QOF
Quality & Productivity Indicators
Dr Steve Jenkins
& Chris Valchero
11th July 2012
QOF Q&P indicators
• Congratulations!- Most practices achieved
maximum QP 6-11 points available in Yr 1
• Year 2
– Building on successes from year 1 and some
amendments based on our learning
– Trafford CCG continue to facilitate process
– Overseen by NHS Greater Manchester Cluster
• Some National revisions to Q&P indicators
– Removal of Prescribing Indicators QP1 – 5
– Same Outpatient and Unscheduled Admission
Indicators QP 6 – 11 but new areas
– Addition of A&E Indicators QP 12 – 14
QP 6 – 8
GP outpatient referrals
• Dyspepsia
• Trafford rate of gastroscopies relatively high compared to other PCTs
(Atlas of Variation)
• Continue with Dyspepsia
• Aiming to localise pathway following feedback / discussions from
External Peer Review
• Childhood Eczema
• Dermatology - one of highest outpatient specialties
• Availability of Community Children’s Nursing Teams to support patients
with known diagnoses of eczema
• Developed localised pathway from Trafford Dermatology Guidance
• Rhinitis
• ENT – another of highest outpatient specialities
• Consultant advised an area of common inappropriate referral
• Localised pathway developed by multidisciplinary team
QP 6
What do we need to do?
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•
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Practice Internal Review of outpatient referrals
If no referrals – consider in-house management
Speciality data available within Actuate by mid July
Clinical system search (referral / in-house ) or get secretary
to keep record for specific diagnoses
Compare variance against Map of Medicines Pathways for
each area
Document outcome of Internal Review meeting on QP6
template
QP 6 template now more specific and one template for all 3
areas
Submit to CCG by 28 Sept 2012
QP 7
What do we need to do?
• QP 6 template must be submitted before External
Peer Review Meeting
• TCCG to facilitate a specific QOF Q&P External
Peer Review Meeting – Oct 12 (date tba)
• Practice GP representative to attend
• Practice feedback will inform further localisation of
pathways
• Outcomes / completed QP 7 template submitted to
TCCG shortly after meeting
QOF Quality and Outcomes Framework 2012-13
Template QP 6 Notes of internal Meeting to Review the Data on
Outpatient Referrals
Note: Internal review must be carried out prior to external review.
Practice Name
Date of meeting
Present:
( Full range of clinicians
to be represented
including Nurse
representation)
Confirmation of Review
of Actuate Data at
speciality level and/or
practice clinical data.
(Minimum of 3 patients
per speciality)
ie Gastrology,ENT and
Dermatology
Summary of Referrals
received indictating
degree of compliance.
Fully, Mostly,Partially or
Non-compliant)
( Minimum 3 patients
per speciality)
Dyspepsia
Rhinitis
Ezcema
Dyspepsia
Rhinitis
Ezcema
Referral anomalies
identified.
Give details of where
each speciality is non
compliant with the
pathway, where the
referrals are appropriate
and non compliant.
Details of changes
needed to improve
compliance.
This completed template must be forwarded electronically to Sarah Gunshon.
TCC Business Manager no later than 28th September 2012.Templates received
after this date will not achieve QOF Points.
QOF Quality and Outcomes Framework 2011/12
Template QP7 Notes of External Peer Review Meeting to Compare
Data on Secondary Care Outpatient Referrals
Practice Name
Date of meeting
Present:
(Name of GP
representing the
practice)
Details of other
practices present.
Reflections on referral
behaviour and variances
amongst practices.
Dyspepsia:
Rhinitis;
Ezcema:
What have clinicians
learnt to alter their
referral patterns.
Dyspepsia:
Rhinitis:
Ezcema:
How has this discussion
changed their referral
behaviour.
Dyspepsia:
Rhinitis:
Ideas from discussion to
reduce unnecessary
hospital attendances e.g
Following a new
pathway.
Recommendations to
CCG for service design
improvements for areas
of commissioning
improvement that would
enable more effective
management of patients
in the community.
Ezcema:
Dyspepsia:
Rhinitis;
Ezcema:
Dyspepsia:
Rhinitis:
Ezcema:
This completed template must be forwarded electronically to Sarah Gunshon. TCC
Business Manager. sarah.gunshon@trafford.nhs.uk. The date will be advised at the
External Review. Templates received after the specified date will not achieve QOF
Points.
QP 9 – 11
Unscheduled Admissions
• COPD
• Local best practice Trafford guidelines based on NICE guidance
• Continue high emergency admissions for respiratory conditions
• Build on work undertaken last year
• Asthma
• Trafford PCT ranks high for asthma admissions
• 14th highest diagnosis for which patients admitted in Trafford
• Evidence structured primary care improves symptom control
• TIA
• Evidence timely management of TIA reduces stroke risk (NICE
2008)
• Greater Manchester Cardiac and Stroke Network assessment
pathway with referral to TIA clinics
• Assessment via ABCD2 tool – training DVD & in info pack
• Key priorities for implementation (NICE 2008)
• Rapid recognition of symptoms and diagnosis
• People who have had a suspected TIA who are at high
risk of stroke (that is, with an ABCD2 score of 4 or
above) should have:
– aspirin (300 mg daily) started immediately
– specialist assessment and investigation within 24
hours of onset of symptoms
QP 9
What do we need to do?
•
•
•
•
•
•
•
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•
Practice Internal Review of unscheduled admissions
If no unscheduled admissions, consider in-house mgt
Data available within Actuate by mid July (incl diagnoses)
Keep copies of discharge letters / clinical system search
Proforma for practices to undertake and document review
for each area
Document outcome of Internal Review meeting on QP9
template
QP 9 template now more specific & one template for all
areas
Attach 3 “patient anonymised” proforma to QP 9 template
Submit to CCG by 28 Sept 2012
External Peer Review (QP 10) as per outpatients process
QP 12- 14
Accident & Emergency
QP 12
What do we need to do?
• Practice Internal Review of top 10 A&E attendances
• Over 65s
• Under 15s
• Frequent Flyers
• Quarter 4 patient level data available within Actuate by
mid July (as report)
• Document on proforma - consider day / time / reason
for attendance / management in house
• ? Discharge info for UHSM attendances
• QP12 – one template for all 3 areas with attached
proforma
• Submit to CCG by 28 Sept 2012 for use at External Peer
Review Meeting
QP 13-14
What do we need to do?
• QP 13
• Agree Improvement Plan
• Proposals for improved access
• Arrangements in practice
• Service re-design via CCG
• Submit QP 13 template to CCG shortly after External Peer
review Meeting
• QP 14
• Implement Practice Improvement Plan
• Aim to reduce avoidable A&E emergency attendances
• Quarterly A&E reports will be updated on Actuate (Qtr 1 & 2 data
available)
• Produce report of action take on QP 14
• Submit QP 14 template to CCG by end Feb 2013
Contacts
• TCCG Actuate & QOF Q&P Lead
– Sarah.gunshon@trafford.nhs.uk
– 0161 873 9515
• TCCG Map of Medicine
– Matthew.preece@trafford.nhs.uk
– 0161 873 9511
• QOF Lead
– Gail.sampson@trafford.nhs.uk
What Next?
• Pathways are being finalised
• Complete packs available 3rd week in
July
• Data available on Actuate 3rd week in July
• Practice secretary keep log of referrals
• Keep log of unscheduled admission
discharges
• Re-familiarise with Actuate….
• ANY QUESTIONS?
Process
• Target is to review management plans for minimum of 3
high risk COPD patients per 2000 registered list
• Review last year’s emergency admissions (in pack)
• If needed, review those with more than 3 exacerbations
requiring antibiotics
• Ensure optimum management
• Review use of management plans, rescue therapies
(advice, deferred script for steroids and abx) & referral to
pulmonary rehab (if appropriate)
• Documents in pack – more available from TCC
• Review data and complete audit proforma, discuss at
internal review in practice and return by mid Nov to TCC