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At the heart of general practice since 1960

Understanding the quality and outcomes framework

Many GPs do not yet understand how to calculate payments under the proposed contract quality indicators ­ Dr Tony Snell offers guidance

here are 1,050 points available to be earned under the quality and outcome markers. This means that, by the end of 2005/6, the average practice could earn £126,000 by achieving every one of the quality standards in the four domains, including delivering the 24- and 48-hour access standards.

As each point is worth less in 2004/5 than in 2005/6 (£75 against £120), the maximum an average practice could earn from the Q&O framework in 2004/5 is £78,750 for achieving the same results. Don't forget that you will be getting £9,000 a year preparation money as well. All these resources can be spent by the practice any way it wishes.

So how can you earn this sort of money?

The first step is to thoroughly understand the Q&O framework. The framework is split into four domains (see box 1). Each domain attracts a maximum number of points. The clinical domain has the most points at 550. The domain is broken down into 10 disease areas such as hypertension, and under each disease area are a number of indicators, such as percentage of patients on the disease register with their BP measured.

If a practice is achieving outcomes across all 10 disease areas, then it will qualify for the holistic care payment, a maximum of 30 points. If it is achieving outcomes across the three other domains then it will qualify for quality practice payment, a maximum of 30 points.

If it is also delivering access targets, in addition to the enhanced service payment, the practice can earn another access payment ­ 50 points on top of the quality practice payments.

Each practice will be able to determine where it is by the end of 2003/4. By this I mean it will have a good idea of how accurate its disease registers are in each area, how many patients have had measurements done, and how well these patients are controlled.

Practices will also know how well organised they are, how many of the necessary policies and procedures exist and how many have been implemented ­ in other words, how well placed they are in relation to the Q&O framework.

1. The domains/points

Clinical Organisational Additional Patient experience

CHD 121 Records + Information 85 Cx cytology 22 Survey 70

Stroke/TIA 31 Patient communication 8 CHS 6 Consult.length 30

Cancer 12 Education + training 29 Maternity 6

Hypothyroid 8 Practice management 20 Contraception 2

Diabetes 99 Medicines management 42

Hypertension 105

Mental health 41

Asthma 72

COPD 45

Epilepsy 16

Maximum points 550 184 36 100

Holistic care payments 100

Quality practice payments 30

Access 50

Maximum available total 1050

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