Pay for Quality

44 Pay for Quality KCE Reports 118
to an average of £79 800 ($139 400). From 2005–2006 onward, practices
have been earning £125 ($218) per point.
There are an additional 36 points for Papanicolaou tests, childhood
immunizations, maternity services, and contraceptive services and 50 points
for the achievement of high standards of access. An additional 130 points can
be awarded to practices that score highly in all areas.
2. Organizational indicators were included in five categories: records and
information about patients, communication with patients, education and
training, management of medicines, and management of physicians’ practices.
3. The rewards in the section that covers the experience of patients relate to
the use of surveys in the doctor’s own practice, which earns up to 70 points,
and to the length of consultations, which earns up to 30 points. For the
latter, there is an incentive for practices whose routine booking interval is
10 minutes or more. The introduction of patient surveys was a point of
contention. Until recently, surveys have not been commonly used in the
NHS, and doctors were suspicious of their use. Partly because of this, and
partly because of limited experience with available instruments for evaluating
patients’ opinions, an early decision was made to reward doctors for
surveying their patients and for acting on the results; however, payments
would not be linked to the scores from actual questionnaires. Family
practitioners may choose from one of two approved questionnaires, which
cover categories such as access to and interpersonal aspects of care. In
addition to making plans for acting on survey results, there is an additional
incentive for family practitioners to involve their patients in these
discussions.
The payments are in addition to the practices’ core funding, which is based on the
number of patients, adjusted for characteristics of the patients and the area (Doran et
al., 2006).
There is a single common electronic medical record for all practices, and data on quality
of care are extracted automatically from clinical computing systems of practices and are
collated in the central National Health Service Quality Management and Analysis System
(QMAS) database. The central collection of claims data allows the government to
monitor overall implementation of the quality framework, and mechanisms are
established to update the indicators when required.
The scheme allows practices to exclude patients who they deem inappropriate from
specific indicators (exception reporting). Patients can be excluded based on one or
more of the following reasons 84 :
• The patient has received at least three invitations for a review during the
preceding 12 months but has not attended.
• The indicator is judged to be inappropriate for the patient because of
particular circumstances, such as terminal illness, extreme frailty, or the
presence of a supervening condition that makes the specified treatment
clinically inappropriate.
• The patient has recently received a diagnosis or has recently registered with
the practice.
• The patient is taking the maximum tolerated dose of a medication, but the
levels remain suboptimal.
• The patient has had an allergic or other adverse reaction to a specified
medication or has another contraindication to the medication.
• The patient does not agree with the investigation or treatment.
• A specified investigative service is unavailable to the family practitioner.