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Good QOF organisation pays dividends

As you check and chase up patients to score as many last-minute QOF points as possible, make sure the work you do is productive, says Dr John Couch

As you check and chase up patients to score as many last-minute QOF points as possible, make sure the work you do is productive, says Dr John Couch

As Dr Clay indicated in his article on the previous pages, the benefit of a last-minute check and chase to get as much extra data as possible included in your QOF targets cannot be overstated.

But the initiative must be methodical and properly organised. A frantic and random dash to collect data is not only undignified but also will be much less efficient. Smart practices will spend a brief moment studying the domains and indicators that will be most productive in terms of final payment. Make full use of your practice software QOF facilities. In EMIS this would be POPMAN. Draw up a list of indicators that are currently below the maximum threshold.

Then you should rank them in two ways:

  • First, in order of total points available – indicators where there are most points highest on the list
  • Second, draw up a list with the lowest numbers of patients needed to achieve the next threshold target highest on the list

Once you've done this you can use both of these lists to spot the indicators where you can gain the highest number of points for the lowest numbers of patients. Use an up-to-date disk or hard copy of the Revisions to the GMS contract 2006/7 as a reference if needed.

Two examples

Heart failure indicator 2 is worth six points and requires patients with new diagnoses to have had an echocardiogram or been referred to a cardiologist (although not necessarily seen yet). There will be relatively few patients in this group, so only one or two may lower your points score by a considerable proportion. Check your list and either refer (adding 8H44 coding) or exception code if appropriate.

Mental health indicator 7 is worth three points and refers to patients with a major mental illness who miss follow-up. Many practices have not even tried to identify patients in this group, in which case three points are lost. If you search and find even one such patient, and then follow them up within 14 days of non-attendance, coding them appropriately, all three points will be earned.

Contrast this with diabetes indicator 21, retinal screening (worth six points). Hundreds of diabetes patients need to have received screening. If you are, say, 30 patients below the 90 per cent threshold it would take much more work to gain an extra point, even if you could get patients screened in time.

On the other hand, dementia indicator 2 is worth a maximum of 15 points, involves many fewer patients, and the review and care plan can be done before this month expires.

Finally do not forget that some patients will qualify for exception reporting in most domains and this must be coded every year. For efficiency, spread the load of chasing uncompleted data and exception codes across the practice team. Make full use of telephone contact where appropriate, but also ensure sufficient appointment slots and visit when necessary.

Remember that each extra point gained is worth £124.60 for average size practices – considerably more for larger ones – so if you can glean an extra 10, 20 or even more points by last-minute action, it is certainly worth it.

Take a deep breath and get started. But keep paper bags handy, just in case hyperventilation sets in.

Dr John Couch is a GP in Ashford, Middlesex

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