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Cash-strapped PCOs tighten scrutiny of GPs' quality data

Primary care organisations are stepping up scrutiny of GPs' quality and outcomes framework data as part of increasing efforts to save money, writes

Emma Wilkinson.

Scores of PCOs are starting to use sophisticated data analysis tools to compare GPs' performance with disease prevalence and prescribing data.

Exception reporting can also be cross-referenced against pre-valence and league tables of practices produced against various indicators.

The tools, which are being marketed to PCOs in seminars organised by the NHS, can also enable prevalence to be calculated more accurately and identify anomalies in payments to practices.

Jill Burke, managing director of Insight Solutions, an IT consultancy which has provided advice on QOF data analysis to 75 PCOs, has advised NHS managers at the seminars to target 'high point' indicators for closest scrutiny. Disease areas in which the practice has a specialty should also be targeted, she said.

Ms Burke told Pulse that PCOs were increasingly doing careful analysis of individual practice data.

She said: 'It was a very new concept for a practice to be assessed. But PCTs are more aware that this is something they have to do and the assessments are now becoming more robust and targeted.'

Pulse revealed earlier this year (16 February) that an NHS unit at Keele University had circulated reports to 30 PCTs in the West Midlands which combin-ed disease prevalence and prescribing data to rank GPs. It is now planning a second round of reports on how practices in the region are performing on prescribing to flag up those that need further investigation by PCTs.

GPs warned some PCTs were taking inspections of QOF data too far and were breaking the 'high trust' ethos of the contract.

Dr Charles Zuckerman, joint executive secretary of Birmingham LMC, said some PCTs were adopting a hands-off approach with low-key QOF visits while others were going into practices with a fine-tooth comb.

He said: 'They're tying us up in red tape and not allowing us to get on with the job of treating individual patients.

'There's far too much scrutiny and the result is an unremitting lowering of morale.'

QOF managers get help with disease prevalence

Doncaster PCT has developed its own system to help QOF managers make a more accurate assessment of disease prevalence at individual practices.

Laurie Mott, public health information specialist at the PCT, said: 'Prevalence is quite crude so we developed a model to predict the expected number of patients with CHD, etc, in each practice.

'First you look at age and sex which you can apply to the practice population but then certain conditions also relate to deprivation so you can adjust for that.'

The PCT then looks at the expected prevalence for CHD, diabetes, epilepsy, asthma and hyperthyroidism for each practice and identifies those that fall outside the expected range.

'It wasn't done in a punitive or suspicious way,' said Mr Mott. 'QOF managers got a report for each practice with the expected number and actual number. If it was higher or lower there could be very good reasons for that.'

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