QOF

Maximising your QOF income: Mental health area

Updated November 2022

Summary – indicators and value

  • Indicators: 7
  • Points: 38
  • Prevalence*: 0.9%
  • Estimated value per patient:  £90

*Prevalence is an estimate based on latest available QOF data and current trends. For further explanation read more details here.

Background

Last year, QOF saw an extra three indicators introduced to the mental health area, giving a total of seven indicators and a high number of points – and potential income – per patient.

One of the additional indicators was a former QOF indicator on keeping a record of alcohol consumption that was reintroduced.

The other two were new indicators for blood lipid and blood glucose checks.  Past indicators for blood tests in patients on the mental health register had a lower age cut-off at 40, but now the indicators have no age limits (although most patients are adults).

The indicators can be summarised as:

  • Indicator 1: Maintain register of patients with mental health problems (4 points)
  • Indicator 2: Annual comprehensive care plan in 90% of patients (6 points)
  • Indicator 3: Blood pressure measurement in 90% of patients (4 points)
  • Indicator 4: Measurement of BMI in 90% of patients (4 points)
  • Indicator 5: Record of alcohol consumption in past 12 months (4 points)
  • Indicator 6: Measurement of lipid profile in past 12 months in patients currently prescribed antipsychotics, and/or at high CVD risk (8 points)
  • Indicator 7: Measurement of blood glucose/HbA1c in past 12 months (8 points)

Together the above form the basis of an annual review and, along with smoking status recorded as part of the smoking area, mean QOF now includes all six elements of the Comprehensive Annual Physical Health Check introduced in the NHS Long Term Plan.

Although the number of patients on the mental health register has been rising over the years, there is still a relatively high payment per patient. This reflects the importance placed on the identification and treatment of mental health problems by NHS England.

Indicator 1. Maintain register of patients with mental health problems (4 points)

There are many codes that will place a patient on the register. Any mentioning psychosis, schizophrenia, mania or bipolar disorder will be effective.

There is no way to remove patients from the register. Although codes for psychosis resolved exist, they do not have any effect on QOF. Instead, patients who have not received medication or a secondary care review for five years can be coded as being in remission. This will leave the patients on the register for prevalence purposes, but excuses them from the other indicators.

There are a number of codes that can be used for patients in remission, corresponding to the various diagnostic codes, although the QOF rules don’t insist they match. For instance, if a patient has a diagnosis of hypomania, a code of paranoid state in remission would record them as being in remission for QOF.

Tips:

  • Diagnoses from secondary care can be vague. It is vital that patients have a recognised diagnostic code so that they become eligible for the other indicators. Performing a search for antipsychotic drugs or lithium may identify patients who have been missed. Appropriate codes for psychosis can then be entered.
  • The number of patients on antipsychotic medication is likely to be small, so even a single extra code will pay for the time that you spend checking the records.
  • If a patient has a relapse following remission, they will need a new diagnostic code.

Indicator 2: Annual comprehensive care plan (6 points)

Six points are available if 90% of patients have an annual care plan. The official guidance gives some detail on what should be included in this.

Agreeing or reviewing a mental health care plan will fulfil the criteria and there are a number of valid codes for the Care Programme Approach, where a patient has agreed a plan with their community worker.

Tips

  • It can be difficult to arrange a review with this group, particularly if they are already under active review by mental health services. Where patients are receiving medication from the practice a reminder can be sent with a prescription.
  • Occasionally it may be necessary to give a shorter course of medication on each prescription, giving the message that this is to tide them over until a review is undertaken for their own safety.
  • Patients who are usually under the secondary care mental health services should also be invited. Working with community mental health services can give extra encouragement for these patients to attend.
  • Patients can be exception reported (now under the ‘personalised care adjustment’ codes) if they dissent or fail to respond after two invitations. The practice should then consider if they should continue to prescribe.
  • There are general exception reporting codes and a three-month period of automatic exception reporting following a new registration. This only applies after the first diagnosis; after a relapse the care plan will be due immediately.

Indicator 3: Blood pressure measurement (4 points) and Indicator 4: BMI measurement (4 points)

Both these indicators can be incorporated into the annual plan and both offer full points for recording the information in 90% of patients. Together they also carry more points than the generation of the care plan.

The BMI indicator was reintroduced in 2019; after its removal from QOF in 2015, measurement rates fell from 90% to 60%.

Tips

  • There is no maximum acceptable blood pressure in this QOF indicator. Simply recording a measurement is all that is required.
  • Remember that the BMI measurement applies to all patients, whether overweight or not.
  • Weight and height can be measured by suitably trained reception staff, but provide a template to enter the data so they are reminded to make the BMI calculation.
  • Searching for patients with a weight measurement but no BMI record in the current year can be a quick way to boost achievement rates.
  • There is exception reporting if the patient refuses to have their blood pressure taken, as well as the usual three-month grace period after registration or a new diagnosis (but not relapse).

Indicator 5: Alcohol consumption record in preceding 12 months (4 points)

All patients on the register should have a record of alcohol consumption each year. This indicator was removed in 2019 but has returned unchanged.

It is not an especially difficult indicator if patients are having an annual review and carries four points. Most of these patients will need to have smoking status recorded as well. The most important thing is that it is part of your templates from the start of the year to ensure that the information is efficiently recorded.

It does not need to be a face to face review – it could be by phone or electronic questionnaire.

Indicator 6: Lipid measurement in preceding 12 months (8 points)

There are eight points if 90% of patients on the register have a cholesterol measurement during the year. There is no age limit here other than all patients on the register must be over 18 years old.

Technically the annual check is only required if the patient

  • Is currently taking antipsychotic medication or
  • Have pre-existing cardiovascular disease or
  • BMI ≥23 (25 if coded as white) or
  • Smokes.

However if the patient does not meet any of the above criteria the requirement then becomes every two years and with the HbA1c indicator (see below) it is probably simplest to check lipids annually.

Indicator 7: Blood glucose/HbA1c measurement in preceding 12 months (8 points)

There are a further eight points for reaching 90% of patients on the register, of any age, with a HbA1c measurement. Although not required this should normally be the same blood sample as the cholesterol measurement above. If you are efficient the two blood test indicators could be considered as a single indicator worth 16 points. The blood tests are worth over two and a half times the value of the annual review!

Patients who already have diabetes will not count towards this indicator. If the result is raised patients can be added to either the diabetes or non-diabetic hyperglycaemia register – increasing income. 

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

Further reading/resources

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Full indicators

Indicator 1: The contractor establishes and maintains a register of patients with schizophrenia, bipolar affective disorder and other psychoses and other patients on lithium therapy (MH001). 

Indicator 2: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate (MH002). Payment threshold: 40-90% 

Indicator 3: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 12 months (MH003). Payment threshold: 50-90% 

Indicator 4: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of body mass index in the preceding 12 months (MH006). Payment threshold: 50-90% 

Indicator 5: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 12 months (MH007). Payment threshold:  50-90%  

Indicator 6: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of a lipid profile in the preceding 12 months (in those patients currently prescribed antipsychotics, and/or who have pre-existing cardiovascular conditions, and/or smoke, and/or are overweight [BMI of ≥23 kg/m2 or ≥25 kg/m2 if ethnicity is recorded as White]) or preceding 24 months for all other patients (MH011). Payment threshold: 50-90%  

Indicator 7: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose or HbA1c in the preceding 12 months (MH012). Payment threshold: 50-90% 

Guide URL:
https://pulse-intelligence.co.uk/guide/maximising-your-qof-income-mental-health-2/
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