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Roundup of the new QOF guidance

Atrial fibrillation registers should include all patients with an initial event, and paroxysmal, persistent and permanent disease.

GPs can earn up to 10 points for diagnosing patients with ECG or specialist-confirmed diagnosis, but the guidance warns referral or obtaining specialist opinion is not sufficient.

There are up to 15 points for treating patients with anticoagulation agents warfarin and phenindione or anti-platelet agents aspirin, clopidogrel and dipyridamole.

Computer records will be a valid source of data when compiling a register of chronic kidney disease patients.

Six quality points are available for the register, which should include adults with a last GFR or estimated GFR of <60ml/min/1.73m2. From 2006, estimates of GFR will be included following creatinine testing.

Up to six points are available for records of BP and up to 11 for the percentage of patients whose last reading was 140/85mmHg or less.

GPs should use two questions to screen for depression in patients with diabetes or CHD.

They are: 'During the last month have you often been bothered by feeling down, depressed or hopeless?'

And second: 'During the last month, have you often been bothered by having little interest or pleasure in doing things?'

The guidance suggests three questionnaires to evaluate depression severity in all patients: the Beck Depression Inventory second edition, Hospital Anxiety and Depression Scale, and Patient Health Questionnaire, which is available free online at: www.depression-primarycare.org

Dementia registers should be compiled largely by correspondence with secondary care, but GP diagnoses based on clinical judgment and patient knowledge should be included.

Face-to-face reviews should focus on the support needs of patients and carers, and cover the patient's physical and mental health and communication and co-ordination with second-ary care.

Five points are available for practices with a register, and up to 15 depend on the percentage with a review of care in the previous 15 months.

The new guidance makes absolutely clear that reversibility testing will be necessary to gain points for diagnosis of COPD.

The disease will be diagnosed if the patient has an FEV1 of less than 70 per cent of predicted normal, an FEV1/FVC ratio of less than 70 per cent, and there is a less than 15 per cent response to a reversibility test.

Where asthma is also present, patients should be placed on registers for both diseases.

But the top threshold for the percentage of patients with a confirmed diagnosis of COPD has been reduced from 80 to 70 per cent to make the target easier to hit.

Schizophrenia, bipolar affective disorder and other psychoses have been included in the mental health section. GPs can earn up to three points for following up patients with the conditions who do not attend practice for annual review within 14 days.

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