Guide: QOF

Maximising income from QOF: The ‘non-diabetic hyperglycaemia’ indicator

Updated November 2022

Summary – indicators and value

Indicators: 1
Points: 18
Prevalence: 5%*
£/patient on the register (est.): £8

Background

For the past few years there has been a national effort to identify patients with blood sugar readings above the normal range, but below the diagnostic criteria for diabetes.

The main vehicle for this has been the National Diabetes Prevention Programme delivered across England, with practices incentivised through local enhanced services to refer patients to exercise and diet programmes, as well as other courses on implementing behavioural changes, to prevent them developing diabetes.

These services will remain, but the new indicator introduced into QOF this year will further incentivise follow-up of patients who have been identified in the Programme for an annual review of their blood sugar.

It is difficult to estimate how many patients this will involve, as the published national figures are of pretty low quality, but according to data from the National Diabetes Audit (see below) it could be around 5% of your patient list.

Indicator – the proportion of patients with non-diabetic hyperglycaemia who have had their blood glucose checked in the past year

This is a relatively straightforward indicator although it is likely that a large number of patients will qualify – probably over 50% of the number of patients on your diabetes register. That represents a lot of blood tests and so starting early will allow you to spread the activity through the year.

All patients who have had a diagnosis of non-diabetic hyperglycaemia (NDH) at any time including ‘pre-diabetes’ or impaired glucose tolerance will qualify for this indicator, if they do not already have a diagnosis of diabetes. This will require a diagnostic code to be entered.

Impaired glucose tolerance is defined by NICE as an HbA1c between 47 and 47mmol/molHb. If that test is not appropriate, perhaps due to haemoglobins variants, a fasting glucose of 5.5-6.9mmol/l will also qualify. These results will not put a patient onto the register on their own – the diagnostic code must also be entered.

The National Diabetes Audit shows that the current use of diagnostic codes varies considerably between practices. Practices that have used the diagnostic codes in the past will need to make sure that 90% of those patients have a further HbA1c test this year.

If the practice has not used diagnostic codes in the past then it would make sense to enter them only after this year’s blood result to maximise achievement and use the most up to date information.

There is no way to remove a patient from the register once the diagnosis has been entered.

How to increase your prevalence – identifying patients with NDH

You can boost your prevalence figures – increasing the payment per point – by making additional diagnoses. This means finding the right patients to have a blood test. There are three groups that you might want to target:

First, obviously, are patients who already have a diagnosis of impaired glucose tolerance.

Second are patients who have had a blood test result in the diagnostic range in previous years, but have not received a diagnosis. These blood test results should be used in a search to invite patients for a further blood test this year.

Finally, you might want to consider using a diabetes risk calculator such as QDiabetes to identify patients with a higher chance of developing diabetes. These are patients who are more likely to develop impaired glucose tolerance or diabetes – increasing prevalence figures and payments.

Making the blood test results count

When the patient has had their blood test then their result will either be normal, raised or diagnostic for diabetes. If it is normal then no action is needed, but the patient will count towards the indicator, if they had already been coded as having the NDH diagnosis. They should continue to have annual blood tests in the future.

If the result is in the NDH range then a diagnosis should be entered if they do not already have one. They will be counted towards the indicator and will require further annual blood tests. It is important to have a robust mechanism to add the at NDH diagnosis when a result has been received. There may also be an enhanced service incentive to refer patients to a local weight reduction service.

If they have a result diagnostic of diabetes then this code should be entered and they will appear on, an attract payment for, the diabetes register. If they have had a NDH diagnosis in the past, then the blood test will also count for the new indicator this year.

As usual if a patient has a two separate invitations code then they will be excepted from this indicator. The only code currently counted is the non-specific ‘Quality and Outcomes Framework quality indicator-related care invitation’, although I would hope a more specific code will appear before the end of the QOF year.

The full points will be achieved if 90% of patients have the blood test although this may be challenging in a potentially quite healthy group of patients.

Dr Gavin Jamie is a GP partner in Swindon and runs the QOF Database website