Never mind the width, feel the quality!

Paul Midgley of the Healthcare Partnership reviews the impending new GMS contract-related ‘Quality and Outcomes framework’ (QOF) practice assessment visits that every PCT will be making on every practice across the UK during the period October 2004-January 2005. This article outlines the process, the concerns this will raise for practices, and how you can use this as an opportunity to support key practices in their hour of need and boost your credibility and contacts with key target customers into the bargain.

Introduction

The new GMS contract, introduced into General Practices across the UK in April 2004, brings with it a platinum-plated, (voluntary) incentive scheme (QOF) for all practices to earn substantial additional income in addition to their guaranteed patient population-based monthly payments (known as the ‘Global Sum’ for GMS practices). Practices engaging in the QOF scheme achieve points by providing a wide variety of chronic disease management and practice organisation services to nationally prescribed standards (email HCP for details of the QOF scheme – see next page). An average sized practice, achieving full marks in the QOF scheme (1050 points), will earn an extra £78,750 in year 1 (April 04-March 05) and £126,000 in year 2 (April 05-March 06). It is estimated that by the third year of the contract, high achieving practices could derive a third of their income from the QOF! Needless to say, every practice is actively engaged in trying to gain as many points as they can – because as we know, points make prizes . . . With this much money at stake, the Department of Health has insisted that PCTs ‘risk manage’ the process by visiting each practice involved in the QOF scheme, to verify certain aspects of their compliance (including fraud prevention), and to help practices to aim high and achieve good results, as this benefits both patients and practices alike.

Where are we now?

Every PCT has now appointed QOF Assessment visit teams, each team comprising the following roles at a minimum:

  • Visit lead – a PCT manager involved in the new GMS contract
  • A local GP
  • A lay member (ie non healthcare person to represent patients’ concerns) Other individuals may be co-opted onto these teams – e.g. a practice manager representative. In addition, practices may request that their LMC representative attends, or even an accountant or solicitor! The DoH released details of the QOF Assessment visits in the middle of July, and aimed to have visit dates in the diary for every practice by the beginning of August. Given the tight timescale, the intervening Summer holiday, September being the start of the frenetic ‘flu vaccination season, and that practices are only 1/3 of their way into the new GMS contract at time of writing, means many practices are panicking about providing the level of information required to fulfil the visit team’s needs. Also, practices being visited in October may find it difficult to demonstrate significant progress towards their year-end QOF points aspiration which they estimated back in January, after only 6 months of the contract. An additional factor causing concern is that QMAS, a national computer system on which all the practices’ data must be present, does not go live across England till September, giving some practices only one month to learn how to use QMAS and add their own data manually! (for more information on QMAS, which links to all practice IT systems, visit www.npfit.nhs.uk/qmas).
  • Timings around the QOF Assessment Visits

    Here are the timelines of the visit process, which all occurs within a 2 month period around the visit date itself. Every practice will be visited within the period October 2005- January 2006.

  • By end July, agree date for QOF Assessment practice visit
  • September – QMAS global IT QOF measurement system goes live in England. Practice needs to be able to use QMAS to calculate Chronic Disease Management points aspect of QOF, and to input other areas of QOF achievement onto QMAS manually via a web link
  • 1 month prior to visit – practice submits written portfolio and QMAS data to PCT QOF visit team
  • 2 weeks prior to visit – PCT assessment team reviews written portfolio & QMAS data, to identify areas of focus for practice visit – contacts practice to resolve areas of concern/gain extra info
  • 1 week prior to visit – PCT sends practice outline agenda for the visit
  • Assessment Visit – review achievements; assess likely QOF points outcomes at 31/3/05; confirm data quality and accuracy of reporting via random checks; discuss QOF points aspirations for 2005-6; agree outcomes of the visit and any action plans
  • 2 weeks post-visit – PCT drafts report and shares with practice
  • 1 month post visit – PCT finalises report, signed off by Chief Executive
  • Outcomes of the QOF assessment visit for every General Practice

  • Written report
  • Likely QOF points achievement
  • Areas of good practice
  • Remedial action plan
  • Learning points for future assessment visits
  • Formative Development Plan for the practice (suggestions where the practice might focus)
  • Areas of QOF requiring written evidence from the practice for the visit

    Practices will be sent a 20-page pro-forma inviting them to submit written evidence of achieving standards against individual QOF indicators under the following headings:

    Records and Information about patients 19 indicators, 85 points), including Smoking Cessation and Blood Pressure measurement targets Information for patients (8 indicators, 8 points) – includes information about smoking cessation Education and training (9 indicators, 29 points), including PDP, appraisal, CPR training and Significant event reviews Practice management (10 indicators, 20 points), including Hep B vaccination status Medicines management(10 indicators, 42 points), including drugs for treating anaphylaxis, and medication reviews for all patients on repeat medicines Patient experience (4 indicators, 100 points), including running an approved patient survey and involving a patient group in the results feedback Additional services including: Cervical screening (7 indicators, 22 points) Child health surveillance (1 indicator,6 points) Maternity services (1 indicator, 6 points) Contraceptive services (1 indicator, 2 points)

    Support required to make QOF Assessment visit process a success

    The following areas require training and meeting support:

  • PCT QOF Assessment visit team training events
  • Training for Practice Managers/GPs by PCTs on the process
  • How to use QMAS correctly
  • Effective use of practice IT system to gain maximum points on QOF
  • Training within practices to brief staff on how to prepare for the visit
  • Post-visit Development Planning to sharpen the practice’s focus on key priority areas
  • Post visit process meeting for PCT QOF assessors to learn from their experiences in advance of year 2 visits
  • What can you do?

    Does your product help practices meet key targets outside the chronic disease areas where you may well have already been focusing, for example, smoking cessation? Are there any areas above where your company provides training or information that will help practices provide written evidence that they have achieved the required standards? Look carefully at the QOF indicator areas mentioned above (contact HCP for a copy of the full QOF indicators document).

    If your company does not provide the required services or support themselves, could you provide these to key practices via a third party supplier? (see below). Talk to key target GPs, or practice managers in target practices, to find out what their needs are around the new GMS contract, and discuss the QOF Assessment visits. Your help could range from simply providing lunch at a meeting they have already scheduled, to providing a bespoke workshop for a practice etc on a specific aspect of the visit process or follow up development action planning.

    What have you got to lose? Customers will be impressed at your knowledge, delighted that you are taking an interest, and keen that you are helping wherever you can. You in turn will gain better access to key customers, and will sell more as a result . . .

    If you would like further information on the training provided by the Healthcare Partnership, and the range of 25 topical talks and skills development workshops designed and run specifically for NHS and Pharma customers via our team of expert facilitators, then please call us on 0870 2413506 or email enquiries@healthcarepartnership.com Find out how we can help improve your access to key customers by providing ‘Preparing for your QOF Assessment Visit’ and other GMS contract related talks/workshops that attract good numbers of high quality customers. We can tailor these talks with a clinical slant if required.