QOF

Revised QOF for 2020/21 – a checklist

GP partner Dr Keith Hopcroft outlines what practices need to start focusing on to ensure they meet this year’s revised QOF requirements.

The revised QOF guidance detailing how points and payments will be determined has now been published. While practices may have been anticipating that most points/income would be protected, in fact, only about half of it is, and even that comes with strings attached. Practices only have around 6 months to get on top of this, so it’s imperative that we focus on the right bits.

What follows is a checklist of what to focus on now.

1. Areas that are still performance related, ie, not income protected

Four flu indicators (points in brackets): CHD (14), COPD (12), diabetes (6), stroke/TIA (4). Note points have been doubled for all of these, but these are not extra points, they have been recycled.

Plan: ensure that your flu call/recall strategy focuses on these groups early on and includes contacting defaulters to exclude them if necessary.

Two cervical screening indicators (14 and 8 points respectively, again doubled).

Plan: prioritise catching up with smears; exception report those who decline.

Disease registers (81 points): new diagnoses are added to the registers automatically (eg, for diabetes, dementia, asthma and many others). Revised QOF states that it is expected that prevalence will remain roughly the same as previous years and this will be policed (not clear how – the implication is that they don’t want chronic disease diagnosis to be ‘neglected’). So it is important for us to keep coding new diagnoses – and also because we get paid according to prevalence levels. The problem is we cannot currently make some QOF-standard diagnoses (eg, for asthma) if we can’t get the tests done.

Plan: be diligent in coding new diagnoses; for those where testing would normally be needed for QOF (mainly asthma, COPD), code them if history is highly suggestive. This will present a challenge for next QOF year (where we haven’t been able to do the required investigations) but there will be work-rounds, eg, exception reporting.

Indicators related to optimal prescribing:

Atrial Fibrillation/anticoagulation (12)
CHD/antiplatelets (7)
Heart Failure/ACEI or A2RB (6)
Heart Failure/BB (6)
CVA or TIA/antiplatelet (4)
DM + nephropathy/ACEI or A2RB (3)
DM >40 QRisk >10%/statin (4)
DM+CVD/statin (2)

Plan: practices should be doing all this anyway – encourage clinicians to act on any QOF prompt related to these. Task your QOF lead with monitoring.

2. Areas that are ‘income protected’

This covers everything else except the Quality Improvement section (see point 3 below).

However, the income protection is conditional on practices agreeing with their commissioner (by November, through eDEC) how they will proactively prioritise those at highest risk, including:

Those at most risk of harm from Covid (BAME/deprived)
Those at risk from poorly controlled long term conditions
Those with a history of missing reviews

Plan: start coding BAME (if you don’t already); perform some searches in key therapeutic areas using these parameters, eg, BAME + no diabetes/COPD RV >1yr, BAME + diabetes and last HbA1c poor control) to recall these patients.

3. Quality improvement (74 points)

There are two areas here – early cancer diagnosis and care of people with learning disabilities. It is supposedly condensed from the original version but it looks much the same. The guidance is many pages long, so the best plan is to look at the reporting templates and focus your efforts around that, as follows.

a) Early Cancer Diagnosis reporting template

What issues did the practice identify with the quality of referrals for early cancer diagnosis?
What actions did the practice take to build confidence in primary care and to reassure patients that general practice can be accessed safely?
What action did the practice take to support restoration of the cervical screening programme?
What changes did the practice make to their system for safety netting?
How many patients who had not attended any appointments were proactively followed up?
What changes will/have been embedded into practice systems to ensure early cancer diagnosis in the future?
If applicable, how did the network peer support meetings and patient participation group influence the practice’s QI plans and understanding of early cancer diagnosis?

Plan: discuss these at your QOF meeting to get team’s view and gain feedback to input (might spin-off an audit or two)

b) Care of People with Learning Disabilities reporting template

What actions did the practice take to ensure that the register is accurate and that BAME patients are accurately represented?
What actions did the practice take to support restoration of annual health checks for patients with a learning disability?
How many flu vaccinations were provided at practice level to people with a learning disability in 2019/20? How many flu vaccinations have been provided for 2020/21?
What percentage of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) have been reviewed to ensure that they were determined appropriately and continue to be clinically indicated?
What changes will/have been embedded into practice systems to ensure improved care of people with learning disabilities in the future?
If applicable, how did the network peer support meetings or patient participation groups influence the practice’s QI plans and understanding of the care of people with learning disabilities?

Plan: as above, with particular input from Learning Disability lead.

Dr Keith Hopcroft is a GP partner in Essex