Firstly, the entire ruleset has been re-named as hypertension rather than blood pressure, as it was previously. There is, however, a new set of business rules called ‘blood pressure’ which deals with screening for hypertension.
Secondly, a new two-tier target for blood pressure targets has been introduced.
So there are two new indicators:
-HYP002 (was BP5).This requires the patient’s BP to be ≤ 150/90. There are only 10 points available for this now, with target thresholds of 44-84%.
-HYP003 (new).This requires that for hypertensives aged <80, their last BP should be ≤ 140/90 from July each year. Target thresholds are 40-80% with 50 points available.
Thirdly, a further new indicator is introduced: HYP004.
This requires all hypertensive patients aged 16-74 to have an annual assessment of physical activity using the GPPAQ (General Practice Physical Activity Questionnaire). Five points are available with thresholds of 40-90%.
What is the GPPAQ? It is a questionnaire about a patient’s activity levels and was developed by NICE in 2006.
It has been introduced into the QOF, with the requirement that GPs apply it to all their target patients, despite the fact that, of the seven questions, only the first three have been validated as being of any predictive value. The patient’s answers to the last four questions are ignored in the final calculation1.
The seven questions cover:
1. How much physical activity the patient’s job requires,
Then the amount the patient does per week of:
5. Housework, and
7. What is the patient’s usual walking speed?
(See below for the full questionnaire2.)
Based on the patient’s first three answers, they are categorised into one of the following activity levels:
Inactive (eg sedentary job and no physical exercise or cycling)
Moderately inactive (eg sedentary job and some but less than one hour of physical exercise and/or cycling per week)
Moderately active (eg a standing job and some, but less than one hour of, physical exercise and/or cycling per week)
Active (eg a physical job and some, but less than one hour of, physical exercise and/or cycling per week or a heavy manual job.
Finally, based on the patient’s GPPAQ score, there is a further new indicator: HYP005.
GPs are required to encourage any patients who score less than ‘active’ to do more exercise by what is termed ‘brief intervention’. This is described as ‘opportunistic advice, discussion, negotiation or encouragement’. I’m sure GPs will embrace this opportunity wholeheartedly.
This brief intervention has to occur once each QOF year for those hypertensives scoring anything but active aged 16-74. Six points are available with thresholds of 40-90%.
The valid code to score HYP005 is 9Oq3: ‘Brief intervention for physical activity completed’
If the patient tells you what to do with your well-meaning advice, there is an exception code you can use: 8IAv ‘Brief intervention for physical activity declined’.
The GPPAQ assessment and the brief intervention can now be done on the same day. The original ruleset suggested that they had to be at least a day apart, but this is corrected in version 25.1 of the ruleset.
All the above refers only to England.
The requirements for each of the other three UK countries vary: some have differences in target thresholds, some have not introduced the two tier BP target requirements and some have eschewed the GPPAQ indicator (well done Wales.)
All details on the precise requirements for each country (based on present information) are available at the link below3 which also has printable spreadsheet summaries available.
Dr Simon Clay is a GP in Erdington, Birmingham
2 The GPPAQ questionnaire can be found at: www.patient.co.uk/doctor/General-Practice-Physical-Activity-Questionnaire-(GPPAQ).htm
3 For details of Dr Clay’s comprehensive QOF Resource disc go to tinyurl.com/qofdisc