How to achieve the maximum quality points
I am confident the majority of my colleagues could aspire to 1,050 quality points if the contract was voted in. We are already meeting such targets with a project called PRICCE (Primary Care Clinical Effectiveness). The idea was to put in place a set of criteria with standards for 13 disease areas that practices in south-east Kent would adopt and agree.
There was a small financial incentive of some £3,000 per GP per year, mainly to cover administrative and IT costs to facilitate the required audit work involved.
The system was similar to the quality framework in the new contract, with criteria for guidelines in the disease areas and standards set to be achieved, such as 75 per cent of hypertensives should have their last blood pressure 150/90mmHg or less, and 100 per cent of patients with IHD should be on aspirin unless contraindicated.
First, our practice held meetings to determine management plans for all disease areas. This proved to be a stimulating and useful learning tool for both doctors and the practice nurse, who soon became an integral part of the team approach to this project. An audit clerk was nominated, and templates drawn up on the computer system. These were often modified to our individual requirements, and is easy to do on most systems.
All GPs agreed to use the templates when dealing with the specific disease areas, thus making audit relatively easy through consistent Read coding.
The disease database was cleaned up on the computer and regular auditing by the clerk became an essential tool to remind and cajole GPs, and therefore patients, into complying with agreed criteria.
Every few months an audit review was established to determine where the practice stood in the PRICCE project and to stimulate further searches and calling of patients for system review, usually by the practice nurse. Meetings of the whole team at six months and then two months before the year end proved important to isolate problem areas and elements that needed more work.
Support group meetings of all involved practices were organised, including GPs and administration staff. These proved an effective medium for help, advice and mutual support, as well as dissemination of dictates from the steering group which supervised and monitored the performance of the project.
The device of exception reporting proved most important and has been incorporated into the new contract.
Astonishingly there was a 95 per cent success rate in achieving standards in the initial wave of practices, and the local take-up rate is now nearing 100 per cent of practices.
So most of east Kent is in a position now to achieve 1,050 points if the new contract came in, and I see no reason why other areas should not achieve a similar result with one year to prepare. It certainly gives one an astonishing insight into one's practice performance.