2019

1. CEG Workshop QOF 2019

2. What are we going to cover? QOF • Changes to clinical indicators • Personalised Care Adjustment (old exception reporting) • Quality Improvement Domains - How CEG can help! Not covering: Workload issues/Indemnity/Digital Technologies/Funding/Primary Care Networks

3. QOF - Three main weaknesses recognised Can feel like tick box medicine Scheme not kept up with changing evidence base Exception reporting too crude and lack transparency

4. QOF Points remains the same

5. Point Value • £187.74 per QOF Point • National average practice population of 8,479

6. What is happening in 2019/2020 QOF? • 28 indicators RETIRING worth 175 pts • 15 indicators NEW/Replacementworth 101 pts (diabetes, BP control, and cervical screening) • NEW Quality Improvement Domain worth 74 pts • Exception reporting replaced with Personalised Care Adjustment

7. Clinical Domain • No changes in: Atrial Fibrillation – 29pts Heart Failure – 29pts Asthma – 45pts Depression – 10pts Cancer – 11pts CKD – 6pts Epilepsy – 1pt Learning Disability – 4pts Rheumatoid Arthritis – 6pts

8. CHD – No loss of points

9. Hypertension – 1 point lost

10. Good news City and Hackney LTC1-E01Y Hypertension with BP <=140/90 [82%] • 86%

11. Stroke/TIA Register – lost 2 points

12. Peripheral Arterial Disease – lost 4 points

13. Diabetes – lost 16 points

16. A word about Frailty • 2017/18 Frailty identification and care part of GP contract • Routine identification of frailty aged 65 and over • Stratify into mild/moderate/severe • Used eFI tool – clinical judgement • Frailty not recorded will make denominators for diabetes more difficult

17. Severe Frailty

18. LTC Template

19. COPD – lost 10 points

21. Dementia – lost 6 points

22. Mental Health – lost 8 points

23. Mental Health – lost 8 points

24. BMI>30 in SMI Population 31% of SMI patients have a record of BMI>=30 compared to 13% in general population

25. Remission from SMI Only use remission codes: • No record of antipsychotic medication • No mental health in-patient episodes; and no secondary or community care mental health follow-up within the last five years

26. Osteoporosis – lost 6 points

27. Palliative Care Register – lost 3 points

28. Public Health Domain No changes in: • Cardiovascular Disease Primary Prevention – 10 pts • Blood Pressure -15 pts • Obesity – 8pts

29. Public Health Domain – Smoking – lost 2 points

30. Public Health – Additional Contraception – lost 7 points

31. Public Health – Cervical Screening – lost 9 points

32. Personalised Care Adjustment • End of life care • Medicine intolerance • Allergies • Contraindications As per current existing rules • Informed dissent • Specific codes to single indicators • Actual invitations sent to patients – 2 now not 3 except cervical screening • Echo • Spirometry • Reversibility • Structured Education • Pulmonary Rehab

33. PCA • As with exception reporting applying a PCA to patient record will remove patient from indicator denominator if QOF defined intervention has not been delivered. • Clear auditable reasons coded or entered in free text on patient record for PCA

34. Note about coding • Intervention Clinically Unsuitable - Generic codes ‘patient unsuitable’ apply to all indicators and more specific codes – more codes will become available in time. • Patient chosen not to receive intervention – Generic codes ‘informed dissent’.

35. New Quality Improvement Domain – 74 points End of Life Care 37 points Prescribing Safety 37 points

36. Prescribing Safety

37. Improvements in prescribing safety • NSAIDs in patients with significant risk of complications such as GI bleeding • Monitor of potentially toxic medications such as lithium prescribing • Valproate and pregnancy prevention

38. Practices will need to:

39. Example - Valproate • E.g. Baseline audit shows that not all girls/women of childbearing potential are recorded as using highly effective contraception e.g. IUD/IUS/IMP

40. CEG Search

41. Set up a SMART outcome • SPECIFIC • MEASURABLE • ACHIEVABLE • RELEVANT • TIME BOUND

42. SMART • Eg. • Increase from 17% to x% of patients using highly effective contraception

45. End of Life Care

46. Improvement in the following measures • Start with assessment of quality of care provided • Identify quality improvement goal • Increase of proportion of people on register • Increase of proportion offered personalised care plan discussions • Increase in proportion of care givers identified and given support • System to receive feedback on experience of care

47. Example – Measure 3 • Baseline audit – 10% of carer identified on practice support register were contacted and given info on grief/bereavement within 1 month • SMART outcome: Increase 10% to X% of family members given supported within X wks/mths of the person on the register dying.

48. Implement the plan • Involve the whole practice team • Engage with colleagues in community • Check progress on plan • Discuss in network peer review meetings – minimum two meetings

50. Any further questions