GP Dr Keith Hopcroft explains what the learning disability module involves, including the updated requirements for this year, and provides a suggested timeline to help your team complete the work efficiently.
The two indicators in this module are:
QILD007 – The contractor can demonstrate continuous quality improvement activity focused upon learning disabilities as specified in the QOF guidance.
QILD008 – The contractor has participated in network activity to regularly share and discuss learning from quality improvement activity focused on the care of patients with a learning disability as specified in the QOF guidance. This would usually include participating in a minimum of two network peer review meetings.
The key elements are to review/improve:
- Accuracy of the learning disability (LD) register
- Uptake of the annual health checks and agreement of a health action plan in those aged 14 and over
- Medication use in people with learning disability
- Recording of ‘reasonable adjustments’ (removing barriers that people with a learning disability might face)
- Implementation of the 2019/20 Learning Disabilities Mortality Review (LeDeR) Programme report
- Engagement with local community
Detail and suggested timeline
NB to maximise efficiency, hold the Early Diagnosis of Cancer QI and the Learning Disability QI meetings at the same time.
1. Diagnostic phase (eg April -> July 2021)
The ‘diagnostic phase’ should try to identify areas for improvement, eg:
- Making the LD register more accurate and comprehensive (eg check your practice prevalence against national figures – QOF prevalence is around 0.5% but national prevalence figures vary considerably).
- A training needs analysis for practice staff on learning disability awareness (eg when did staff last receive training in this area?)
- An analysis of the practice’s overall approach to LD including LD specific areas (eg system for annual LD health checks, including percentage completed – national target is 75%) and non LD specific areas (eg influenza and Covid immunisation rates, appropriate repeat prescribing, rates of cancer screening in this group – the latter could in turn feed into the Early Diagnosis of Cancer QOF QI)
- Self-assessment of ‘reasonable adjustments’ (eg, audit of patient records checking that information and/or communication needs of LD patients are identified and recorded – see Accessible Information Standard Specification)
- Audit repeat prescribing templates to ensure that there is a clear ongoing indication for each drug prescribed
- The updated guidance for 2021/22 also notes that practices should ‘ensure inclusion of any under-represented groups such as children and young people and people from BAME backgrounds’, so it may be worth some of your audits and actions focusing on these subgroups.
2. First PCN QOF QI meeting (likely to be held virtually) to create an improvement plan (eg August 2021)
The precise plan will depend on the outcome of the diagnostic phase above, and could be agreed on a PCN-wide basis, or practice-by-practice. Possible ideas for quality improvements might include steps to:
- Increase the LD prevalence in each practice to that approaching national levels. Note that this will self-correct to an extent: NHSE has identified clinical diagnoses that should automatically ensure a patient is included on the LD register (eg, Down’s syndrome). These patients will be added automatically to the QOF register in QOF in ‘early 2020’. If you are in doubt as to whether an individual patient should be included on the register, the LD register Inclusion Tool might help.
- Increase the uptake of LD annual health checks to 75% of those aged 14 and over on the LD register (eg, by increasing utilisation of patient’s preferred communication method – see below). NB As this is also an Investment and Impact Fund indicators at PCN level, it should be clarified at the PCN QOF meeting who is leading on this to avoid duplication of effort.
- Annotate all LD patient records with communication needs/preferences.
- Get pharmacist to review treatment regimes of those patients on medication for which there is no clear current indication.
Note: set realistic and measurable targets for each aspect of the plan.
3. Implementing the plan (eg Sept -> December 2021)
- Implement the plan agreed above and ideally involve patients (eg patient participation group) in this and discuss how to sustain changes made.
4. Second PCN QOF QI meeting to discuss shared learning (eg Jan/Feb 2022)
- Focus on shared learning from the QI activity and use this forum to discuss any system-wide issues identified in the process.
5. Completion of verification (March 2022)
- Complete the QI monitoring template and enter relevant data onto CQRS.
- Note that failure to achieve any targets set does not equate to a failure to achieve QOF points – these are awarded for participation, provided there is evidence of this.
Dr Keith Hopcroft is a GP in Essex