gms2 qof - qof2

1. GMS2 – QOF - ?QOF2 Dr Tony Snell Co-Vice Chair NHS Confederation GMS Negotiation Team Medical Director Birmingham and the Black Country Strategic Health Authority

3. Limited difference between PMS & nGMS Larger practices More skill mix Local variation to meet local needs ES forces practice collaboration and multipractice consortia development Range of other providers Commercial companies Not for profit organisations Voluntary organisationsLimited difference between PMS & nGMS Larger practices More skill mix Local variation to meet local needs ES forces practice collaboration and multipractice consortia development Range of other providers Commercial companies Not for profit organisations Voluntary organisations

4. Current number of diabetics in South Gloucestershire –front - and predicted number in 10 years (almost double) – back. Ageing + illnesses affecting mainly elderly = high rise in workload. Need to do things differently – skill-mix and concentrate on chronic disease management Again example of changing nature Current number of diabetics in South Gloucestershire –front - and predicted number in 10 years (almost double) – back. Ageing + illnesses affecting mainly elderly = high rise in workload. Need to do things differently – skill-mix and concentrate on chronic disease management Again example of changing nature

5. Pressure on NHS resources About 20% of admissions and bed-days are for patients with 3 or more unplanned admissions in a year This group of patients (9,845 people) represents only 1 in 300 of our population, or about 7 per practice Early intervention with these patients could have significant impact on health and hospital usage

6. Systems Changes PBR – “suck £ into secondary care” PBC – Counterweight Secondary to primary care shift Care closer to patient Demand management Referral control Quality commissioning ?vertical integration ? Pathway development – Medic to Medic DOCS ‘R’ 4 US Clinical Networks Disinvestment strategies

7. GMS Contracts: Other PCTMS Alternative GMS providers (APMS) Private Acute Trust PMS SPMS Pharmacy Dentistry

8. The contract “menu”five types of service

9. Enhanced Services National Enhanced Services OPT-IN – national terms and conditions “services that require specialist skills and/or facilities and/or equipment” Anticoagulant Monitoring Nursing Homes IUCD Drug and Alcohol Misuse Local enhanced services

10. QUALITY & OUTCOMES FRAMEWORK ”A bold initiative to improve quality of care” “With one mighty leap, the NHS vaults over anything being attempted in the United States, the previous leader in quality improvement initiatives” Paul Shekelle, Professor of Medicine, University of California, Los Angeles BMJ. Vol 326, 1 March 2003: 457-8

11. The four domains of quality Clinical Organisational Patient experience Additional services

12. Balance of 1000 points Clinical 550 Organisational 184 Additional Services 36 Patient Experience 100 Holistic Care 100 Quality Practice Payment 30

13. Clinical Areas CHD and LVD Hypertension Diabetes Mellitus Asthma COPD Mental health Stroke or TIA Epilepsy Cancer Hypothyroidism 121 105 99 72 45 41 31 16 12 8

14. Principles Evidence based Indicators fair Clinical indicators are measurable Not disruptive to consultation Large explanatory document to support

15. QUALITY INDICATORS CORONARY HEART DISEASE (1)

16. QUALITY INDICATORSCORONARY HEART DISEASE (2)

17. HYPERTENSION

18. DIABETES MELLITUS (1)

19. DIABETES MELLITUS (2)

20. DIABETES MELLITUS (3)

21. Exception reporting Patients refuse to attend three times Are new or recently diagnosed patients It is not clinically appropriate They have given informed dissent They cannot tolerate medication/therapy They are taking maximum medication They have another supervening condition Investigation not available to practice

22. Quality and Outcomes FrameworkAnalysis of Year End Data

24. Prevalence Map – Diabetes Mellitus

28. QOF Indicators – CHD9

29. Indicator – DM7 Indicator DM7 - The percentage of patients with diabetes in whom the last HbA1C is 10 or less (or equivalent test/reference range depending on local laboratory) in last 15 months. 

30. Indicator - DM7

31. Indicator – DM13 Indicator DM13 - The percentage of patients with diabetes who have a record of micro-albuminuria testing in the previous 15 months (exception reporting for patients with proteinuria).

32. Indicator - DM13

33. Practice List Size

34. Association with Deprivation (IMD 2004) Index of Multiple Deprivation 2004 Super Output Area Weighted IMD score for each practice based on postcode of registrants Correlation between QOF Score and weighted IMD 5% of variation in QOF can be explained by variations in deprivation

35. QOF and Hospital Admissions Correlation with QOF Total Score ? Elective admission rates ? Day Case Rates ? Emergency Admissions ? (sig., weak, –ve,) 5% of variation in emergency admission rates explained by variations in QOF But deprivation confounds this relationship Sub-domain – cervical screening

36. Emergency Admissions and QOF Sub-domains

38. Chronic Kidney Disease (Draft new QOF indicator set) 1

39. Chronic Kidney Disease (Draft new QOF indicator set) 2

40. Chronic Kidney Disease (Draft new QOF indicator set) 3

41. Chronic Kidney Disease