Tips to prepare your practice for year end

QOF expert Dr Gavin Jamie runs through his top five tips for getting your QOF data polished and submitted in good time

The end of the contract year is a busy time for practices, as they need to have all their Quality and Outcomes Framework (QOF) data ready for submission by the end of March.

Making sure the data are accurate and entered properly into the system will ensure the practice receives the correct payment promptly.

Here are some tips to prepare for the QOF year-end and ensure the process goes smoothly.

1. Log in to your CQRS account

QOF data will normally be automatically extracted from the practice computer system on the night of the 31 March. This will then appear on the CQRS system for approval by the practice. The same system is used for a number of enhanced services.

It is important that at least one person in the practice has an active account. Passwords expire annually and often this happens around the end of February or early March, so make sure to check you have access in plenty of time.

There should be some QOF data already visible on CQRS, although this is purely indicative. Only the final submission of the year will count towards payment.

With the Easter holiday period coming up it is important to have someone available to sign off the QOF data during the first couple of weeks of April. If your usual will be on leave, make sure you have an alternative user lined up.

Note that the CQRS cannot be accessed from the internet – it must be done using an NHS connection.

Before the end of March data for the Quality Improvement indicators will need to be entered manually onto CQRS (see below)

2. Check your data daily

You should be able to monitor your QOF data using your practice computer system. Do this on a daily basis for the last few weeks of March.

As QOF will always look at the most recent data, it is possible to lose points as new test results come in. For example, asthma patients can pop back onto the register if they are issued an inhaler and had not already had one during the QOF year.

It should be part of your daily routine to check if any indicators have slipped backwards as a result of recent updates, and to correct them. Pay particular attention to indicators that are close to the upper threshold. Once April arrives there will be no opportunity to update the coding.

I would advise using the ‘look ahead’ searches that measure what would happen if you did no further QOF activity until the end of March. Using a ‘how am I driving’ search can cause issues, as QOF records that were updated in March 2019 expire over the course of the month, which can mean some unpleasant surprises.

Indicators in the public health domain can be easier to miss. I find the primary prevention indicator (worth 10 points) most difficult. It only applies to patients with a new diagnosis of hypertension this year with a QRisk2 score of over 20%. With three hurdles to get over you may find you have no eligible patients – last year 6% of practices missed out on these points simply through not having any eligible patients. Make sure that every patient with a new diagnosis of hypertension has a QRisk2 calculation and breathe a sigh of relief that this indicator is set to be removed from April. Most practices have only two or three eligible patients.

3. Consider your prevalence

Most practices get close to the maximum number of points so the main route to increase income is through prevalence. While this might be a little late in the year for prevalence-adjusted indicators, there are several areas that have prevalence payments but no other indicator requirements.

Searching for a weight measurement but no BMI calculation is a quick way to pick up patients that may be missing from the obesity register. Similarly search for patients started on osteoporosis drugs or antiepileptics can be a quick way to add missing patients to the appropriate registers.

Check that all patients receiving treatment for dementia are correctly coded by running a search for relevant drugs – this is a particularly valuable register. Similarly patients with new depression can be easily missed so check for codes for depression or low mood. These are symptom codes that won’t put patients onto the register.

At the risk of seeming morbid it is important that you have at least one patient on your palliative care register at the end of the year to ensure payment for the full year’s work. This register can naturally change quite frequently, so you should monitor it very closely in March.

4. Look at your exception reporting

There are likely to be some indicators which will not get full points without exception reporting. This has become a little more flexible this year and it certainly pays to code disease specific invitations on your clinical system. Sadly this change is not yet comprehensive and so some patients may need to be coded as ‘informed dissent’ if they have not responded after two invitations.

Other patients may have been coded as not suitable for medications in the past. With the exception of allergies these codes will normally have to be repeated each year where appropriate. If the patient’s situation has not changed then this should be a relatively easy process at the end of year

5. Don’t forget the QI indicators

There are a large number of points for the new Quality Improvement (QI) indicators introduced this year. Now is the time to look up the targets that your practice set for itself earlier in the year. You should also have had two peer meetings on these QI areas – if these have not happened already then they should be scheduled as soon as possible.

There is a standard reporting form to be used for end of life care and safe prescribing. Once completed these can be submitted to the CCG if requested as verification you have followed the process.

There are a total of four QI indicators – two each for prescribing safety and end of life. Claiming for these will need a manual entry to CQRS. This is simply a case of going to CQRS and submitting a ‘yes’ against all of the indicators that have been achieved. This must be done before the 31 March – the earlier you do it the better, to avoid it being missed in the busy weeks at the end of the month. There is a large number of points at stake.

Dr Gavin Jamie is a GP partner in Swindon. He runs the QOF database website.