using qof and service specifications to meet hi needs rachel foskett-tharby
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Using QOF and Service Specifications to meet HI Needs
Rachel Foskett-Tharby
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Key Points
• Know your population
• Know your gap
• Know QOF and actively manage the process
• Get the most from QOF
• Plugging the gaps
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Know your population
• To do this successfully requires:
– Close collaboration between commissioning and public health
– Use of the outputs of the JSNA– Understanding of current service provision
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Know your gap
• Consider in terms of:
– Life years– Access to services– Proportion of patients receiving optimal
treatment– Distribution – inequalities across the patch or
concentrated in pockets?
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Know QOF
• Strengths
• Weaknesses
• Management of process
• Used effectively can impact on health inequalities
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Get the best from QOF
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Where should we be looking?
Four body systemsFour body systems
Heart diseaseHeart diseaseStrokeStroke
DiabetesDiabetesKidney diseaseKidney disease
One main One main mechanismmechanism
Disordered blood Disordered blood chemistrychemistry
Atheroma in blood Atheroma in blood vesselsvessels
Multiple organs affectedMultiple organs affectedOne increases risk of One increases risk of
othersothers
Common risk Common risk factorsfactorsPoor diet (fat, sugar, Poor diet (fat, sugar,
salt)salt)Lack of physical activityLack of physical activity
SmokingSmokingHigh blood pressureHigh blood pressure
Death and disabilityDeath and disability
6.2m people affected6.2m people affected200k deaths pa (38% of 200k deaths pa (38% of
total)total)17% hospital admissions17% hospital admissions50%+ of mortality gaps50%+ of mortality gaps
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individual risk management
Indicators for
Individual Vascular Risk Assessment
Existing guidance and tools (eg SIGN)
NICE Guidelines (in current programme)
Unified risk assessment support system
Low RiskIndividual
maintenance plan
Med RiskManagement plan
Review 1-5 yrs
High RiskIntervention
Eg statinReview yearly
DiseaseExisting clinical
pathways
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4.0%
20.0%
4.6%
2.7%
10.9%
3.8%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Coronary HeartDisease
Hypertension Diabetes
Expected v Registered Prevalence of major QOF conditions
PCT Registered
PCT Expected
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CHD 8 - % patients whose last measured cholesterol <= 5mmol/l (measured in last 15 months)
0%
20%
40%
60%
80%
100%
Practice code
Target Met Target Missed Exception Coded
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CHD 6 - % patients whose last BP reading <= 150/90 (measured in last 15 months)
0%
20%
40%
60%
80%
100%
Practice code
Target Met Target Missed Exception Coded
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DM 20 - % patients whose HbA1C <= 7.4 (measured in last 15 months)
0%
20%
40%
60%
80%
100%
Practice code
Target Met Target Missed Exception coded
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How to add value to QOF CHD (with thanks to NST)
• Calculate an ‘expected’ prevalence of CVD by practice and compare with numbers on registers
• Have strict criteria for exceptions and exclusions from registers for QOF purposes
• Audit records of excepted and excluded patients
• Ensure excepted patients have a care plan
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How to add value (2)
• Establish from QOF scores which practices are not claiming full points for CHD5, stroke 5, CHD 7 and stroke 7
• Establish from QOF scores practices with scope to improve overall effectiveness of clinical practice e.g. CHD6, stroke 6, CHD8 and stroke 8
• Audit practices claiming maximum points to verify outcomes
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How to add value (3)
• Promote systems of medicines management and patient adherence to therapy based on active assessment and appropriate support based on cultural and language requirements
• Ensure referral of newly diagnosed angina patients for exercise testing and specialist assessment
• Consider linking to PBC plans and bonus payments
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QOF and APMS Contracts
• In groups discuss:
– Strengths of using QOF in these contracts– Weaknesses of using QOF in these contracts– Risks and benefits of setting points targets as
part of a contract– Strategies to manage these
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Plug the gaps
• Identify areas not covered by QOF of local significance in terms of HI
• Identify ‘hard to reach’ populations
• Consider evidence based service framework
• Link to PBC plans
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Service Frameworks
• Templates available at www.primarycarecontracting.nhs.uk
• Suggested frameworks available for:– Alcohol– Obesity– Long term conditions– Support for self-care– Sexual health
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Discussion and Questions