate within budget. In 'real terms' this translates to a significant reduction of cases that can be supported. In the 2017-18 there were approximately 11,000 cases via POAC, this will need to reduce to approximately 8,000 for 2018-19.

Currently the programme is tracking over budget, and at this rate the funding will not last the entire financial year. It is with urgency that changes to reduce utilisation must be introduced. Our clinical team has been working on the safest and most effective way to do this, while keeping the original intent of the programme intact.

We write today to inform you a new manual (which acts as your contract service specifications) will be released at the beginning of November. Changes you can expect to see include:

  • clinical conditions and population group priorities
  • changes to follow up care claiming, and overall claim timeframes
  • more specific business rules regarding services that are claimable
  • limits on the types of radiological investigations.

We will hold information evenings to present the changes to the programme to you, and answer any questions you may have. The new manual and associated claiming rules will come into effect on 26 November 2018. In the meantime we will be working with practices to ensure all cases are for patients that general practice can safely provide acute care for in the community, decreasing the need for hospitalisation. 

If this first round of changes doesn't reduce utilisation enough we may need to consider other options such as providing practices with notional volumes for cases, based on your enrolled population. If this becomes necessary we will regularly update you on usage.

All Waikato primary care networks are working together with the DHB on a longer term plan for the programme including implementing recommendations from the recent independent review.

We welcome all your feedback during this process, please contact Puamiria Maaka, Pinnacle MHN operations manager,  or Andrew Swanson-Dobbs, Pinnacle MHNgeneral manager.

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