Ahead of the new QOF year, is it time to have a rethink about who heads up this work in your practice to increase efficiency?
It has been a turbulent time for practices with regards to QOF activity. We’ve had nearly two years of disruption as a result of suspensions, part-suspensions or changes to indicators, so it’s no surprise that clinicians, practice staff and patients are anxious about the upcoming ‘restart’ on 1 April.
As the saying goes, Proper Planning Prevents Poor Performance, so now is the time to start looking at your processes and review who is managing them, in order to maximise your QOF income and help your patients get the most out of services.
Put simply, QOF is a programme that focuses on patients who need regular monitoring and intervention to prevent their conditions worsening, as well as identifies those that are unwell but might not yet know it (i.e. some indicators are for screening purposes).
On the face of it, it seems to be purely clinical work, hence it being much more common for clinicians – GPs or nurses – to be the leading force of QOF work in practices.
However, QOF isn’t just about clinical activity. To ensure it has a beneficial impact on patient care and is lucrative for the practice too, it needs to be administered efficiently and precisely. QOF relies heavily on capturing patient information that is correct and on accurate coding of medical records to ensure we can easily arrange regular appointments or reviews with eligible patients, and have in place a robust call/recall system.
These sorts of tasks fit more neatly into the skillset of non-clinical staff, whose focus and strengths are efficiency and process, than into clinician skills, focused on treatment and medicines. It makes sense to free up clinicians’ time, so they can concentrate on patients and allow non-clinical staff to put their administrative and organising skills to good use.
Practices are gradually realising this, with practice managers and operations managers starting to become more involved in leading activity around QOF – and with great success too.
So, how can you implement changes that result in a more efficient division of labour when it comes to QOF, and be better prepared for the new QOF year?
Below are some tips on how to make this work in practice:
Assign a senior non-clinical member of staff (your practice manager, operations manager or admin lead, for example) the responsibility of working with the current clinical QOF lead to discuss how to transfer work away from the clinical team
Non-clinical individuals can work closely with the clinical teams to plan the year, breaking it down into quarters to understand where you are in the call/recall cycle and how you are performing with your targets (e.g. what percentages have been achieved)
They should familiarise themselves with the required processes and rules, for example, around personalised care adjustment, and keep up to date with revisions of guidance. They should also be able to convey this detail to staff.
Task the QOF lead with providing a monthly update to all staff and a ‘tip of the month’.
A non-clinical QOF lead should benefit from an increased profit share in the same way a GP partner would. Offer a bonus by results or consider making them a non-clinical partner.
Ensure all staff who scan, code and enter data into medical records are properly trained in these skills, have a good understanding of QOF and know which codes are correct and which are erroneous. We generally all rely on our clinical systems’ internal reporting systems to determine patient eligibility. To ensure the correct patients are placed on the various indicator registers, we need their data to have been inputted accurately in the first place. Training is key.
Retrospectively review all records to rectify incorrect or erroneous codes. Going forward, run regular reports and searches to ensure the correct codes are being entered. Where they aren’t, speak to the individual/s concerned, so mistakes can be rectified.
Inform reception staff which texts/emails have been sent out to which patient cohorts, so they can more helpfully deal with any follow up calls they receive. In addition, if relying on texting as a method for call/recall it’s important that reception staff are trained to ask patients to confirm their mobile phone number whenever they call in (this is standard practice in most organisations). This means records are kept up to date (patients often forget to inform their GP when changing numbers) and are more complete.
Implementing a system of birthday medical reviews, where patients are invited for their check-up during their birthday month, are growing in popularity. But non-clinical staff need to ensure this doesn’t end up putting too much pressure on clinicians should a high percentage of the patient cohort happen to have birthdays that fall in the same month/s.
Communication with patients can be by letter, email, text or call. If the first round of invitations didn’t generate the responses hoped for, review why that might be and change your approach. So, if you used texts initially that might be down to not having many mobile numbers on file. It may be better to switch to email if you have high numbers of email addresses.
You can target groups according to clinical area, such as asthma or diabetes. Share your post on local and relevant sites and don’t forget to include the contact method patients should use (calling or emailing the surgery, for example). You don’t have to respond to social media messages.
There are many companies that support QOF activity, such as AccuRx, Primary Care IT and Ardens. Weigh up the cost versus the benefit to your individual practice. You may find it is well worth the investment and eases pressure on clinicians.
Ryan Smith is a non-clinical partner and strategic manager at Kenilworth and Warwick PCN
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