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QOF to link pay to A&E attendance

Practices may have to offer extra appointments in order to meet a controversial new QOF target to reduce ‘avoidable' patient attendances at A&E.

Under the new 2012/13 GMS contract, announced today, the new QOF quality and productivity prescribing indicators brought in this year will be scrapped in March. In their place, for a trial period of a year, will come indicators for GPs to reduce A&E attendances.

Practices will have to undertake a review of their patients' A&E attendances by August 2012.

‘The review will include consideration of whether access to clinicians in the practice is appropriate, in light of the patterns on accident and emergency attendance,' the new indicators says.

In addition, practices must exchange data to conduct external peer reviews, agree an action plan with the CCG and implement it before April 2013. The review may include proposals to improve access to the practice or plans to redesign services or commission new ones.

The other two sets of quality and prescribing indicators added last year – on emergency admissions and referrals – will be extended one year.

But GPs who have tried to cut A&E attendance warn that there are no easy solutions.

Dr Simon Coupe, a GP in Christchurch, Dorset, who has introduced GP triage at his practice, said: ‘It's not as straightforward as people think. I think that access is only a small part of it.'

‘Preliminary figures show that our A&E attendances were not particularly lower than our neighbours, the reason being that we are on the doorstep of a district general hospital. Geography has some role to play. If someone can go two miles up the road to a DGH its difficult to know how you can stop that.'

‘Telephone access if fantastic in many ways: better access for patients, less GP stress and fewer consultations, so you have more time for patients when they do come. But not all GPs are happy with phone triage, and it doesn't necessarily reduce A&E attendance.'

Clinical indicators in the QOF are also to be overhauled, with the introduction of two new disease areas, osteoporosis and peripheral arterial disease, following recommendations by NICE.

Targets GPs will be set include establishing a register of patients with PAD, and achieving blood pressure and cholesterol targets. They will also be asked to draw up a register of patients aged 50 to 74 with a confirmed diagnosis of osteoporosis and recent fragility fracture, and set targets for the prescribing of bone-sparing agents.

Also on NICE advice, seven clinical indicators will be replaced by eight new ones spanning diabetes, mental health, asthma, depression, atrial fibrillation and smoking. Collectively, the seven new indicators will be worth 71 points.

QOF indicator thresholds will also be raised across the board. All lower thresholds for indicators set at 40% to 90% will be raised, with indicators now at 50% to 90%. Lower thresholds for indicators with an upper threshold of between 70% and 85% will be raised to 45%.

There are also upper threshold changes for a series of indicators - CHD6, CHD10, PP1, PP2, HF4, STROKE6, STROKE8, DM17, DM31 COPD10, and CKD5 and lower and upper threshold changes for BP5, MH10 and DEM2.