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The increasing use of chronic care clinics

Under the new contract GPs must ensure that chronic illnesses are managed as effectively as possible, and dedicated clinics are the ideal way of doing this says Dr Stephen Gardiner

The quality framework element of the new GP contract offers practices the opportunity to earn large sums of money through a combination of hitting the quality targets that have been set and ensuring that the information required is searchable and is regularly updated. The average practice can earn up to £78,750 in the first year and £126,000 in the second year if they achieve 1,050 points.

In order to earn maximum income under new GMS, practices must ensure that chronic illnesses are managed as well as possible, the correct codes are recorded and patients are regularly reviewed.

It is generally accepted that getting doctors to record information in a structured way in consultations is a losing battle, so practices need to consider alternatives, and chronic care clinics are ideal.

Developing roles

In my practice, as in many others, we have run nurse-led clinics for the care of diabetes, asthma, COPD and coronary heart disease for many years. We then see patients a week or so later, when all investigations are complete, to make management decisions.

Patients appreciate the detailed review of their conditions and our practice nurses have enjoyed developing their clinical roles. In addition to chronic disease management clinics, we also have clinics staffed by health care assistants trained, among other things, to record information for new patient registrations and to observe simple protocols for the follow-up of patients with raised blood pressure. We are considering adding a stroke clinic as 31 points are available in this area.

The clinic situation is ideal for recording the information required for the quality framework, and your software supplier should by now have produced templates for many conditions directed at fulfilling the needs of chronic disease management recording in GMS2. If they haven't, then it is vital that you contact them to find out why not.

You should also discuss the situation with the health information department of your PCO. These templates will ensure that the correct Read codes are used and that all of the quality indicators are reviewed. The templates can contain reminders of the target values for blood pressure, glycated haemoglobin, cholesterol and so on, and should include a follow-up date.

Unlike most doctors, nurses are very good at systematically completing templates. So using your practice nurses will ensure maximum data recording and maximum income as a result.

In the future many conditions could be managed solely by the clinic nurse following appropriate protocols.

When setting up clinics, practices will need to decide who will run their clinics. Will it be an interested GP or a nurse or nurse practitioner? Training nurses to manage the data recording in chronic diseases can usually be undertaken within a practice.

If the practice wishes to develop the clinic further, then the PCO should be able to give advice on local courses and qualifications for nurses.

We found that patients were unlikely to attend if clinic times were too restrictive. So we offer generic clinic appointments during which a number of conditions can be seen.

We perform monthly automatic searches to recall patients who are late and add a message to their prescription receipt asking them to make an appointment. We write to them if they still do not attend.

Higher levels of points

For many practices it is likely that new staff will be needed in order to ensure higher levels of quality points. I also suggest you consider employing a health care assistant to free-up existing nurse time. The additional income generated should more than compensate for this expenditure and it is worthwhile making plans now.

We expect to be able to achieve all 1,050 available quality framework points. If we do, it will be due largely to the successful operation of our chronic care clinics.

Practices need to use a wide range of methods to meet the challenges of new GMS, and chronic care clinics should prove effective and rewarding.

Setting up a clinic

You will need to

 · Decide who will run it

 · Undertake any necessary training of practice personnel

 · Ensure you have the right templates for chronic disease management recording

 · Liaise with the PCO who can give advice

 · Ensure clinic times suit patients

 · Devise an effective patient recall system

 · Hire new staff, if cost-effective (it usually is)

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