Asthma care that works for practices

Small, practical system changes can make a meaningful difference in asthma care. Over the past two years, Pinnacle has shifted from pay-for-performance to a quality improvement programme (QIP), with a strong early focus and uptake on respiratory health – particularly asthma – in Taranaki.

Why we changed

The shift was driven by what Pinnacle was seeing on the ground. Target-based incentives can unintentionally disadvantage practices serving communities with the greatest barriers to care.

“Pay-for-performance didn’t reduce inequities. It can pull money away from highneed communities because the teams facing the greatest barriers to care are least likely to hit targets. We needed an approach that supports system change, not just target chasing,” says Pinnacle clinical director, Dr Jo Scott-Jones.

Rather than paying only for target achievement, Pinnacle’s quality improvement programme provides a capacity payment based on enrolled service users (ESUs) supported by dashboards, practice-level data, resources, education and tools, and the flexibility for practices to choose improvement areas that fit their context.

Why asthma and Taranaki?

Asthma is a natural focus because it’s common, clinically significant and measurable. In rural settings like Taranaki, better long-term control can also ease pressure on urgent care and hospital services and reduce disruption for whānau.

Jessica Knight, Pinnacle nurse lead in Taranaki, says the focus resonated locally. “In Taranaki, asthma control isn’t just a guideline issue; it also affects urgent care demand, travel, and how stretched teams are day to day. Practices could see this as a practical way to make a real difference,” she said.

What we focused on improving, and what helped change stick

Practices focused on practical, measurable indicators of safer and more effective asthma care – reducing SABA use without ICS and supporting ICS use following asthma admission.

This work is primarily tracked through process measures. “We’re not overclaiming network-wide outcomes yet, but these indicators align with safer, more effective asthma management and long-term control,” says Jo.

A key shift was moving away from ‘GP-only’ change. The work was most effective as a whole-of-team approach with GPs, nurses (including nurse prescribers and nurse practitioners), kaiāwhina and admin staff, supported by simple workflow changes and a shared improvement focus.

QIP was designed to align with the College’s Cornerstone CQI module. Having usable data and practical support can reduce duplication and make CQI more achievable for busy teams, which matters for building Cornerstone-accredited teaching practices. 

The training partnership with Asthma New Zealand

Katie Faaiuaso, nurse lead at Asthma NZ, says local delivery reduces barriers for rural teams and creates a safe space for shared learning and peer support that’s hard to replicate online.

Through the partnership, Asthma NZ delivered locally facilitated, kanohi ki te kanohi (face-to-face) respiratory education sessions in Taranaki, tailored to general practice teams and focused on practical, evidence-based asthma and COPD management.

The training strengthened team confidence and capability. “Teams were better equipped to teach correct inhaler technique, proactively implement asthma action plans, and identify patients needing review earlier,” said Jessica.

Where to next

Asthma is one part of a wider quality improvement programme, but it shows what’s possible when improvement is practical, team-based and supported. The aim is to help practices deliver consistent high-quality asthma care, reduce inequities and sustain change over time, with a fair approach that doesn’t disadvantage high-need communities.

Next steps in Taranaki include COPD training and a three-month respiratory push (April–June) aligned with Respiratory POAC funding. This includes templates and practice resources, and funded consults so high-risk patients can be seen free of charge, strengthening equity for those most affected.

Asthma NZ also plans to continue the partnership with Pinnacle by repeating and scaling the locally delivered training model, alongside ongoing support, networking and regular sharing of best practice.

View this story in the April 2026 GP Voice magazine.