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At the heart of general practice since 1960

Epilepsy, hypothyroidism and cancer

Dr John Couch continues our series by looking at the requirements needed to earn points from epilepsy, hypothyroidism and cancer

Points achieved with complete ease

Epilepsy 1 Practice can produce a register of patients receiving drug treatment for epilepsy

Value two points

As numbers are relatively small it should not take much work to build a computer register for epilepsy. A computer search of repeat prescriptions for all the anti-epileptic drugs will include patients in this group who are on treatment and exclude those who are not and have been fit-free for some time. Each patient's records must then be checked to validate that they have epilepsy and exclude those with other diagnoses such as chronic pain and hypomania. The validated patients can then receive an F25 per cent Read code. Ensure the list is kept up to date and do not add new patients until the diagnosis in confirmed.

Thyroid 1 Practice can produce a register of patients with hypothyroidism

Value two points

It is also easy to build a register for this group. Search under thyroxine. Then check each patient's record to confirm the diagnosis. Add the approved Read code, CO4 per cent or CO3 per cent, unless already entered. Your register will consist of patients with one of these codes who are on thyroxine. Do not code new patients with borderline TSH results who are being monitored until hypothyroidism is confirmed.

Cancer 1 Practice can produce a register of all cancer patients, defined as a 'register of patients with a diagnosis of cancer excluding non-melanotic skin cancers', diagnosed after 1.4.03

Value six points

The register is for new diagnoses from 1.4.03. There are 38 Read codes covering the commonest malignancies. Practices that use Read code diagnoses should be able to search easily. Those that do not will find the task harder unless they already keep a paper-based register. Code all new cases from now via a template. Check your two-week rule referrals since 1/4/03. Ask all clinicians to check opportunistically when they see patients with relatively recent cancer.

Points achieved with good planning

Epilepsy 2 The percentage of patients age 16 and over on drug treatment for epilepsy who have a record of seizure frequency in the previous 15 months

Value four points – payment tiers 25-90 per cent

Epilepsy is a relatively neglected disease area. Few practices will have coded for seizure frequency and other epilepsy parameters let alone run an epilepsy clinic. While the latter is not absolutely necessary it is probably the best method of ensuring standardised 'best care' and data entry. Patients may also be more willing to attend a clinic. At the very least set up a call/recall system with a clear template, for all clinicians, containing the necessary Read codes. Extract data from letters for patients attending hospital. Arrange relevant blood tests before seeing patients. Set up a clear referral protocol with your local neurologist. For defaulters, consider phone consultations to gather data, if this is the only option.

Epilepsy 3 The percentage of patients age 16 and over on drug treatment for epilepsy who have a record of medication review in the previous 15 months

Value four points – payment tiers 25-90 per cent

As for Epilepsy 2. If you have a clinic and this is nurse-led, ensure the protocol has clear guidance on GP involvement when drug levels are abnormal or when patients are still symptomatic. Set repeat prescription review dates no more than 12 months ahead to allow defaulters to be chased.

Epilepsy 4 The percentage of patients age 16 and over on drug treatment for epilepsy who have been convulsion free for the last 12 months recorded in the last 15 months

Value six points – payment tiers 25-70 per cent

As for Epilepsy 2.

Thyroid 2 The percentage of patients with hypothyroidism with thyroid function tests recorded in the previous 15 months

Value six points – payment tiers 25-90 per cent

Use prescription review dates as reminders to arrange routine thyroid function tests. For well-controlled patients these should be done annually as a minimum. Do not put review dates forward until the result has been received. Ensure both electronic and manually entered results have the correct code (442%). Have efficient systems for chasing defaulters.

Cancer 2

The percentage of patients with cancer diagnosed from 1.4.03 with a review by the practice, recorded within six months of confirmed diagnosis – this should include an assessment of support needs, if any, and a review of co-ordination arrangements with secondary care

Value six points – payment tiers 25-90 per cent

The purposes of this indicator are to ensure patient support and that GP, community and secondary care follow-up are clear to both GP and patient. Practices will need to set up recall systems from their cancer register to ensure this occurs within six months of diagnosis, although in practice this review is more likely to be indicated sooner. Enter the correct code (8CLO). Check early on that your software can search for the correct criteria; if not some if this may need to be done manually.

Points achieved with real striving

There are no points in this group

John Couch is a GP in Ashford, Middlesex

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