I thought we were good with data – I spent 18 years in the IT industry so I know about data quality, and our QOF prevalence was fairly good. However, we could always do better, so we decided to have a company conduct a QOF health check.
What we did
We are the largest practice in Suffolk, with 23,000 patients, five surgeries in a single practice, seven partners, seven salaried GPs and many other clinical and non-clinical staff, so we booked the company for two days instead of the usual one. This cost £3,600: £3,000 for the health check and £600 for the second day.
The first stage of the process was for the consultancy to go through our patient list with its algorithm to identify patients not already coded whom we could add to our QOF registers and boost prevalence scores.
At the end of this we had a 160-page report, and someone from the consultancy came to our surgery for two days to go through it with us.
On these days we identified the registers that would be most productive and cost effective in terms of time spent, for example osteoporosis and dementia. Then, since individual staff are responsible for several registers, time was spent with each member of the four-person QOF team going through their list. This was an excellent learning opportunity and a chance to correct some beliefs, as some staff were operating under old guidance. Rules change, sometimes people forget, and sometimes they get contradictory instructions.
Patients who required a clinical decision were passed onto a clinician to review later.
Work continued throughout the next few months as we went through the rest of the report ourselves, splitting up decisions between non-clinicians and GPs to decide how to code patients.
The cost of the check was not too large for a practice of our size so we decided it was worth a gamble – and it more than paid off.
It needed ongoing work after the initial time spent with the consultants. However, this is now just ‘business as usual’ and incorporated into our routine work on QOF, so has not added to our workload. Our staff are all keen to hit QOF targets, and this exercise has been a massive help in keeping them motivated.
Information governance and confidentiality were a concern and we needed to be reassured that appropriate protections were in place.
I didn’t expect to be impressed by the outcome. As I said, we thought the quality of our coding was fairly good. But by the end of the two days our increase in prevalence was worth £8,800. This has doubled with the work we’ve done since. For example: we increased the number of patients on our dementia register from 241 to 290. And the number of people on the osteoporosis register increased from 1 to 121. On a wider level, it will help our CCG reach quality premium targets for diagnosis of dementia, which means £180,000 more for our local NHS. As a result, our CCG has commissioned the consultancy to help other practices identify patients with dementia.
The positive effects will last for a few years as the patients we’ve added will stay on the register until they leave or die. However, we will probably do something similar again in two or three years. Some things will be miscoded, new patients will arrive and it should be routine to repeat quality audits.
David Cripps is practice manager at Hardwicke House Group Practice in Sudbury, Suffolk
This article was commissioned independently. Interface Clinical Services, the consultancy that provided the health check, had no input into the copy