Primary Options Update

20 Feb 2019

We would ask that in order to reduce the information requests coming back to practices, please do not initiate referrals unless there is to be an claim attached to the referral. This invoice could either be from your practice or from a radiology provider if a diagnostic Ultrasound or X-Ray has been requested. If there is no invoice, we will not accept but delete the referral to ensure that the numbers stay within the contractual amount.

The monthly GP peer review group will meet again from February. At these meetings cases are randomly audited to ensure decisions made by the Primary Options team are consistent with those that would be made by other GPs

Changes to the POAC contract in Waikato were required after WDHB indicated they would not fund any overspend as they had done in previous years. In order to manage within the contract allocation Pinnacle MHN was required to review the delivery of POAC. The changed business rules that came into force with the revised POAC manual have now been in place since Nov 26th, 2018.  We are very appreciative of the effort practices have made to provide clear concise information to ensure the referrals can be accurately assessed. Since those changes were implemented, utilisation against the contracted volumes and funding is more proportionate. Quarter 1 practice claims utilized 39% of the annual volumes and funding, which has dropped to 29% of annual volumes and funding in Quarter 2. While there has been considerable improvement made in the performance against the contract for the last 6 months of the contract, we have only 32% of the available volumes and funding remaining. As a result, for the last months of this financial year referral volumes will need to be capped. Further communication regarding this will be sent in due course.