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Programmes » Respite care (POAC) - Tairāwhiti

Respite care (POAC)

Tairāwhiti | Wellbeing | Under 18 | Over 18 | Over 65

Overview

Treatment of patients who are acutely unwell and for whom 4 nights of respite care would be sufficient to avoid a hospital admission. 

This service is part of the Primary Options for Acute Care (POAC) programme.

Your Pinnacle Services Contract applies to this service. By claiming for this service, you have indicated that you have read and agreed to the business rules set out here.

This is NOT a clinical guideline. 

Details

Which practices can claim for this service?

All practices in Tairāwhiti region can claim for this service. 

Who is eligible for this service?
  • Patients domiciled in Te Whatu Ora Tairāwhiti area.
  • Patients who are acutely unwell and for whom four nights of respite care would be sufficient to avoid a hospital admission.  
  • Patients 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. 
  • Respite care is for those patients who require rest home level care rather than hospital level care.
  • Patients who are prone to wander or are frequent fallers are not suitable for respite care
Who is excluded from the service?
  • Patients not domiciled in Te Whatu Ora Tairāwhiti area.
  • 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 four nights respite. 

NB: Respite care under POAC is not to be utilised to support discharge from hospital or a failed discharge from hospital. 
  
 
Exclusion criteria to access POAC funding should not preclude emergency treatment of any medical conditions. 

When is the service complete?

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 can 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. Please indicate this in the clinical outcome.  

Claiming guidelines

The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient. If the claim cannot be funded by POAC, the patient may be liable to the practice for the fees incurred. 

Respite care is for those patients who require rest home level care rather than hospital level care.

The request for respite care is to be made via the Primary Options team who will then authorise funding for the placement of the patient.

Once funding is approved the practice can then liaise directly with the whanau and respite care providers to determine the most suitable available placement.

Please note:

 

  • Patients who need continence products, must provide their own products while in respite care to avoid being charged
  • Medications need to be blister packed
  • Patients need to have their own transport arranged.
  • Patients who are prone to wander or are frequent fallers are not suitable for respite care

 

Contracted respite providers are funded directly through Primary Options. The facility can contact the Primary Options team to confirm funding should they choose, however providing the facility with the patients authorised Primary Options number is sufficient.

Please make your claim via Primary Options, select Respite Care and then attach the appropriate invoice(s).

Prices listed below are GST inclusive.  

GP/NP/CP extended consultation: $79 or 

Rural GP/NP/CP extended consultation: $89 or

This funding is available to those practices that receive rural funding. 

Afterhours GP/NP/CP Extended consultation: $99 

This funding can be claimed when care is provided after 5pm, on weekends or on public holidays.

To cover an additional 15 minutes of GP/NP time above the initial 15-minute consultation. This invoice can be claimed twice per episode of care to fund a maximum of 30 minutes of additional time. This invoice can only be claimed at the time of the initial consultation

GP/NP home visit: $126 or RN home visit: $79
This is limited to one per episode of care within 3 days of the initial consult and cannot be claimed on the day of the initial consult. 

GP/NP home visit: $126 or RN home visit: $79 
This is limited to one per episode of care within 3 days of the initial consult and cannot be claimed on the day of the initial consult. 

 

What level of clinical notes do I need to submit?

Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of POAC funding.  

Respite care is for those patients who require rest home level care rather than hospital level care.

The request for respite care is to be made via the Primary Options team who will then authorise funding for the placement of the patient.

Once funding is approved the practice can then liaise directly with the whanau and respite care providers to determine the most suitable available placement.

Please note:

 

  • Patients who need continence products, must provide their own products while in respite care to avoid being charged
  • Medications need to be blister packed
  • Patients need to have their own transport arranged.
  • Patients who are prone to wander or are frequent fallers are not suitable for respite care

 

Contracted respite providers are funded directly through Primary Options. The facility can contact the Primary Options team to confirm funding should they choose, however providing the facility with the patients authorised Primary Options number is sufficient.

Does the patient have to pay?

The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient. 

How is the service funded?

The service is funded by Te Whatu Ora. 

Contact

Primary options team, Pinnacle Midlands Health Network
infoprimaryoptions@pinnacle.health.nz
027 687 7312

Contact Kate Torrie, 06 869 0500 ext 8707, Tairāwhiti DHB Needs Assessment and Coordination Service (NASC), to ascertain the patient's current level of funding/package of care.

RELATED RESOURCES
Primary Options radiology providers
Published: 15/07/2020 | Document

Pinnacle has contracts with a number of radiology providers under Primary Options for Acute Care (POAC).

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POAC business rules - Tairāwhiti
Published: 03/08/2020 | Document

Business rules for the Primary Options Acute Care programme (Tairāwhiti), which supports primary care through funding specific clinical services.

View resource
Primary Options resources
Published: 18/02/2025 | 22 files | Document

Quick guides to assist practices with identifying eligibility criteria;invoices that can be claimed; managing claims and providing assistance with understanding remittance reports

View resource | Download files
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