Using QOF and Service Specifications to meet HI Needs

1. Using QOF and Service Specifications to meet HI Needs Rachel Foskett-Tharby

2. Key Points • Know your population • Know your gap • Know QOF and actively manage the process • Get the most from QOF • Plugging the gaps

3. Know your population • To do this successfully requires: • Close collaboration between commissioning and public health • Use of the outputs of the JSNA • Understanding of current service provision

4. Know your gap • Consider in terms of: • Life years • Access to services • Proportion of patients receiving optimal treatment • Distribution – inequalities across the patch or concentrated in pockets?

5. Know QOF • Strengths • Weaknesses • Management of process • Used effectively can impact on health inequalities

6. Get the best from QOF

7. Four body systems One main mechanism Common risk factors Death and disability Heart disease Stroke Diabetes Kidney disease Poor diet (fat, sugar, salt) Lack of physical activity Smoking High blood pressure 6.2m people affected 200k deaths pa (38% of total) 17% hospital admissions 50%+ of mortality gaps Disordered blood chemistry Atheroma in blood vessels Multiple organs affected One increases risk of others Where should we be looking?

8. individual risk management Individual Vascular Risk Assessment Existing guidance and tools (eg SIGN) NICE Guidelines (in current programme) Unified risk assessment support system Low Risk Individual maintenance plan High Risk Intervention Eg statin Review yearly Disease Existing clinical pathways Med Risk Management plan Review 1-5 yrs Indicators for

13. How to add value to QOF CHD (with thanks to NST) • Calculate an ‘expected’ prevalence of CVD by practice and compare with numbers on registers • Have strict criteria for exceptions and exclusions from registers for QOF purposes • Audit records of excepted and excluded patients • Ensure excepted patients have a care plan

14. How to add value (2) • Establish from QOF scores which practices are not claiming full points for CHD5, stroke 5, CHD 7 and stroke 7 • Establish from QOF scores practices with scope to improve overall effectiveness of clinical practice e.g. CHD6, stroke 6, CHD8 and stroke 8 • Audit practices claiming maximum points to verify outcomes

15. How to add value (3) • Promote systems of medicines management and patient adherence to therapy based on active assessment and appropriate support based on cultural and language requirements • Ensure referral of newly diagnosed angina patients for exercise testing and specialist assessment • Consider linking to PBC plans and bonus payments

16. QOF and APMS Contracts • In groups discuss: • Strengths of using QOF in these contracts • Weaknesses of using QOF in these contracts • Risks and benefits of setting points targets as part of a contract • Strategies to manage these

17. Plug the gaps • Identify areas not covered by QOF of local significance in terms of HI • Identify ‘hard to reach’ populations • Consider evidence based service framework • Link to PBC plans

18. Service Frameworks • Templates available at www.primarycarecontracting.nhs.uk • Suggested frameworks available for: • Alcohol • Obesity • Long term conditions • Support for self-care • Sexual health

19. Discussion and Questions