GP partner Dr Keith Hopcroft outlines what the new Quality Improvement module on Supporting people with learning disabilities involves, and how to approach it to gain maximum points with the minimum of fuss
Overview
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 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)
- 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 2020)
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 immunization 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.
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:
- 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 utilization of patient’s preferred communication method – see below).
- 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 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: Supporting people with learning disabilities
