Step-by-step guide to QOF QI module 2020/21: Early Diagnosis of Cancer

GP partner Dr Keith Hopcroft outlines what the new QOF Quality Improvement module for 2020/21 on Early diagnosis of cancer involves, and how to approach it to gain maximum points with the minimum of fuss

Overview

The two QOF indicators in this module are:

QIECD005 – The contractor can demonstrate continuous quality improvement activity focused upon early cancer diagnosis as specified in the QOF guidance.

QIECD006 – The contractor has participated in network activity to regularly share and discuss learning from quality improvement activity focused on early cancer diagnosis as specified in the QOF guidance. This would usually include participating in a minimum of two peer review meetings.

The key elements are to review/improve:

• Uptake of the practice population’s uptake of national breast, cervical and bowel cancer screening programmes.

AND

• Referral practices for patients suspected of having cancer.

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 2020)

The ‘diagnostic phase’ should a) evaluate the practice population’s uptake of screening programmes and b) assess how well the practice currently diagnoses cases of cancer at the earliest possible stage.

a) Screening programme uptake: this should include an assessment of practice screening rates compared with local or national baselines. Various resources are listed for this in the guidance – most practices will find the Public Health England Cancer Services page quickly provides all the information required. The guidance suggests that practices ‘might wish to focus on inequalities in screening’ – useful background and suggestions on this are given on the Cancer Research UK website.

b) Current referral practice: this could be achieved through

• Participation in the National Cancer Diagnosis Audit
• Other audits/reviews, eg, time from first presentation to referral; proportion of new cancer diagnoses referred using the two-week-wait referral route; proportion of new cancer patients diagnosed following an emergency presentation; proportion of new cancer patients diagnosed following a routine referral; safety netting of patients referred on the two week pathway (eg proportion of DNAs contacted by practice)

Note: the guidance suggests:

• Audits should comprise at least 20 cases (no suggestion of adjustment according to list size)
• Practices might want to make noteworthy cases significant event analyses.

2. First PCN QOF QI meeting to create an improvement plan (eg, August 2020)

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:

• Enhance overall screening rates for cervical, breast and bowel cancer (eg computer pop-up prompts for defaulters) especially for those programmes where there is poor uptake at Network level.
• Reduce inequalities in the uptake of screening in certain population groups (eg provide a wider range of information formats)
• Increase the proportion of cases in which cancer diagnoses are reviewed (eg a significant event analysis for every diagnosis made after acute admission)
• A reduction in time from presentation to referral (eg a refresher on current NICE guidance for cancer referral)
• An increase in the percentage of cancer referrals where safety netting is used (eg proactive contact of patients who do not attend two-week-wait appointments).

Note: set realistic and measurable targets for each aspect of the plan.

3. Implementing the plan (eg Sept -> December 2020)

• 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 2021)

• 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 2021)

• 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 partner in Essex

Source – NHS England. QOF Quality Improvement domain 2020/21: Early diagnosis of cancer