Maintaining your disease register
The new contract makes it more important than ever that disease registers are well maintained, says Dr John Couch.
Under the new contract GPs have a carrot, in the form of quality payments, and a probable stick, in the form of GP league tables, to drive their efforts to maintain high quality disease registers.
And there are other equally valid reasons for GPs to make sure their registers are accurate. Good disease registers allow a much more structured and effective approach to chronic disease management.
They will also form the bedrock of centrally held patient records, meaning that in future the quality and value of our record keeping will have a much wider audience.
It is natural to breathe a sigh of relief when a new register is drawn up, but this is only half the task. A disease register changes virtually daily as more patients are diagnosed, new patients arrive, diagnoses change and existing patients leave or die. Think of your register as a new car which, once built, still requires regular maintenance.
Assuming you already have registers for the 10 clinical quality framework diseases, you should recheck that you are using the correct Read codes, not only for the diseases themselves but also the essential clinical data. The codes can be found on the BMA website: www.bma.org.uk/ap.nsf/content/newreadcodes
Remember that exception reporting is allowed and these codes are only just being released; make sure these are included in your templates. Monitor future changes too.
Everyone in your team must know each individual's responsibility in the collection, entry and validation process and why the data is being collected . This suggests that regular whole team meetings are the way forward. Paradoxically, larger practices will find this more difficult (a case of big is not beautiful).
Establish protocols and time limits for each situation where data needs to be added, such as new patient records. Keep the personnel level for adding disease category codes on a relatively narrow base, perhaps clinicians and one or two key non-clinical staff only.
One golden rule do not add a new diagnosis until it has been reliably confirmed, as it is a nightmare to try and remove a Read code. So, code a patient presenting with typical angina as 'chest pain' until you have specialist confirmation.
It is safer to insist that templates are used for every contact within the current (and any future) quality framework categories. Even a single data entry such as diagnosis should be included in this rule. This is the best way to be sure of correct coding. Make sure GP registrars and locums are all aware of this.
I suggest monthly training sessions that begin from basic principles to avoid overestimating the starting point. A computer with projector is useful for bigger groups. Include individual 'hands on' training to maximise effectiveness. Encourage all team members to ask for help if they need it.
Always check whether your PCO can help with training or at least provide funds for buying time from your software provider.
Responsibility for each register should be delegated to one team member. Validate your register at least annually. There is no easy way to do this. We print off the register by usual GP who then checks their own list. We try to remove diagnoses that are incorrect and keep a record of these patients in case they still appear next time. Once you start entering exclusion codes these should be validated regularly too.