Updated November 2022
*Prevalence is an estimate based on latest available QOF data and current trends. For further explanation read more details here.
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:
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.
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:
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
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
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.
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
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.
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
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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%
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