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Independents' Day

Time for a QOF brush-up

The quality and outcomes framework reaches its administrative climax in March but you should be taking anticipatory action now, says Dr John Couch

The quality and outcomes framework reaches its administrative climax in March but you should be taking anticipatory action now, says Dr John Couch

One of the most frustrating administrative aspects of the QOF is that it reaches its climax at the most inappropriate time of year.

The lead-up to the end of March is the busiest time of year for most practices, so this makes the last-minute QOF dash to 31 March a fraught time for us, given the high winter workload.

So I would like to suggest that, during this pre-Christmas period, a wash and brush-up may reduce some of the final blood, sweat and tears in three months' time.

Although this year maximum points have been reduced to 1,000, this still represents around 25-30 per cent of the average GP's annual NHS income. So gleaning as many points as possible is certainly worthwhile, even if some of the new categories are proving to be a challenge.

A natural starting point is to review your current QMAS performance and compare it with last year. This will give both a general overview and will highlight those domains and indicators that require more attention. The following examples may help provide a clearer focus, although space precludes a comprehensive list.

Of the new domains, depression and chronic kidney disease (CJD) have been the most difficult.

Depression severity tools such as PHQ9 take up large chunks of consultation time and have proved difficult to apply at busy times. This domain carries 25 points, so check your performance now and try to encourage your team to improve. It can save time to give patients the questionnaire to self-complete before the next consultation.

In CKD, achieving a blood pressure at or less than 140/85mmHg achieves most points (11). Give each clinician a list of those outside the range for actioning. Check that your team are coding CKD and establish a policy for borderline eGFRs of 57-59ml/min.

I have found problems with incorrect atrial fibrillation dating as 'new' when in fact they are 'old'. Remind your team to be careful and do check that your template is not automatically giving a new diagnosis at each contact. Beware of atrial flutter – the ECG code for this does not count towards QOF points.

The two smoking indicators carry 68 points. Remind everyone that this data must never be skipped and ensure all chronic disease templates include smoking codes.

Remember that for this year at least the patient experience survey (PES) still applies, in addition to the access survey currently in the headlines and being carried out externally. You should have already completed your PES (25 points) but have you reflected, summarised and reported via a team meeting (20 points) and developed an action plan with patient participation yet (30 points)? You should ideally be in the final stages. If not, plan this ASAP.

Remember that you need to exception report each relevant patient in every domain annually. Do a computer search of last year's exceptions, print this off, and get GPs to tick off those (with reasons) who can be re-coded this year. Ensure that any other patients who meet the criteria are also coded opportunistically.

I would also like to suggest that we all start thinking proactively what new domains and indicators appear for 2007/8. Don't worry, I'm only joking!

John Couch is a GP in Ashford, Middlesex

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