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New QOF indicator focuses on reducing ‘avoidable’ appointments

New QOF indicator focuses on reducing ‘avoidable’ appointments

Reducing ‘avoidable’ appointments will be part of QOF activity for GP practices from April, according to new contractual guidance.

The latest QOF guidance, as well as the full legal document for the new GP contract imposed by NHS England, said that work to reduce avoidable appointments will include a focus on ‘high intensity service users.’

The indicator is one of the ‘quality improvement’ indicators and is worth 15 points – around £3,250 to the average practice – and practices need to ‘demonstrate improvement in reducing avoidable appointments’.

The guidance suggests that to do this practices should:

  • use ‘business intelligence tools’ or collect data themselves, to understand demand and activity by day and time of day;
  • ‘develop an understanding of the telephone queue’ either by extracting data from their cloudbased telephony system or asking staff to collect data over a period;
  • use the data to understand peaks of activity and match capacity to demand.

ICBs should support practices to access ‘effective tools’ to enable this data on demand and capacity to be more easily understood by GPs.

The guidance said: ‘It will enable clinical time to be spent on managing more appropriate appointments, enabling more time with complex patients and contribute to more manageable workloads and GP retention.

‘The starting point for addressing avoidable appointments is understanding current activity.’

It will also help building a ‘shared understanding across the system about the impact on general practice workload.’

The guidance added: ‘Where BI tools are available, practices may find it helpful to have training or support in how to most effectively use the tool.

‘Clinicians working together to define which appointments may be avoidable can enable a practice to review its care navigation and triage processes to give patients more appropriate services.’

Speaking at a webinar last week, Dr Clare Bannon, a member of the GPC executive, explained that this new QOF indicator is also ‘about looking at engaging with the new telephone systems.’

She said: ‘So there’s digital telephone systems coming in that will give us more information about our call rates, it’ll enable us to have call queueing, it’ll enable us to see exactly what the demand is like throughout the day.

‘And that QOF quality improvement indicator is about using that data and looking at staffing levels and looking at when the busy times during the day are and making changes to improve access in that way.’

NHS England imposed the contract with a focus on access, and the imposition has led to talk of potential industrial action, with GPC England convening a special meeting on 27 April to discuss next steps.

The imposed contract also contains a ban on asking patients to call back at a different time but last week the GPC confirmed this will not mean having to offer them an appointment on first contact.

The QOF indicator in full

QI019 (15 points)

The contractor can demonstrate improvement in reducing avoidable appointments. A suggested approach is outlined below:

1. Using BI tools, if available and practice collected data where not, to understand the practice activity including variations over the days of the week, time of day and time of year.

2. Developing an understanding of the telephone queue either by extracting data from their cloudbased telephony system or asking staff to collect data over a period.

3. Using that data to understand their peaks of activity and better matching their capacity to their demand by, for instance, reviewing rotas.

4. Using improvement techniques described in the Primary Care Transformation Teams webinar series on Demand and Capacity which provides practical advice and guidance.

5. Referencing the Royal College of General Practitioner’s 6 steps to start to improve delivering continuity of care from their Continuity Toolkit for those who need it and adapting to suit the needs of the practice.



Please note, only GPs are permitted to add comments to articles

Iain Chalmers 3 April, 2023 5:31 pm

Bugger me April Fools ideas seem to be coming out thick & fast

Robert James Andrew Mackenzie Koefman 3 April, 2023 6:05 pm

Have they never understood we have been doing this for years and the outcome is health demand is never predictable other than Mondays and fridays are the busiest days

Michael Mullineux 3 April, 2023 6:10 pm

NHSE and those that spout idiotic nonsense like the fool above are seriously deluded. As if a cloud based telephony system is going to fix the issue of not enough GPs, finite and shrinking appointment capacity and spiralling NHSE and HMG fueled demand. We have had a cloud based system in place for years and all it does is demonstrate the depressing fact that we as a practice of 12,00 patients are fielding about 1000 calls a day.

Douglas Callow 3 April, 2023 6:55 pm

Gaslighting pure and simple

Some" Bloke 3 April, 2023 7:10 pm

Wow! So they think we can both fix problems with stress and burnout AND reduce “avoidable” demand (which is no small undertaking in a free at point of abuse system). All that for few thousand quid!
My childish self wants to think they really think highly of
my abilities. My realistic GP self worries they think of, or want to see, us desperate enough to actually go along with this gibberish.
Would GPC check if this definitely applies here, England, still UK, planet Earth in the Solar system, Milky way?

David Church 3 April, 2023 7:22 pm

What you may not have realised is how easy it actually is to score those 15 ‘avoidability’ points :
Count how many appointments you had for May, 2022.
Check your rota and avilability for May, 2023, and ensure that you have less appointments available than last year.
Count how many less (it only has to be one, but you could show off here), fill in the qof claim, and hey presto, you have proved you have less appointments – and whatever number less, well they were obviously the avoidable ones!
It isn’t medical rocket science after all. It’s only some guy at the DHSE who came up with it.

David Mummery 3 April, 2023 7:30 pm

How do you know an appointment is ‘avoidable ‘ until you’ve actually had the appointment? Calling all GPs at NHS England – come back to the frontline , you are our only hope…

Some" Bloke 3 April, 2023 7:34 pm

Still thinking about avoidable and stress. What if, if I was able to apply a small charge, say £25 for appointments that I deemed unnecessary. Double that if I also felt stressed because of them. Might that possibly help? Can’t do that in NHS you say? Ok, back to reality.
Not engaging with this nonsense is the only consideration it deserves

Fedup GP 3 April, 2023 8:02 pm

Utter bullsh1t. They don’t have a fu*king clue.
Getting 2ndry care to do there own work would possibly free up some time…but they appear to be teflon like on these matters. Only a few years to go and I couldn’t give a fu*k any more. Early retirement here I come…..

Mark Funnell 3 April, 2023 8:23 pm

“Avoidable appointments” in general practice, the latest bright idea from the team so fond of “unwarranted variations” elsewhere, what do they really expect of this – who is going to tell my patient that they are an avoidable contact! Do they think that we deliberately fill our days with avoidable contacts?
They might be “avoidable” if there was a social system that supported people in crisis or which provided alternatives to the GP for people to go to when in need.
Yes my social prescribers do a great job of trying to help lonely, isolated people or those in social/financial need but they keep coming in their droves.
Have these clever people at NHSE heard about people’s ideas , concerns or expectations? They have been given the idea that they can see any of us whenever they want & they have an expectation that they can have anything they want from us because that is the message that the politicians put out to try to get votes for their next election.
This goes alongside a QOF target to deal with the stress on the GP system that is caused by longstanding failure of the government to deal with the mounting shortage of GPs. My stress is only going to be dealt with by giving me more GP colleagues who deliver the GP job including all the admin (or my retirement which is looking ever more attractive) & not by any process that seeks to deflect attention from the real problem
The concept of an avoidable appointment in the context they give is really dismissive of the need of some of our patients & should be treated with the contempt it deserves.
Please cut the rhetoric & meaningless targets & plans & put something in place to get new GPs in place before the whole system collapses completely

Nick Mann 3 April, 2023 9:07 pm

Spot on, Mark.

Keith Greenish 4 April, 2023 10:21 am

Absolutely spot on David Mummery and Mark Funnell, the sole reason for the decline of primary care is the failure over the last 30+ years to nurture the GP workforce. Sadly this latest useless plan highlights the mistaken belief that technology has the ability to solve all primary care’s problems. When will they learn?

SUBHASH BHATT 4 April, 2023 1:29 pm

Concentrate is giving more appointments. Avoidable appointments are where patient does not want to see us but just wishes to have advise. Talking to patient is appointment but not face to face.. staff should clearly ask if patients wants to see gp or just talk.
Monday and Friday rush is result of handing over ooh over weekend to nhs 111. Replace this with a practice or group of practices dealing with these patients and all money of nhs 111 to be distributed to practices..

Richard Greenway 4 April, 2023 3:59 pm

So they want to restrict demand… by measuring capacity more, and matching (inadequate) capacity to (excessive) demand.
That square peg still won’t go in.

Dr No 4 April, 2023 11:06 pm

I wish I knew which planet the people who formulate this crap are living on. Cos I’d nuke it from orbit. It’s the only way to be sure…