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GPs buried under trusts' workload dump

GPs will need to take part in network peer-review meetings as part of QOF

GP practices will need to participate in peer-review meetings within their primary care network, as part of new indicators added to the Quality and Outcomes Framework (QOF).

GPs will have to join a minimum of two peer review meetings on what they are doing to improve safe prescribing and two meetings to discuss how they are improving end-of-life care.

The latest QOF guidance, published on Friday, outlines the new quality improvement domain, which includes two areas which will change annually.

This year the domain will focus on prescribing safety and end-of-life care, and will equate to 74 points - 37 for each area.

Prescribing safety will cover NSAIDs, lithium and valproate in women of child bearing age, while end-of-life care will focus on early identification and support for people with advanced progressive illness who might die within the next twelve months and their family/care-givers.

The new QOF guidance has said that for each section, practices can earn 27 points for showing ‘continuous quality improvement activity’ and ten points for participating in the network meetings where they will ‘regularly share and discuss learning from quality improvement activity’.

According to the document, the overarching aim of these QI indicators is to lead to improvements in the following aspects:

  • Reduce the rate of potentially hazardous prescribing, with a focus upon the safer use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients at significant risk of complications such as gastro-intestinal bleeding
  • Better monitoring of potentially toxic medications and the creation of safe systems to support drug monitoring through a focus upon lithium prescribing (or another agreed medication if no patients on the registered list are currently being prescribed lithium)
  • Better engagement of patients with their medication through a focus upon valproate and pregnancy prevention
  • Improve collaboration between practices, networks and community pharmacists to share learning and improve systems to reduce harm and improve safety
  • Early identification and support for people with advanced progressive illness who might die within the next 12 months
  • Well-planned and coordinated care that is responsive to the patient’s changing needs with the aim of improving the experience of care
  • Identification and support for family / informal care-givers, both as part of the core care team around the patient and as individuals facing impending bereavement

In order to earn the points, practices will need to evaluate the current quality of their prescribing safety and end-of-life care and identify areas for improvement – this would usually include an baseline assessment of current prescribing and a retrospective death audit.

They will also need to implement an improvement plan, participate in a minimum of 2 network peer review meetings, and complete a QI monitoring template.

The focus on NSAIDs comes after the Government announced a new scheme to trace GP prescribing errors last year, with the aim of preventing 600 deaths in primary care a year. At the time, the Government said the scheme will initially look at hospital admissions from GI bleeds, highlighting how often - for example - a practice had not prescribed gastroprotection with an NSAID prescription and this has resulted in a hospital admission.

Although it said practice figures on this would be published last spring - a move condemned by GPs - this did not happen and no further information has since been released.

Other changes to the QOF for 2019/20 include:

  • The retirement of 28 indicators (worth 175 points) which are either no longer in line with NICE guidance, have known measurement issues (usually because of low numbers at a practice level) or where the care described is now viewed as a core professional responsibility.
  • The introduction of 15 new indicators (worth 101 points) to bring QOF into closer alignment with NICE guidance and Screening Committee recommendations, mainly on diabetes, blood pressure control and cervical screening.
  • Exception reporting has been replaced with a Personalised Care Adjustment. This will better reflect individual clinical situations and patients’ wishes.

The size of QOF remains unchanged for 2019/20 at 559 points, however the value of a QOF point in will increase from £179.26 in 2018/19 to £187.74, and the national average practice population figure will be 8,479.

There will also be no changes to payment thresholds for indicators carried forward from 2018/19.

Indicators in full

Prescribing safety

QI001: The contractor can demonstrate continuous quality improvement activity focused upon prescribing safety as specified in the QOF guidance – worth 27 points

QI002: The contractor has participated in network activity to regularly share and discuss learning from quality improvement activity as specified in the QOF guidance. This would usually include participating in a minimum of two peer review meetings – worth 10 points

End of life care

QI003: The contractor can demonstrate continuous quality improvement activity focused on end of life care as specified in the QOF guidance – worth 27 points

QI004: The contractor has participated in network activity to regularly share and discuss learning from quality improvement activity as specified in the QOF guidance. This would usually include participating in a minimum of two network peer review meetings - worth 10 points

Source: 2019/20 GMS contract QOF

Readers' comments (13)

  • Reminds me of a big reason behind leaving at 50, good luck to the remainers.

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  • Cobblers

    I can see the CCG's Pharmacy Advisers licking their lips in anticipation and readying their PowerPoint files.

    Utter utter waste of time. Am SO glad I'm out of it. It can only encourage others, tettering on the brink, to jump. Come on in the water is lovely.

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  • am i wrong but weren't we doing this 10 years ago and it didn't work then because of staff shortages. you can prescribe all the ppi you like but i can't guarantee the patient is taking them, you would need a drug test for this. end of life care needs end of life staff, as the NHS and care systems are all struggling to find anyone to do the work bit pointless asking us to improve any system. why not fix the fundamental issues first before sorting out the extras.

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  • Definition of insanity,doing the same thing over and over again and expecting a different result.Welcome to the UK.We were doing this rubbish over and over but now we are in a much worse place.

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  • Turn out the lights- are you talking about Brexit or GP?

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  • Both its a UK contagion.

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  • THIS bureaucracy MUST STOP.

    I CAN SEE PCNs WITH HUGE LISTS OF RUBBISH GETTING IN THE WAY.

    THE GOVERNMENT ARE OBSESSED BY BOX-TICKING

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  • Our practice QOF income is going to drop by £30-40,000 as the indicators being withdrawn are weighted for our exceptionally high disease prevalence (retirement town with one of oldest populations in Europe) and being replaced with average value points.

    For instance 6 osteoporosis points, worth £9,000 to my practice, replaced with 6 prescribing points worth £1,600 = loss of £7,400

    This issue penalises practices with large disease registers, high prevalence, high frailty, and high complexity, and redistributes QOF funds back to the university practices. Back to the bad old days of the square-rooting formula, no in fact this is worse. No coincidence that leafy suburbs and Babylon stand to gain the most with their fitter populations and very low disease prevalence.

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  • Proposal from NHS managers thinking: To generate more meetings and more meetings to decide on the next meeting and more paper work so they can get a pay rise and expand our work force. It does not matter the patients that need to be seen since we will all be in meetings organising and then re-organising repeatedly regardless of whether it works.

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  • Another reason to escape the NHS.

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