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Independents' Day

Where do I start on quality points?

or many years GPs have complained they have not been rewarded for providing a quality service. The quality and outcome framework will at last enable us to demonstrate that quality is high on our agenda.

At first glance, the scheme looks complex and bureaucratic, and many GPs have expressed concern that the framework will result in work being undertaken, and data collected, for little clinical gain. But when one starts considering the various disease categories and the indicators being measured, things don't look so bad.

It is important to remember the indicators are evidence based, and the data being collected is expected to be useful for enhancing patient care. Moreover, one shouldn't lose sight of the fact that GPs will be paid for demonstrating that a quality service is being provided!

Although the contract will not be fully implemented until next April, now is the time to start preparing for the quality and outcome framework. There are 10 clinical domains within the framework, and it will become important to have accurate disease registers covering these.

The original version of the contract had quality payment points directly linked to the allocation formula; as a result of pressure from GPs, the latest version will apply a 'disease prevalence factor' using practice-recorded prevalence data collected from practice disease registers. Work will also be ongoing to eventually delink quality payments from the allocation formula.

Consequently, having accurate registers in all areas will not only provide 54 quality points, they may also help determine the value of the points. In addition, because of the 'holistic care' payment, worth a possible 100 points, it will be important to demonstrate quality activity in at least eight clinical areas, as the payment will be directly linked to the activity in the third lowest clinical area.

To assist practices gear up for the new contract, quality preparation payments will be available, although the amount will be less than that stated in the original documentation. In essence, the average practice will receive £9,000 this year, reducing to £3,250 in 2004/5. It will be worthwhile looking at staffing levels and ensuring adequate time is being devoted to data processing or note summarising with a view to ensuring accurate disease registers. At the same time, one could check to determine whether certain aspects of care had been accurately recorded (or if care had been offered, but declined!).

One of the simpler clinical areas relates to hypothyroidism. If repeat prescribing is computerised, it is easy to identify which patients are on medication. It should be relatively straightforward to ensure each patient record has the condition 'hypothyroidism' in the summary or problem field. A trawl through the notes will determine which patients have had their thyroid function checked within the last 15 months. If the computer is linked for pathology results (and those results are Read coded), the search may be even simpler. If no recent result, ensure the patient record is flagged, perhaps in the repeat prescription field, reminding that a test is due.

Having the register and 90 per cent of patients with up-to-date tests earns the practice eight points. In all disease areas, it is important to ensure at least 25 per cent of patients have the indicator measured, but it is also worthwhile looking to see what percentage of patients need to be covered to obtain maximum points.

In the vast majority of clinical areas, practices will actually find they have seen patients and recorded the relevant information somewhere. The next nine months must be used to develop systems to ensure information is collected in a retrievable manner. I feel sure most practices will not find it difficult to achieve something in the order of 400-500 quality points, subject to suitable preparation.

Dr Rob Barnett recaps what the quality framework is all about, what money is involved and what issues practices must address as soon as possible

Most will find they have already recorded the information somewhere~

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