files/abou… · web vie

Proposed Changes to the Quality and Outcomes Framework: 2014/15

Summary

Proposed points to be removed

Clinical domain Table 1 221Public Health domain Table 2 49Patient Experience domain Table 3 33Organisational domain Table 4 41Transfer to new QOF Local Service Development Domain. (44)

Total 300

Effect of proposed changes

Clinical Domain Indicators and Public Health Domain Indicators The effect of removing the indicators will not reduce clinical workload, rather it will allow GPs to use professional judgement to treat their patients according to best practice guidelines, and will reduce bureaucracy, unnecessary patient testing and unnecessary frequency of patient recall and recording. Consideration is also being given to how to monitor future quality of care provision of the removed indicators through GP local cluster groups. A number of indicators have been also retained but timescales have been extended.

Patient Experience Domain The removal of this indicator will allow GPs to adopt flexibility in appointment setting based on clinical need.

Organisation Domain The removal of these indictors reflects embedded good GP practice and will reduce an administrative workload.

Application of points to removed

All points to apply to GSE at full points value [ i.e. no 6% reduction for OOH]

1

Table 1: Clinical domain

QOF ID Points Value

Indicator wording Rationale for change / amendment Proposed change / amendment

PointsValue

New PointsValue

Points to be Removed

AF 001 5 The contractor establishes and maintains a register of patients with atrial fibrillation

Register established Reduce points to acknowledge embedded in general practice

Retain – but reduce points 5 2 3

AF002 10 The percentage of patients with atrial fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the preceding 12 months (excluding those whose previous CHADS2 score is greater than 1)

Unnecessarily prescriptive Extending the timeframe to 3 years will ensure that reviews of risk assessment are driven by individual patient circumstances, taking into account patient preferences. This approach will reduce bureaucracy and unnecessary repeat of risk assessment, encouraging greater use of clinical judgement. Reduce points to reflect timeframe extension.

Retain. Extend timeframe from 15 months to 3 years to allow greater use of clinical judgement

10 5 5

CHD 001

4 The contractor establishes and maintains a register of patients with coronary heart disease



CHD003 17 The percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the preceding 12 months) is 5 mmol/l or less

Embedded in general practiceCholesterol management is considered to be embedded in General Practice. Periodic data extraction will confirm that good practice in cholesterol management is maintained .

Retire 17 0 17

2

QOF ID Points Value


PointsValue

New PointsValue


HF001 4 The contractor establishes and maintains a register of patients with heart failure



HYP 001

6 The contractor establishes and maintains a register of patients with established hypertension

Register established.Reduce points to acknowledge embedded in general practice


HYP003 50 The percentage of patients aged 79 or under with hypertension in whom the last recorded blood pressure reading (measured in the preceding 9 months) is 140/90 mmHg or less

Unnecessarily prescriptive NICE supports removal of indicators HYP004 and HYP005 as they believe they are not based on clinical need. QOF indicators will continue to measure the proportion of patients with hypertension in whom the last blood pressure reading (measured in the preceding 9 months) is 150/90 mmHg or less. The removal of these indicators is not expected to have a significant impact on clinical outcomes and will allow general practice to flex their clinical approach based on the need of individual patientsIn relation to HYP002: extend timeframe to 12 months, add 15 points from HYPOO3. Total points revised to 25. Retain upper threshold.

Retire [HYP002: extend timeframe to 12 months and add 15 points from HYPOO3]

45 0 30

3

QOF ID Points Value


PointsValue

New PointsValue


PAD 001

2 The contractor established and maintains a register of patients with peripheral arterial disease

Unnecessarily prescriptive See above. The management of risk factors is identified through a number of indicators. However, work has been initiated to develop an holistic approach to cardiovascular risk management across Wales and this will include the management of peripheral arterial disease.

Retire 2 0 2

PAD 002

2 The percentage of patients with peripheral arterial disease in whom the last blood pressure reading ( measured in the preceding15 months) is 150/90 mmHg or less

Unnecessarily prescriptive See above

Retire 2 0 2

PAD003

3 The percentage of patients with peripheral arterial disease in whom the last measured total cholesterol (measured in the preceding 12 months) is 5 mmol/l or less

Overlap/duplicationNICE commented that PAD indicators collectively may see most patients covered by other parts of QOF (i.e. coronary heart disease and hypertension). The number of patients with PAD only would be extremely small.

Retire 3 0 3

4

QOF ID Points Value


PointsValue

New PointsValue


PAD 004

2 The percentage of patients with peripheral arterial disease with a record in the preceding 15 months that aspirin or an alternative ant-platelet is being taken.

Unnecessarily prescriptive See above

Retire 2 0 2

STIA004

2 The percentage of patients with stroke or transient ischaemic attack (TIA) who have a record of total cholesterol in the preceding 12 months

Embedded in general practice

Cholesterol management is considered to be embedded in General Practice. Periodic data extraction will confirm that good practice in cholesterol management is maintained

Retire. 2 0 2

5

QOF ID Points Value


PointsValue

New PointsValue


Embedded in general practiceCholesterol management is considered to be embedded in General Practice. Periodic data extraction will confirm that good practice in cholesterol management is maintained

STIA005

5 The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of DM whose last measured total cholesterol (measured in the preceding 12 months) is 5 mmol/l or less

Retire .

5 0 5

DM001 6 The contractor establishes and maintains a register of all aged 17 years or over with diabetes mellitus which specifies the type of diabetes

Register establishedReduce points to acknowledge embedded in general practice


DMOO4 6 The percentage of patients with diabetes on the register whose last measured total cholesterol ( measured in the preceding 15 months) is 5mmol/or less

Embedded in general practice Cholesterol management is considered to be embedded in General Practice. Annual data extraction through the National Diabetes Audit will confirm that good practice in cholesterol management is maintained

Retire 6 0 6

6

QOF ID Points Value


PointsValue

New PointsValue


DM005 3 The percentage of patients with diabetes, on the register, who have a record of an albumin :creatinine ratio test in the preceding 12 months

Embedded in general practice

The management of diabetes is considered to be established in General Practice. Process and outcome measures will be monitored through the National Diabetes Audit.

Retire 3 0 3

DM006 3 The percentage of patients with diabetes on the register with a diagnosis of nephropathy ( clinical proteinuria) or micro albuminuria who are currently treated with an ACE- 1 ( or ARBs)

See aboveRetire 3 0 3

DM009 The percentage of patients with diabetes on the register in whom the last IFCC HbA1c is 75 mmol / mol or less in the preceding 15 months

See aboveRetire 10 0 10

DM011 5 The percentage of patients with diabetes, on the register, who have a record of retinal screening in the preceding 12 months

Not appropriate to general practiceRetinal screening is not delivered by general practice.

Retire 5 0 5

7

QOF ID Points Value


PointsValue

New PointsValue


DM013 3 The percentage of patients with diabetes, on the register, who have a record of a dietary review by a suitably competent professional in the preceding 12 months

Unnecessarily prescriptiveQOF will continue to require registers of patients with diabetes and provide incentives for a range of associated interventions and outcomes, including blood pressure control, cholesterol control, control of HbA1c, flu immunisation, foot examinations, and referral to structured education programme for newly diagnosed patients. Dietary review is considered to be a core element of diabetes care, which is established in General Practice.A review of the Diabetes Directed Enhanced Service will be undertaken to ensure that appropriate incentives are in place to maintain and develop the quality of diabetes care in the community.

Retire 3 0 3

DM015 4 The percentage of male patients with diabetes, on the register, with a record of being asked about erectile dysfunction in the preceding 12 months

Unnecessarily prescriptiveNICE confirmed that it may not be necessary to deliver DMO15 and DM016 annually and would support their removal. . Extending the timeframe to 3 years recognises the importance of dialogue that is sensitive to individual patients needs. This

RetainExtend timeframe from 15 months to 3 years to allow greater use of clinical judgement.

4 4 0

8

QOF ID Points Value


PointsValue

New PointsValue


approach will ensure that patients have a regular opportunity to discuss any concerns but will allow greater use of clinical judgement in relation to the frequency of questioning.Reduce points to reflect timeframe extension.

DM016 6 The percentage of male patients with diabetes, on the register, who have a record of erectile dysfunction with a record of advice and assessment of contributory factors and treatment options in the preceding 12 months


6 3 3

THY001 1 The contractor establishes and maintains a register of patients with hypothyroidism who are currently treated with levothyroxine

Embedded in general practiceNICE support removal of this indicator.Management established in General Practice.

Retire 1 0 1

THY002 6 The percentage of patients with hypothyroidism, on the register, with thyroid function tests recorded in the preceding 12 months

Embedded in general practiceThese indicators are at high achievement levels and NICE has noted that these patients were managed effectively prior to the inclusion of these indicators in QOF. The removal of these indicators will allow general practice to flex their clinical approach based on the need of individual patients.

Retire 6 0 6

9

QOF ID Points Value


PointsValue

New PointsValue


AST 001

4 The contractor establishes and maintains a register of patients with asthma, excluding patients with asthma who have been prescribed no asthma related drugs in the preceding 12 months

Register established Reduce points to ensure consistency across disease registers.

Retain 4 2 2

DEM 001

5 The contractor establishes and maintains a register of patients with dementia

Register established Reduce points to ensure consistency across disease registers.

Retain, but reduce points 5 2 3

DEM 003

6 The percentage of patients with a new diagnosis of dementia recorded in the preceding 1 April to 31 March with a record of FBC , calcium, glucose renal, and liver function, thyroid function tests, serum vitamin B12 and folate levels recorded between 6 months before or after entering on to the register

Covered through DEM 002 Retire 6 0 6

10

QOF ID Points Value


PointsValue

New PointsValue


DEP001 21 The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have had a bio-psychosocial assessment by the point of diagnosis. The completion of the assessment is to be recorded on the same day as the diagnosis is recorded

No significant impact on clinical outcomes

NICE supports the removal of this indicator on the basis that there is no evidence it has a significant impact on clinical outcomes. General practitioners provide an holistic approach to care for all conditions, including consideration of all aspects of a bio psychosocial assessment.

Retire 21 0 21

MH001 4 The contractor establishes and maintains a register of patients with schizophrenia, bipolar affective disorder, and other psychoses and other patients on lithium therapy.

Register established Reduce points to acknowledge embedded in general practice.


11

QOF ID Points Value


PointsValue

New PointsValue


MH 003 4 The percentage of patients with schizophrenia , bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 15 months

Directed Enhanced Service in place A Directed Enhanced Service is supporting the development of GPs and their practice teams to better understand and support the needs of patients with these conditions. This work will ensure that routine chronic disease management services are accessible to all patients. Periodic data extractions will review the management of care for this patient group.

Retire 4 0 4

MH004 5 The percentage of patients aged 40 or over with schizophrenia, bipolar affective disorder and other psychoses who have a record of total cholesterol:hdl ratio in the preceding 12 months

As above

As above

Retire . 5 0 5

MH005 5 The percentage of patients aged 40 or over with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose or HbA1c in the preceding 12 months

Retire 5 0 5

12

QOF ID Points Value


PointsValue

New PointsValue


As above MH006 4 The percentage of

patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in the preceding 12 months

Retire 4 0 4

MH011 6 The % of patients with schizophrenia…

New indicator to cover MH 3,4,5,6

[ 12]

EP002 6 The percentage of patients aged 18 or over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded in the preceding 12 months

Not sufficiently within control of general practiceMany patients with epilepsy will not have had a seizure in last 12 months and those who do are frequently not within the control of general practice.

Retire 6 0 6

EP003 3 The percentage of women aged 18 or over and who have not attained the age of 55 who are taking antiepileptic drugs who have a record of information and counselling about contraception, conception and pregnancy in the preceding 12 months

Unnecessarily prescriptiveExtending the timeframe to 3 years will reduce bureaucracy and unnecessary testing and will allow greater use of clinical judgement. Reduce points to reflect timeframe extension.

Note that NM 71 replaces EP003 but 55 years retained


3 2 1

13

QOF ID Points Value


PointsValue

New PointsValue


RA003 7 The percentage of patients with rheumatoid arthritis aged 30 or over and who have not attained the age of 85 who have had a cardiovascular risk assessment using a CVD risk assessment tool adjusted for RA in the preceding 12 months

Unnecessarily prescriptiveExtending the timeframe to 3 years will reduce bureaucracy and unnecessary testing and will allow greater use of clinical judgement. Reduce points to reflect timeframe extension

Unnecessarily prescriptiveExtending the timeframe to 3 years will reduce bureaucracy and unnecessary testing and will allow greater use of clinical judgement. No reduction in points


7 4 3

RA004 5 The percentage of patients aged 50 or over and who have not attained the age of 91 with rheumatoid arthritis who have had an assessment of fracture risk using a risk assessment tool adjusted for RA in the preceding 24 months

RetainExtend timeframe to 3 years to allow greater use of clinical judgement

5 5 0

PC002 3 The contractor has regular ( at least three monthly) multi disciplinary case review meetings where all patients on the palliative care register are discussed

Amend to require 2 monthly meetings 3 6 [3]

14

QOF ID Points Value


PointsValue

New PointsValue


OST00 1

3 The contractor establishes and maintains a register of patients…aged 50 or over and aged 75 or over .. with fragility fracture



LD001 4 The contractor establishes and maintains a register of patients aged 18 or over with learning difficulties.



OB001 8 The contractor establishes and maintainsa register of patients aged 16 or over with a BMI > = 30 in the preceding 15 months



COPD001

3 The contractor establishes and maintains a register of patients withCOPD

Register establishedReduce points to acknowledge embedded in general practice.


15

QOF ID Points Value


PointsValue

New PointsValue


COPD004

7 The percentage of patients with COPD with a record of FEV1 in the preceding 12 months

Unnecessarily prescriptiveApply only for MRC dyspnoea ≥ 3 in the preceding 12 months. Reduce points to reflect restricted application. Patients with MRC dyspnoea scores less than 3 will be monitored according to an agreed personal care plan.

Retain – but reduce points

.

7 4 3

CAN001 5 The contractor establishes and maintains a register of all cancer patients defined as a register of patients with a diagnosis of cancer excluding non melanotic skin cancers diagnosed on or after 1 April 2003



16

QOF ID Points Value


PointsValue

New PointsValue


CKD 32 Entire domain Adopt a holistic approach to cardiovascular risk assessment NICE agree that the definitions of CKD may have been broadened too widely as healthy people may be labelled with CKD and declining kidney function is in line with normal ageing. NICE noted that CKD is a risk factor for CVD, but also noted the uncertainties associated with this set of indicators and the importance of reviewing the indicators when the CKD guideline has been updated and published (provisionally due for publication July 2014).The intention is to adopt a more holistic approach to cardiovascular risk assessment at locality level whilst also preparing for the introduction of the National CKD audit.

Retire 32 0 32

AF003 6 AF003. In those patients with atrial fibrillation in whom there is a record of a CHADS2 score of 1 (latest in the preceding 12 months), the percentage of patients who are currently treated with anti-coagulation drug therapy or anti-platelet therapy

Unnecessarily prescriptiveExtend timeframe to 3 years to allow greater use of clinical judgement and remove brackets “ latest in the preceding 12 months”. Reduce points to reflect timeframe extension

RetainExtend timeframe to 3 years to allow greater use of clinical judgement and remove brackets “ latest in the preceding 12 months”

6 3 3

Total 221

17

Table 2: Public health domain

QOF ID Points Value


Points New Points Value

Points Removed

CVD-PP002

5 The percentage of patients diagnosed with hypertension (diagnosed after on or after 1 April 2009) who are given lifestyle advice in the preceding 12 months for: smoking cessation, safe alcohol consumption and healthy diet

Sufficiently embedded in general practiceNICE advises that these interventions should be undertaken if there is a positive finding of hypertension, but considers that they are probably now part of routine practice and that the QOF indicator doesn’t assess the quality of the intervention.

The removal of these indicators will allow general practice to flex their clinical approach based on the need of individual patients. The activity described in these indicators is embedded in general practice.

Retire 5 0 5

SMOK001 11 The percentage of patients aged 15 or over whose notes record smoking status in the preceding 24 months

Duplication/overlapNICE support the removal of this indicator as there is overlap with local initiatives and with another indicator (SMOK004) so there will be no impact on clinical care.

Retire 11 0 11

SMOK 003

2 The contractor supports patients who smoke in stopping smoking by a strategy which includes providing literature and offering appropriate therapy

Embedded in general practiceThis work is embedded in General Practice and will be further developed through Locality Networks, with particular emphasis on collaborative working with Public Health, Community Pharmacy and Voluntary Sector services to improve smoking cessation rates

Retire 2 0 2

18

QOF ID Points Value



Points Removed

BP 001 15 The percentage of patients aged 40 or over who have a record of blood pressure in the preceding 5 years

Base on local commissioning

agree that the age range for this indicator should be based on local commissioning. This indicator relates to a significant workload at lower ages as patients are less likely to attend the GP surgery for other conditions.

By amending the age range 50 years this indicator will focus on the aged group 45+ where risks are more significant than at younger ages.

Retain 10 5

CHS001 6 Child development checks are offered at intervals that are consistent with national guidelines and policy agreed with NHS England

Duplication/overlapNICE support the removal of this indicator as they do not believe it supports the quality of delivery within general practice. It is duplicated in national guidelines.

Retire 6 0 6

CS003 2 The contractor ensures there is a system for informing all women of the results of cervical screening tests

Not responsibility of general practiceThis indicator as it is not the responsibility of general practice.

Retire 2 0 2

19

QOF ID Points Value



Points Removed

CS004 2 The contractor has policy for auditing its cervical screening service and performs an audit of inadequate cervical screening tests in relation to individual sample takers at least every two years

Protocol in place GP (and nurses) participate in annual appraisal and skills are audited. CSIW protocols in place where smear takers with high proportion of inadequate smears / not sampling of TZ zone is highlighted to the individual.

Retire 2 0 2

MAT001 6 Antenatal care and screening are offered according to current local guidelines agreed with NHS England

Duplication/overlapNICE support the removal of this indicator as they do not believe it supports the quality of delivery within general practice. It is duplicated in national guidelines.

Retire 6 0 6

CON002 3 The percentage of women, on the register, prescribed an oral or patch contraceptive method in the preceding 12 months who have also received information from the contractor about long acting reversible methods of contraception in the preceding 12 months

Sufficiently well embedded in general practiceNICE support the removal of this indicator as achievement is high and the activity is embedded in general practice.

Retire

3 0 3

CON 001 4 The contractor establishes and maintains a register of women…

Sufficiently well embedded in general practice

Retire 4 0 4

20

QOF ID Points Value



Points Removed

CON 003 4 The percentage of women, on the register prescribed emergency hormonal contraception …

Sufficiently well embedded in general practiceAlso, recognition that other 3rd parties can prescribe emergency contraception and GP practices not aware of this.

Retire 3 0 3

Total 49

21

Table 3: Patient Experience domain

QOF ID Points Value

Indicator wording Rationale for change Wales Points New Points Value

Points Removed

PE001 33 Length of routine consultation not less than 10 minutes .

To enable flexibility in appointment setting to reflect clinical need and to recognise the increasing range of approaches to access advice.

Retire 33 0 33

Total 33

Table 4: Organisation domain QOF ID Points

ValueIndicator wording Rationale for change Wales Points New

Points Value

Points Removed

REC 001 1 System for transferring and acting on information about patients seen by otherDoctors

Sufficiently embedded as good practice. Retire 1 0 1

REC 002 2 System to alert out of hours service or duty doctor to patients dying at home


EDU 001 3 Annual review of patient complaints

Review of complaints part of process in addressing Francis Review and Robbie Powell. This will be covered through new requirement for completion of CGSAT.

Retire 3 0 3

EDU 002 4 Undertake12 significant event reviews in preceding 3 years

Review of significant events part of process in addressing Francis Review and Robbie Powell. This will be covered through new requirement for completion of CGSAT .

Retire 4 0 4

22

QOF ID Points Value


Points Removed

EDU 003 6 Undertake 3 significant event reviews in the preceding year

Review of significant events part of process in addressing Francis Review and Robbie Powell. This will be covered through new requirement for completion of CGSAT.

Retire 6 0 6

MAN002 3 Range of appointment times to patients to include mornings and afternoon

See PE domain removal. Retire 3 0 3

MAN003 3 The contractor has a protocol for the identification of carers and a mechanism for the referral of carers for social services


MAN001 1 Individual healthcare professionals have access to information on local procedures relating to Child Protection


MED 001 2 Possess equipment and emergency drugs to treat anaphylaxis


MED 002 2 System to check expiry dates on emergency drugs


MED 003 3 Hours from requesting a prescription to availability is 72 hours or less


MED 004 6 Hours from requesting a prescription to availability is 48 hours or less


23

QOF ID Points Value


Points Removed

MED 008 8 Medication review in preceding 15 months

Addressed through MED 7 . Retire But add 3 points to MED 007

8 0 5

Total 41

Notes :

Seasonal flu: The timeframe for the 2013/14 seasonal flu indicators is 1 September to 31 March each year. Amend the indicators to allow GP practices to begin vaccinating from 1 August each year to commence the programme. Change to apply to CHD004, COPD006, DM010 and STIA006. No change to points.

Cancer review (CAN002, 6 points): amend the timeframe from three months to six months to allow greater flexibility to according to the pattern of care of individual patients given that contact within three months may not be necessary for all patients. However, where clinically appropriate, a review will be delivered within three months. Amend wording to include telephone consultation with offer of face to face appointment. No change to points

Depression review (DEP002, 10 points): Retain and amend timeframe to 2-8 weeks. No change to points.

Referral after a stroke or TIA (STIA002, 2 points): Since not clinically necessary to refer a patient after each TIA, indicator to be amended to require a referral after each stroke and only after the first TIA. The indicator would also be reset from 1 April 2014. No change to points. .

NICE Replacements Agreed to LD001 with NICE recommended replacement NM73 respectively. No changes to points of thresholds are proposed as a result of these changes.

New NICE recommendations Agreed not to introduce new NICE indicators - in line with the general approach this year to streamline QOF.

24

2013/14Existing indicator

2014/15NICE replacement indicator

LD001

(4 points)

The contractor establishes and maintains a register of patients aged 18 or over with learning disabilities

NM73 The contractor establishes and maintains a register of patients with learning disabilities

25

files/abou… · web vie

Documents