User Group Presentation March 2011

1. User Group PresentationMarch 2011 Alison Young

2. My Agenda • Vision Updates • Audits & Guidelines • Data Collection • DES • QOF

3. Vision Updates • February and March Drug Dictionaries are in progress at the moment • DLM 320 on release • DLM 321 on release • User Guides available on the website • Drug Changes require intervention

4. Audits & Guidelines • Audits • NHS Health Checks available now • Further updates to this available soon • Pneumococcal 2011 audits available • Guidelines • NHS Checks with GPPAQ Calculator – available now

5. HPA website automated collection NOT available in England and Wales yet but further testing likely in 2011 Working in Scotland for flu vaccination and influenza like illness monitoring DES (England)Requirements published Ethnicity and Heart Failure retired Some changes to Alcohol, Learning Disabilities and Osteoporosis Audits and guidelines to follow soon Data Collection & DES

6. QOF 2011-12 • NICE & Information Centre take over from April 2011 • NICE responsible for the guidance • NHS IC responsible for the Business Rules and collection of data • Documents for v19 have arrived • Retirements, Points and % changes • Business Rules • Version 19.00.00 Guidelines & Audits • Will be on the website ASAP in late May • V20 will be published in the next few months • Will need conformance • Will contain Q1 Read Codes • Will need QMAS switched on before rolling to site – expected September

7. QOF 2011-12 • 96.5 points released by retiring indicators • 28 points available to conduct an internal review of prescribing • 21 points for internal review of care pathways use • 27.5 points for reviewing emergency admissions

8. Retiring indicators • CHD5 & CHD7 • BP and cholesterol in the last 15m • DM5, DM11 & DM16 • HbA1c, BP and cholesterol in last 15m • STROKE5 • BP in last 15m • MH7 • Pts who DNA and are followed up within 14 days

9. Retiring indicators cont…. • EPIL07 • Medication review in last 15m • Information4 • Patient given information to choose new practice on removal • RECORDS21 • Ethic origin for 100% of new registrations • PE7 and PE8 • Patient experience of appointment booking

10. Replacement indicators • CHD11 -> CHD14 • Pts with MI from 01/04/2011 treated with ACE(or ARB if ACE intolerant), aspirin or alternate anti-platelet therapy, beta-blocker AND statin – 10pts • CHD2 -> CHD13 • Pts with new angina diagnosis from 01/04/2011 referred for specialist assessment – 7pts

11. Replacement indicators • PP01 • Pts with new diagnosis of hypertension in the preceding 1st April to 31st March with risk assessment at the outset of diagnosis within 3 months -8pts • DM23 -> DM26 • Last IFCC-HbA1c is 59 mmol/mol or less (equivalent to 7.5% DCCT value) in last 15m -17pts • DM24 -> DM27 • Last IFCC-HbA1c is 64 mmol/mol or less (equivalent to 8% DCCT value) in last 15m -8pts • DM25 -> DM28 • Last IFCC-HbA1c is 75 mmol/mol or less (equivalent to 9% DCCT value) in last 15m – 10pts • Business Rules still allow both IFCC and DCCT Aligned values.

12. Replacement Indicators • DM9 ->DM29 • The percentage of patients with diabetes with a record of a foot examination and risk classification: low risk, increased risk, high risk or ulcerated foot within the preceding 15 months – 4pts • New coding for foot risk 2G5E, 2G5F, 2G5G, 2G5H, 2G5I, 2G5J, 2G5K and 2G5L • Exceptions include single and bilateral amputees • DM12 -> DM30 & DM31 • BP 150/90 or less - 8pts • BP 140/80 or less – 10pts

13. Replacement indicators • MH9 is now split into 6 indicators • MH11 MH Register patients with alcohol consumption recorded last 15m - 4pts • MH12 MH Register patients with BMI recorded last 15m – 4pts • NH13 MH Register patients with BP recorded last 15m -4pts • MH14 MH Register over 40 with cholesterol:hdl ratio (44PG.)recorded last 15m - 5pts • MH15 MH Register patients with blood glucose level recorded last 15m (excluding Diabetics) – 5pts • MH16 MH Register female patients 25-64 in Eng & NI, 20-60 in Scot and 20-64 in Wales with cytology last 5 years – 5pts

14. Replacement indicators • MH04 -> MH17 • Pts on lithium with serum creatinine & TSH in the preceding 9m – 1pt • MH05 -> MH18 • Pts on lithium with lithium levels in therapeutic range preceding 4 months -2pts • MH06 -> MH10 • Pts with documented comprehensive care plan – 6pts • DEP02 -> DEP04 • New diagnosis of depression in last year assessment of severity at the time of diagnosis -17pts

15. Replacement indicators • DEP03 -> DEP05 • Second assessment of severity with 4-12 weeks after initial recording – 8pts • COPD01 -> COPD14 • Register of patients with COPD – 3pts • COPD12 -> COPD15 • Percentage of pts diagnosed after 1st April confirmed by post-bronchodilator spirometry

16. New Indicators • EP09 - The percentage of women under 55on anti-epileptic drugs who have a record of contraception, conception and pregnancy counselling in the last 15m - 3pts 40-90% • LD02 – The percentage of patients on the Learning Disabilities register with Down’s Syndrome over 18 who have a blood TSH in the last 15m (exc. those on thyroid disease register) - 3pts 40-70% • And QP Indicators – not reported through Vision • QP1-5 – Internal review of prescribing and assessment of cost effectiveness. • QP 6-8 – Internal review of out-patient referrals for commissioning and service design improvements • QP 9-11 – Internal review of emergency admissions for commissioning and service design improvements

17. Reduced Points and Thresholds • DEP01 Case finding for Depression in Diabetics and CHD patients goes down from 8 to 6 points. • BP4 Percentage of pts with hypertension with record of BP last 9 months down from 18 to16points

18. Increased Thresholds • CHD06 -Patients with CHD last BP less than 150/90 threshold increased to 71% • STROKE06 – Patients with Stroke or TIA last BP less than 150/90 increased to 71% • DM30 – Patients with Diabetes last BP less than 150/90 increased to 71%