Proactive respiratory care programme

Any Pinnacle practice in Lakes can offer and claim for this service.

This service includes funding for two consultations with any clinical member of staff and one consultation with a prescriber. 

This will enable full review of the patient’s respiratory condition, identification of any unmet needs or education requirements, development of a management plan and follow up to evaluate the patients understanding of their self-management.

The key outcomes from these extended consultations should include:

• full review of the patients’ respiratory condition including ACT/CAT assessment
• spirometry testing if appropriate
• review of medications which may include a referral to pharmacy for further detailed medication education
• education of inhaler technique
• development of written patient self-management/action plan
• provision of subsidised vaccine (e.g. influenza, shingles) - note patients can be charged for non-subsidised vaccines such as pneumovax if clinically indicated
• discussion of eligibility for anti-virals should patient test positive for COVID-19
• Referral to relevant services which may include
  • Smoking cessation support
  • Healthy homes service
  • Pulmonary rehab
  • Social services
  • Health improvement practitioner
  • Pinnacle extended care team

Patients with asthma, COPD or bronchiectasis who are either

• Māori or Pacific or Q5 or CSC holders who are at high risk of respiratory exacerbation over the winter months (e.g. prescribed regular preventer inhalers and yet still have a number of exacerbations requiring short course steroids +/- frequent repeat prescriptions for reliever inhalers)

OR

• Patients who have had a respiratory related hospital admission or ED presentation in the past 12 months

You cannot claim under the service for a patient who is acutely unwell at the time of consultation.

The programme will fund a total of three consultations per patient per calendar year.

• Patients not enrolled in a Lakes Pinnacle general practice.
• Out of region patients do not have funding provided under this programme.
• Patients with long COVID-19 symptoms that have not resulted in a diagnosis of asthma or COPD.

You cannot claim under this service for a patient who is acutely unwell at the time of consultation.

This funding is only available for care provided between 1 April and 30 June 2026.

Submit your referral via Primary Options using the initial condition coding: Proactive Respiratory Care.

When invoicing for the service please lodge an 'outcome and invoice' form and select the appropriate invoice(s).

The prices listed below are GST inclusive. 

Please note only one claim can be made per consultation.

Proactive Respiratory RN review - In person (once only): $81.37 
Full review of the patient’s respiratory condition to include ACT/CAT assessment, spirometry testing as appropriate, review of medications, development of a management plan, inhaler and condition education, referrals as appropriate. This consultation should be a face to face.

Proactive Respiratory Prescriber review - In person or virtual (once only): $81.37 
To include medication review, authorisation of a management plan, prescriptions for medications to treat exacerbations. This consultation can be provided by any prescriber.

Proactive Respiratory RN follow-up - In person or virtual (once only): $40.17
Follow up consultation to ensure the patient is comfortable managing their respiratory condition, including appropriate inhaler use and provision of further education. 

These consultations cover all time and consumables and there can be no extra charge to the patient.

You cannot claim under this service for a patient who is acutely unwell at the time of consultation.

For indici practices the claim form will require you to identify how the patient meets the criteria

For non indici practices we will require you to confirm the CSC, Q5 and/or respiratory related hospital admission or ED presentation in the past 12 months criteria within the clinical notes

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

For indici practices the claim form will require you to identify how the patient meets the criteria

For non indici practices we will require you to confirm the CSC, Q5 and/or respiratory related hospital admission or ED presentation in the past 12 months criteria within the clinical notes

No. A patient co-payment cannot be charged.

If a patient presents with an exacerbation of their condition and is acutely unwell you can still claim Primary Options for Acute Care where the treatment provided in general practice is preventing an admission to the emergency department. Please remember the patient still funds the initial consult in that instance.

Yes, please claim as usual for cases where a patient presents acutely with an exacerbation of their condition and the treatment provided in general practice is preventing an admission to the emergency department.

If the patient meets POAC criteria, please initiate a separate referral for any invoices claimed under that POAC pathway.

POAC cannot be claimed on the same day as any of the above consultations.

The service is funded by Te Whatu Ora.