Q. What is QMAS?
QMAS stands for the Quality Management and Analysis System - a computer system which collated data from practices to support the Quality Outcomes Framework payments introduced as part of the new GMS contract in 2004. QMAS will make QOF payments for the last time this year.
Q. What is CQRS?
CQRS stands for Calculating Quality Reporting Service. CQRS will calculate achievement and payments on quality services delivered by GP practices, including the QOF, nationally-commissioned enhanced services and services commissioned locally from GP practices that go beyond the scope of the GP contract. It will also be able to calculate achievement by clinical commissioning groups against outcome indicators and quality rewards.
QOF expert Dr Gavin Jamie, who is on CQRS project advisory group, explains: ‘CQRS will calculate next year’s QOF - 2012/13 will be QMAS as usual and paid in April - and it will do next years aspiration payments. It won’t be ready at the start of the year but the data from QMAS will be used (with some adjustment for the reduction from 1000 to 900 points).’
NHS Connecting for Health adds: ‘CQRS is being developed to support the organisational structures and commissioning arrangements being implemented as a result of the Health and Social Care Act. It will be able to calculate achievement and payments for any service that follows the same data collection and calculating logic as the main services. This will include locally commissioned services.
‘CQRS is being developed to support the organisational structures and commissioning arrangements being implemented as a result of the Health and Social Care Act. It will be able to calculate achievement and payments for any service that follows the same data collection and calculating logic as the main services. This will include locally commissioned services.’
Q. What is GPES?
GPES stands for General Practice Extraction Service. It is a centrally-managed primary care data extraction service that will, for the first time, extract information from GP IT systems for a range of purposes at a national level. GPES will extract data to support payments to GPs, and pass this to the CQRS which will calculate the payments.
It will thus form part of the new process to provide payments to GPs and clinical commissioning groups and will deliver data for the Quality Outcomes Framework from April 2013.
GPES replaces QMAS in that it will be used to provide the data that will make QOF payments. However, it will also be used for any LES or DES payments and will also allow CCGs to demonstrate target achievement.
GPES will also allow approved third parties to access anonymous data for research and national policy development (for a fee, payable to the Government).
Information technology company ATOS has been awarded the contract to provide the tool that will produce the extract queries, whilst the extractions themselves will be conducted by the GP practice system suppliers.
According to the NHS Information Centre - who are running GPES - it will also ensure patient confidentiality and privacy.
Q. When will the old system be replaced?
CQRS will be in place to calculate payments for GP practices across England from the 2013/14 financial year. QMAS will remain operational until the end of July 2013 to allow for end-of-year activities for the QOF for 2012/13.
Q. Why is QMAS being replaced?
QMAS is relatively limited in what it can extract from the patient record and with the need for both practices and CCGs to demonstrate more of what they are achieving - and to be paid accordingly - a more adaptable system was needed.
According to the NHS Information Centre: ‘GP patient records are currently extracted using a variety of systems that are both technically complex and resource intensive. GPES will resolve this issue by centralising the data query and extraction services, removing the complex scheduling processes and reducing the burden on practice staff.’
Q. Are we obliged to switch?
If you want to receive QOF payments, effectively, yes. However, practices will initially be asked to make one general choice, supported by a data processing agreement between GPES and the practice. The practice will be asked to choose whether or not practice data may, in general, be extracted for queries outputting ‘effectively anonymised’ data.
Practices will then be informed about each GPES query and asked to choose -on a query-by-query basis - whether to opt in. Where no response is received from a practice on a particular query, GPES will assume ‘no’ and will not extract the data.
It is expected that all practices will agree to extracts such as QOF. From April 2013 onwards the only way for practices to submit QOF data is via GPES.
Q. I keep getting training invites – how much training do I need, how long will it take? Who needs training?
The NHS Information Centre recommends that training be completed by anyone in the practice who manages the GP clinical system.
NHS Connecting for Health is providing training for both CQRS and GPES. One CQRS training place will be available per GP practice for this training and it is imperative that an individual from each GP practice participates in the training. Bookings are now being taken for the first phase of CQRS training. More information on how to book training sessions can be found online.
Training for GPES is available online via the NHS Information Centre Practices can register to receive GPES news and training updates via email and will also be able to download a GPES information pack and a desk-aid to guide them through the first few extraction requests.
Q. Is the new system compatible with all GP computer systems?
Yes. Your GP system supplier will also provide support and guidance to ensure that you do not have any problems in submitting your QOF data via GPES for 2013/14.
Q. Will the current information on QMAS all be migrated over to the new system?
Yes. Existing data from QMAS will be migrated to CQRS, giving users ongoing access to their QOF reports from previous years.
Q. If practices refuse, miss or fail to respond to a query from GPES, will there be any financial penalties?
The NHS Commissioning Board advises that, if a GP practice is not able to provide data on QOF achievement then the Board can ask the practice to provide data manually based on an audit of the relevant patient records. The Board is able to ask for whatever information it reasonably requires to verify QOF payments (either ongoing aspiration payments or final end of year payments). Any dispute would go to the normal GP contract dispute resolution procedures.
Q. What are the advantages of agreeing to provide data for GPES queries? Are there any ethical issues such as confidentiality that partnerships should discuss together before CQRS and GPES launch?
The data that GPES will extract and supply to CQRS will not be patient identifiable and as such there are no issues relating to confidentiality. The data will be supplied to CQRS in order to perform the calculations required to support QOF and other quality services. If a GP practice decides not to submit their QOF data via GPES, CQRS would not receive any automatic feeds of data to calculate QOF and other quality services.
If the GP practice wished to receive payments they would still have to provide whatever information the commissioning organisation (either the NHSCB Area Team or CCG) reasonably asked it to provide as evidence of its achievement. This would probably involve the practice undertaking manual audits for all of the indicators and typing the data into CQRS using the data entry screens.
Q. How can I protect my QOF income from disaster?
Simply by making sure your practice is prepared for the switchover and that the person in your practice responsible for the clinical system is trained on GPES and CQRS.
GPs and practice managers are involved in supervising the new system and making sure it works for practices. The GPES independent advisory group includes three GPs including representatives of the BMA and RCGP. There are also separate GP and practice manager consultation groups as well as a patient group. The GP group includes ‘experts’ identified by the BMA, RCGP and Primary Healthcare Specialist group of the BCS. Information will never be extracted without referral to the independent advisory group.
Alisdair Stirling is a freelance journalist