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At the heart of general practice since 1960

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To earn maximum quality pay a practice must make gaining points a part of everyday routine, writes Dr John Couch

It is now only nine months to the cut-off date for 2004/5 quality and outcome framework points. Your points tally at March 31, 2005, will not only define the final annual payout but also the size of the 2005/6 aspiration payments. Around one-third of your potential future income will eventually be at stake by 2006. No matter how well you think you have organised your campaign, it is worth another objective view of your systems before time runs out.

Master plan and

master planner

There are more than 20 clinical and non-clinical domains covered by the Q&O framework. It is therefore vital that at least one practice member has a broad strategic overview of these. In many practices either the practice manager or one of the partners has assumed this role.

So much is at stake that dedicated time must be allotted. A master plan and timetable should be followed with deadlines for such areas as the patient survey. There should be no last-minute scramble for points.

A monthly points score chart should be produced, circulated and discussed with all staff. This helps to maintain focus and stimulate improvement in underperforming areas.

By now weak and strong domains should be obvious. The positive and negative lessons from both groups need to be co-ordinated in order to continue to move point scores forwards in all domains.

For instance, template errors in one area must be quickly rectified and also assessed for overlap in other domains. A domain team should therefore immediately relay problems (and solutions where possible) to the Q&O lead. Manpower difficulties can be remedied in the same way.

Finally the evidence needed for verification must be gathered and collated. Don't forget that for some practices verification visits start in only three months.

A team for each domain

Work should have commenced months ago in all areas. However, this may not have been possible for a variety of reasons. Teamwork is vital for all sizes of practice.

Each domain should be planned and administered by named personnel, even where the total work is spread across the whole practice. For clinical areas a clinician (GP and/or nurse) and administration assistant works best.

For non-clinical areas a clinician is not always necessary. The whole practice must respect and follow advice from each team.

Team goals must include:

lRecording and retrieving accurate data in the most efficient manner possible

lProtocols for improving results of therapeutic indicators such as HBA1C and cholesterol levels

lMaximising the number of patients covered in

the target group

lGood communication with Q&O lead and

rest of the practice

lAchieving or exceeding aspired points.

Is your hardware and software

up to the job?

The Q&O framework has highlighted many deficiencies in both hardware and software. Insufficient numbers of terminals, lack of hard disk space, slow processors, inadequate search facilities, template and Read code problems have all caused enormous headaches for practices.

This has been aggravated by the less than smooth transition of PCOs taking over computer costs. There are now long queues of practices waiting for new systems and software upgrades, although some priority has at least been given to those with the most geriatric systems. We must all keep up pressure to ensure the funding originally promised by the Government is actually delivered.

Few of us use our computers to maximum potential. Templates and coding are the key to all of the clinical and some of the non-clinical domains. Templates should be user-friendly and accurate in both coding and dating. All team members should be shown how to use them properly. This includes locums. We recently found one locum who omitted to 'file' each template thus wasting every entry for a whole session!

As some of us have recently discovered, Read coding has been refined so that some old template codes are now no longer counted. For example, for epilepsy there is now a code for 'epilepsy medication review' rather than simply 'medication review'. Dating is also a problem. If a patient who had an MI 20 years ago is seen for review and given a current default diagnosis date because the template was incorrectly set up or data was entered too rapidly, the system will automatically expect a new cardiology referral or exercise ECG. It takes much longer to undo these mistakes than to make them. Review your coding regularly.

Make regular use of your software reminder, search and Q&O points calculator facilities ('Popman' for EMIS users). These are invaluable tools for planning, monitoring progress, picking up and rectifying coding problems and detecting underperforming indicators and domains.

Where templates are not the answer, make sure you set up a solid system for meeting the criteria. Areas such as the patient survey fall within this category.

Finally, make maximum use of your internal e-mail system. This is a great way to keep everyone informed and focused.

Meetings

Face-to-face communication remains important. This is still the best way for networking and morale building. Quarterly or even monthly Q&O practice meetings are essential to achieve high scores. To avoid wasting precious time, have an agenda with a decent 'any other business' slot at the end – and make use of the latter.

Good patient relations are vital. We should remember that the drive to reach high points is primarily about improving patient care. The financial incentives are, for the Government, a means to this end. How well each practice achieves this will depend on how good they are at getting the message across to patients.

A hard sell is likely to alienate many. A firm, friendly but persistent sell is more likely to succeed, although the difference between the two approaches can be very narrow.

Key patient relation aims should be to:

lImprove patient awareness of health issues

lEncourage and persuade poor attenders to address health needs

lOffer sufficient access to clinicians and clinics

lSet clear review dates and reminders.

Good patient communication has never been more important. This must start at face-to-face consultations. Other traditional approaches via letters, posters, practice leaflets and repeat prescription reminders will continue. Use of practice websites is increasing and 'cold' calling patients will increase.

Phoning patients can be an excellent way to offer clinic appointments and obtain domain data such as smoking habits. Logging such calls in patients' records can also aid exception reporting. Staff making these calls should use a script to ensure a positive message is given every time. Don't forget to flag up persistent defaulters for opportunistic quality issues the next time they come in. Even the most intransigent patient turns up eventually.

Finally, your charm offensive should make for glowing comments in your patient survey.

John Couch is a GP in Ashford, Middlesex

Crucial things to do

in the practice

lEnsure a 'master planner' is overseeing the Q&O framework

lProduce, circulate and discuss – on

a monthly basis – a Q&O points score chart

lAppoint a named person/team to oversee each domain

lEnsure your computer hardware

and software is up to the job

lEnsure everyone in the practice (including locums) can use your computer system effectively

lHave regular and effective practice meetings

lCommunicate well with staff

lCommunicate well with patients

lEnsure you establish and maintain good relationships with patients

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