The Quality and Outcomes Framework (QOF) is one of the biggest ‘pay for performance’ schemes in the world. It has played a major part in the standardisation of long-term condition care and comprises a substantial part of practice revenue.
Since its introduction in 2004, the scheme has evolved but not undergone a substantial review. It was welcome news that in 2017 NHS England agreed to undertake a review of QOF, as the environment in which general practice is now operating has significantly changed.
The ‘Five-year framework for GP contract reform to implement The NHS Long Term Plan’ document published by the British Medical Association and NHS England in January 2019 gave practices an initial first glimpse of the QOF domain indicator changes.
From April 2019, 28 indicators worth 175 points were retired; of these 175 points, 101 points were recycled into 15 more clinically appropriate indicators, and the remaining 74 points have been used to create two quality improvement (QI) modules within a new quality improvement domain. For 2019/20, the QI modules will cover ‘prescribing safety’ and ‘end-of-life care’ - these modules are anticipated to change on an annual basis.
Another significant change for 2019/20 is that exception reporting is being replaced with a Personalised Care Adjustment (PCA). As with exception reporting, applying a PCA to the patient record will remove that patient from an indicator denominator if the QOF defined intervention has not been delivered. It will not result in patients being removed from the disease register or other target population.
PCAs can be applied to a patient record if the indicator is unsuitable for the patient, patient choice, the patient did not respond to offers of care, the specific service is not available or if the patient is newly diagnosed or a newly registered patient. Ultimately, the decision to apply PCAs should be based on clinical judgement, informed by patient preferences and supported by shared decision-making principles.
With such significant changes in QOF domain indicators, which were only made available earlier in the year, IT system suppliers are still going through the development, testing and certification of their QOF reporting/monitoring modules. The knock on effect of this is that for the last 5 months practices have had no QOF reporting/monitoring capabilities within their IT systems.
The lack of reporting/monitoring information for the new indicators is impacting on how practices manage their workloads, not to mention that for the next 3-4 months practices will start focussing on winter pressure issues, influenza campaigns, as well as continuing to manage their patients’ chronic conditions etc…
To mitigate against an unmanageable rush of activity in the latter half of the QOF year, there are a few things which practice managers can implement now to help streamline the workload as best as possible, they are:
- If you have not done so already, meet with your team to discuss the indicator changes
- Print and laminate a summary of the indicator changes and put them in the consulting/treatment rooms as a reference guide for clinicians
- Update computer templates with the latest read codes, if necessary
- Develop simple searches and reports to look for patients who fall out of the new thresholds i.e. test results not within range, then review the patients manually, with clinical support, to see if they need a second recall – this may be time consuming now but should save time later in the year
- The new QI domain relates to the development and implementation of a quality improvement plan and sharing of learning across individual Primary Care Networks – raise and discuss this at your next network meeting to see what the Clinical Director’s or Lead Practice Manager’s plans are for the QI domains
- Frailty registers play a part in some of the new domain indicators so make sure your patients are coded correctly using the IT systems Electronic Frailty Index as a guide for clinical decision
The above advice should help to minimise the number of patients requiring a second recall in the latter stages of the QOF year. General Practice is not a stranger to change, and this change to QOF Domain Indicators promises to be one of the better ones. Once technology has caught up, practices will be better placed to manage their patient’s conditions.
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