Women’s health (POAC)

All Pinnacle practices in the Te Whatu Ora Lakes area.

• Patients domiciled in Te Whatu Ora Lakes area.
• 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: 
• TOP/miscarriage – more than 14 days post event  
• vaginal delivery – more than 6 weeks post-delivery.  

• Patients not domiciled in Te Whatu Ora Lakes area.
• 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: 
  • mild PID: considered to be routine GP business
  • moderate PID: considered routine GP business Refer acutely to Gynaecology if no response to treatment within 72 hrs  
  • 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  
• Administration of IM medication. 

Exclusion criteria to access POAC funding should not preclude emergency treatment of any medical conditions. 

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.    

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

Please make your claim via Primary Options, select Women's Health and then attach the appropriate invoice(s).

Prices listed below are GST inclusive.

IV medication: $87
This invoice is a package of care i.e. it includes an allocation for staff time as well as consumables, it cannot be claimed along with any other claims. 

Practice observations: $1.00 per minute  or

Rural practice observations: $1.00 per minute 

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

 Practice observations – maximum 3 hours and based on treatment provided as evidenced in clinical notes. This invoice can only be claimed at the time of the initial consultation.

In-clinic observations can be claimed based on 3 x 10 minute baseline observations per hour.

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/CP follow up: $79 or RN follow up: $39 or

Rural GP/NP/CP follow up: $89 or RN follow up: $49 or

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

Afterhours GP/NP/CP follow up: $99 or RN follow up $59

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

A follow-up visit may be funded (based on treatment provided as evidenced in clinical notes).

This is limited to one consult within the acute episode of care. While follow up consultations can be virtual, to be eligible for funding, documentation needs to include a two-way conversation between the practice and the patient. A sent message with no documented response does not meet the definition of a 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. 

Funded via third party providers 
A pelvic ultrasound is funded under this service if it is clinically indicated (Tip: Ultrasound scans are rarely indicated in the diagnosis of endometriosis). 

Radiology is only funded for same-day investigations (within a 24-hour period). 

Patients who are not acutely unwell and do not require a same day ultrasound are not funded under POAC and should be referred to primary referred radiology.  

GP provided point of care ultrasound is excluded from POAC services – it is expected that patients will be charged for this service. 

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. 

Note ultrasounds are available to patients for threatened miscarriage in Rotorua and Taupo at TRG – there is a surcharge of $20.00 unless the patient has been referred from the DHB or has a community services card. 

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

The service is funded by Te Whatu Ora.