GP practices will need to participate in peer-review meetings within their primary care network, as part of new indicators added to the Quality and Outcomes Framework (QOF).
GPs will have to join a minimum of two peer review meetings on what they are doing to improve safe prescribing and two meetings to discuss how they are improving end-of-life care.
The latest QOF guidance, published on Friday, outlines the new quality improvement domain, which includes two areas which will change annually.
This year the domain will focus on prescribing safety and end-of-life care, and will equate to 74 points – 37 for each area.
Prescribing safety will cover NSAIDs, lithium and valproate in women of child bearing age, while end-of-life care will focus on early identification and support for people with advanced progressive illness who might die within the next twelve months and their family/care-givers.
The new QOF guidance has said that for each section, practices can earn 27 points for showing ‘continuous quality improvement activity’ and ten points for participating in the network meetings where they will ‘regularly share and discuss learning from quality improvement activity’.
According to the document, the overarching aim of these QI indicators is to lead to improvements in the following aspects:
- Reduce the rate of potentially hazardous prescribing, with a focus upon the safer use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients at significant risk of complications such as gastro-intestinal bleeding
- Better monitoring of potentially toxic medications and the creation of safe systems to support drug monitoring through a focus upon lithium prescribing (or another agreed medication if no patients on the registered list are currently being prescribed lithium)
- Better engagement of patients with their medication through a focus upon valproate and pregnancy prevention
- Improve collaboration between practices, networks and community pharmacists to share learning and improve systems to reduce harm and improve safety
- Early identification and support for people with advanced progressive illness who might die within the next 12 months
- Well-planned and coordinated care that is responsive to the patient’s changing needs with the aim of improving the experience of care
- Identification and support for family / informal care-givers, both as part of the core care team around the patient and as individuals facing impending bereavement
In order to earn the points, practices will need to evaluate the current quality of their prescribing safety and end-of-life care and identify areas for improvement – this would usually include an baseline assessment of current prescribing and a retrospective death audit.
They will also need to implement an improvement plan, participate in a minimum of 2 network peer review meetings, and complete a QI monitoring template.
The focus on NSAIDs comes after the Government announced a new scheme to trace GP prescribing errors last year, with the aim of preventing 600 deaths in primary care a year. At the time, the Government said the scheme will initially look at hospital admissions from GI bleeds, highlighting how often – for example – a practice had not prescribed gastroprotection with an NSAID prescription and this has resulted in a hospital admission.
Other changes to the QOF for 2019/20 include:
- The retirement of 28 indicators (worth 175 points) which are either no longer in line with NICE guidance, have known measurement issues (usually because of low numbers at a practice level) or where the care described is now viewed as a core professional responsibility.
- The introduction of 15 new indicators (worth 101 points) to bring QOF into closer alignment with NICE guidance and Screening Committee recommendations, mainly on diabetes, blood pressure control and cervical screening.
- Exception reporting has been replaced with a Personalised Care Adjustment. This will better reflect individual clinical situations and patients’ wishes.
The size of QOF remains unchanged for 2019/20 at 559 points, however the value of a QOF point in will increase from £179.26 in 2018/19 to £187.74, and the national average practice population figure will be 8,479.
There will also be no changes to payment thresholds for indicators carried forward from 2018/19.
Indicators in full
QI001: The contractor can demonstrate continuous quality improvement activity focused upon prescribing safety as specified in the QOF guidance – worth 27 points
QI002: The contractor has participated in network activity to regularly share and discuss learning from quality improvement activity as specified in the QOF guidance. This would usually include participating in a minimum of two peer review meetings – worth 10 points
End of life care
QI003: The contractor can demonstrate continuous quality improvement activity focused on end of life care as specified in the QOF guidance – worth 27 points
QI004: The contractor has participated in network activity to regularly share and discuss learning from quality improvement activity as specified in the QOF guidance. This would usually include participating in a minimum of two network peer review meetings – worth 10 points
Source: 2019/20 GMS contract QOF