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At the heart of general practice since 1960

Maximising income from quality markers

he quality framework is the most confusing and potentially intimidating part of the new contract. It is reminiscent of the health promotion banding system of 1993, when GPs were paid according to their ability to record and retrieve information.

Many practices then did not earn as much as they deserved because they were deterred by the complicated administration. There is a risk the same might happen now.

Let's not pretend the contract's quality framework is less complicated than Virginia Bottomley's brainchild. It is much, much more so.

This is offset by the fact that in the intervening decade most GPs have learned to co-exist with information technology. Under the influence of national service frameworks, SIGN guidelines, PCO initiatives or your own determination to give your patients good, evidence-based care, you are probably closer than you think to the top of the scale of quality markers.

All that remains is to tailor your computer records to fit the contract, which would have been worth doing whatever the result of the ballot. So here are my areas to address, in order of priority.

 · Ensure your computer system is up to the job. If it is incapable of storing and retrieving vast amounts of clinical information with a few keystrokes, or if your practice is one of the 158 in England that is completely uncomputerised, contact your PCO. Full funding is available for installing, upgrading and maintaining systems.

 · Standardise your data recording within the practice. The best system in the world is of no value if information is not entered or is entered chaotically.

The practice needs to decide:

­ Which Read codes will you use? Using several different codes to record the same condition

makes data retrieval more laborious and less reliable than it should be.

­ Who will be responsible for data recording? If GPs are expected to enter data during consultations or at the end of surgeries, recognise that this takes a finite amount of time and increase the length of each appointment or factor in catch-up time. If a member of clerical staff

will be entering clinical information, make sure they are appropriately trained and that transferring the information from the paper records is straightforward. Above all, do not dump the entire responsibility upon your practice nurse.

 · Ensure everyone has equal access to training and decision-making. A GP or staff member who has no sense of ownership of the practice computer system is unlikely to use it to its full capacity.

 · Decide which disease areas you are going to focus on. You need not deal with everything at once. The bulk of the quality points will come from cardiovascular disease and diabetes, and almost every practice can already expect to achieve the organisational targets and the level 2 or 3 clinical targets in these areas. However, the framework in these areas is complex. Don't forget the 'easy' points that can be achieved elsewhere. Hypothyroidism may only be worth eight points, but if you can pull up a list of patients on thyroxine, code them all as hypothyroid, and enter their last TFT result on computer (recalling them if the last result was abnormal or was more than 12 months ago), you will earn those points for minimal effort. When updating your records, give everyone involved a specific area of responsibility.

 · Think about what you can achieve this year. The pay is aspirational initially ­ practices will be paid in advance for what they anticipate achieving. How hard are you prepared to work to maximise your income?

 · Think about how quickly you can reach level 4 or 5. Practices will not be able to remain on level 2 or 3 indefinitely. There is no scope for stopping short of level 4, where assessment is based on clinical endpoints such as the percentage of patients with heart disease whose cholesterol and blood pressure are treated to target.

The sweetener is that the pay increments become much wider at the top end of the scale. As these targets are soundly evidence-based, and data recording without a clinical purpose is of no real benefit to anyone apart from Government number crunchers, it makes medical as well as financial sense to aim to reach level 4 quickly.

GPs are probably closer than they think to the top of the scale of quality markers, says

Dr Lorna Gold

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